Review Date: 15th September 2017

Next Review: September 2018 Reviewed by: Carol Walpole Specialist Moving &Handling Advisor

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Non-patient (Inanimate)

Manual Handling Booklet For All Staff

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CONTENTS

LEGAL REQUIREMENTS ......................................................................................... 3

L.O.L.E.R. LIFTING OPERATIONS AND LIFTING EQUIPMENT REGULATIONS 1998 ........................................................................................................................... 4

P.U.W.E.R. PROVISION TO THE USE OF WORKING EQUIPMENT REGULATIONS 1998 ................................................................................................ 4

REPORTING OF INJURIES, DISEASES AND DANGEROUS OCCURRENCES REGULATIONS (R.I.D.D.O.R.) .................................................................................. 4

RISK ASSESSMENTS ............................................................................................... 5

SPINAL AWARENESS .............................................................................................. 5

SPINAL ANATOMY: INTERVERTEBRAL DISCS .................................................... 7

EVERYDAY BACK CARE ......................................................................................... 8

MUSCULO-SKELETAL INJURY ............................................................................... 9

BIOMECHANICS ..................................................................................................... 10

NUMERICAL GUIDELINES ..................................................................................... 11

GETTING TO GRIPS WITH MANUAL HANDLING ................................................. 12

PRINCIPLES OF MOVING AND HANDLING .......................................................... 15

MOVING AND HANDLING ADVICE........................................................................ 16

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LEGAL REQUIREMENTS

Summary of Key Points.

The Health and Safety at Work Act (HASAWA) 1974 Management of Health and Safety at work regulations 1999 Manual Handling Operations Regulations 1992 (MHORegs) Amended 2002 L.O.L.E.R. 1998 P.U.W.E.R. 1998

Employers’ Responsibilities

Employers have general health and safety responsibilities concerning: 1. Employees and others. 2. The workplace environment, adequate space, sufficient ventilation, lighting

Provision, inspection & maintenance of equipment 3. Responsibilities to carry out lifting operations safely 4. Instruction, Supervision and Training. 5. Provide safe systems of work

The Manual Handling Operations Regulations place responsibilities on the Employer for: 1. Avoidance of manual handling 2. Assessment of risks 3. Reduction of risks 4. Provision of information on the load 5. Review of risk assessments

Employees’ Responsibilities

1. Attend and follow the training you have received. 2. Use work equipment your employer has provided in accordance with

instructions, supervision and training. 3. Take reasonable care of yourself and others who maybe be affected by your

acts or omissions. 4. Co-operate with your employer on health and safety. 5. Tell someone (your employer, supervisor, or health and safety representative)

if you think work or inadequate precautions are putting anyone’s health and safety at serious risk.

Under the Manual Handling Operations Regulations, the main responsibility of the employee is:

To make use of safe systems of work provided by the employer.

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L.O.L.E.R. LIFTING OPERATIONS AND LIFTING EQUIPMENT REGULATIONS 1998

Employers Duties to ensure:

The strength, stability and safety of lifting equipment

It is positioned and installed in such a way as to minimise risks.

It is marked to indicate its safe working load.

Every lifting operation is properly planned by a competent person, appropriately supervised and carried out in a safe manner.

If it is for lifting persons and liable to deterioration it must be checked at least six monthly by a competent person who will specify when the next check is due. A copy of the examination must be sent to the employer who must also be notified of any dangerous defects.

What equipment is covered by the Regulations?

Lifting equipment includes any equipment used at work for lifting or lowering loads, such as hoists, Including attachments and accessories used for supporting, such as slings.

P.U.W.E.R. PROVISION AND USE OF WORKING EQUIPMENT REGULATIONS 1998

Employers Duties:

To ensure work equipment is suitable for the purpose for which it is used.

To provide written instructions.

To provide training, including any risks involved and precautions taken.

Equipment must be maintained in an efficient state, efficient working order and in good repair. A maintenance log is to be kept up to date.

REPORTING OF INJURIES, DISEASES AND DANGEROUS OCCURRENCES REGULATIONS (R.I.D.D.O.R.)

The legal requirement for reporting injuries are mostly contained in the Reporting of Injuries, diseases and Dangerous Occurrences Regulations (R.I.D.D.O.R.) 1995. Updated in 2013- Reporting must take place within 10 calendar days of the incident.

Employers must:

Report all specified accidents and injuries to the appropriate outside agency

Use the Datix incident reporting system

Investigate

Employees must:

Report all accidents and injuries to the employer as soon as possible.

