SIST-TP CEN ISO/TR 12296:2014
(Main)Ergonomics - Manual handling of people in the healthcare sector (ISO/TR 12296:2012)
Ergonomics - Manual handling of people in the healthcare sector (ISO/TR 12296:2012)
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. Its 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, including 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 supervisors, 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 (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 do 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.
Ergonomie - Manuelles Bewegen von Personen im Bereich der Pflege (ISO/TR 12296:2012)
Dieser Technische Bericht liefert eine Anleitung für die Beurteilung der mit dem manuellen Bewegen von Patienten im Bereich des Gesundheitswesens verbundenen Probleme und Risiken sowie zur Ermittlung ergonomischer Strategien und Maßnahmen und zu deren Anwendung auf diese Probleme und Risiken.
Seine Hauptziele bestehen in Folgendem:
- Verbesserung der Arbeitsbedingungen der Pflegekräfte durch Reduzierung des biomechanischen Überlastungsrisikos, wodurch arbeitsbedingte Erkrankungen und Verletzungen und infolgedessen die Kosten und Fehlzeiten begrenzt werden, und
- Berücksichtigung der Qualität der Pflege, Sicherheit, Würde und Privatsphäre der Patienten in Hinblick auf deren Bedürfnisse, einschließlich der spezifischen persönlichen Pflege und Körperpflege.
Er ist vorgesehen für alle Nutzer (oder Pflegekräfte und Beschäftigte), deren pflegerische Tätigkeit das manuelle Bewegen von Patienten beinhaltet, und insbesondere für Manager und Beschäftigte im Gesundheitswesen, Verantwortliche im Arbeits- und Gesundheitsschutz, Hersteller von Hilfsmitteln/Arbeitsmitteln und Ausstattungen, Ausbildungs- und Trainingsleiter sowie Planer von Gesundheitseinrichtungen .
Seine Empfehlungen sind vorwiegend auf das Bewegen von Menschen (Erwachsene und Kinder) bei der Bereitstellung von Gesundheitsdienstleitungen in speziell zu diesem Zweck errichteten oder angepassten Gebäuden und Arbeitsumgebungen anwendbar. Einige der Empfehlungen sind auch auf weitere Bereiche anwendbar (z. B. häusliche Pflege, Notfallversorgung, ehrenamtlich Pflegende, Bewegen von Verstorbenen).
Die Empfehlungen für das Bewegen von Patienten berücksichtigen die Arbeitsorganisation, den Patienten-Typ und die Anzahl der zu bewegenden Patienten, die Hilfsmittel, die räumlichen Gegebenheiten, in denen Patienten bewegt werden, sowie die Ausbildung der Pflegekräfte und ungünstige Körperhaltungen; sie gelten jedoch nicht für die Handhabung von Gegenständen (Bewegen, Transportieren, Schieben und Ziehen) oder von Tieren. Eine gemeinsame Analyse verschiedener in einer Schicht anfallender Aufgaben, die das Bewegen von Patienten, das Ziehen und Schieben oder die Handhabung und den Transport von Lasten umfassen, wird nicht betrachtet.
Ergonomie - Manutention manuelle des personnes dans le secteur de la santé (ISO/TR 12296:2012)
L'ISO/TR 12296:2012 fournit des lignes directives pour l'évaluation des problèmes et des risques associés à la manutention manuelle des patients dans le secteur de la santé, ainsi que pour l'identification et l'application de stratégies et de solutions ergonomiques à ces problèmes et ces risques.
Il a principalement pour objectif d'améliorer les conditions de travail des soignants en diminuant le risque de surcharge biomécanique, ce qui limite donc les maladies et accidents de travail, ainsi que les coûts et l'absentéisme qui en résultent, et de justifier la qualité des soins aux patients, la sécurité, la dignité et la vie privée des patients par rapport à leurs besoins, y compris les soins et l'hygiène personnels spécifiques.
Il est destiné à tous les utilisateurs (soignants et salariés) impliqués dans la manutention manuelle pour les soins et, en particulier, les cadres et les soignants, les agents de santé chargés de la sécurité et de la santé au travail, les fabricants d'appareils et accessoires fonctionnels et d'équipements, les superviseurs d'éducation et de formation et les concepteurs d'établissements de santé.
