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David Olley4th EditionPrinciples ofA practical guide covering the principles of manual handling of objectsand moving and handling of people.

Contains public sector information published by the Health and SafetyExecutive and licensed under the Open Government Licence V1.0Principles of©2019 Safety Publishing Ltd. All rights reserved. No part of this publication may be reproduced in any form or byany means without the written permission of Safety Publishing Ltd.Tel: 0800 756 5152 www.safetypublishing.co.uk4th EditionThis handbook is ideal for use insupport of a properly structuredmoving & handling course. It will alsoprove invaluable as ongoing referencefor someone who has completed thecourse.ContentsIntroductionThe Risk 2Relevant Statistics 3Working Days Lost 4The LawRegulations 5Employer’s Responsibilities 5Employee’s Responsibilities 5Musculoskeletal InjuryInjury by Site 6Injury by Type 6Sprains and Strains 6The Spine 7Back Pain 8Slipped Disc 8Policy and TrainingPolicy 9Training 10Care Plan 10Risk AssessmentRisk Categories 12Risk Reduction 12Pre-Assistance Assessment 13Mechanical AidsSmall Handling Aids 15Hoists and Slings 24Wheelchairs 35Bathroom Assistance 32Specific MovesSit to Stand 17Lateral Transfer 22Condemned Moves 14The Fallen Person 36Confined Space 39Slide Boards and Sheets 20

Moving and assisting people is a form of manual handling. It can be defined asany activity requiring force to push, pull, lift, lower, transfer or in some way moveor support a person or body part of a person with or without the use of devicesor mechanical aids. Employers must ensure that wherever possible manual handlingtasks that could involve a risk to the health and safety of their employees are avoided,so far as is reasonably practicable.Wherethesetasksareunavoidabletrainingofthework‐force should be in place to minimise the risk. Theaim of this training is to provide a basicknowledge necessary for the employee toreduce the risk of injury to themselves and toothers.More than a third of lost time accidentsat work result from manual handling.Over 1 million people in the UK sufferfrom musculo‐skeletal disorders caused ormade worse by their jobs. This leads to over12 million working days lost per year, inaddition to the pain and suffering caused tothe individual by these conditions.Healthcare staff have a very high risk of injury, derived mainly from poorpatient handling practice.The risk of injury occurring may depend onseveral factors:- The task to be performed.- The environment in which the task is to beperformed.- The level of fitness or health of thoseperforming the tasks, including previoushistory of injury.- Changes in intensity or duration of work,brought about by factors such as staffshortages.- Availability of help.- Availability of mechanical aids.- Level of training.Some of these factors can be modified and others have to be accepted.The RiskMOVING & HANDLINGIntroduction

Each year in the health and social care sector around:5% of workers suffer from an illness they believed to be work related2% of workers sustain a work related injury86,000Self reportednon-fatalworkplaceinjuriesMoving and handling (27%)Slips, trips and falls (27%)Physical assault (21%)3MOVING & HANDLINGStatistics

This leads to5.7 million working days lost2.9 million days 1.5 million days0.6 million days 0.7 million daysWork-related stressWork-relatedmusculoskeletaldisordersOther work related conditions* Workplace injurySources :▪ Illness prevalence, Labour Force Survey annual average 2011/12, 2013/14,2014/15▪ Injury incidence, Labour Force Survey annual average 2012/13, 2014/15▪ Injurykind,RIDDORnon‐fatalinjury2013/14,2014/15▪ Days lost, Labour Force Survey 2014/15* Indicates that estimate is based on fewer than 40 sample casesMOVING & HANDLINGStatistics

