Nursing Home Safety Manual

What Should a Nursing Home Safety Manual Include?

The contents of a Nursing Home Safety Manual should reflect the operations and hazards present at the facility.

Depending on operations, the manual may address:

• Nursing home safety responsibilities.
• Hazard assessments.
• Safety inspections.
• Safe resident handling and mobility.
• Ergonomics.
• Mechanical lifts and transfer devices.
• Workplace violence prevention.
• Bloodborne Pathogens.
• Needlestick and sharps safety.
• Infectious disease exposure control.
• Respiratory protection.
• Personal Protective Equipment.
• Hazard Communication.
• Hazardous drugs.
• Housekeeping.
• Laundry.
• Dietary and kitchen operations.
• Slips, trips and falls.
• Facility maintenance.
• Lockout/Tagout.
• Medical equipment.
• Oxygen and compressed gases.
• Shiftwork and fatigue.
• Emergency procedures.

Programs should be selected according to employee duties, equipment, chemicals, resident-care activities, and other workplace hazards actually present.

Nursing Home Safety Program

An effective Nursing Home Safety Program establishes responsibilities and procedures for identifying workplace hazards, protecting employees from resident-handling injuries, preventing workplace violence, controlling occupational exposures, maintaining safe facility operations, and responding to emergencies.

Management should provide employees with the equipment, training, PPE, staffing support, procedures, and other resources necessary to perform assigned work safely.

Managers, supervisors, and other designated personnel should:

• Identify occupational hazards.
• Conduct workplace assessments.
• Maintain applicable written safety programs.
• Evaluate resident-handling hazards.
• Provide appropriate resident-handling equipment.
• Maintain workplace-violence prevention procedures.
• Maintain Bloodborne Pathogens procedures where applicable.
• Evaluate infectious-disease hazards.
• Provide required PPE.
• Maintain safe equipment.
• Conduct workplace inspections.
• Correct unsafe conditions.
• Investigate injuries and near misses.
• Provide employee training.
• Maintain applicable records.

Employees should follow established safety procedures, use required resident-handling equipment and PPE, report unsafe conditions, and promptly report injuries, exposure incidents, threats, assaults, and other occupational hazards.

Nursing Home Hazard Assessments

The facility should evaluate hazards associated with each department and employee job classification.

Hazard assessments may consider:

• Resident lifting and repositioning.
• Resident aggression.
• Blood and body fluids.
• Sharps.
• Infectious diseases.
• Hazardous drugs.
• Cleaning chemicals.
• Laundry operations.
• Kitchen equipment.
• Hot surfaces.
• Medical equipment.
• Oxygen.
• Electrical equipment.
• Slippery floors.
• Material handling.
• Maintenance activities.
• Noise.
• Heat.
• Outdoor work.

Assessments should be reviewed when equipment, resident-care procedures, chemicals, staffing methods, or workplace conditions change significantly.

Nursing Home Safety Inspections

Periodic safety inspections can help identify hazards before they contribute to employee injuries.

Inspections may include:

• Resident rooms.
• Nursing stations.
• Bathrooms and shower areas.
• Hallways.
• Dining areas.
• Kitchens.
• Laundry rooms.
• Housekeeping areas.
• Storage rooms.
• Maintenance shops.
• Mechanical rooms.
• Exterior walkways.
• Parking areas.
• Emergency exits.
• Medical equipment.
• Resident-handling equipment.

Identified hazards should be documented and corrected in a timely manner.

Job Safety Analysis (JSA/JHA)

A Job Safety Analysis (JSA/JHA) may be useful for tasks where a step-by-step hazard analysis can improve employee protection.

Potential nursing home JSAs/JHAs may address:

• Resident transfers.
• Repositioning residents.
• Mechanical lift use.
• Bathing assistance.
• Sharps handling.
• Blood and body-fluid cleanup.
• Laundry handling.
• Kitchen equipment.
• Chemical handling.
• Maintenance work.
• Snow and ice removal.

Safe Resident Handling and Mobility

Resident lifting, transferring, repositioning, and mobility assistance can expose nursing home employees to significant musculoskeletal stress.

The facility should maintain procedures designed to reduce unnecessary manual lifting and encourage the use of appropriate resident-handling equipment and techniques.

