1、 Reference number ISO/TR 12296:2012(E) ISO 2012TECHNICAL REPORT ISO/TR 12296 First edition 2012-06-01 Ergonomics Manual handling of people in the healthcare sector Ergonomie Manutention manuelle des personnes dans le secteur de la sant ISO/TR 12296:2012(E) COPYRIGHT PROTECTED DOCUMENT ISO 2012 All r
2、ights reserved. Unless otherwise specified, no part of this publication may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying and microfilm, without permission in writing from either ISO at the address below or ISOs member body in the country of
3、the requester. ISO copyright office Case postale 56 CH-1211 Geneva 20 Tel. + 41 22 749 01 11 Fax + 41 22 749 09 47 E-mail copyrightiso.org Web www.iso.org Published in Switzerland ii ISO 2012 All rights reservedISO/TR 12296:2012(E) ISO 2012 All rights reserved iiiContents Page Foreword iv Introducti
4、on . v 1 Scope 1 2 Terms, definitions and abbreviated terms 1 3 Recommendations 2 3.1 General aspects . 2 3.2 Risk assessment . 3 3.2.1 Hazard identification . 4 3.2.2 Risk estimation and evaluation 6 3.3 Risk reduction 7 Annex A (informative) Risk estimation and risk evaluation . 8 Annex B (informa
5、tive) Organizational aspects of patient handling interventions . 38 Annex C (informative) Aids and equipment . 43 Annex D (informative) Buildings and environment . 59 Annex E (informative) Staff education and training 71 Annex F (informative) Relevant information regarding the evaluation of interven
6、tion effectiveness . 74 Bibliography 80 ISO/TR 12296:2012(E) iv ISO 2012 All rights reservedForeword ISO (the International Organization for Standardization) is a worldwide federation of national standards bodies (ISO member bodies). The work of preparing International Standards is normally carried
7、out through ISO technical committees. Each member body interested in a subject for which a technical committee has been established has the right to be represented on that committee. International organizations, governmental and non-governmental, in liaison with ISO, also take part in the work. ISO
8、collaborates closely with the International Electrotechnical Commission (IEC) on all matters of electrotechnical standardization. International Standards are drafted in accordance with the rules given in the ISO/IEC Directives, Part 2. The main task of technical committees is to prepare Internationa
9、l Standards. Draft International Standards adopted by the technical committees are circulated to the member bodies for voting. Publication as an International Standard requires approval by at least 75 % of the member bodies casting a vote. In exceptional circumstances, when a technical committee has
10、 collected data of a different kind from that which is normally published as an International Standard (“state of the art”, for example), it may decide by a simple majority vote of its participating members to publish a Technical Report. A Technical Report is entirely informative in nature and does
11、not have to be reviewed until the data it provides are considered to be no longer valid or useful. Attention is drawn to the possibility that some of the elements of this document may be the subject of patent rights. ISO shall not be held responsible for identifying any or all such patent rights. IS
12、O/TR 12296 was prepared by Technical Committee ISO/TC 159, Ergonomics, Subcommittee SC 3, Anthropometry and biomechanics. ISO/TR 12296:2012(E) ISO 2012 All rights reserved vIntroduction National and international statistics provide evidence that healthcare staff are subject to some of the highest ri
13、sks of musculoskeletal disorders (particularly for the spine and shoulder), as compared with other jobs. Manual patient handling often induces high loads on the musculoskeletal systems, in particular on the lower back. Manual patient handling ought to be avoided where possible 1)or be performed in a
14、 low-risk manner. Factors such as the number, capacity, experience and qualification of caregivers can interact with the following conditions to produce an increased risk of musculoskeletal disorders: number, type and condition of patients to be handled; awkward postures and force exertion; inadequa
15、cy (or absence) of equipment; restricted spaces where patients are handled; lack of education and training in caregivers specific tasks. An ergonomic approach can have a significant impact on reducing risk from manual patient handling. A good analysis of work organization, including handling tasks a
16、nd the above-mentioned risk determinants, is extremely important in reducing risks to caregivers. The recommendations presented in this Technical Report allow identification of hazards, an estimation of the risk associated with manual patient handling and the application of solutions. They are based
17、 primarily on data integration from epidemiological and biomechanical approaches to manual (patient) handling and on the consensus of international experts in patient handling. The assessment and control of risks associated with other aspects of manual handling can be found in ISO 11228-1, ISO 11228