Ensure all accidents and injuries are recorded on Datix

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Individual Capability

Load

Environment

Equipment

Task

What are ‘reportable’ injuries? The following injuries are reportable under ‘RIDDOR’ when they result from a work-related accident:

The death of any person

Specified Injuries to workers

Injuries to workers which result in their incapacitation for more than 7 days

Injuries to non-workers which result in them being taken directly to hospital for treatment, or specified injuries to non-workers which occur on hospital premises.

Other considerations

It is essential that you are aware that you can be held personally and legally accountable for your actions or inactions as a carer who manually handles.

For further information on R.I.D.D.O.R. reportable injuries, check the HSE website www.hse.gov.uk

RISK ASSESSMENTS

Factors Reducing the Risk of Injury In an attempt to reduce the risk of injury during manual handling, consideration should be given to the following five factors: Task:

Improving task layout

Using the body more efficiently

Improving work routine

Provision of training in handling while seated

Provision of training in team handling

Provision of personal protective equipment

Maintenance and accessibility of equipment

Individual Capability:

Awareness of personal capacity

Provision of knowledge and training

Staff selection appropriate for the task

Physical strength and ability.

Any medical conditions.

Load:

E Environment L Load I Individual Capability T Task E Equipment

Make it lighter (not usually possible with clients*)

Easier to manage

Easier to grasp

More stable

Less damaging to hold

Equipment:

To reduce physical effort and risk of injury

To reduce the load

T Task I Individual Capability L Load E Environment E Equipment

To provide an improved and safer system of work

Working Environment:

Remove space constraints

Consider condition and nature of floor

Reduce work at different levels

Control thermal environment

Maximise lighting conditions

SPINAL AWARENESS

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SUMMARY OF KEY POINTS

The Spine The spine is the central composition of the skeleton. It consists of thirty-three vertebrae, each pair with an intervertebral disc between them, and the muscles and ligaments. The most commonly injured areas of the spine are the cervical and lumbar regions, due to their mobility, position and lack of protection. The Spinal Unit & Intervertebral Disc The intervertebral disc has four main functions. It:

Absorbs shock

Acts as a spacer between vertebrae

Reduces friction during movement

Limits excessive movement The disc can be damaged by mechanical or chemical changes. It can rupture suddenly ‘prolapsed disc’ (commonly known as a ‘slipped disc’), which can be due to either direct trauma or cumulative injury which occurs over time. The Spine has four regions:

Cervical Region (7)

Thoracic Region (12)

Lumbar Region (5)

Pelvis including the Sacrum (5) And Coccyx (4)

Correct Posture The correct posture in any physical activity is one which:

Maintains the natural curvature of the spine

Maintains the balance of the body

Minimises the level of spinal stress Three Key Principles of Safe Manual handling 1. Maintain a natural, upright posture whenever

possible during manual handling, keeping your ‘Spine in Line’

2. Always create a good, stable base with your legs and feet

3. Keep any load, or point of force, as close to your vertical centre of gravity as possible

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SPINAL ANATOMY: INTERVERTEBRAL DISCS

Between each vertebral body is a cushion called an intervertebral disc. Each disc absorbs the stress and shock the body incurs during movement and prevents the vertebrae from grinding against one another. The intervertebral discs are the largest structures in the body without a vascular supply. By means of osmosis, each disc absorbs needed nutrients.

Each disc is made up of two parts: the annulus fibrosus and the nucleus pulposus.

Annulus Fibrosus The annulus is a sturdy tire-like structure that encases a gel-like centre, the nucleus pulposus. The annulus enhances the spine’s rotational stability and helps to resist compressive stress.

The annulus is a layered structure consisting of water and sturdy elastic collagen fibres. The fibres are oriented at different angles horizontally similar to the construction of a radial tire. Collagen consists of fibrous bundles made of protein bound together by proteoglycan gel.

The intervertebral discs are the largest structures in the body without a vascular supply. Through osmosis, each disc absorbs needed nutrients.

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Nucleus Pulposus The centre portion of each intervertebral disc is a filled with a gel-like elastic substance. Together with the annulus fibrosis, the nucleus pulposus transmits stress and weight from vertebra to vertebra.

The structural components of the nucleus pulposus is similar to the annulus fibrosus; water, collagen and proteoglycans. The difference is the concentration of these substances. The nucleus contains more water than the annulus.

Endplates The top (superior) and bottom (inferior) of each vertebral body is coated with an endplate. Endplates are complex structures that blend into the intervertebral disc and help hold the disc in place.