Resident-handling procedures should consider:

• Resident mobility.
• Ability to bear weight.
• Cognitive ability.
• Ability to follow instructions.
• Resident size and weight.
• Fall risk.
• Required assistance.
• Available equipment.
• Available staff.
• Environmental conditions.

Employees should not attempt resident-handling tasks that exceed their training, physical capability, available assistance, or the safe limitations of available equipment.

Resident Handling Assessments

Resident-handling needs should be evaluated so employees understand the appropriate transfer or mobility method.

Assessments may identify whether the resident requires:

• Independent mobility.
• Standby assistance.
• Limited assistance.
• Transfer belts.
• Sit-to-stand equipment.
• Full mechanical lifting.
• Two or more employees.
• Specialized bariatric equipment.

Changes in resident condition should prompt reevaluation when appropriate.

Mechanical Lifts

Mechanical lifting equipment can reduce employee exposure to manual lifting.

Equipment should:

• Be appropriate for the resident.
• Have sufficient rated capacity.
• Be maintained in safe condition.
• Be readily available.
• Be used according to manufacturer instructions.
• Be inspected as appropriate.

Employees should receive training before independently operating unfamiliar lift equipment.

Lift Slings

Slings should be appropriate for the resident, lift, and transfer being performed.

Employees should inspect slings for:

• Tears.
• Fraying.
• Damaged stitching.
• Damaged attachment points.
• Contamination.
• Other deterioration.

Defective slings should be removed from service.

Sit-to-Stand Devices

Sit-to-stand devices may be appropriate for residents who retain sufficient weight-bearing ability and can participate in the transfer.

Employees should follow the resident’s assessed transfer method and manufacturer instructions.

A sit-to-stand device should not be used merely because it is more convenient when the resident cannot safely use it.

Transfer Belts and Assistive Devices

Transfer belts, slide sheets, transfer boards, repositioning aids, and other devices may reduce physical strain when appropriate.

Employees should receive instruction in proper use.

Equipment should be readily accessible so employees are not encouraged to substitute unsafe manual lifting.

Repositioning Residents

Repositioning residents in bed can place significant stress on employees’ backs, shoulders, and upper extremities.

Employees should use available equipment and appropriate assistance rather than manually lifting substantial resident weight whenever feasible.

Bed height should be adjusted where possible to reduce bending and reaching.

Bed-to-Chair Transfers

Employees should evaluate the resident and environment before beginning a transfer.

Considerations include:

• Resident mobility.
• Weight-bearing ability.
• Equipment.
• Wheelchair position.
• Bed height.
• Floor conditions.
• Tubing or medical equipment.
• Available assistance.

Employees should stop when conditions change and the planned transfer can no longer be performed safely.

Toileting and Bathing Assistance

Bathrooms and shower areas can combine resident-handling hazards with wet and slippery surfaces.

Appropriate controls may include:

• Grab bars.
• Shower chairs.
• Transfer equipment.
• Slip-resistant surfaces.
• Adequate space.
• Appropriate footwear.
• Staff assistance.

Employees should not sacrifice safe body positioning merely to complete a transfer quickly.

Resident Falls

Employees may instinctively attempt to catch a falling resident, which can expose the employee to serious musculoskeletal injury.

Training should address appropriate response to a resident who begins to fall.

Employees should not be expected to support a load beyond their physical capability.

Two-Person Assistance

When a resident’s assessed transfer method requires two employees, adequate assistance should be available.

Employees should not routinely perform two-person transfers alone because staffing or scheduling makes assistance inconvenient.

Bariatric Resident Handling — When Applicable

Facilities caring for bariatric residents should evaluate whether specialized equipment and procedures are necessary.

Considerations may include:

• Lift capacity.
• Sling capacity.
• Bed capacity.
• Wheelchairs.
• Transfer equipment.
• Space.
• Staffing.
• Emergency evacuation.

Equipment should never be used beyond its rated capacity.

Resident Lift Equipment Inspection

Resident-handling equipment should be inspected and maintained according to manufacturer recommendations and facility procedures.

Employees should report:

• Damaged controls.
• Battery problems.
• Damaged slings.
• Worn casters.
• Unusual noises.
• Structural damage.
• Other defects.

