Physical Therapy Safety Manual

Physical Therapy Workplace Hazards

Physical therapy employees may be exposed to hazards involving:

• Patient lifting and transfers
• Patient repositioning
• Gait and mobility assistance
• Patient falls
• Awkward postures
• Repetitive activities
• Forceful exertion
• Exercise and rehabilitation equipment
• Treatment tables
• Wheelchairs and mobility devices
• Blood and body fluids
• Infectious diseases
• Cleaning and disinfecting chemicals
• Electrical equipment
• Hot and cold therapy
• Wet walking surfaces
• Workplace violence
• Medical emergencies

Employees should receive training appropriate to their assigned duties and workplace hazards.

Safe Patient Handling

Assisting patients with movement can expose physical therapy employees to significant musculoskeletal stress.

Employees should evaluate the patient and planned activity before providing physical assistance.

Considerations may include:

• Patient mobility
• Weight-bearing ability
• Balance
• Strength
• Cognitive status
• Ability to follow instructions
• Equipment needed
• Space available
• Number of employees needed
• Potential for sudden movement or loss of balance

Appropriate assistive equipment and additional personnel should be used when necessary.

Patient Handling & Employee Injuries

Physical therapy employees may experience back, shoulder, neck, arm, and other musculoskeletal injuries while assisting patients.

Higher-risk activities may include:

• Lifting dependent patients
• Repositioning patients
• Supporting unstable patients
• Attempting to stop a falling patient
• Moving heavy patients
• Repetitive transfers
• Working in awkward positions
• Reaching across treatment tables
• Pushing wheelchairs or equipment
• Providing prolonged manual assistance

The practice should reduce unnecessary manual lifting and use appropriate equipment or assistance when practical.

Patient Transfers

Patient transfers may occur between:

• Wheelchairs and treatment tables
• Chairs and standing positions
• Wheelchairs and exercise equipment
• Vehicles and mobility devices
• Floors and other surfaces
• Different rehabilitation equipment

Before a transfer, employees should:

• Evaluate the patient’s abilities.
• Explain the planned movement.
• Position equipment appropriately.
• Lock wheelchair brakes when appropriate.
• Remove or reposition obstacles.
• Adjust treatment surfaces when possible.
• Use appropriate transfer devices.
• Obtain additional assistance when necessary.

Employees should not attempt a transfer they cannot safely control.

Transfer Equipment

Transfer equipment may include:

• Transfer boards
• Sliding devices
• Patient lifts
• Standing-assist devices
• Gait belts
• Transfer belts
• Adjustable treatment tables
• Wheelchairs with removable components
• Other mobility-assistance devices

Employees should be trained in the equipment they are expected to use.

Equipment should be inspected and maintained according to facility procedures and manufacturer instructions.

Gait Belts

Gait or walking belts may provide stabilization for appropriate ambulatory patients.

Employees should:

• Evaluate whether the device is appropriate for the patient.
• Position the belt correctly.
• Inspect the belt before use.
• Maintain appropriate body positioning.
• Avoid using the belt as a substitute for lifting equipment when the patient cannot safely support sufficient body weight.

Gait Training

Employees assisting patients with walking should evaluate:

• Patient balance
• Strength
• Weight-bearing restrictions
• Assistive devices
• Footwear
• Walking surface
• Obstacles
• Fatigue
• Cognitive status
• Required employee assistance

The treatment area should provide sufficient space for the activity.

Patient Fall Prevention

Patients undergoing physical therapy may have impaired:

• Strength
• Balance
• Coordination
• Mobility
• Endurance
• Judgment
• Sensation

Employees should maintain appropriate supervision and assistance based on the patient’s condition and planned activity.

Treatment areas should be maintained to minimize unnecessary fall hazards.

Responding to a Falling Patient

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

Employees should receive appropriate training for responding to loss of balance and patient falls.

Staff should not place themselves in a position where an uncontrolled patient fall is likely to cause serious injury to the employee.

Following a fall, appropriate facility procedures should be followed for assessment, assistance, reporting, and obtaining medical support.

Floor-Level Patient Assistance

Attempting to manually lift a patient from the floor can create substantial employee injury risk.

Before moving a patient from the floor:

• Evaluate the patient’s condition.
• Obtain appropriate assistance.
• Use suitable patient-handling equipment when available.
• Clear the surrounding area.
• Avoid unnecessary manual lifting.

Emergency medical assistance should be obtained when indicated.

Bariatric Patient Handling

Patients with greater body weight may require specialized equipment or additional personnel.

