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MANUAL HANDLING
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Basic Back Care Theory Update Course

Contents
You can complete this course in more than one session and use the menu on the left of this page to navigate
to the last page you viewed.

This course covers the following topics:

• Definitions

• Health and Safety law as applied to manual handling

• The risk assessment process in manual handling - a structured approach to minimising risk

• An overview of the structure and function of the spine

• Advice on how to keep your back safer when moving and handling

• The unsafe ways of assisting clients.

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Statistics
Manual handling injuries account for approximately 30% of all general workplace reported injuries and almost
50% of reported injuries by care workers who assist clients to move.

However, these only represent the tip of a very large pyramid. For each injury reported it is estimated that
there are 10 additional injuries that are not reported and approximately 200 near misses.

Remember that moving and handling people presents the highest risk of injury, far higher than any other group
of workers including those people working in construction and agriculture.

What does the law say we must do about the risk of harm associated with
manual handling?
This is covered by the Health and Safety at Work Act 1974 which aims to make the workplace as safe as
reasonably possible for staff and anyone affected by their work.

But because there are so many different types of work being done in workplaces across the UK, the Act sits on
top of many individual regulations each one directed at different hazards within the workplace - for example the
Control of Substances Hazardous to Health (COSHH) 2002 etc.

The purpose of legislation is to reduce risk exposure and target risk factors in order to minimise the risk of
injury.

Central to this course is the Manual Handling Operations Regulation 1992. The other regulations shown below
are also relevent to Manual Handling.
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Law - Manual Handling Operations Regulation 1992
The regulation aims to eliminate or reduce the risk of injury when moving and handling to the lowest level
reasonably practicable. The steps that have to be taken are, in order:
Avoid. (the need for manual handling if possible). For example can we avoid the need to manual handle by
rearranging the task or using equipment?

Assess. All the manual handling tasks that cannot be avoided must be properly assessed.

Reduce. Clearly it is not enough just to do a risk assessment. Based on the assessment we must ensure that
the risk of injury is reduced for staff and clients. How much does it need to be reduced? It must be reduced so
far as is reasonably practicable (SFAIRP).

Review. The risk assessment must be written down in the client moving and handling plan in sufficient detail to
make the system of work clearly understandable. But change happens over time. The environment may
change, the client may change, staff may change. Therefore the risk assessment must be reviewed to reflect
these changes. Not only that, even if no changes happen the assessment must still be periodically updated at
regular and scheduled intervals.

This can be summarised as follows.

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What are our responsibilities as members of staff?
Once the risk assessment has been done we need to follow the safe system of work as laid down in the
moving and handling plan. If any changes occur that make the moving and handling plan no longer current and
applicable, this must be reported immediately to the responsible person.

Risk Assessment - hazard and risk

Central to understanding the risk assessment process is the difference between a hazard and a risk. In
everyday language these terms are used to express the same thing. For example, 'that was hazardous' and
'that was risky'.

In risk assessments however they have distinct and different meanings.

A hazard is anything that has the potential to cause harm. Trailing leads, confined spaces, water on the floor
are all examples of a hazard.

A risk is the chance or probability of harm occurring from a hazard and takes into account the likely
seriousness of the injury or incident should it occur.
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Risk Assessment - TILEE

We often undertake risk assessments in everyday life, for example driving a car and crossing a road. These
assessments are of course informal, not structured and certainly not written down!

When completing a manual handling risk assessment it is useful to have a structured approach so that hazards
are easier to see and risks are easier to control. In manual handling the risk assessment must consider the
hazards and risks in the following areas:

Where:
The Task is the purpose of the manual handling, i.e. what is being done. Examples of client manual handling
tasks are - standing, sitting, walking, getting into bed, turning in bed and personal care.

• The Individual is the member(s) of staff assisting the client to move.

• The Load is the client who is being assisted to move.

• The Environment - is the space in which the client is being moved.

• The Equipment - is the available equipment.

