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Objective: This study investigated the effects of hospital bed features on the biomechanical stresses experienced by nurses when turning and laterally repositioning patients. Turn Assist, a common feature in ICU beds that helps to rotate patients, and side rail orientation were evaluated. Background: Manual patient handling is a risk factor for musculoskeletal injury, and turning patients is one of the most common patient handling activities. No known studies have evaluated bed attributes such as the Turn Assist feature and side rail orientation that may affect the stresses experienced by the nurse. Method: Nine female nurses laterally repositioned and turned a 63-kg and 123-kg subject on an ICU bed while motion capture, ground reaction forces, and hand force data were recorded. Loading of the spine and shoulder was modeled using 3D Static Strength Prediction Program (3DSSPP). Results: Spine compression and shear forces did not exceed recommended limits when turning or laterally repositioning. However, the mean pull forces required to manually laterally reposition even the 63-kg subject was 340 Newtons, more than 50% greater than limits established in psychophysical testing. Turn Assist considerably reduced spine loading and pull forces for both turning and laterally repositioning. Lowering side rails reduced spinal compression by 11% when turning patients. Conclusion: Laterally repositioning patients as part of turning may pose an injury risk to caregivers. Turn Assist reduces physical loading on nurses when turning and repositioning patients. Application: Caregivers should consider using Turn Assist and other aids such as mechanical lifts or sliding sheets especially when turning patients requires lateral repositioning.

Objective: The aim of this experiment was to investigate the effects of anti-fatigue mats on perceived discomfort and behavioral responses (weight-shifting between the feet) during prolonged standing. Background: Prolonged standing is a common requirement in the workplace and is a well-known cause of discomfort. Anti-fatigue mats have been shown to reduce discomfort resulting from standing, but no study has identified a particular mat that performs better than others or examined the relationship between discomfort and weight-shifting. Methods: Participants stood for 4 hours on four commercially available "anti-fatigue" mats and a hard surface (control condition). Subjective ratings of discomfort were measured, and in-shoe pressure was recorded and used to evaluate weight-shifting during standing. Results: Compared to the control condition, after 4 hours of standing discomfort was reduced by three of the four mats, but discomfort ratings did not significantly differ among mats. However, significant differences among mats were found in the frequency of weight-shifting, and weight-shifting was positively correlated to discomfort. Conclusion: These results suggest that subjective reports of discomfort were not sufficiently sensitive to detect differences among mats for the experimental conditions tested. Behavioral responses, specifically weight-shifting between feet, may provide a more sensitive alternative to subjective reports.

Objective To identify and critically evaluate methods for proning patients with COVID-19 in the intensive care unit (ICU). Background Acute respiratory distress syndrome (ARDS) is common in hospitalized patients with COVID-19. Proning improves blood oxygenation and survival rates in these patients but is not commonly performed due to the difficulty of the procedure. Methods An academic literature review, internet video search, and consultation with five subject-matter experts was performed to identify known methods for proning. Evaluation of each method considered the number of healthcare workers required, physical stresses on staff, risk of adverse events to patients, and equipment cost and availability. Results Several variations of manual techniques and-lift assisted techniques were identified in addition to a specialized proning bed. Manual methods require more healthcare workers, higher physical stresses, and greater risk of adverse events than lift-assisted methods or the proning bed. Conclusion Both the specialized proning bed and a lift-assisted method using straps largely eliminated manual forces required for proning while allowing for a controlled lowering and positioning of the patient. Application This review will guide practitioners to the most suitable methods for proning patients in the ICU.

Objective The aim of the study was to estimate the risk of injury when repositioning patients of different weight with commonly used repositioning aids. Background Repositioning dependent patients in bed is the most common type of patient handling activity and is associated with high rates of musculoskeletal disorders in healthcare workers. Several studies have evaluated repositioning aids, but typically for a single patient weight and often without estimating risk of injury based on biomechanical analysis. Method Ten nurses performed four repositioning activities on three participants (50, 77, 141 kg) using three repositioning aids (pair of friction-reducing sheets [FRS], turn and position glide sheet, air-assisted transfer device) and a draw sheet. Motion capture, hand forces, and ground reaction forces were recorded. Spine loading was estimated using a dynamic biomechanical model. Results Hand forces and spine compression exceeded recommended limits for most patient weights and repositioning tasks with the draw sheet. FRS and glide sheet reduced these loads but still exceeded recommended limits for all but the 50-kg patient. Only the air-assisted transfer device reduced forces to accepted levels for all patient weights. Physical stresses were relatively low when turning patients. Conclusion Most repositioning aids are insufficient to properly mitigate risk of musculoskeletal injury in healthcare workers. Only the air-assisted transfer device was sufficient to adequately mitigate the risk of injury when moving patients of average or above-average weight. Application To safely move dependent patients, a robust solution requires mechanical lifts and may utilize air-assisted transfer devices for patient transfers.

Objective: The study objective was to quantify the movement of hospital bed occupants relative to the bed in typical bed articulations. Background: Movement of a patient in bed results in two common adverse events: (a) increase in shear and friction forces between the patient and bed, which are extrinsic pressure ulcer risk factors, and (b) musculoskeletal injuries to nurses, resulting from repositioning patients who have migrated down in bed. Method: The study involved 12 participants who lay supine in three hospital beds, which were articulated to common positions. Body movement relative to the bed was quantified with the use of motion capture. Cumulative movement, net displacement, and torso compression (shoulder to trochanter distance) were calculated for different bed types and bed movements. Results: Bed design and bed movement had a significant effect on most of the dependent variables. Bed design (e.g., type) influenced cumulative movement by up to 115%, net displacement by up to 70%, and torso compression by about 20%. Bed movement (e.g., knee elevation) reduced cumulative migration by up to 35%. Conclusion: The quantification of patient migration provides a metric for evaluating the interaction between body and bed surfaces. Overall, the measures were sensitive to design changes in bed frames, bed articulations, and mattress inflation. Application: Documentation of the cumulative movement, net displacement, and torso compression provides hospital bed designers quantifiable measures for reducing migration and potentially shear and friction forces when designing bed frames, bed articulations, and mattresses. Optimization of these metrics may ultimately have an impact on patient and caregiver health.

Objective: This study presents anthropometric data for individuals with high body mass index (BMI). Modified anthropometric dimensions were also developed to address the challenges of obtaining accurate and repeatable data for this population segment. Background: The prevalence of obesity affects approximately 40% of the U.S. adult population. Anthropometric data are needed to guide product design and safety, but few individuals with high BMI have been measured in available datasets. Method: Anthropometric data for a convenience sample of 288 adults with high BMI (≥30 kg/m2) were collected. To increase participation and minimize participant discomfort, measurements were collected at three bariatric weight loss clinics and one academic research institution. Results: The current obese cohort are heavier than the U.S. general population, with a difference in mean body weight of 47 kg for women and 56 kg for men. The obese cohort are also heavier and have a higher BMI compared with the NIOSH (National Institute for Occupational Safety and Health) truck driver population. Waist circumferential measures of the current obese cohort were larger than women or men in either population compared, a result indicative of meaningful body shape differences. Conclusion: To our knowledge, this study is the first to collect anthropometric data for the obese population segment and conduct comparisons to the U.S. general population and available occupational databases. The obese cohort differed substantially with respect to the distributions of anthropometric variables. Application: These data provide insights about the obese population segment that are relevant to product design, and establish a foundation for future data collection efforts.