Moving and Handling People 5The Law Relating to Moving and Assisting PeopleHealth and Safety at Work Act 1974 (HSWAManual Handling Operations Regulations 1992 (MHOR) (as amended 2002)Outlines the general duties upon employers concerning the moving of loads.Management of Health and Safety at Work Regulations 1999 (MHSWR)This sets out the general duties for improving health and safety and introduces therequirements of a risk assessment and risk managementProvision and Use of Work Equipment Regulations 1998 (PUWER)This covers minimum requirements for equipment used in the workplace.Lifting Operations and Lifting Equipment Regulations 1998 (LOLER)Covers requirements for inspection and maintenance of lifting equipment in theworkplace.Employer’s DutiesAvoid: avoid so far as is reasonably practicable the need for their employees toundertake any manual handling operations at work which might involve the risk ofinjury.Assess: where it is not possible to avoid any manual handling, they should make adetailed and thorough assessment of the risk.Reduce: using the findings of the risk assessment, steps must be taken to reducethe risk to the lowest practicable level.Review: undertake reviews of the risk assessment whenever there has been asignificant change in the circumstances and implement any appropriate changes inprocedures, based on the review.Provide information: provide clear instructions and training to employees basedon the risk assessment and ensure adequate supervision.Each employee, whilst at work, shall make full and proper use of any system of workprovided for their use by their employer. The employee’s duties will include:Co‐operate: with their employer on health and safety issues.Take care: that proper working systems are followed and that appropriate safetyequipment is used.Inform: the employer if they identify any dangerous practices.Employee’s Duties3MOVING & HANDLINGLegislation

These are the most common type of injuries that result from manual handling. Theymay include injury to the bony skeleton such as fractures and dislocations but morecommonly refer to injury to the soft tissues, such as the muscle, tendon,ligament and cartilage – sprains and strains.Themostcommontypeofwork‐relatedmusculo‐skeletaldisorderwhichthengoeson to cause lost time injury is back injury.Musculo Skeletal InjuryBackRest of the bodyArmHandSite of InjuryType of InjuryFracturesStrainsLacerationsContusionsOtherSuperficialStrain occurs when a muscle or tendon has been overloaded or stretched, resultingin the tearing of some of the fibres.A Lumbar Sprain occurs when the ligaments that support a joint in the spine areoverstretched and torn.For all practical purposes it makes very little difference if it is a muscle strain or aligament sprain that is causing the pain, since the treatment and prognosis for bothof them is the same.When the muscles or ligaments in the lower back are damaged the area aroundthem will usually become inflamed. This inflammation leads to back spasm and it isthis spasm that causes both severe low back pain and difficulty in moving.Strains and SprainsMOVING & HANDLINGInjuries

CervicalvertebraeThoracicvertebraeLumbarvertebraeSacrum &CoccyxThe spine is a column of 33 bones called vertebraestacked one on top of the other. The vertebrae areseparated by pads of cartilage called intervertebraldiscs.The discs consist of a tough fibrous shell with asofterjelly‐likeinnerandtheyfunctionascushionsor shock absorbers.Running in the space behind the vertebral bodies isthe spinal‐cord. The spinal‐cord is the main cablethat carries information from the body to the brainand directions or instructions from the brain to thebody.Branching outfromthespinal‐cordatthelevelofeach vertebrae there are spinal nerves that carry theinformation in and out of the cord.It is possible to injure the spine without damagingthespinal‐cordanditisalsopossibletodamagethecord without fracturing the spine.The natural “S” shape of the spine is designed to provide strength and stability, soas the spine is moved from this shape it becomes less stable, the forces acting on itare increased and its ability to support loads is decreased.Spinal CordSpinal NerveInter vertebral DiscVertebral BodyVertebral BodySpinal NerveSpinal CordSpinal Structures3MOVING & HANDLINGThe Spine

Back pain is very common. Four out of five of us are likely to experience one ormore episodes of back pain at some time in our lives. Most sudden back pain is dueto muscle spasm caused by tiredness or strain injury, but it may also be due to aslipped disc, wear and tear on the joints or a trapped spinal nerve.A sudden attack of back pain may be very painful but it is not often very serious andit does not usually require medical attention. In most cases the best treatment isto keep as mobile as the pain will allow. Bed rest or lying still for days will make themuscles seize up and begin to waste away. This means that they will take muchlonger to recover.Things that may provoke back pain include:- heavy manual activity- lifting and carrying- poor posture- reaching, twisting and lifting- repetitive handling tasks- slips or tripsAlthough back pain isn’t usually serious you should see a doctor if you have any ofthe following:- you feel ill or have a high temperature as well as severe back pain.- you feel numb or have pins and needles in both legs, around the genitalarea, the inside of the tops of the thighs or around your back passage.- both of your legs feel weak or you are unsteady on them.- you become incontinent.- the pain is getting worse for no apparent reason.In this condition, properly called a prolapsedintervertebral disc or PID, the disc, usually inthe lower back, ruptures and bulges into thespace occupied by the spinal nerves.The effect of this is to cause pain which maytravel along the pathway of the affectednerve.The most commonly affected nerve is thesciatic nerve in the leg (sciatica) but if ithappens in the neck then you may suffersimilar pain in the arm on the affected side.Slipped DiscDiscProlapsePressureon nerveSpinal cordMOVING & HANDLINGBack Pain