Unsafe equipment should be removed from service until repaired.

Ergonomics

Nursing home employees may experience ergonomic stress from:

• Resident handling.
• Repetitive repositioning.
• Bending over beds.
• Pushing wheelchairs.
• Moving equipment.
• Housekeeping.
• Laundry.
• Food service.
• Material handling.
• Computer work.

Engineering controls, equipment, work practices, and job design should be considered to reduce unnecessary musculoskeletal stress.

Workplace Violence Prevention

Nursing home employees may experience violence or aggression from residents, visitors, family members, coworkers, or other individuals.

Resident aggression may be associated with dementia, cognitive impairment, behavioral conditions, confusion, pain, fear, medication effects, or other factors.

A Workplace Violence Prevention Program should establish procedures for identifying, reporting, evaluating, and responding to violence and threats.

Resident Aggression

Employees may encounter:

• Hitting.
• Kicking.
• Biting.
• Scratching.
• Spitting.
• Grabbing.
• Throwing objects.
• Verbal threats.
• Other aggressive behavior.

Employees should receive training appropriate to the residents and behaviors they may encounter.

Dementia and Cognitive Impairment

Residents with dementia or other cognitive impairment may not understand employee instructions or may respond unpredictably during care.

Employee-safety procedures should consider:

• Known triggers.
• Resident preferences.
• Communication techniques.
• Timing of care.
• Staff assistance.
• Environmental conditions.
• Previous incidents.

Relevant safety information should be communicated among employees who provide care.

Behavioral Warning Signs

Employees should recognize behaviors that may indicate escalating agitation.

These may include:

• Raised voice.
• Pacing.
• Threatening language.
• Increased physical agitation.
• Clenched fists.
• Aggressive gestures.
• Attempts to strike.
• Throwing objects.

Employees should seek assistance before a situation escalates beyond their ability to manage safely.

De-Escalation

Employees may use appropriate de-escalation techniques consistent with their training and the resident’s care plan.

Employees should:

• Remain calm.
• Use respectful communication.
• Avoid unnecessary confrontation.
• Maintain appropriate distance.
• Preserve access to an exit.
• Obtain assistance when needed.

De-escalation does not require employees to remain in an immediately dangerous situation.

Resident Care Planning and Employee Safety

Information concerning known aggressive behavior or employee-safety risks should be considered in resident care planning where appropriate.

Safety precautions may include:

• Additional staff.
• Modified approaches to care.
• Timing changes.
• Environmental modifications.
• Specialized training.

Employee protection and resident dignity should both be considered.

Family and Visitor Violence

Threats or violence may also come from family members, visitors, or other individuals.

Procedures should address:

• Threat reporting.
• Security assistance.
• Visitor restrictions where appropriate.
• Emergency communication.
• Law-enforcement assistance when necessary.

Employees should promptly report credible threats.

Staff Assistance Procedures

Employees should have a practical method for summoning assistance during a violent or potentially violent incident.

Methods may include:

• Call buttons.
• Radios.
• Phones.
• Personal alarms.
• Verbal codes.
• Facility alarm systems.

Employees should know how and when to use the available system.

Violence Incident Reporting

Threats, assaults, bites, scratches, and near misses should be reported according to facility procedures.

Incidents should be evaluated for:

• Contributing factors.
• Repeat patterns.
• Environmental issues.
• Staffing considerations.
• Resident-care considerations.
• Need for additional controls.

Employees should not be discouraged from reporting an assault because the resident was cognitively impaired.

Bloodborne Pathogens

Employees whose duties involve reasonably anticipated occupational exposure to human blood or other potentially infectious materials should be protected according to applicable Bloodborne Pathogens requirements.

Where applicable, the facility should maintain an appropriate Exposure Control Plan.

The program may address:

• Exposure determination.
• Universal Precautions.
• Engineering controls.
• Work-practice controls.
• PPE.
• Sharps safety.
• Hepatitis B vaccination.
• Exposure incidents.
• Post-exposure evaluation.
• Training.
• Recordkeeping.

Exposure Determination

The employer should identify job classifications and tasks where occupational exposure is reasonably anticipated.