The practice should evaluate:

• Equipment capacity
• Treatment-table capacity
• Wheelchair capacity
• Transfer-device capacity
• Space
• Staffing
• Emergency procedures

Employees should not exceed equipment capacity or attempt unsafe manual handling.

Wheelchair Safety

Employees should inspect wheelchairs for obvious defects before use when appropriate.

Employees should:

• Use wheel locks during transfers when appropriate.
• Position footrests and armrests properly.
• Keep hands and feet clear of pinch points.
• Control wheelchairs on slopes.
• Avoid excessive speed.
• Maintain awareness of doorways and obstacles.

Defective wheelchairs should be removed from service or otherwise controlled until repaired.

Walkers, Canes & Crutches

Mobility devices should be appropriate for the intended use and maintained in safe condition.

Employees should watch for:

• Worn tips
• Loose components
• Improper adjustment
• Damaged handles
• Unstable frames
• Other defects

Damaged equipment should not be used until corrected.

Treatment Tables

Treatment tables should be:

• Stable
• Maintained in safe condition
• Appropriate for the patient
• Positioned to allow safe employee access
• Operated according to manufacturer instructions

Height-adjustable tables should be adjusted when practical to reduce excessive bending and reaching.

Employees should keep hands, feet, cords, and equipment clear of moving table components.

Powered Treatment Tables

Powered tables may create electrical, crushing, pinch-point, and unexpected-movement hazards.

Employees should:

• Inspect controls and cords.
• Keep people clear of moving components.
• Avoid placing hands or feet near pinch points.
• Report unusual operation.
• Remove defective equipment from service.

Maintenance should be performed by appropriately qualified personnel.

Physical Therapist Ergonomics

Physical therapists may perform repetitive or physically demanding activities throughout the workday.

Ergonomic risk factors may include:

• Bending
• Twisting
• Reaching
• Kneeling
• Prolonged standing
• Sustained postures
• Repetitive manual therapy
• Forceful exertion
• Patient handling
• Moving equipment

Employees should adjust work positions and treatment surfaces when practical to reduce unnecessary physical stress.

Manual Therapy

Manual therapy can require sustained hand force, awkward wrist positions, prolonged leaning, and repetitive movement.

Where practical, employees should:

• Position the patient appropriately.
• Adjust treatment-table height.
• Maintain neutral body positioning.
• Avoid unnecessary reaching.
• Vary activities.
• Take appropriate recovery opportunities.

Employees should report persistent symptoms of musculoskeletal strain.

Exercise Equipment

Physical therapy facilities may use:

• Treadmills
• Stationary bicycles
• Elliptical equipment
• Steppers
• Resistance machines
• Cable systems
• Upper-body ergometers
• Balance equipment
• Other exercise devices

Equipment should be inspected, maintained, and used according to manufacturer instructions.

Patients should receive appropriate instruction and supervision.

Treadmill Safety

Before treadmill use:

• Verify the area is clear.
• Evaluate the patient’s ability.
• Explain controls.
• Use appropriate speed and incline.
• Maintain necessary supervision.
• Ensure emergency-stop features are accessible.

Employees should consider the possibility of sudden patient fatigue, dizziness, loss of balance, or equipment malfunction.

Stationary Exercise Equipment

Stationary bicycles, steppers, and similar equipment should be adjusted appropriately for the patient.

Employees should:

• Check equipment stability.
• Secure adjustable components.
• Keep loose objects away from moving parts.
• Maintain clear access.
• Report defects.

Resistance Equipment

Resistance machines, cables, pulleys, and similar equipment can create pinch, struck-by, and stored-energy hazards.

Employees should:

• Inspect cables and attachments.
• Maintain guards.
• Secure pins and adjustment devices.
• Keep body parts clear of moving components.
• Control weights during adjustment.
• Remove defective equipment from use.

Free Weights

Dumbbells, weighted bars, medicine balls, and other free weights should be stored securely.

Employees should:

• Maintain clear lifting areas.
• Return weights to designated storage.
• Avoid leaving weights on walking surfaces.
• Use appropriate lifting techniques.
• Provide patient supervision based on the activity.

Resistance Bands

Elastic resistance bands can fail unexpectedly and create snap-back hazards.

Bands should be inspected for:

• Tears
• Cracks
• Cuts
• Excessive wear
• Damaged handles
• Damaged attachment points

Damaged bands should be removed from service.

Employees should avoid positioning themselves or others unnecessarily in the potential recoil path.

Balance Training Equipment

Balance boards, foam pads, balls, unstable surfaces, and similar devices intentionally challenge patient stability.

Employees should:

• Evaluate the patient’s abilities.
• Provide appropriate guarding or assistance.
• Maintain adequate clearance.
• Remove unrelated obstacles.
• Use stable support surfaces where appropriate.