Ses recommandations s'appliquent principalement au déplacement des personnes (adultes et enfants) pour la prestation des soins de santé dans des bâtiments et environnements construits ou adaptés à dessein. Certaines recommandations peuvent aussi s'appliquer à des domaines plus larges (par exemple les soins à domicile, les soins d'urgence, les soignants bénévoles, la manutention des cadavres).
Les recommandations sur la manutention des patients prennent en compte l'organisation du travail, le type et le nombre de patients à manutentionner, les aides, les espaces où les patients sont manipulés, ainsi que l'éducation et les postures inconfortables des soignants, mais ne s'appliquent pas à la manipulation (déplacement, transfert, tirer/pousser) des objets ou des animaux. L'analyse commune des tâches d'une équipe journalière impliquant la manutention, le tirer/pousser des patients, ou la manutention et le transport d'objets n'est pas prise en compte.
Ergonomija - Ročno premeščanje ljudi v zdravstvu in negi (ISO/TR 12296:2012)
General Information
Standards Content (Sample)
SLOVENSKI STANDARD
SIST-TP CEN ISO/TR 12296:2014
01-marec-2014
(UJRQRPLMD5RþQRSUHPHãþDQMHOMXGLY]GUDYVWYXLQQHJL ,6275
Ergonomics - Manual handling of people in the healthcare sector (ISO/TR 12296:2012)
Ergonomie - Manuelles Bewegen von Personen im Bereich der Pflege (ISO/TR
12296:2012)
Ergonomie - Manutention manuelle des personnes dans le secteur de la santé (ISO/TR
12296:2012)
Ta slovenski standard je istoveten z: CEN ISO/TR 12296:2013
ICS:
11.020.10 Zdravstvene storitve na Health care services in
splošno general
13.180 Ergonomija Ergonomics
SIST-TP CEN ISO/TR 12296:2014 en,fr,de
2003-01.Slovenski inštitut za standardizacijo. Razmnoževanje celote ali delov tega standarda ni dovoljeno.
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SIST-TP CEN ISO/TR 12296:2014
TECHNICAL REPORT
CEN ISO/TR 12296
RAPPORT TECHNIQUE
TECHNISCHER BERICHT
September 2013
ICS 13.180
English Version
Ergonomics - Manual handling of people in the healthcare sector
(ISO/TR 12296:2012)
Ergonomie - Manutention manuelle des personnes dans le Ergonomie - Manuelles Bewegen von Personen im Bereich
secteur de la santé (ISO/TR 12296:2012) der Pflege (ISO/TR 12296:2012)
This Technical Report was approved by CEN on 19 August 2013. It has been drawn up by the Technical Committee CEN/TC 122.
CEN members are the national standards bodies of Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia,
Finland, Former Yugoslav Republic of Macedonia, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania,
Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and United
Kingdom.
EUROPEAN COMMITTEE FOR STANDARDIZATION
COMITÉ EUROPÉEN DE NORMALISATION
EUROPÄISCHES KOMITEE FÜR NORMUNG
CEN-CENELEC Management Centre: Avenue Marnix 17, B-1000 Brussels
© 2013 CEN All rights of exploitation in any form and by any means reserved Ref. No. CEN ISO/TR 12296:2013: E
worldwide for CEN national Members.
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Contents
Page
Foreword .3
2
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Foreword
The text of ISO/TR 12296:2012 has been prepared by Technical Committee ISO/TC 159 “Ergonomics” of the
International Organization for Standardization (ISO) and has been taken over as CEN ISO/TR 12296:2013 by
Technical Committee CEN/TC 122 “Ergonomics” the secretariat of which is held by DIN.
Attention is drawn to the possibility that some of the elements of this document may be the subject of patent
rights. CEN [and/or CENELEC] shall not be held responsible for identifying any or all such patent rights.
Endorsement notice
The text of ISO/TR 12296:2012 has been approved by CEN as CEN ISO/TR 12296:2013 without any
modification.