Potential tasks include:

• Blood glucose testing.
• Injections.
• Wound care.
• Specimen handling.
• Handling contaminated sharps.
• Blood cleanup.
• Certain personal-care activities.

Exposure determination should reflect actual duties rather than job title alone.

Needlestick and Sharps Safety

Employees may encounter needles, lancets, syringes, scalpels, and other sharps.

Appropriate engineering and work-practice controls should be used.

Employees should:

• Use safer medical devices where required.
• Dispose of sharps promptly.
• Avoid unnecessary recapping.
• Never reach blindly into waste.
• Report needlesticks immediately.

Sharps Containers

Sharps containers should be:

• Closable.
• Puncture resistant.
• Leak resistant as appropriate.
• Accessible.
• Maintained upright.
• Replaced before overfilling.

Containers should be located as close as feasible to the areas where sharps are used.

Sharps in Laundry and Waste

Housekeeping and laundry employees can be injured by improperly discarded sharps.

Employees should not:

• Reach blindly into linen.
• Reach blindly into waste containers.
• Manually compress trash bags.
• Hold bags against the body.

Improperly discarded sharps should be reported.

Exposure Incidents

Needlesticks, cuts, mucous-membrane splashes, and other potential occupational exposures should be reported immediately.

Applicable post-exposure evaluation procedures should begin promptly.

Employees should know whom to contact on all shifts.

Infectious Disease Exposure Control

Nursing home employees may be exposed to infectious diseases through close resident contact, respiratory secretions, blood, body fluids, contaminated surfaces, laundry, and other sources.

The facility should evaluate occupational exposure and establish appropriate controls.

These may include:

• Hand hygiene.
• PPE.
• Cleaning and disinfection.
• Exposure precautions.
• Respiratory protection where required.
• Employee training.
• Exposure reporting.

Respiratory Infections

Respiratory infections can spread among residents, employees, and visitors.

Controls may include:

• Source control.
• Hand hygiene.
• Appropriate PPE.
• Ventilation measures.
• Respiratory protection when required.
• Isolation or other precautions.
• Employee exposure procedures.

Tuberculosis — When Applicable

Facilities should evaluate employee exposure to tuberculosis based on resident populations, services, and other risk factors.

Where respirators are required for occupational TB exposure, applicable Respiratory Protection requirements should be followed.

Hand Hygiene

Employees should perform hand hygiene at appropriate times, including:

• Before and after resident care.
• After contact with blood or body fluids.
• After glove removal.
• After contact with contaminated surfaces.
• Before eating or drinking.

Appropriate handwashing or hand-hygiene facilities and supplies should be available.

Cleaning and Disinfection

Environmental cleaning procedures should address resident rooms, common areas, bathrooms, equipment, and other potentially contaminated surfaces.

Employees should use approved products according to manufacturer instructions and facility procedures.

Required PPE should be provided.

Respiratory Protection — When Required

When respirators are necessary to protect employees from occupational respiratory hazards, the facility should maintain an appropriate Respiratory Protection Program.

Applicable elements may include:

• Hazard evaluation.
• Respirator selection.
• Medical evaluation.
• Fit testing.
• Training.
• Inspection.
• Maintenance.
• Program evaluation.

Personal Protective Equipment

PPE should be selected according to employee exposures.

Depending on duties, PPE may include:

• Examination gloves.
• Chemical-resistant gloves.
• Safety glasses.
• Goggles.
• Face shields.
• Protective clothing.
• Respiratory protection.
• Protective footwear.
• Hearing protection.

PPE should be readily available where employees need it.

Hazard Communication

Nursing homes may use hazardous chemicals in clinical care, housekeeping, laundry, maintenance, dietary, grounds, and other operations.

Where applicable, the facility should maintain a Hazard Communication Program addressing:

• Chemical inventories.
• Safety Data Sheets.
• Container labeling.
• Employee training.
• Non-routine tasks.
• Contractor communication.

Cleaning and Disinfecting Chemicals

Employees should follow label and Safety Data Sheet instructions when using cleaning and disinfecting products.

Employees should:

• Use required PPE.
• Follow dilution procedures.
• Maintain labels.
• Provide ventilation when appropriate.
• Avoid unauthorized chemical mixing.
• Report spills and exposures.