Parallel Bars

Parallel bars should be maintained in safe condition.

Employees should verify that adjustable components are secure before use.

The surrounding floor should remain clear of unnecessary equipment and trip hazards.

Stairs & Training Platforms

Therapy stairs, curbs, ramps, and platforms should:

• Be stable.
• Have appropriate handrails where provided.
• Remain clear of obstacles.
• Be used with appropriate patient supervision.

Employees should position themselves to assist the patient without creating unnecessary risk to themselves.

Therapeutic Balls & Unstable Surfaces

Exercise balls and similar equipment can move unexpectedly.

Employees should evaluate:

• Patient balance
• Surface condition
• Available space
• Nearby objects
• Required assistance

Equipment should be inspected for damage and used according to manufacturer instructions.

Electrical Safety

Physical therapy facilities may use electrically powered treatment and exercise equipment.

Employees should:

• Inspect equipment and cords.
• Report damaged plugs.
• Keep electrical components away from water.
• Avoid unauthorized repairs.
• Maintain access to electrical panels.
• Remove unsafe equipment from service.

Electrical equipment should be used according to manufacturer instructions.

Electrical Stimulation Equipment

Electrical stimulation equipment should be maintained and operated by appropriately trained personnel.

Employees should:

• Inspect leads and cables.
• Follow manufacturer procedures.
• Keep equipment dry.
• Report damaged components.
• Disconnect equipment appropriately before cleaning or servicing.

Clinical decisions concerning use of therapeutic electrical stimulation remain the responsibility of appropriately qualified healthcare professionals.

Therapeutic Ultrasound Equipment

Therapeutic ultrasound equipment should be inspected and maintained according to manufacturer instructions.

Employees should follow established procedures for:

• Equipment setup
• Cleaning
• Electrical safety
• Cord management
• Storage

Clinical use should be performed only by appropriately qualified personnel.

Hot Therapy

Physical therapy practices may use:

• Hot packs
• Hydrocollator units
• Heating pads
• Paraffin equipment
• Other heat-treatment devices

Employees may be exposed to hot water, hot surfaces, steam, or heated materials.

Employees should use appropriate handling tools and avoid direct contact with hot surfaces.

Hydrocollator Safety

Hydrocollator units can contain very hot water.

Employees should:

• Use appropriate tools to remove hot packs.
• Avoid splashing.
• Maintain equipment properly.
• Keep the surrounding floor dry.
• Report leaks or malfunctions.

Employees should not reach unnecessarily into hot water.

Cold Therapy

Cold packs, ice, and other cold-therapy products should be handled and stored according to established procedures.

Leaks or condensation should be controlled to prevent slip hazards.

Cryotherapy Equipment

Facilities using specialized cryotherapy or cooling equipment should follow manufacturer instructions and address hazards associated with the specific equipment.

Employees should receive appropriate training before operating specialized systems.

Aquatic Therapy

Physical therapy practices offering aquatic therapy should establish procedures addressing:

• Wet walking surfaces
• Patient entry and exit
• Patient transfers
• Water rescue
• Electrical equipment
• Pool chemicals
• Infection control
• Emergency response
• Employee supervision

Aquatic-therapy hazards should be addressed according to the facility and equipment involved.

Slips, Trips & Falls

Physical therapy clinics can have numerous potential trip hazards, including:

• Mobility devices
• Exercise equipment
• Electrical cords
• Resistance bands
• Weights
• Treatment equipment
• Patient belongings
• Wet floors
• Therapy supplies

Walkways should be kept as clear as practical.

Spills and wet conditions should be addressed promptly.

Bloodborne Pathogens

Physical therapy employees may potentially encounter blood or other potentially infectious materials during patient care, first aid, wound-related therapy, or emergency situations.

The facility should establish appropriate exposure-control procedures where occupational exposure exists.

Employees with occupational exposure should receive required training and protective measures.

Standard Precautions

Employees should use appropriate precautions when contact with blood, body fluids, non-intact skin, or other potentially infectious materials may occur.

Protective measures may include:

• Hand hygiene
• Gloves
• Eye protection
• Face protection
• Protective clothing
• Safe handling of contaminated materials
• Appropriate cleaning and disinfection

Hand Hygiene

Employees should perform hand hygiene at appropriate times during patient care.

Handwashing facilities and appropriate hand-hygiene products should be readily accessible.

Employees should follow facility infection-control procedures.

Infection Prevention

Physical therapy practices may treat patients with respiratory illnesses, skin conditions, wounds, or other potentially transmissible infections.