3
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SIST-TP CEN ISO/TR 12296:2014
TECHNICAL ISO/TR
REPORT 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 santé
Reference number
ISO/TR 12296:2012(E)
©
ISO 2012
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COPYRIGHT PROTECTED DOCUMENT
© ISO 2012
All rights 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
ISO's member body in the country of 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 copyright@iso.org
Web www.iso.org
Published in Switzerland
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Contents Page
Foreword . iv
Introduction . 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 (informative) 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 intervention effectiveness . 74
Bibliography . 80
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Foreword
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 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 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 International 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 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 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.
ISO/TR 12296 was prepared by Technical Committee ISO/TC 159, Ergonomics, Subcommittee SC 3,
Anthropometry and biomechanics.
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Introduction
National and international statistics provide evidence that healthcare staff are subject to some of the highest
risks 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
1)
back. Manual patient handling ought to be avoided where possible or be performed in a 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;
inadequacy (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 and 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 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 11228-2, 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.
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TECHNICAL REPORT ISO/TR 12296:2012(E)
Ergonomics — Manual 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.
Its 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, including 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 supervisors, 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 (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 do 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, the following terms, definitions and abbreviated terms apply.
2.1
aids and equipment
assistive devices eliminating or reducing the caregiver's 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 patient handling activities
2.3
environment
all physical conditions of the area where patients have to be handled, including space, climate and surfaces
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2.4
manual patient handling
activity requiring force to push, pull, lift, lower, transfer or in 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 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 totally 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, 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 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 aspects especially in changing work practices, defining
training needs, purchasing technology/equipment and designing work environments.
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Risk assessment
Risk management
Based on:
Organizational aspects;
Adequate aids and equipment;
Buildings and environment;
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); staff
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/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 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 found to be acceptable.
For the purposes of this Technical Report, the risk assessment model shown in Figure 2 is used.
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Hazard identification
Step 1 No obvious hazard
3.2.1
Hazard present
Risk estimation & evaluation
Step 2 Acceptable risk (green)
3.2.2
Monitor & review
Risk present
(yellow, red)
Risk management:
- Organizational aspects (Annex B)
- Assistive devices (Annex C)
- Environment (Annex D)
- Training (Annex E)
Check of effectiveness
Negative Positive
(Annex F)
Figure 2 — Risk assessment model
3.2.1 Hazard identification
A hazard is present when patients are manually handled. The number and type of these patient transfers
should be quantified (e.g. on a daily average) in different ways according to the healthcare area considered.
For example: in operating theatres it would constitute the number of operations needing patient handling; 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 handling.
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) 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 determine the
handling method used by caregivers to a certain extent. The type of handling associated with patient's
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 handling method may produce a much
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higher 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
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 the 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-handling 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 inducing 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 coincides 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 and 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 imbalanced. 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 equipment is strongly recommended to obtain a vital load reduction for the
lumbar spine and to limit the biomechanical overload risk for the caregivers. Equipment and facilities must be
currently and properly maintained for safe usage. The equipment purchase process should be based upon
clear task requirements (type of handling) and the environment where they are used, and thus result in the
selection of equipment fit for the specific workplace and task conditions.
3.2.1.5 Environment
The environment where patients are handled may be a hazard if inadequate. All spaces where patients are
handled should be considered for equipment use and correct handling postures. Additional factors such as
thermal constraints, steps, thresholds, obstacles and slippery floors should be considered.
3.2.1.6 Individual characteristics
Individual skills and capabilities, level of training, age, gender and health status of the caregiver should be
considered when carrying out a risk assessment. Skill and experience are likely to benefit the caregiver when
performing the task and reduce the risk of injury. Training may increase the level of skill and ability to carry out
a task. Clothing and footwear should be functional and should facilitate movement and a stable posture.
3.2.1.7 Patient characteristics
The patient's body weight may be a hazard by itself. In particular, bariatric patients require adequate
equipment and space for their needs. Handling of even a part of the body may produce biomechanical
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overload. Special hazards may arise in case patients oppose the motion for psychiatric or cognitive problems
or issues due to medication. In this case, biomechanical load of musculoskeletal structures could be high.