Hazardous Drugs — When Applicable

Some nursing facilities may handle medications classified as hazardous drugs.

Where employee exposure is reasonably foreseeable, controls may address:

• Receiving.
• Storage.
• Preparation.
• Administration.
• Crushing or manipulating medications.
• Spills.
• Waste.
• Contaminated resident body fluids.

Appropriate engineering controls, work practices, PPE, and employee training should be used.

Hazardous Drug Spill Response — When Applicable

Employees who may encounter hazardous-drug spills should understand applicable spill procedures.

Appropriate spill supplies and PPE should be available where necessary.

Employees should not attempt cleanup beyond their training or available protection.

Oxygen Safety

Supplemental oxygen may be used throughout nursing facilities.

Oxygen can accelerate combustion and increase fire severity.

Employees should follow procedures addressing:

• Smoking restrictions.
• Open flames.
• Cylinder storage.
• Oxygen equipment.
• Electrical equipment.
• Emergency response.

Oxygen equipment should be kept away from ignition sources.

Compressed Gas Cylinders — When Applicable

Compressed-gas cylinders should be appropriately secured and protected from damage.

Employees assigned to handle cylinders should understand safe:

• Storage.
• Movement.
• Valve protection.
• Regulator use.
• Emergency procedures.

Damaged cylinders or equipment should be reported.

Medical Equipment Safety

Employees may operate or work around:

• Resident lifts.
• Adjustable beds.
• Infusion pumps.
• Oxygen concentrators.
• Suction equipment.
• Wheelchairs.
• Nebulizers.
• Monitoring equipment.
• Other medical devices.

Equipment should be used according to manufacturer instructions and facility procedures.

Damaged or malfunctioning equipment should be removed from service or otherwise controlled until corrected.

Housekeeping Safety

Housekeeping employees may encounter chemical, biological, ergonomic, electrical, and slip-and-fall hazards.

Procedures should address:

• Cleaning chemicals.
• PPE.
• Blood and body-fluid cleanup.
• Sharps.
• Wet floors.
• Lifting.
• Waste handling.
• Electrical equipment.
• Resident-room hazards.

Housekeeping employees should receive safety training appropriate to their exposures.

Blood and Body-Fluid Cleanup

Employees assigned to clean blood or other potentially infectious materials should receive appropriate training and PPE.

Procedures should address:

• Area control.
• PPE.
• Appropriate disinfectants.
• Sharps.
• Waste disposal.
• Hand hygiene.
• Exposure reporting.

Wet Floors

Wet floors should be controlled through appropriate cleaning methods, warning signs, barriers, ventilation, and prompt drying where feasible.

Employees should avoid creating unnecessary slip hazards during cleaning operations.

Laundry Safety

Laundry employees may be exposed to:

• Contaminated linens.
• Sharps.
• Chemicals.
• Hot surfaces.
• Machinery.
• Repetitive motion.
• Manual material handling.
• Slips and falls.

Laundry procedures should reflect the facility’s equipment and operations.

Contaminated Linen Handling

Contaminated laundry should be handled with minimum agitation and according to applicable infection-control and occupational-exposure procedures.

Employees should not sort or handle contaminated laundry in a manner that unnecessarily increases exposure.

Appropriate PPE should be used.

Laundry Equipment

Washers, dryers, presses, and other equipment should be maintained in safe condition.

Employees should not bypass machine guards or interlocks.

Servicing and maintenance should follow applicable hazardous-energy-control procedures.

Laundry Chemicals

Employees should receive information and training concerning detergents, bleaches, sanitizers, and other hazardous products they use.

Required PPE and safe dilution procedures should be followed.

Dietary and Kitchen Safety

Nursing home dietary employees may encounter:

• Knives.
• Slicers.
• Mixers.
• Hot surfaces.
• Steam.
• Fryers.
• Ovens.
• Chemicals.
• Slippery floors.
• Manual material handling.
• Powered equipment.

Employees should receive task-specific safety training.

Knife and Cutting Tool Safety

Kitchen knives and other cutting tools should be appropriate for the task and maintained in safe condition.