18、-2, ISO 11228-3 and ISO 11226. 1) As per European Council Directive 90/269/EEC on the minimum health and safety requirements for the manual handling of loads where there is a risk particularly of back injury to workers. TECHNICAL REPORT ISO/TR 12296:2012(E) ISO 2012 All rights reserved 1Ergonomics M
19、anual handling of people in the healthcare sector 1 Scope This Technical Report provides guidance for assessing the problems and risks associated with manual patient handling in the healthcare sector, and for identifying and applying ergonomic strategies and solutions to those problems and risks. It
20、s main goals are to improve caregivers working conditions by decreasing biomechanical overload risk, thus limiting work- related illness and injury, as well as the consequent costs and absenteeism, and to account for patients care quality, safety, dignity and privacy as regards their needs, includin
21、g specific personal care and hygiene. It is intended for all users (or caregivers and workers) involved in healthcare manual handling and, in particular, healthcare managers and workers, occupational safety and health caregivers, producers of assistive devices and equipment, education and training s
22、upervisors, and designers of healthcare facilities. Its recommendations are primarily applicable to the movement of people (adults and children) in the provision of healthcare services in purposely built or adapted buildings and environments. Some recommendations can also be applied to wider areas (
23、e.g. home care, emergency care, voluntary caregivers, cadaver handling). The recommendations for patient handling take into consideration work organization, type and number of patients to be handled, aids, spaces where patients are handled, as well as caregivers education and awkward postures, but d
24、o not apply to object (movement, transfer, pushing and pulling) or animal handling. Task joint analysis in a daily shift involving patient handling, pulling and pushing or object handling and transport is not considered. 2 Terms, definitions and abbreviated terms For the purposes of this document, t
25、he following terms, definitions and abbreviated terms apply. 2.1 aids and equipment assistive devices eliminating or reducing the caregivers physical effort during handling of a non- or partially cooperating patient 2.2 caregiver individual required by his or her job specification to perform manual
26、patient handling activities 2.3 environment all physical conditions of the area where patients have to be handled, including space, climate and surfaces ISO/TR 12296:2012(E) 2 ISO 2012 All rights reserved2.4 manual patient handling activity requiring force to push, pull, lift, lower, transfer or in
27、some way move or support a person or body part of a person with or without assistive devices 2.5 patient individual who requires assistance to move Note 1 to entry: Types of patients include totally non-cooperating patients (to be fully handled by a caregiver), partially cooperating patients (to be
28、partially handled by a caregiver). fully cooperating patients. Note 2 to entry: Missing willingness of the patient for cooperation may induce an increase in musculoskeletal load for the caregiver. Note 3 to entry: Other types of patient classifications are mentioned in C.4. Abbreviated terms NC tota
29、lly non-cooperating patient PC partially cooperating patient MSD musculoskeletal disorders MPH manual patient handling LBP low-back or lower-back pain PU pressure ulcer 3 Recommendations 3.1 General aspects A systematic review of patient handling literature shows that a strategy for risk assessment,
30、 application of engineering controls and management must be comprehensive (multifactor interventions) to be successful. Consequently, a strategy for risk prevention based on analytical assessment of the risk itself, all of its potential determinants (organizational, structural and educational), and
31、on some key aspects of risk management is outlined below (see Figure 1). The strategy includes the use of managerial processes and systems for reducing causes and effects of musculoskeletal and other organizational losses from healthcare institutions. The participatory approach is emphasized in all
32、aspects especially in changing work practices, defining training needs, purchasing technology/equipment and designing work environments. ISO/TR 12296:2012(E) ISO 2012 All rights reserved 3Risk assessment Risk management Based on: Organizational aspects; Adequate aids and equipment; Buildings and env
33、ironment; Training and education; Check of effectiveness Figure 1 Comprehensive strategy The annexes present details of the main relevant aspects of the general strategy: risk assessment (Annex A); organizational aspects (Annex B); aids and equipment (Annex C); buildings and environment (Annex D); s