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Risk Assessment - The Task
• Things (risk factors) to consider about the Task
• How is the task currently performed?
• What postures and movements are required?
• How long does the task take?
• Does it involve twisting, or bending?
• Does it require you to reach upwards or forwards?
• When and how often is it done?
• Is there sufficient rest between this task and the next?
• Does the task take a long time to complete and is there sufficient rest between tasks?
Risk assessment - The Individual (you and me!)
• Just because most people can undertake a task safely does not mean that everyone can do so. You must
consider whether it is safe for you to do the task.
• Things to consider about yourself
• Are you fit enough to do the task or do you have an injury or a medical condition that might put you at
excessive risk of injury or prevent you from applying best practice techniques?
• Are you pregnant and does the pregnancy mean that this particular manual handling task is an excessive
risk?
• Are you trained and even with training are you confident that you have the knowledge to undertake this
particular task?
• Have you read the client's moving and handling plan or are you undertaking the task with someone who is
familiar with it?
• How well do you know the client and do you know how they might react to a given situation.? Do you know
them well enough to maximise their level of cooperation?
• Are you familiar with any equipment used in the workplace to assist the client?
• If in doubt always seek advice.
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Risk Assessment - The Client

Things to consider about the client - Clients are not like inanimate loads; they may be unpredictable and move
unexpectedly, they may be floppy or difficult to grasp. In addition clients, like everyone else, can and are likely
to have changes in mood depending on many factors.

The following list is not meant to be exhaustive but includes some factors relating to clients that need to be
taken into account during a risk assessment:
• apprehension or fear of being moved
• degree of cooperation
• ability to understand and communicate
• behaviour
• sensory impairment
• pain
• tissue viability
• medication
• weight
• type of clothing

For example:
Clothing - tightly fitted non-elastic clothing will increase the risk when assisting a client with dressing. Different
clothes or making adaptations such as Velcro seams can reduce the effort and risks and is appropriate for
some clients based on the assessment.
Pain - pain relief and manual handling should be coordinated.
Ability to understand and communicate - communication with clients should always be specific to that
individual and be at appropriate level in terms of content, speed, pitch etc.
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Risk Assessment - The Working Environment
Things to consider in the Environment

• Is there enough space for the task? Is there enough space for the client, for you and your colleagues and
all the equipment you may need to use?
• Are there problems in the design of the environment? Are the doorways and corridors too narrow or is the
shape of the environment awkward?
• Is there anything on the floor that you or your client might slip or trip on? Slide sheets are particularly high
risk slip hazards.
• Is it too hot or too cold which might impair your grip or cause fatigue?
• Is your environment very busy, noisy or distracting?

Equipment
Does the Task require specific equipment, for example a height adjustable profiling bed or slide sheets?

Is the equipment safe and is it maintained?

Is everyone trained in using the equipment and also does everyone know how to use the equipment?
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Moving and Handling Forms
1. The Individual Client Risk Assessment and Action Plan lays out in detail the risk assessment process
(T.I.L.E.E.) and is completed when a more detailed structure is required to complete the client assessment.
This would be in more complex situations where the method of transfer is not easily apparent.

If you are using a computer on the Trust intranet you can view the complete document here.

2. The Client Moving and Handling Plan is used to record the safe system of work resulting from the risk
assessment. If you are using a computer on the Trust intranet you can view the form here.

Provision and Use of Work Equipment Regulation (PUWER) 1998

Equipment is often used to assist clients to move and these must be fit for purpose.

What work equipment is covered?

Generally any equipment which is used at work, for example; beds, patient hoists, slide sheets and rota stands.

What are the requirements?

it must be suitable for the intended purpose
it must be safe for use and maintained in a safe condition
it must be used by people who have received adequate training and instruction to use it safely
it must be fitted with adequate guards and warning signs where appropriate.

A simple guide to PUWER 1998 can be found on the Health and Safety Executive website at this link
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Law - Human Rights Act 1998

Before leaving the law it is important to note that clients also have rights including those laid down in the
Human Rights Act 1998 which is based on the European Convention on Human Rights.