From an operative point of view it is recommended to proceed with the next step (risk estimation/ evaluation)
whenever there is a presence of non- (or partially) cooperating patients and one or more of the above quoted
hazards/problems are identified.
The next step (risk estimation/evaluation) should include patient characteristics such as non- (or partially)
cooperating patient, and/or body size and mass.
3.2.2 Risk estimation and evaluation
An accurate analytical risk assessment, including data collection for consequent preventive measures, should
consider the presence of several factors and their interrelationships: type of patient; induced “care load”;
available caregiver staff; available and adequate equipment; building; environment and spaces and training
and skill of nursing staff. Given the above factors, the use of consolidated methods applicable to manual
handling of objects (such as those reported in ISO 11228-1 and ISO 11228-2) for patient handling is difficult.
Annex A is devoted to risk estimation and risk evaluation:
A.1 reports an “oriented” review of several methods useful for the purposes of risk estimation or evaluation as
intended in this Technical Report, as derived from literature or from relevant national or international
guidelines.
The methods described are classified primarily in relation to their simplicity/complexity. Complexity generally
entails a more involved task of risk estimation or detailed risk evaluation. Methods can also be classified in
relation to the healthcare sectors in which they could be most effectively applied.
Users of this Technical Report should start with the information in Annex A to select the appropriate method to
use for a simple or detailed risk assessment, depending upon the kind of hazards and risk factors identified in
step 1, the healthcare sectors examined and the experience of the analyst in the use of the proposed methods.
A.2 presents guidelines, taken primarily from national sources, for risk assessment for manual patient
handling and provides suggestions on any relevant issue (aids, environment, caregivers' training and
education, etc.) directed to reducing risk. As such they are not actual risk assessment tools but do provide
useful information.
A.3 reports, on the basis of the same scenario, practical applications of four methods (Dortmund Approach,
TilThermometer, MAPO and PTAI), so the intended users can choose the most appropriate one for the
situation to be assessed.
The risk assessment method used (estimation, detailed evaluation) should allow the collection of pertinent
data regarding the type and quantity of required handling, availability and requirements of handling aids and
equipment and the level of specific training received (and the consequent training needs) of caregivers.
The method used for risk assessment should allow risk classification by the three-zone model (green, yellow,
red) and address the consequent action to take according to criteria given in Table 1.
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Table 1 — Risk estimation/evaluation — Final assessment criteria
Zone Exposure classification Consequences
GREEN ACCEPTABLE Acceptable, no consequences.
YELLOW NOT RECOMMENDED Advisable to set up improvements with regard to
structural risk factors or to suggest other
organizational and educational measures. Further
evaluation is required and adequate measures have
to be done if necessary.
RED UNACCEPTABLE/TO BE AVOIDED Redesign or take actions to lower the risks.
3.3 Risk reduction
Where a presence of risk/problems resulted from the previous step, a comprehensive approach (multifactor
interventions) for risk reduction should be adopted. The comprehensive approach is most likely to be
successful. This approach should be based on the results of the analytical risk assessment. A proper
risk/problem assessment is the basis for appropriate choices in risk reduction.
Risk reduction can be achieved by combining improvements to different risk factors and should consider,
among other things:
The adequate number and the quality of the staff for taking care of the different kind of patients.
The selection and correct use of appropriate aids for handling patients. Aids should be chosen according
adequate ergonomics and quality criteria (see Annex C).
Adequate programs of staff information, education and training considered as part of the risk
management system of the organization and as complementary to the other interventions types here
considered (literature reports that interventions based solely on technique training had no impact on
working practices or injury rates).
The definition of a general risk management system and of clear policies and procedures by the
organization.
A check on the effectiveness of the intervention (part of the risk reduction strategy) is highly recommended.
Annex B presents organizational aspects of patient handling interventions.
Annex C presents criteria for the choice and use of adequate aids and equipment.
Annex D presents information on buildings and environment for the aspects involved in this Technical Report.
Annex E presents information regarding the fundamentals of staff education and training.
Annex F presents information regarding the evaluation of intervention effectiveness.