Employees should:

• Cut away from the body where feasible.
• Store knives safely.
• Use appropriate cutting surfaces.
• Avoid attempting to catch falling knives.
• Report damaged tools.

Kitchen Machine Guarding

Slicers, mixers, processors, and other powered equipment should have required guards and safety devices in place.

Employees should not reach into operating equipment or bypass guards.

Cleaning and servicing should follow applicable procedures.

Burns and Hot Surfaces

Employees should use appropriate protection when working with:

• Ovens.
• Steam equipment.
• Hot liquids.
• Hot pans.
• Fryers.
• Dishwashing equipment.

Hot equipment should be maintained in safe operating condition.

Slips, Trips and Falls

Nursing homes contain many areas where wet floors, clutter, cords, equipment, resident-care activities, and outdoor conditions can create fall hazards.

Particular attention should be given to:

• Resident rooms.
• Bathrooms.
• Shower areas.
• Kitchens.
• Dining areas.
• Laundry rooms.
• Entrances.
• Exterior walkways.

Walking-Working Surfaces

Floors, stairs, ramps, platforms, and walkways should be maintained in safe condition.

Hazards such as damaged flooring, loose mats, clutter, cords, and spills should be corrected promptly.

Slip-Resistant Footwear

Slip-resistant footwear may be appropriate for employees working in kitchens, housekeeping, laundry, bathing areas, and other locations where wet or contaminated floors are common.

Footwear requirements should reflect the hazard assessment.

Facility Maintenance Safety

Maintenance employees may perform electrical, mechanical, plumbing, HVAC, grounds, repair, and construction-related work.

Depending on assigned tasks, programs may address:

• Electrical Safety.
• Lockout/Tagout.
• Hand & Power Tools.
• Ladders.
• Machine Guarding.
• Hot Work.
• Confined Space.
• Hazard Communication.
• PPE.

Only appropriately trained and authorized employees should perform specialized work.

Lockout/Tagout — When Applicable

Maintenance, laundry, kitchen, and other equipment may contain hazardous energy.

Where applicable, hazardous-energy-control procedures should address:

• Shutdown.
• Energy isolation.
• Lockout or tagout.
• Stored energy.
• Verification.
• Return to service.

Employees should not rely solely on normal operating controls when Lockout/Tagout is required.

Electrical Safety

Electrical equipment should be maintained in safe condition.

Employees should report:

• Damaged cords.
• Broken plugs.
• Exposed wiring.
• Damaged outlets.
• Sparking.
• Shocks.
• Other electrical defects.

Only qualified employees should perform electrical work requiring specialized training.

Hand and Power Tools

Tools should be appropriate for the task and maintained in safe condition.

Damaged tools should be removed from service.

Employees should use required guards and PPE.

Ladder Safety

Employees should use appropriate ladders or approved access equipment rather than standing on chairs, furniture, boxes, or other unstable surfaces.

Ladders should be inspected and used according to applicable procedures.

Hot Work — When Applicable

Welding, cutting, brazing, grinding, and other hot work can create fire and burn hazards.

Where applicable, procedures should address:

• Combustible materials.
• Fire protection.
• Hot-work authorization.
• Ventilation.
• PPE.
• Fire watch where required.

Boiler and Mechanical Rooms — When Applicable

Access to boiler, generator, HVAC, electrical, and mechanical areas should be limited as appropriate.

These areas should not be used for uncontrolled general storage.

Employees performing maintenance should be trained for the hazards involved.

Grounds Maintenance

Employees performing grounds work may encounter:

• Mowers.
• Trimmers.
• Power tools.
• Heat.
• Cold.
• Pesticides.
• Traffic.
• Manual lifting.

Applicable safety procedures should reflect the tasks performed.

Contractor Safety

Nursing homes may use contractors for construction, maintenance, electrical work, HVAC, pest control, medical equipment, fire protection, and other services.

Contractor activities should be coordinated with facility operations.

Relevant hazards should be communicated where required.

Shiftwork and Fatigue

Nursing homes operate continuously and may require employees to work nights, weekends, overtime, extended shifts, or rotating schedules.

Fatigue can affect:

• Attention.
• Reaction time.
• Decision-making.
• Patient handling.
• Driving.
• Employee well-being.