EVERYDAY BACK CARE

POSTURE Bad posture is one of the leading causes of back pain particularly poor sitting posture. Lower backache is the body’s warning sign that muscles are tired and overworked and injury could easily occur. The position of the pelvis and the strength and flexibility of supporting muscle groups affect the degree of extension to the lumbar vertebrae. We need to maintain good posture all the time i.e. with the pelvis in a central position. Whether the back is flattened or excessively curved, the result can be discomfort, pain and often injury. This means that whether we are standing in a bus queue, sitting at a desk, driving a car or relaxing on a settee, we should strive to maintain the 4 natural curves of the body and the correct position of the pelvis. Back pain can also be the symptom of overuse and is the body’s response to tired, overworked, often unbalanced muscles which are then more likely to succumb to injury. Remember: The potentially damaging factors to the back are those activities that we do all or most of the time. To maintain full mobility and suppleness- AVOID:

Holding a stressed posture e.g. bending or twisting

Holding a stressed posture whilst lifting a load

Holding a double stressed posture e.g. bending and twisting together

Repetition

Sudden jerky back movements DO

Exercise safely and regularly

Include cardiovascular, strengthening and flexibility work

Be aware of your posture all the time and strive to maintain good posture as much as possible.

Muscle strength The stronger the muscles of the upper body, the more stable the spine becomes. It needs to be well supported and protected by strong muscles. But remember, we never use our back muscles to ‘do’ a lift. The muscles we use and which must, therefore, be really strong are our quadriceps, gluteal and transverse abdominal muscles, and, to a lesser degree, the muscles of the shoulders, arms and upper body.

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Everyone needs to know the correct technique and the basic rules for lifting but that isn’t enough! They also need to be strong enough to do the lift safely, whatever the lift may be.

MUSCULO-SKELETAL INJURY

SUMMARY OF KEY POINTS

Causes of Back Pain

There are three main types of back pain that we have covered here:

1. PRIMARY 2. SECONDARY 3. REFERRED

Primary back pain is widespread, and results from damage to soft tissue around the spine, due to trauma, pathological changes, fatigue or postural stresses.

Secondary back pain often manifests itself as pain radiating into the leg, and muscle weakness or loss of sensation. It is caused by damage to the spinal nerves by a disc or by osteophytes.

Referred back pain originates from the pelvis or abdomen, but is felt in the spinal area.

The Injury Complex is a diagram which illustrates the factors which can contribute to Musculo-skeletal injuries:

Many injuries are of a cumulative nature, whereby continual trauma causes weakness, which in turn causes further injury.

RSI & Cumulative

Strain

Ageing

Direct Trauma

Physiological & Psychological

Factors

Congenital Defects

Chemical and Biological

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There are various activities that can increase the likelihood of back injury or pain due to their loading effects on the spine. These are worth remembering. If we add to those activities we’ve already discussed, the list then includes:

Physical manual work

Static postures

Repetitive manual work Vibration

Poor posture, such as stooping, bending or twisting

Lifting and forceful movements

Unaccustomed work, when we’re carrying out a handling task we’re not used to

BIOMECHANICS

BIOMECHANICS - is the application of mechanics to the living body. The vertebral column depends for its stability on the supporting musculature. The muscles of the spine and the abdominal wall control spinal movements and protect the spine from motion beyond the physiological range.

How Different Positions Affect Spinal Pressure

When standing erect, the load on the spine arises mainly from the effect of gravity and little muscular activity is needed to maintain this position. When in forward flexion the muscles have to work to maintain the bent position against gravity and this produces a compressive force on the discs. This force is 6 times greater when the trunk is bent forward to the horizontal than when it is upright.

The Importance of Keeping the Load Close The load is mainly taken by the lumbro-sacral discs as this area acts as the fulcrum or pivot point. Hence, most frequently it is the lower lumbar area that is injured. It is also important to remember that holding loads away from the trunk has a similar effect upon the spine. To hold the load away from the trunk whilst being in forward flexion increases the force by lengthening the lever even further.

Correct Posture in Any Physical Activity

Maintains the natural curvature of the spine Maintains the balance of the body Minimises levels of spinal stress

Three Principles of Good Manual Handling

Keep your spine in line Create a stable base Keep any load as close as possible to your vertical centre of gravity

For Back care Exercises: www.Backcare.org.uk or contact 0845 130 2704

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NUMERICAL GUIDELINES

The filter for lifting and lowering is used to assess whether the risks fall inside the guideline figures. If so you do not normally have to complete a full assessment. The guideline figures assume that:-

The load is easy to grasp

The task takes place in reasonable conditions; and

The handler is in a stable body position The guideline provides a reasonable protection for around 95% of working men and women. The guidelines do not give us safe working limits and it must be remembered that moving loads that fall inside of the guidelines should still be avoided or reduced if possible. The guidelines ‘should not be regarded as weight limits or approved limits for safe lifting’. There are also numerical filters for carrying, pushing and pulling, twisting and handling whilst seated. For full information see Appendix 3, MHOR, Guidance on the Regulations 2004.