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ISO/TR 12296:2012(E)
Annex A
(informative)
Risk estimation and risk evaluation
A.1 Methods of risk estimation and evaluation
This annex provides a synthetic description of risk estimation and risk evaluation methods found in scientific
literature. For each of them the main characteristics are described.
Method Quantified Main Benefits Limitations Type of use When and where
factors determinant risk applied (also
factor/s grey literature)
OWAS Postures of whole Posture of a
...
SLOVENSKI STANDARD
kSIST-TP FprCEN ISO/TR 12296:2013
01-maj-2013
(UJRQRPLMD5RþQRSUHPHãþDQMHOMXGLYGHMDYQRVWL]GUDYVWYHQHJDYDUVWYD ,6275
Ergonomics - Manual handling of people in the healthcare sector (ISO/TR 12296:2012)
Ergonomie - Manuelles Bewegen von Personen im Bereich der Pflege (ISO/TR
12296:2012)
Ergonomie - Manutention manuelle des personnes dans le secteur de la santé (ISO/TR
12296:2012)
Ta slovenski standard je istoveten z: FprCEN ISO/TR 12296
ICS:
13.180 Ergonomija Ergonomics
kSIST-TP FprCEN ISO/TR 12296:2013 en,fr,de
2003-01.Slovenski inštitut za standardizacijo. Razmnoževanje celote ali delov tega standarda ni dovoljeno.
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kSIST-TP FprCEN ISO/TR 12296:2013
TECHNICAL REPORT
FINAL DRAFT
FprCEN ISO/TR 12296
RAPPORT TECHNIQUE
TECHNISCHER BERICHT
April 2013
ICS 13.180
English Version
Ergonomics - Manual handling of people in the healthcare sector
(ISO/TR 12296:2012)
Ergonomie - Manutention manuelle des personnes dans le Ergonomie - Manuelles Bewegen von Personen im Bereich
secteur de la santé (ISO/TR 12296:2012) der Pflege (ISO/TR 12296:2012)
This draft Technical Report is submitted to CEN members for Technical Committee Approval. It has been drawn up by the Technical
Committee CEN/TC 122.
CEN members are the national standards bodies of Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia,
Finland, Former Yugoslav Republic of Macedonia, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania,
Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland, Turkey and United
Kingdom.
Recipients of this draft are invited to submit, with their comments, notification of any relevant patent rights of which they are aware and to
provide supporting documentation.
Warning : This document is not a Technical Report. It is distributed for review and comments. It is subject to change without notice and
shall not be referred to as a Technical Report.
EUROPEAN COMMITTEE FOR STANDARDIZATION
COMITÉ EUROPÉEN DE NORMALISATION
EUROPÄISCHES KOMITEE FÜR NORMUNG
Management Centre: Avenue Marnix 17, B-1000 Brussels
© 2013 CEN All rights of exploitation in any form and by any means reserved Ref. No. FprCEN ISO/TR 12296:2013: E
worldwide for CEN national Members.
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FprCEN ISO/TR 12296:2013 (E)
Contents
Page
Foreword . 3
2
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FprCEN ISO/TR 12296:2013 (E)
Foreword
The text of ISO/TR 12296:2012 has been prepared by Technical Committee ISO/TC 159 “Ergonomics” of the
International Organization for Standardization (ISO) and has been taken over as FprCEN ISO/TR 12296:2013
by Technical Committee CEN/TC 122 “Ergonomics” the secretariat of which is held by DIN.
This document is currently submitted to the Technical Committee Approval.
Endorsement notice
The text of ISO/TR 12296:2012 has been approved by CEN as FprCEN ISO/TR 12296:2013 without any
modification.
3
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kSIST-TP FprCEN ISO/TR 12296:2013
TECHNICAL ISO/TR
REPORT 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 santé
Reference number
ISO/TR 12296:2012(E)
©
ISO 2012
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ISO/TR 12296:2012(E)
COPYRIGHT PROTECTED DOCUMENT
© ISO 2012
All rights 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
ISO's member body in the country of 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 copyright@iso.org
Web www.iso.org
Published in Switzerland
ii © ISO 2012 – All rights reserved
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Contents Page
Foreword . iv
Introduction . 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 (informative) 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 intervention effectiveness . 74
Bibliography . 80
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Foreword
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 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 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 International 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 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 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.
