California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4 - Division of Industrial Safety › Subchapter 7 - General Industry Safety Orders › Group 15 - Occupational Noise and Ergonomics › Article 106 - Ergonomics › Section 5120 - Health Care Worker Back and Musculoskeletal Injury Prevention

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Scope and
						Application. This Section shall apply to all general acute care hospitals.
EXCEPTION: (1): This Section shall not apply to general
						  acute care hospitals within the Department of Corrections and Rehabilitation or
						  the State Department of Developmental Services.
EXCEPTION: (2): This section shall not apply to units
						  within a general acute care hospital that are separately licensed as a distinct
						  part under Title 22 Section
						  70625 and
						  70627.
NOTE: to subsection (a): This section does not preclude
						  the application of Section
						  3203 or other Title 8 safety orders
						  to patient handling in health care facilities, services and operations not
						  covered by this section, nor does it preclude the application of other sections
						  of Title 8, including but not limited to Sections
						  3203 and
						  5110, to patient handling in
						  general acute care hospitals.
(b) Definitions.
"Designated health care worker" means an employee
						  responsible for performing or assisting in patient handling activities who is
						  specifically trained to handle patient lifts, repositioning, and transfers
						  using patient transfer, repositioning, and lifting devices as appropriate for
						  the specific patient.
"Designated registered nurse" means a registered nurse
						  who has responsibilities under the Plan required by subsection (c), including,
						  but not limited to, the responsibilities of a designated health care worker,
						  preparation of a safe patient handling instruction, the observation and
						  direction of patient lifts or mobilizations, or the communication of patient
						  handling information to patients or their authorized representatives.
"Emergency" means unanticipated circumstances that can
						  be life-threatening or pose a risk of significant injuries to the patient,
						  staff or public, requiring immediate action.
"Equipment" means a powered or non-powered device that
						  effectively reduces the forces exerted by or on employees while they perform
						  patient handling activities, including all accessories necessary for the
						  operation of the device. Devices and accessories include replaceable and
						  disposable items.
"General acute care hospital" (GACH) means a hospital,
						  licensed by the California Department of Public Health as such in accordance
						  with Title 22, California Code of Regulations.
"Lift team" means designated health care workers
						  specifically trained to work together to perform patient handling activities
						  using equipment as appropriate for the specific patient.
"Lifting" means the vertical movement of a patient or
						  the support of part or all of a patient's body.
"Manual patient handling" means the lifting,
						  transferring, repositioning, or mobilizing of part or all of a patient's body
						  done without the assistance of equipment.
"Mobilizing" means the putting into movement, or
						  assisting in the putting into movement, of part or all of a patient's
						  body.
"Musculoskeletal injury" means acute injury or
						  cumulative trauma of the muscles, tendons, ligaments, bursa, peripheral nerves,
						  joints, bone or blood vessels.
"Patient" means a person who is receiving diagnostic,
						  therapeutic or preventive health services or who is under observation or
						  treatment for illness or injury or for care during and after pregnancy.
"Patient care unit" means a unit or department that is
						  included within a general acute care hospital's license that provides direct
						  patient care including but not limited to nursing units, diagnostic imaging,
						  emergency department, or rehabilitation and behavioral health.
"Patient handling" means lifting, transferring,
						  repositioning or mobilizing of part or all of a patient's body.
"Repositioning" means changing a patient's position on
						  a bed, gurney, chair or other support surface.
"Safe patient handling policy" means a policy that
						  requires replacement of manual lifting and transferring of patients with
						  powered patient transfer devices, lifting devices, and lift teams, as
						  appropriate for the specific patient and consistent with the employer's safety
						  policies and the professional judgment and clinical assessment of the
						  registered nurse.
"Transferring" means moving a patient from one surface
						  to another (for example from a bed to a gurney).
(c) Patient protection and health care worker
						back and musculoskeletal injury prevention plan. As part of the Injury and
						Illness Prevention Program (IIPP) required by Section
						3203, each hospital covered by this
						section shall establish, implement and maintain an effective written patient
						protection and health care worker back and musculoskeletal injury prevention
						plan (Plan). The Plan shall be maintained and implemented at all times for all
						patient care units. The Plan may be incorporated into the IIPP, or may be
						maintained as a separate document. The Plan applicable to the unit shall be
						available to employees in each patient care unit at all times. The Plan shall
						include:
(1) An effective safe patient
						handling policy component reflected in professional occupational safety
						guidelines for the protection of patients and health care workers in health
						care facilities.
NOTE: to subsection (c)(1). Examples of professional
						  occupational safety guidelines for the protection and care of patients and
						  health care workers are listed in Appendix A.
(2) The names and/or job titles of the
						persons responsible for implementing the Plan.
(3) The methods the hospital will use to
						coordinate the implementation of the Plan with other employers whose employees
						have work assignments that include being present on patient care units. These
						methods shall include how employees will be provided with the awareness
						training required by subsection (d)(4), and procedures for investigation and
						recording of injuries associated with patient handling. In addition, the
						hospital's Plan shall include procedures to ensure that the Plan is implemented
						for employees of other employers who are responsible for performing or
						assisting in patient handling activities, including the provision of training
						required for designated health care workers.
(4) Procedures to ensure that supervisory and
						non-supervisory employees comply with the Plan and use specified procedures and
						equipment when performing a patient handling activity, in accordance with
						Section 3203(a)(2).
