Minimising Back Injury When Showering a Patient


More than half of residents in elderly and home care need substantial and daily assistance with washing and/or showering which requires a great deal of load on caregivers bodies. So what can be done to help?

Each year, more than 200,000 caregivers in U.S. hospitals experience musculoskeletal injuries and a leading cause is poor workplace ergonomics.1 While hospitals and long-term care facilities have reduced their injury rates over time, caregivers still face significantly higher rates of injury than in private industry as a whole2,3.

The danger of static load vs dynamic load

It has often been assumed that dynamic load, such as manual resident transfers and repositioning, is the source of most of the caregiver injuries4,5,6,7,8. However, studies have indicated that static load — unnatural postures held over prolonged periods of time — may cause even more long-term damage to caregiver health than dynamic loads9.

Hygiene care requires a great deal of static load on caregivers’ bodies as when they are showering or washing a resident they are often leaning in over a resident for a longer period of time, without being able to support their own weight, since both hands are needed to carry out the hygiene procedure.

With 61% of residents in elderly and home care needing substantial and daily assistance with washing and/or showering 7, therefore the impact of interventions aimed at reducing caregivers’ static load during hygiene routines can be profound.

What can be done to help?

All working postures lasting more than one minute in a position of more than 30-45 degrees flexion, rotation and / or latero-flexion should be avoided 2. Such postures lasting more than four minutes at a time – as hygiene care often requires – demand urgent preventative action 2,3,7,10.

Using ergonomically supportive hygiene equipment, such as high-low showering chairs or trolleys, has been proven to help reduce static load on the caregiver7. The correct equipment enables the caregiver to come close to the resident and also adjust the height to fit their needs and the specific task they are carrying out.

It has also been shown that using adequate equipment can stimulate mobility in resident without taking more time7. This means nursing procedures can be improved at the same time as improving the health and quality of life for the resident, all with the introduction of the correct showering chair or trolley.

For more, download a summary of a recent study on prevention programs for Hygiene Care that elaborates on different washing techniques and equipment to help minimise static load.


Download Showering Study

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1- An evaluation of a ‘‘best practices’’ musculoskeletal injury prevention program in nursing homes, J W Collins et al., Injury Prevention 2004;10:206–211. doi: 10.1136/ip.2004.005595

2- ISO/TR, Ergonomics – Manual handling of people in the healthcare sector: ISO/TR 12296. Gevena 2012

3- Hignett SM, Fray M, Battevi N et al. International consensus on manual handling of people in the healthcare Sector: Technical Report ISO/TR 12296. International Journal of Industrial Ergonomics 2014; 44(1): 191-195

4- Jansen J, Morgenstern H, Burdorf A. Dose-response relations between occupational exposures to physical and psychosocial factors and the risk of low back pain. Occupational Environmental Medicine 2004;61(12):972-979

5- Freitag S, Fincke-Junod I, Seddouki R et al. Frequent bending – an underestimated burden in nursing professions. Annals of Occupational Hygiene 2012; 56(6):697-707

6- Freitag S, Seddouki R, Dulon M, Kersten JF, Larsson TJ, Nienhaus A. The effect of working position on trunk posture and exertion for routine nursing tasks: an experimental study. Annals of Occupational Hygiene 2014;58(3):317-325

7- Knibbe JJ, Knibbe NE, Vijtde monitoring fysieke belasting in verpleeg – en verzorgingshuizen, thuiszorg en kraamzorg 2015 in opdracht van A+O WT (Fifth National Monitoring Physical Load in Nursing Homes, Home Care and Maternity Care 2015, Commissioned by A+O WT). The Hague, 2015

8- Schall MC Jr, Fethke NB, Chen H. Working postures and physical activity among registered nurses. Applied Ergonomics 2016;54:243-250

9- Jansen, JP, The impact of physical load on the course of low back pain, PhD Thesis, Rotterdam, Erasmus University, 2004.

10- Annotated summary ISO/TR 12296: ArjoHuntleigh document (PDF) / /iso/