Facility procedures should address:

• Hand hygiene
• Cleaning and disinfection
• PPE
• Respiratory hygiene
• Patient-care equipment
• Environmental surfaces
• Exposure response
• Employee illness

Cleaning & Disinfection

Treatment tables, exercise equipment, mobility devices, and other shared patient-care surfaces should be cleaned and disinfected according to facility procedures and product instructions.

Frequently touched surfaces may include:

• Treatment tables
• Exercise-machine controls
• Handrails
• Parallel bars
• Weights
• Mobility devices
• Door handles
• Countertops
• Shared therapy equipment

Employees should use appropriate products and observe required contact times.

Cleaning Chemicals

Employees using disinfectants and cleaning products should receive appropriate Hazard Communication information and training when applicable.

Employees should:

• Follow product labels.
• Avoid mixing incompatible chemicals.
• Use appropriate PPE.
• Maintain ventilation.
• Store products properly.
• Report spills and exposures.

Hazard Communication

Physical therapy facilities may use hazardous chemicals such as:

• Disinfectants
• Cleaning products
• Adhesives
• Solvents
• Maintenance products
• Pool chemicals
• Other workplace chemicals

Employees should have access to appropriate labels and Safety Data Sheets and receive applicable training.

Personal Protective Equipment

PPE should be selected based on anticipated exposure.

PPE may include:

• Examination gloves
• Utility gloves
• Safety glasses
• Goggles
• Face protection
• Protective clothing
• Other task-specific equipment

Employees should understand when PPE is required and how to use it properly.

Sharps Safety

Some physical therapy settings may contain needles or other sharps associated with patient care or related clinical services.

Sharps should be handled and disposed of according to applicable procedures.

Employees should never reach blindly into waste containers or other areas where discarded sharps could be present.

Needlestick or sharps exposures should be reported immediately.

Medical Waste

Contaminated materials should be handled and disposed of according to applicable facility procedures.

Employees should know how to identify and handle regulated medical waste when present.

Laundry & Linens

Reusable linens may become contaminated during patient treatment.

Employees should:

• Handle used linens appropriately.
• Avoid unnecessary shaking.
• Use designated containers.
• Perform hand hygiene after handling contaminated materials.
• Follow facility laundering procedures.

Patient Medical Emergencies

Patients participating in physical therapy may experience:

• Falls
• Chest pain
• Difficulty breathing
• Dizziness
• Fainting
• Seizures
• Sudden weakness
• Altered mental status
• Other medical emergencies

Employees should know how to activate the facility’s emergency-response procedures.

First Aid & CPR

Appropriate personnel should maintain required first-aid, CPR, and other emergency-response training based on facility needs and applicable requirements.

Employees should know:

• How to summon emergency medical services.
• Where emergency equipment is located.
• How to report an emergency.
• Their assigned emergency responsibilities.

Automated External Defibrillators

Facilities equipped with an automated external defibrillator should establish procedures for:

• Accessibility
• Inspection
• Maintenance
• Supplies
• Employee training
• Emergency use

The AED should remain accessible when the facility is occupied.

Emergency Equipment

Emergency equipment should be:

• Readily accessible
• Appropriately maintained
• Periodically inspected
• Known to employees expected to use it

Access should not be blocked by treatment or exercise equipment.

Workplace Violence

Healthcare employees may encounter threatening, aggressive, or disruptive behavior from patients, family members, visitors, or others.

Employees should know how to:

• Recognize escalating behavior.
• Obtain assistance.
• Maintain access to exits.
• Report threats.
• Follow emergency procedures.

Employees should not be expected to physically intervene in violent situations beyond their training and assigned responsibilities.

Aggressive or Confused Patients

Some patients may become confused, agitated, combative, or unpredictable because of medical, cognitive, behavioral, or other conditions.

Employees should evaluate whether additional assistance is necessary before attempting physical treatment or transfers.

Staff safety should be considered when determining how to proceed.

Working Alone

Employees may occasionally work alone or with limited staffing during opening, closing, home visits, or other operations.

Procedures should consider:

• Communication
• Emergency assistance
• Patient behavior
• Medical emergencies
• Security
• Facility access

Employees should have a reliable method of obtaining assistance.

Workplace Security

Physical therapy practices should consider security issues involving:

• Facility access
• Patient and visitor areas
• Parking areas
• Opening and closing
• Employee belongings
• Suspicious activity
• Threatening behavior

Employees should know how to report security concerns.

Fire Prevention

Employees should maintain clear access to:

• Exits
• Fire extinguishers
• Alarm devices
• Electrical panels
• Emergency equipment

Combustible materials should be stored appropriately.