ISO/TR 12296 was prepared by Technical Committee ISO/TC 159, Ergonomics, Subcommittee SC 3,
Anthropometry and biomechanics.
iv © ISO 2012 – All rights reserved
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Introduction
National and international statistics provide evidence that healthcare staff are subject to some of the highest
risks 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
1)
back. Manual patient handling ought to be avoided where possible or be performed in a 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;
inadequacy (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 and 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 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 11228-2, 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.
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kSIST-TP FprCEN ISO/TR 12296:2013
TECHNICAL REPORT ISO/TR 12296:2012(E)
Ergonomics — Manual 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.
Its 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, including 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 supervisors, 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 (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 do 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, the following terms, definitions and abbreviated terms apply.
2.1
aids and equipment
assistive devices eliminating or reducing the caregiver's 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 patient handling activities
2.3
environment
all physical conditions of the area where patients have to be handled, including space, climate and surfaces
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2.4
manual patient handling
activity requiring force to push, pull, lift, lower, transfer or in 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 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 totally 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, 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 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 aspects especially in changing work practices, defining
training needs, purchasing technology/equipment and designing work environments.
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Risk assessment
Risk management
Based on:
Organizational aspects;
Adequate aids and equipment;
Buildings and environment;
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); staff
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/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 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 found to be acceptable.
For the purposes of this Technical Report, the risk assessment model shown in Figure 2 is used.
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Hazard identification
Step 1 No obvious hazard
3.2.1
Hazard present
Risk estimation & evaluation
Step 2 Acceptable risk (green)
3.2.2
Monitor & review
Risk present
(yellow, red)
Risk management:
- Organizational aspects (Annex B)
- Assistive devices (Annex C)
- Environment (Annex D)
- Training (Annex E)
Check of effectiveness
Negative Positive
(Annex F)
Figure 2 — Risk assessment model
3.2.1 Hazard identification
A hazard is present when patients are manually handled. The number and type of these patient transfers
should be quantified (e.g. on a daily average) in different ways according to the healthcare area considered.
For example: in operating theatres it would constitute the number of operations needing patient handling; 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 handling.
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) 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 determine the
handling method used by caregivers to a certain extent. The type of handling associated with patient's
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 handling method may produce a much
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higher 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
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 the 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-handling 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 inducing 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 coincides 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 and 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 imbalanced. 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 equipment is strongly recommended to obtain a vital load reduction for the
lumbar spine and to limit the biomechanical overload risk for the caregivers. Equipment and facilities must be
currently and properly maintained for safe usage. The equipment purchase process should be based upon
clear task requirements (type of handling) and the environment where they are used, and thus result in the
selection of equipment fit for the specific workplace and task conditions.
3.2.1.5 Environment
The environment where patients are handled may be a hazard if inadequate. All spaces where patients are
handled should be considered for equipment use and correct handling postures. Additional factors such as
thermal constraints, steps, thresholds, obstacles and slippery floors should be considered.
3.2.1.6 Individual characteristics
Individual skills and capabilities, level of training, age, gender and health status of the caregiver should be
considered when carrying out a risk assessment. Skill and experience are likely to benefit the caregiver when
performing the task and reduce the risk of injury. Training may increase the level of skill and ability to carry out
a task. Clothing and footwear should be functional and should facilitate movement and a stable posture.
3.2.1.7 Patient characteristics
The patient's body weight may be a hazard by itself. In particular, bariatric patients require adequate
equipment and space for their needs. Handling of even a part of the body may produce biomechanical
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overload. Special hazards may arise in case patients oppose the motion for psychiatric or cognitive problems
or issues due to medication. In this case, biomechanical load of musculoskeletal structures could be high.
From an operative point of view it is recommended to proceed with the next step (risk estimation/ evaluation)
whenever there is a presence of non- (or partially) cooperating patients and one or more of the above quoted
hazards/problems are identified.