Work schedules and staffing practices should consider the safety effects of fatigue.

Long Work Hours and Overtime

Employees should be encouraged to report fatigue that may interfere with safe job performance.

Staffing and scheduling should not routinely depend on excessive work hours that create avoidable safety risks.

Employees should use available rest and meal periods according to facility procedures.

Night Shift Safety

Night-shift employees may encounter:

• Reduced staffing.
• Fatigue.
• Lower lighting.
• Resident confusion.
• Security concerns.
• Working alone in isolated areas.

Appropriate communication and assistance should remain available on all shifts.

Workplace Stress

Healthcare work can involve emotional demands, workload pressure, resident deaths, difficult family interactions, violence, staffing challenges, and shiftwork.

The facility should encourage employees to report safety concerns and should avoid creating a workplace culture in which employees believe injuries, threats, or excessive fatigue must simply be accepted as part of the job.

Emergency Action Plan

Nursing homes require emergency procedures that account for employees working in an occupied residential healthcare environment.

The Emergency Action Plan may address:

• Fire.
• Severe weather.
• Power failure.
• Utility failure.
• Hazardous-material release.
• Workplace violence.
• Medical emergencies.
• Evacuation.
• Shelter-in-place.

Employees should understand alarm methods, emergency communication, assigned responsibilities, and evacuation procedures.

Resident Evacuation Assistance

Some residents may be unable to evacuate independently.

Emergency planning should consider:

• Resident mobility.
• Wheelchairs.
• Resident lifts.
• Evacuation devices.
• Stairways.
• Smoke compartments.
• Available staff.
• Alternative relocation areas.

Employees should receive training appropriate to their emergency responsibilities.

Fire Prevention

Fire-prevention procedures should address hazards associated with:

• Oxygen.
• Smoking.
• Kitchens.
• Laundry equipment.
• Electrical systems.
• Maintenance activities.
• Combustible storage.
• Hot work.

Fire-protection equipment and exit routes should remain accessible.

Emergency Exits and Egress

Required exit routes should remain clear.

Beds, wheelchairs, carts, supplies, laundry, equipment, and other materials should not obstruct required exits or corridors.

Fire doors and other required protective features should not be improperly blocked or defeated.

Severe Weather

Procedures should address severe weather appropriate to the facility’s location.

Potential events include:

• Tornadoes.
• Hurricanes.
• Flooding.
• Extreme heat.
• Extreme cold.
• Wildfires.
• Winter storms.

Employees should understand shelter, evacuation, and communication procedures.

Power and Utility Failure

Loss of electricity, water, heating, cooling, or other utilities can affect employee and resident safety.

Emergency planning should consider:

• Emergency lighting.
• Medical equipment.
• Oxygen.
• Heating and cooling.
• Food service.
• Elevators.
• Communication.
• Generator operation.

First Aid and Employee Injuries

Employees should promptly report occupational injuries and illnesses.

Particular attention should be given to:

• Resident-handling injuries.
• Needlesticks.
• Blood exposure.
• Bites and scratches.
• Slips and falls.
• Chemical exposures.
• Burns.
• Workplace violence.

Prompt reporting helps ensure appropriate medical evaluation and allows the facility to investigate contributing hazards.

Injury and Illness Reporting

Employees should be encouraged to report injuries, symptoms, threats, assaults, and near misses without fear of retaliation.

Early reporting of musculoskeletal symptoms may help identify resident-handling or ergonomic problems before they become more severe.

Nursing Home Safety Training

Safety training should reflect each employee’s assigned duties and workplace exposures.

Depending on job responsibilities, training may address:

• Safe resident handling.
• Mechanical lifts.
• Workplace violence.
• Bloodborne Pathogens.
• Needlestick prevention.
• Infectious diseases.
• PPE.
• Respiratory protection.
• Chemical safety.
• Housekeeping.
• Laundry.
• Kitchen safety.
• Lockout/Tagout.
• Emergency procedures.

Training should be understandable to employees and provided at required intervals.

New Employee Safety Orientation

New employees should receive appropriate safety orientation before independently performing assigned work.