34、taff education and training (Annex E); effectiveness check (Annex F). The following sections (3.2 and 3.3) describe the basic recommendations for this strategy. 3.2 Risk assessment Risk assessment is one of the pillars of preventive strategies. Risk assessment consists of the following steps: hazard
35、/problem identification, risk estimation/evaluation. It is emphasized that for the purposes of this Technical Report, hazard identification and risk assessment are related not just at health risk identification but also in problem identification and problem solving. A risk assessment is recommended
36、when new equipment is introduced, organizational issues are modified (number of caregivers, number of non-cooperating patients), spaces are reorganized from an environmental viewpoint (rooms, services) and whenever other changes could affect risk characteristics, even if the previous condition was f
37、ound to be acceptable. For the purposes of this Technical Report, the risk assessment model shown in Figure 2 is used. ISO/TR 12296:2012(E) 4 ISO 2012 All rights reservedStep 1 Step 2 Hazard identification 3.2.1 Risk management: - Organizational aspects (Annex B) - Assistive devices (Annex C) - Envi
38、ronment (Annex D) - Training (Annex E) Check of effectiveness (Annex F) Risk estimation in outpatient operations, the number of access requests for patients; in hospital wards, the number of patients. Patient quantification will be a preliminary factor to assess the time, number and frequency of han
39、dling. Also the presence of a hazard requires that other factors should be taken into account that may address the subsequent risk evaluation. 3.2.1.1 Type of handling The type of handling is defined by the task to be performed (e.g. repositioning a patient lying in the bed, or emplacing the bed pan
40、) as well as by the handling technique applied for task execution. Task execution may be biomechanically improved, in particular, if small aids are additionally used. Furthermore, the type of patient (totally non-cooperating, partially or fully cooperating) and the type of assistive procedures will
41、determine the handling method used by caregivers to a certain extent. The type of handling associated with patients functional mobility level will define different hazard levels. A handling type used for cooperating patients may result in a low hazard while for a non-cooperating patient the same han
42、dling method may produce a much ISO/TR 12296:2012(E) ISO 2012 All rights reserved 5higher hazard. Analysing patient handling currently carried out in a given healthcare area should lead to quantification of different types of handling necessary to address both the choice of most appropriate handling
43、 mode and usage of aids in that situation and also the number of caregivers needed throughout the day. 3.2.1.2 Work organization The overall work organization can modify the risk of injury. The number of caregivers carrying out patient handling and their organization (one or more caregivers) over th
44、e day is a crucial factor to assess along with handling frequency and mode. Furthermore, caregivers should be trained to safely perform each task and how to recognize hazardous workplaces, tasks, equipment conditions and time allocated to the task. 3.2.1.3 Posture and force exertion During patient-h
45、andling activities, the spinal column of caregivers, especially the lumbar section, is subject to high mechanical loading (i.e. compressive and sagittal or lateral shear forces at the intervertebral discs). Biomechanical load through patient handling is regarded as one of the most relevant factors i
46、nducing low- back pain and the development of degenerative disorders at lumbar spinal structures. Lumbar load strongly depends on the mobility status of the patient, equipment in use, posture adopted and the forces exerted by the caregiver to perform the handling action. Patient handling often coinc
47、ides with postures and asymmetric forces with respect to the median sagittal plane that result in relatively high biomechanical load and an increased overload risk. Awkward postures due to various elements and conditions (available spaces, equipment used, number of caregivers handling the patient an
48、d education and training) often lead to decreased abilities for force exertions and increased risk of injury from high loads being placed on body joints or segments. For postures, asymmetry may be due to arm position or lateral trunk flexion or torsion. Forces may act laterally or are bilaterally im
49、balanced. A reduction of high lumbar loads can be achieved by using biomechanically efficient transfer methods. The caregiver should exert the force with a stable and balanced posture enabling application of his/her body weight to their environment (e.g. bed, chair, patient) and thus minimizing the forces acting on the back and shoulders. 3.2.1.4 Assistive devices The lack, absence or inappropriateness, of aids and equipment is a hazard during patient handling. The application of appropriate aids and equipme
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