Nursing & Clinical Care
Moving and lifting patients, handling sharps and hazardous drugs, and working with patients and visitors under stress.
Patient handling leads the risk: lifting, transferring and repositioning patients by hand is a major source of musculoskeletal injury for nurses and nursing assistants. This guide also covers sharps and bloodborne pathogens, hazardous drugs and disinfectants, and workplace violence.
Most patient-handling injuries are sprains and strains of the back and shoulders from repeated manual lifts, transfers and repositioning. Lifting technique alone does not prevent them, so safe patient handling programs replace manual lifts with ceiling and floor lifts, sit-to-stand aids and lateral-transfer devices, assess each patient's handling needs, and keep the equipment close by, maintained and used.
Clinical work adds three more hazards. Needles and other sharps can transmit hepatitis B, hepatitis C and HIV, so safety-engineered devices, point-of-use sharps containers and, in the US, an exposure control plan under OSHA's Bloodborne Pathogens standard (29 CFR 1910.1030) come first. Hazardous drugs, including many chemotherapy agents, and high-level disinfectants are controlled with containment, ventilation and closed transfer devices before gloves and gowns. Patients and visitors can become aggressive, especially in emergency and behavioral-health settings; in 2018, US healthcare and social assistance workers were five times as likely as workers overall to be injured by workplace violence (BLS). Prevention programs combine environmental design, risk flagging, de-escalation and post-incident support.
The main hazards and the controls that reduce them
Work down the hierarchy of controls: remove or substitute the hazard where you can, then use engineering and administrative controls. PPE is the last line of defense, not a substitute for the controls above it.
Patient-handling musculoskeletal injury
Manually lifting, transferring and repositioning patients loads the back and shoulders, and patient weight, posture and sudden movement add to the strain.
- Install ceiling lifts and provide floor lifts, sit-to-stand aids and lateral-transfer devices
- Adopt a safe patient handling policy that replaces manual lifts with equipment
- Assess each patient's mobility and handling needs
- Keep equipment close to the point of care, maintained and charged
- Train staff on the equipment and the patient assessment
Sharps injuries and bloodborne pathogens
Needles and other sharps expose workers to bloodborne pathogens, including hepatitis B, hepatitis C and HIV, during procedures, between steps and at disposal.
- Use safety-engineered sharps and needleless systems, chosen with input from frontline staff
- Place sharps containers at the point of use and replace them before they overfill
- Do not recap used needles; where a procedure requires it, use a one-handed technique or mechanical device
- Keep a written exposure control plan, review it annually, and offer hepatitis B vaccination
- Train staff on safe handling and post-exposure reporting
Hazardous-drug and disinfectant exposure
Preparing and giving hazardous drugs, including many chemotherapy agents, and using high-level disinfectants expose staff to carcinogenic, reproductive and irritant hazards through skin contact and inhalation.
- Prepare hazardous drugs in ventilated containment, as USP <800> sets out in the US
- Use closed-system drug-transfer devices where USP <800> calls for them
- Ventilate areas where high-level disinfectants are used and keep containers covered
- Maintain the facility's hazardous-drug list and safety data sheets, and train staff on both
- Provide chemotherapy-tested gloves, gowns and eye protection
Workplace violence from patients and visitors
Patients, visitors and behavioral-health situations can lead to verbal abuse, threats and assaults, with emergency departments and psychiatric units among the higher-risk settings.
- Design units with alarms, good lighting and layouts that keep an exit route clear
- Build a workplace-violence prevention program with management commitment and staff input
- Assess and flag patients and areas with elevated risk
- Provide de-escalation training and response teams
- Staff high-risk areas adequately and avoid working alone with high-risk patients
- Support reporting and post-incident care for staff
The core safety programs for this work
Safe patient handling program
Ceiling and floor lifts, sit-to-stand aids and lateral-transfer devices replace manual lifts, each patient's handling needs are assessed, and the right equipment is kept close by and maintained. Training covers the equipment and the assessment.
Bloodborne pathogens and sharps safety
Safety-engineered devices chosen with frontline input, point-of-use sharps containers, a no-recap rule, and an exposure control plan with hepatitis B vaccination address the sharps hazard. Staff report every sharps injury straight away so post-exposure evaluation can start promptly.
Workplace-violence prevention
A prevention program with environmental controls, risk flagging, de-escalation training, response teams and post-incident support treats violence as an occupational hazard, not only a security matter.
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