Electrical and heating equipment should be maintained in safe condition.

Emergency Action Plan

Employees should understand procedures for foreseeable emergencies such as:

• Fire
• Medical emergencies
• Severe weather
• Power failure
• Workplace violence
• Chemical spills
• Building evacuation

Exit routes should remain unobstructed.

Housekeeping

Treatment and exercise areas should be maintained in an orderly condition.

Employees should:

• Return equipment to designated storage.
• Keep aisles clear.
• Control cords.
• Store weights securely.
• Clean spills.
• Remove damaged equipment.
• Maintain clear emergency access.

Storage

Equipment and supplies should be stored to prevent:

• Falling objects
• Unstable stacking
• Blocked exits
• Trip hazards
• Excessive reaching
• Unsafe lifting

Frequently used items should be placed where practical to reduce unnecessary ergonomic stress.

Manual Material Handling

Employees may lift or move:

• Exercise equipment
• Weights
• Supplies
• Treatment equipment
• Boxes
• Mobility devices

Employees should evaluate loads before lifting and use mechanical assistance or team lifting when practical.

Equipment Inspection

Physical therapy equipment should be periodically inspected according to facility procedures.

Inspections may include:

• Treatment tables
• Exercise machines
• Resistance equipment
• Mobility devices
• Transfer equipment
• Electrical equipment
• Therapy stairs
• Parallel bars
• Emergency equipment

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

Equipment Maintenance

Preventive maintenance should be performed according to manufacturer recommendations and facility procedures.

Only appropriately qualified employees or service personnel should perform repairs requiring specialized knowledge.

Maintenance records should be retained as appropriate.

Lockout/Tagout

Maintenance personnel servicing equipment may be exposed to electrical, mechanical, pneumatic, hydraulic, gravitational, or other hazardous energy.

Applicable hazardous-energy control procedures should be followed when unexpected startup or release of stored energy could cause injury.

Only trained and authorized employees should perform covered lockout/tagout activities.

Employee Exposure Reporting

Employees should promptly report occupational exposures involving:

• Blood or body fluids
• Needlesticks or sharps
• Hazardous chemicals
• Infectious diseases
• Other potentially harmful substances

Exposure incidents should be evaluated according to applicable facility procedures.

Employee Injury Reporting

Employees should promptly report:

• Back strains
• Shoulder injuries
• Musculoskeletal symptoms
• Patient-handling injuries
• Slips and falls
• Equipment injuries
• Needlesticks
• Chemical exposures
• Workplace violence incidents
• Other work-related injuries

Early reporting can allow hazards to be evaluated and corrective action taken.

Near-Miss Reporting

Near misses should also be reported when appropriate.

Examples may include:

• Nearly dropped patients
• Unexpected patient loss of balance
• Equipment failures
• Unsecured treatment tables
• Broken resistance bands
• Electrical defects
• Slip hazards
• Unsafe transfers

Near-miss information can help identify hazards before a serious injury occurs.

Incident Investigation

Significant incidents and near misses should be reviewed to identify contributing factors.

Investigations may consider:

• Patient-handling methods
• Staffing
• Equipment availability
• Equipment condition
• Facility layout
• Training
• Communication
• Procedures
• Environmental conditions
• Employee workload

Corrective actions should address identified causes where practical.

Physical Therapy Safety Training

Employee training should correspond to assigned responsibilities and may include:

• Physical therapy workplace hazards
• Safe patient handling
• Patient transfers
• Mobility assistance
• Gait training
• Patient fall response
• Ergonomics
• Treatment-table safety
• Exercise-equipment safety
• Electrical safety
• Hot and cold therapy
• Aquatic-therapy hazards
• Bloodborne pathogens
• Standard Precautions
• Infection prevention
• Cleaning and disinfection
• Hazard Communication
• PPE
• Sharps safety
• Medical emergencies
• CPR and AED procedures
• Workplace violence
• Security
• Fire prevention
• Emergency procedures
• Housekeeping
• Equipment inspection
• Incident reporting

Training should be updated when new equipment, procedures, services, or workplace hazards are introduced.

Customized Physical Therapy Safety Manuals

Physical therapy practices vary significantly. Some provide primarily outpatient orthopedic rehabilitation, while others specialize in neurological rehabilitation, sports medicine, pediatric therapy, geriatric rehabilitation, occupational rehabilitation, aquatic therapy, balance and vestibular programs, or other services.

A customized Physical Therapy Safety Manual can be developed around your patient population, treatment methods, safe patient-handling needs, rehabilitation equipment, infection exposures, emergency procedures, facility layout, staffing, and employee workplace hazards.