The relevant articles of the Convention are:

Article 2 - The right to life

Article 3 - Inhuman treatment. No one shall be subjected to torture or to inhuman or degrading treatment or
punishment.
Article 8 - The right to privacy. Everyone has the right for his private and family life, his home and his
correspondence.
Anatomy
The human spine consists of 32 individual bones (vertebrae) that are stacked one on top of another to form a
flexible column. Viewed from the side the spine has a series of curves which act like a spring to protect our
heads from the forces generated by walking and jumping.

What are the different structures that form the spine?

(Intervertebral) disc - Are flat, round discs that act as shock absorbers and physical spacers to separate the
vertebrae to allow room for the spinal nerves to exit the spine. The discs also allow the spine to be as flexible
as it is.

The facet joints are paired joints at the back of the spine which direct and limit the range of movement between
vertebrae.
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Ligaments - are tough bands of tissue that surround the facet joints and also pass between the bodies of the
vertebrae. Ligaments help limit movement and they hold everything together

Spinal Muscles - like all muscles these provide the power to move bones, in this case the vertebrae. These
muscles are small, delicate and weak (when compared with the large leg muscles) and form a network that
runs the length of the spine. For example, any individual muscle may span one, two, three or more vertebrae
which allows very fine control over the spine.
These muscles are not designed for powerful work, such as bending the back to lift loads.

Tendons - are non contractile bands that join the muscles to the bone. These are needed because they take
up less space on the bone. The best place to see tendons is the wrist where they pass from the forearm
muscles to the fingers.

Anatomy
Given that back injuries are common and most people will either have suffered from back pain or know
someone who has, are backs really fragile and weak?

Actually, far from it and a fit and healthy spine used correctly is very strong. Back injuries are so common
because most people do not use their back correctly.

The next page shows the correct way to use the back. When looking at it please remember that we use our
backs just as much in everyday life as we do at work.
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Safer Principles 1.
The key safer principles of manual handling are
1. Avoid. Avoid the need to do the task if it is practicable to do so.
2. Think. If it is not practicable to avoid then where necessary think and plan the task before doing it for real.
For example, before hoisting a client from a bed to a wheelchair is everybody able to spend the required
time without hurrying and is all the equipment immediately to hand? Is the bed at the correct height and
can both sides of the bed be accessed?
3. Spine-in-line. Once you are ready to begin manual handling you should keep your back as straight as
possible. This is called 'spine-in-line. It simply means avoid twisting your back or bending forwards,
backwards or to the side.
4. Stable and mobile base. The feet should be placed shoulder width apart with one foot in front of the other
and the knees and hips slightly bent. By using the hips and knees the need to bend the spine is reduced.
5. Load close. The load should be kept as close to the body as possible although when assisting a client this
can be problematic as clients can sometimes be unpredictable in behaviour.
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Safer Principles 2.
In addition to the Key Safer Principles you should always try to:
• Move smoothly rather than jerk
• Report any concerns that you may have, for example if something within the environment prevents you
from adopting these principles when moving and handling.

Finally, consider how a small child would pick up a toy from the floor.

A child lifts with a straight back and using the hips and knees to bend because of his lack of balance and back
muscle strength but this is the way that we are 'designed' to lift. The way that most adults move, lift and handle
loads and objects is essentially a learned bad habit.

Controversial Techniques
A number of techniques used to be used to move and handle clients but since the Manual Handling Regulation
1992 and the need to reduce the risk of injury they are now considered unsafe.

These techniques are not to be used without the express agreement of the Manual Handling Advisor.
The Drag Lift
The Orthox Lift
The Bear Hug
The Top and Tail
The Australian Lift
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Hoisting Theory Course

Welcome to Hoisting Theory
Please ensure that you are in-date with your basic
back care theory and familiar with the concepts
before continuing. This hoisting theory course and
the questions in the quiz assume this knowledge.
If necessary please go back and complete that
course now.