Guidelines for Lifting and Lowering

Source: HSE, Manual Handling at Work Guide

REMEMBER – THERE IS NO SAFE WEIGHT TO LIFT

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GETTING TO GRIPS WITH MANUAL HANDLING

Good handling technique for lifting Here are some practical tips, suitable for use in training people in safe manual handling. In the following section a basic lifting operation is taken as an example.

Think before lifting/handling. Plan the lift. Can handling aids be used? Where is the load going to be placed? Will help be needed with the load? Remove obstructions such as discarded wrapping materials. For a long lift, consider resting the load midway on a table or bench to change grip. Keep the load close to the waist. Keep the load close to the body for as long as possible whilst lifting. Keep the heaviest side of the load next to the body. If a close approach to the load is not possible, try to slide it towards the body before attempting to lift it.

Adopt a stable position. The feet should be apart with one leg slightly forward to maintain balance (alongside the load, if it is on the ground). The worker should be prepared to move their feet during the lift to maintain their stability. Avoid tight clothing or unsuitable footwear, which may make this difficult.

Get a good hold. Where possible the load should be hugged as close as possible to the body. This may be better than gripping it tightly with hands only

Start in a good posture. At the start of the lift, slight bending of the back, hips and knees is preferable to fully flexing the back (stooping) or fully flexing the hips and knees (squatting).

Don’t flex the back any further when

lifting. This can happen if the legs begin

to straighten before starting to raise the

load.

Avoid twisting the back or leaning sideways, especially when the back is bent. Shoulders should be kept level and facing in the same direction as the hips. Turning by moving the feet is better than twisting and lifting at the same time.

Keep the head up when handling.

Look ahead, not down at the load, once it

has been held securely.

Move smoothly. The load should not be jerked or snatched as this can make it harder to keep control and can increase the risk of injury.

Don’t lift or handle more than can be easily managed. There is a difference between what people can lift and what they can safely lift. If in doubt, seek advice or get help

Put down, then adjust. If precise positioning of the load is necessary, put it down first, then slide it into the desired position

Good handling technique for pushing and pulling

Here are some practical points to remember when loads are pushed or pulled.

Handling devices. Aids such as barrows and trolleys should have handle heights that are between the

shoulder and the waist. Devices should be well-maintained with wheels that run smoothly (the law requires that equipment is maintained).

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When purchasing new trolleys etc, ensure

they are of good quality with large

diameter

wheels made of suitable material and with

castors, bearings etc which will last with

minimum maintenance. Consultation with

your employees and safety representatives

will help, as they know what works and

what doesn’t.

Force. As a rough guide the amount of

force that needs to be applied to move a

load over a flat, level surface using a well-

maintained handling aid is at least 2% of

the load weight. For example, if the load

weight is 400 kg, then the force needed to

move the load is 8 kg. The force needed

will be larger, perhaps a lot larger, if

conditions are not perfect (eg wheels not in

the right position or a device that is poorly

maintained). The operator should try to

push rather than pull when moving a load,

provided they can see over it and control

steering and stopping.

Slopes. Employees should enlist help from another worker whenever necessary if they have to negotiate a slope or ramp, as pushing and pulling forces can be very high. For example, if a load of 400 kg is moved up a slope of 1 in 12

(about 5o), the required force is over 30 kg

even in ideal conditions – good wheels and a smooth slope. This is above the guideline weight for men and well above the guideline for women.

Uneven surfaces. Moving an object over soft or uneven surfaces requires higher forces. On an uneven surface, the force needed to start the load moving could increase to 10% of the load weight, although this might be offset to some extent by using larger wheels. Soft ground may be even worse.

Stand and place. To make it easier to

push or pull, employees should keep their

feet well away from the load and go no

faster than walking speed. This will stop

them becoming too tired too quickly.

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Special Lifts You may have to use different types of lift for some objects. Remember to always plan the task before you begin.

One-handed lifting

If you need to lift using only one hand, for example when lifting a bucket, take extra care.

Divide the load if you can.

Brace your body with the opposite arm, if possible. This will help steady and support your body.

Reach for the load. Bend your knees, and keep your back straight.

Grip the load firmly (use a handle if possible).

Lift with your legs, using your free arm for balance.

Keep your shoulders level. Switch hands regularly

Team lifts

If your load is heavy, large or awkward, you may need to work with one or more people.

Work with others who are of similar build and height to you.

Choose one person to give instructions

Make sure everyone has a good grip on the load.