(5) Procedures for identifying and evaluating
						patient handling hazards, in accordance with Section
						3203(a)(4)
						including all of the following:
(A) A
						procedure to determine the types, quantities and locations for powered patient
						handling equipment and other patient handling equipment required for each unit
						covered by the Plan. This procedure shall include determining where permanent
						and portable equipment should be placed in order to ensure its availability and
						accessibility at all times. The equipment needs for each unit shall be
						initially evaluated by 11/30/2014 unless an initial evaluation meeting the
						requirements of this subsection was conducted after January 1, 2012. GACH
						facilities or units that become operational after 11/30/2014 shall have this
						procedure conducted prior to the start of patient handling operations in that
						facility. The procedures shall include how designated health care workers can
						participate in the evaluations.
(B)
						Procedures by which the designated registered nurse, as the coordinator of
						care, will assess the mobility needs of each patient to determine the
						appropriate patient handling procedures based on the nurse's professional
						judgment using assessment tools, decision trees, algorithms or other effective
						means, and prepare safe patient handling instructions for the patient. The Plan
						shall include the means by which health care workers and supervisors licensed
						in other disciplines can provide input to the designated registered nurse
						regarding the patient mobility assessment.
(C) Evaluation of the need for, use,
						availability, accessibility, and effectiveness of patient handling equipment
						and procedures. These evaluations shall be conducted:
1. When the Plan is first
						established;
2. Whenever the
						equipment or conditions change in a manner that may affect safe patient
						handling;
3. Whenever the employer
						is made aware of a new or previously unrecognized patient handling hazard;
						and
4. At least annually for each
						unit covered by the Plan.
(6) Procedures for the investigation of
						musculoskeletal injuries related to patient handling. To the extent that
						relevant information is available, this shall include:
(A) Review of any patient specific risk
						factors and the designated registered nurse's safe patient handling
						instruction;
(B) Review of whether
						the Plan was effectively implemented, including the availability and correct
						use of equipment, the availability and use of sufficient staff, and whether the
						employees involved had been trained as required by subsection (d);
						and
(C) Solicitation from the
						injured employee and other staff involved in the incident of their opinions
						regarding the cause of the incident, and whether any measure would have
						prevented the injury.
(7)
						Procedures for correcting hazards related to patient handling, including:
(A) The evaluation and selection of patient
						handling equipment, including the involvement of designated registered nurses
						and other designated health care workers, and, where utilized, lift team
						members;
(B) How sufficient and
						appropriate patient handling equipment, selected in accordance with subsections
						(c)(5) and (c)(7)(A), will be made available on each unit covered by this
						section. This shall include procedures for procurement, inspection,
						maintenance, repair, and replacement of appropriate patient handling equipment.
						Where equipment is shared between units, these procedures shall also include
						the means by which the current location of the equipment can be
						determined;
(C) The procedures by
						which the designated registered nurse will observe and direct patient lifts and
						mobilizations on each patient care unit, in accordance with Labor Code Section
						6403.5 and
						Title 22, California Code of Regulations, Section
						70215;
(D) The procedures by which the designated
						registered nurse will communicate the nurse's assessment regarding patient
						handling practices to the patient and patient's authorized representatives, in
						accordance with Title 22, California Code of Regulations, Section
						70215;
(E) The procedures by which lift teams and/or
						other designated health care workers will be available to perform lifts and
						other patient handling tasks in each patient care unit at all times in
						accordance with the Safe Patient Handling Policy. An employee is not considered
						to be available if the employee's other assignments prevent the person from
						participating in the patient handling tasks within the timeframe determined to
						be necessary by the person designated to observe and direct the patient lifts
						and mobilizations in accordance with subsection (c)(7)(C) and (c)(7)(F).
						Designated health care workers and lift team members shall follow the safe
						patient handling policy, including replacement of manual patient handling with
						powered patient transfer devices and lifting devices as appropriate for the
						specific situation and patient.
(F)
						The procedures to be followed by designated health care workers and lift team
						members in performing patient handling tasks under normal circumstances, in
						emergencies, in situations in which there is no designated registered nurse
						present, in situations in which patients are not cooperative with the safe
						patient handling instruction, and in those situations in which there is no
						applicable individual safe patient handling instruction.
(G) Procedures for correcting problems found
						during the review of the Plan.
(8) Procedures for communicating with
						employees regarding safe patient handling matters, including:
(A) The method by which the designated
						registered nurse's safe patient handling instruction for each patient will be
						documented and communicated to designated health care workers and lift team
						members providing care to that patient;
(B) The means by which employees may
						communicate without fear of reprisal their concerns regarding performing a
						patient handling activity as instructed, and the means by which concerns and
						reported hazards will be investigated and corrected as necessary; and
(C) The means by which designated health care
						workers, lift team members, designated registered nurses, and their supervisors
						can participate in reviewing the effectiveness of the Plan in their work areas
						or departments.
(9)
						Procedures for providing training to employees who may be present in patient
						care units in accordance with subsection (d).
(10) For facilities or units in existence as
						of 10/1/2014, a list of the patient handling equipment identified in (c)(7)(B)
						that cannot be implemented by the effective date of the standard shall be made.
						For each listed item, this shall include the reason for the delay, and the
						schedule by which the equipment will be put into use, and alternative measures
						to protect employees until the equipment is put into use. In any event, any
						equipment identified shall be put into use no later than one year after
						10/1/2014.
(11) Procedures for
						reviewing, at least annually, the effectiveness of the Plan in each patient
						care unit, which shall include a review of injury data and trends. The Plan
						shall include an effective procedure for obtaining the active involvement of
						employees in reviewing and updating the Plan with respect to the procedures
						performed by employees in their respective work areas or departments.
						Deficiencies found during this review shall be corrected, in accordance with
						subsection (c)(7) and Section
						3203.