Orientation may address:

• General nursing home hazards.
• Resident handling.
• Workplace violence.
• Bloodborne Pathogens.
• Sharps.
• Infectious diseases.
• PPE.
• Hazard Communication.
• Slips and falls.
• Emergency procedures.
• Injury reporting.

Employees assigned to higher-hazard tasks should receive additional task-specific instruction.

Nursing Home JSA/JHA

Nursing homes can use JSAs/JHAs to document safe work practices for selected tasks.

Potential Nursing Home JSAs/JHAs include:

• Mechanical resident lift use.
• Resident transfers.
• Repositioning residents.
• Bathing assistance.
• Blood and body-fluid cleanup.
• Sharps handling.
• Laundry operations.
• Kitchen equipment.
• Chemical handling.
• Maintenance work.
• Snow and ice removal.

Nursing Home Safety Meetings

Periodic safety meetings can reinforce safe work practices and address current facility concerns.

Potential topics include:

• Resident handling.
• Lift equipment.
• Workplace violence.
• Sharps.
• Infectious diseases.
• PPE.
• Slips and falls.
• Housekeeping.
• Kitchen safety.
• Emergency response.

Recordkeeping

Nursing homes should maintain occupational safety and health records required for their operations.

Records may include:

• Employee training.
• Injury and illness records.
• Bloodborne Pathogens records.
• Sharps injuries.
• Workplace-violence incidents.
• Resident-handling evaluations.
• Equipment inspections.
• Respiratory Protection records.
• Exposure records.
• Other required program records.

Confidential employee medical information should be maintained according to applicable requirements.

Additional Safety Programs

Depending on nursing home operations, additional safety programs may be necessary for:

• Safe Patient/Resident Handling.
• Ergonomics.
• Workplace Violence Prevention.
• Bloodborne Pathogens.
• Needlestick & Sharps Safety.
• Infectious Disease Exposure Control.
• Tuberculosis Exposure Control.
• Respiratory Protection.
• Personal Protective Equipment.
• Hazard Communication.
• Hazardous Drugs.
• Compressed Gas Cylinders.
• Housekeeping.
• Food Service Safety.
• Lockout/Tagout.
• Machine Guarding.
• Electrical Safety.
• Hand & Power Tools.
• Ladder Safety.
• Slips, Trips & Falls.
• Walking-Working Surfaces.
• Manual Lifting & Material Handling.
• Heat Stress.
• Cold Stress.
• Emergency Action Plan.
• Fire Prevention.
• First Aid.
• Spill Prevention & Response.
• Hazardous Waste Management.
• Contractor Safety.

These programs should be included when employee duties, equipment, chemicals, or workplace hazards make them applicable rather than automatically adding programs unrelated to the facility.

Building a Nursing Home Safety Manual

A useful Nursing Home Safety Manual should reflect the actual facility rather than simply adapting a generic healthcare or medical-office manual.

A skilled nursing facility with extensive clinical services may require a different combination of programs than a smaller long-term care operation.

The manual should consider:

• Resident population.
• Resident mobility.
• Dementia and behavioral conditions.
• Clinical procedures.
• Blood and sharps exposure.
• Infectious diseases.
• Medications.
• Oxygen.
• Medical equipment.
• Housekeeping.
• Laundry.
• Dietary services.
• Maintenance.
• Shiftwork.
• Emergency operations.

Selecting the appropriate programs creates a manual that is comprehensive without filling it with procedures unrelated to the work employees actually perform.

Customized Nursing Home Safety Manuals

A Nursing Home Safety Manual can be developed around the facility’s resident-care services, employee duties, resident-handling requirements, workplace-violence risks, blood and sharps exposures, infectious-disease hazards, housekeeping, laundry, dietary operations, maintenance activities, medical equipment, and other occupational exposures.

The finished manual may incorporate applicable programs for Safe Resident Handling, Ergonomics, Workplace Violence Prevention, Bloodborne Pathogens, Needlestick and Sharps Safety, Infectious Disease Exposure Control, Respiratory Protection, PPE, Hazard Communication, Hazardous Drugs, Housekeeping, Food Service, Lockout/Tagout, Emergency Action Planning, and other hazards present within the operation.

This provides nursing home and long-term care employers with a practical safety manual organized around the work their employees actually perform.