Lift from the hips at the same time, then raise the load to the right level.

Move smoothly and at the same time.

Awkward objects

Some objects may be an unusual or difficult shape and size.

Stand over one corner of the load, with your feet comfortably apart.

Grasp the bottom inside and top outside corners.

If the weight is unbalanced, lift and carry the object with its heaviest side close to your body. Bend your knees and lift, keeping the same grip.

Lifting to a high place.

Try not to lift anything above your shoulders as it may put strain on your body.

Lighten the load if you can by dividing it into smaller loads.

Stand on something sturdy (not a chair) with one foot in front of the other unless you are using a stepladder.

Use a mechanical aid or get help if the load is awkward or heavy.

Lowering from a high place

Take extra care when you are lowering objects from above your head.

Test the load’s weight by pushing up on it. Check to see if the weight of the load will shift when you lift it.

Check to make sure there isn’t anything on top of the load that could fall off when you lift it.

Stand as close to the load as possible.

Grip the object firmly, sliding it down your body.

Use a mechanical aid or get help if necessary.

Get advice if you are not sure about anything

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PRINCIPLES OF MOVING AND HANDLING

1. Wear appropriate clothing and footwear

2. Never manually handle unless there is no other option

3. Know your own handling capacity

4. Wear suitable footwear and clothing

5. Assess the person or object to be handled before commencing the manoeuvre

6. Explain the manoeuvre to the person to be transferred and any assisting carers

7. Prepare the handling area

8. Where appropriate, apply the brakes on equipment

9. Make a good stable base with your legs and feet.

10. Work well within your circle of balance

11. Keep the person or object to be transferred as close to your body as possible

12. Make sure of a good handhold.

13. Where appropriate, use rhythm and timing when transferring

14. Raise your head on commencing the move

15. Bend your knees when transferring not - your back

16. Never twist during a manoeuvre

17. Avoid static stooping.

18. Try to work as close to your natural, erect spinal posture as possible.

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Stretches for Sedentary Workers https://osmondgroup.co.uk/res/Posture_Guidance.pdf

These exercises are designed to help and protect a healthy body. The benefits of stretching are improved flexibility and decreased risk of injury. They address muscular imbalance, decrease physical stress and make you feel better.

1. BACK AND NECK

Clasp hands behind head. Bend head forward, gradually stretching out the upper part of the neck, whilst breathing deeply. Keep the back and shoulder regions as upright as possible to stretch the muscles at the back of the neck. Hold for five slow breaths.

2. SIDE NECK

Place palm of right hand above left ear. Pull head to right, stretching side of neck, whilst taking three deep breaths. This stretches the muscles at the side of the neck. Repeat to other side.

3. UPPER BACK & SHOULDERS

Stand sideways to wall. Place right hand on wall (straight elbow) and stretch left arm over head to right.

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Keep feet together. Take four deep breaths in the position, repeat on other side. This stretches the side of the spine and spinal muscles.

4. BACKWARD SHOULDER STRETCH

Clasp hands behind back. Reach out backwards over chair back, whilst expanding chest, arching back and lifting hands. This stretches the chest and muscles of the chest. Hold for five slow breaths.

MOVING AND HANDLING ADVICE

If you have any manual handling issues/concerns in your department/ward, advice can be sought from:

Your department’s/ward’s manual handling key worker.

Your line/department/ward manager.

Occupational Health

Carol Walpole Specialist Moving and Handling Advisor x 3464

Veda Gilbert, Mandatory and Role Specific Lead x 5149

Helen Taylor L & D Facilitator x 5149

For queries about manual handling training please contact the: Employee Support Team x 5148 Learning and Development Department (Trust Handling Trainers x 5149) The Specialist Moving & Handling Advisor x 3464

Moving and Handling Guidance Folder There is now a Moving and Handling Guidance Folder on the shared drive. To access this folder:- Click onto RCH Shared Folder Click onto RCH-PFES Click onto Health & Safety risk assessments. Click onto Moving and Handling Guidance. When you click onto this folder there are subjects including back care exercises, video links to view for practical techniques, forms, risk assessment and many subjects relating to Moving and handling which you should find helpful.

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Useful Websites: www.hse.gov.uk https://osmondgroup.co.uk/res/Stretching_Excercises.pdf https://osmondgroup.co.uk/res/Posture_Guidance.pdf http://www.backcare.org.uk/wp-content/uploads/2015/02/Top-10-Tips-for-Back-Pain-Factsheet.pdf

On the Trust Intranet Home page to source the ‘Moving and Handling Policy’ Click on to document search Enter ‘Moving & Handling Policy’ Tick RCHT Box Click onto ‘Moving and Handling Policy’