Basic Principles
Hoisting is a form of manual handling, i.e. it is the "transporting or supporting of a load ... by hand or by bodily
force” Manual Handling Operations Regulations (MHOR) 1992. Therefore all the theory covered in the basic
back care course also applies to this hoisting course.

The theory in the Basic Back Care course included:

• Definitions
• Statistics
• Law (including the need for all clients to have a manual handling risk assessment)
• Anatomy and safer principles of moving and handling
• The risk assessment process (Task - Individual - Load/Client - Environment - Equipment)
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The Lifting Operations and Lifting Equipment (LOLER) 1998

In addition to the regulations within the Health and Safety at Work Act 1974 already covered in the Basic Back
Care course, LOLER specifically covers lifting equipment such as cranes and patient hoists.

As with everything in the workplace, safety is important and this regulation gives a common sense approach to
maximise safety when using patient hoists.
LOLER is concerned with ensuring safety when operating the hoist and requires that:

• people using the hoist are trained and competent. The transfer is performed safely i.e. planned and
organised (risk assessed and with a completed moving and plan).
• the equipment is strong and stable enough (marked with the safe working load, SWL).
• positioned and installed to minimise risk.
• is subject to regular (pre-use) checks.
• inspected and serviced by competent people.

Although hoists and slings must be marked with the Safe Working Load (SWL) this information is not much
help unless we also know the client's weight.
Hoists and slings in our Trust are inspected by outside engineers every 6 months and are normally serviced at
the same time.
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Pre-use check for the hoist

Before using a hoist make sure that:

1. The hoist has a service label and is within the 6 monthly service date. The label will show the date of the last
service and the date the next service is due.
2. You know the safe working load (SWL) of the hoist and this should be marked on the hoist. You should also
know the weight of the client, especially if they may approach the SWL of the hoist (or sling).
You should also be familiar with the emergency controls (emergency lower and the emergency stop) and how
to use them.
Also ensure that:
the battery is charged (electric hoist)? It is all too easy to forget to leave the hoist on charge when not in use
with the result that the hoist might stop working during a hoist. This risk can be reduced by ward based
systems and also by having a second battery on charge.

• the brakes work

• the wheel turn freely
• the hoist works (the hoist lifts/lowers and the base opens and closes).
• that all necessary attachments are in place
• the hoist is clean and hygienic
• there is no obvious damage - bare wires, damage to sockets.
• when using a liko golvo hoist check whether the belt is frayed or twisted and also whether the spreader bar
is fitted with a padded jacket.
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Pre-use check for the sling

• Before using a sling the following checks must be made to ensure the sling is suitable and safe.

• Is the sling clean and hygenic?

• Is it the correct sling for the client, the hoist and the type of transfer?

• Is the stitching showing signs of wear ? This usually happens where the loops attach to the body of the
sling

• Can you read the label? The ink is designed to fade over time with repeated washing and indicates the
sling must be condemned as the fabric may have become weak.

• Do you know the SWL of the sling as well as the hoist?

• Is the fabric wrinkled? This usually indicates heat damage. The sling has been washed or tumbled dried at
too high a temperature and must be discarded.

• Disposable slings should be condemned and disposed of if they become wet. They should never be
washed or cleaned.
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1. Basic Back Care: This Basic Back Care (BBC) Theory Update course is for clinical staff who have
previously completed a whole day induction in BBC. It must be completed before attending any practical
session or having practical techniques assessed on the ward. To complete the annual update in BBC, both
theory and practical must be completed.

2. Hoisting: This hoisting update course is for staff who have previously completed a half day induction in
hoisting. The course assumes knowledge of BBC and therefore you must have completed and be in date with
BBC theory before taking the hoisting course. Some questions in the hoisting quiz assume this prior knowledge
of BBC. This hoist theory course must be completed before attending any practical session or having practical
techniques assessed on the ward. To complete the annual update in hoisting, both theory and practical must
be completed.
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