Moving and handling people is a form of manual handlingand is covered by the same legislation. It differs fromother manual handling tasks because it has an element ofrisk to the care giver but also offers an element of risk tothe person being moved. In the past, people handlingskills have focused on health care professionals workingin hospitals, but with more care taking place in thecommunity the risk is now more widespread. Whenworking in the community, employees will probably haveto cope with less than ideal conditions in terms of space,access to beds, fixed height beds, availability ofmechanical aids and also the availability of help. The aimof this training is to provide the basic knowledgenecessary for the employee to reduce the risk of injury tothemselves and to those in their care.An organisation’s policy on the manual handling of people must:- meet the requirements of the legislation.- be written clearly and in such a way that it is easily understood by everyoneinvolved.- be available to all of the staff that are affected by it.- be written in such a way that it can be easily enforced.- be regularly revised and updated, at least annually, either by adding furtherinformation as an insert or by reprinting the entire document.- The policy should address the issue of whether to move people manually or withequipment.- The policy should promote the independence and dignity of those receivingcare, as well as the health and welfare of those providing it.The following issues will need to be addressed:- General risk assessment.- Individual risk assessment.- Principles of safe practice.- Training requirements.- Methods of monitoring effectiveness.Policy3MOVING & HANDLINGPolicy

-Provision of suitable training isfundamental to implementing policy.- Training programs should incorporate theaims and expected outcomes of theorganisation.- An appropriate amount of time must beallocated.- The training should be to recognisedstandards.- The training should be available to allmembers of staff involved in moving and handling of people.- All managers of staff involved in moving and handling should receive training inrisk assessment.- A record should be kept of staff who have attended training.TrainingThese are produced by the employerbased on the findings of the riskassessments. They apply to eachindividual client and every client musthave their own care plan.The relevant part of the care plan, thatwhich covers safety and moving andhandling, must be made available to youbefore you commence any handling ofthe client. This care plan forms your safeworking system when dealing with thatclient. It should identify the handling tasks and safe methods for performing thosetasks.Where a particular method or mechanical aid must be used it would be identified inthis document. Remember that this is your safe system of work, you are obliged bylaw to follow these instructions. You should have time to inspect this document anddiscuss its contents with your manager or supervisor before meeting the client forthe first time. This is the opportunity to identify and discuss any problems or issuesyou may have with the content.Care PlanMOVING & HANDLINGTraining & Care Plan

Implement the safe system of workReview regularlyDoes the task involvemanual handling?Is there a risk of injury?Carry out an initial assessment of riskIs it practical to avoid the task?Can changes be made to reducethe risk?Does a significant riskof injury remain?Carry out specific manualhandling risk assessmentIdentify ways of reducing the risk(safe system of work)No further actionChange how the task isto be performedUpdate initial risk assessmentYesYesYesNoYesNoNoManual Handling Risk Assessment Flow Chart3MOVING & HANDLINGRisk Assessment

Risk assessment is undertaken to identify potential risk so that preventativemeasures can be put in place to make the situation as safe as possible.Risk could be categorised as:Green Acceptable No ConsequencesYellow Not recommended Improvements are advised. Furtherevaluation is required and adequatemeasures taken if necessaryRed Unnacceptable / To be Take immediate action to reduce theavoided riskFollowing risk assessment the level of risk can be reduced by making improvementsto different potential risk factors, which might include:- The number and quality of staff- Selection and correct use of appropriate aids- Staff information, education and training programs- The production of clear policies and procedures by the organisationRisk ReductionRisk Assessment ModelHazard?Estimate riskManage RiskMonitor &reviewNo Obvious HazardHazard PresentRisk PresentYellow/RedAcceptable RiskGreenPositiveNegative Check effectivenessMOVING & HANDLINGRisk Assessment