The next step (risk estimation/evaluation) should include patient characteristics such as non- (or partially)
cooperating patient, and/or body size and mass.
3.2.2 Risk estimation and evaluation
An accurate analytical risk assessment, including data collection for consequent preventive measures, should
consider the presence of several factors and their interrelationships: type of patient; induced “care load”;
available caregiver staff; available and adequate equipment; building; environment and spaces and training
and skill of nursing staff. Given the above factors, the use of consolidated methods applicable to manual
handling of objects (such as those reported in ISO 11228-1 and ISO 11228-2) for patient handling is difficult.
Annex A is devoted to risk estimation and risk evaluation:
A.1 reports an “oriented” review of several methods useful for the purposes of risk estimation or evaluation as
intended in this Technical Report, as derived from literature or from relevant national or international
guidelines.
The methods described are classified primarily in relation to their simplicity/complexity. Complexity generally
entails a more involved task of risk estimation or detailed risk evaluation. Methods can also be classified in
relation to the healthcare sectors in which they could be most effectively applied.
Users of this Technical Report should start with the information in Annex A to select the appropriate method to
use for a simple or detailed risk assessment, depending upon the kind of hazards and risk factors identified in
step 1, the healthcare sectors examined and the experience of the analyst in the use of the proposed methods.
A.2 presents guidelines, taken primarily from national sources, for risk assessment for manual patient
handling and provides suggestions on any relevant issue (aids, environment, caregivers' training and
education, etc.) directed to reducing risk. As such they are not actual risk assessment tools but do provide
useful information.
A.3 reports, on the basis of the same scenario, practical applications of four methods (Dortmund Approach,
TilThermometer, MAPO and PTAI), so the intended users can choose the most appropriate one for the
situation to be assessed.
The risk assessment method used (estimation, detailed evaluation) should allow the collection of pertinent
data regarding the type and quantity of required handling, availability and requirements of handling aids and
equipment and the level of specific training received (and the consequent training needs) of caregivers.
The method used for risk assessment should allow risk classification by the three-zone model (green, yellow,
red) and address the consequent action to take according to criteria given in Table 1.
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Table 1 — Risk estimation/evaluation — Final assessment criteria
Zone Exposure classification Consequences
GREEN ACCEPTABLE Acceptable, no consequences.
YELLOW NOT RECOMMENDED Advisable to set up improvements with regard to
structural risk factors or to suggest other
organizational and educational measures. Further
evaluation is required and adequate measures have
to be done if necessary.
RED UNACCEPTABLE/TO BE AVOIDED Redesign or take actions to lower the risks.
3.3 Risk reduction
Where a presence of risk/problems resulted from the previous step, a comprehensive approach (multifactor
interventions) for risk reduction should be adopted. The comprehensive approach is most likely to be
successful. This approach should be based on the results of the analytical risk assessment. A proper
risk/problem assessment is the basis for appropriate choices in risk reduction.
Risk reduction can be achieved by combining improvements to different risk factors and should consider,
among other things:
The adequate number and the quality of the staff for taking care of the different kind of patients.
The selection and correct use of appropriate aids for handling patients. Aids should be chosen according
adequate ergonomics and quality criteria (see Annex C).
Adequate programs of staff information, education and training considered as part of the risk
management system of the organization and as complementary to the other interventions types here
considered (literature reports that interventions based solely on technique training had no impact on
working practices or injury rates).
The definition of a general risk management system and of clear policies and procedures by the
organization.
A check on the effectiveness of the intervention (part of the risk reduction strategy) is highly recommended.
Annex B presents organizational aspects of patient handling interventions.
Annex C presents criteria for the choice and use of adequate aids and equipment.
Annex D presents information on buildings and environment for the aspects involved in this Technical Report.
Annex E presents information regarding the fundamentals of staff education and training.
Annex F presents information regarding the evaluation of intervention effectiveness.
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kSIST-TP FprCEN ISO/TR 12296:2013
ISO/TR 12296:2012(E)
Annex A
(informative)
Risk estimation and risk evaluation
A.1 Methods of risk estimation and evaluation
This annex provides a synthetic description of risk estimation and risk evaluation methods found in scientific
li
...
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