Course 624 - Healthcare: Slip, Trip, and Fall Prevention

Safety guides and audits to make your job as a safety professional easier

Top Hazards and Solutions

STFs account for most lost-time injuries in healthcare.

Work-related slip, trip, and fall incidents can frequently result in serious disabling injuries that impact a healthcare employee’s ability to do his or her job, often resulting in:

  • lost workdays,
  • reduced productivity,
  • expensive worker compensation claims, and
  • diminished ability to care for patients.

According to the U.S. Bureau of Labor Statistics [2009], the incidence rate of lost-workday injuries from slips, trips, and falls (STFs) on the same level in hospitals was 38.2 per 10,000 employees, which was 90% greater than the average rate for all other private industries combined (20.1 per 10,000 employees).

STFs as a whole are the second most common cause of lost-workday injuries in hospitals. The large population of workers at risk and the frequent occurrence make STF accidents a substantial problem for health care workers.

This module takes a closer look at several top hazards that cause STFs in the healthcare setting.

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1. Which type of accident in healthcare has a much higher rate of causing injuries than the rate experienced by other private industries?

a. Slips, trips, and falls (STFs)
b. Falls to a lower level
c. Workplace stress
d. Infection with Covid

Next Section

Contaminants on the Floor

According to OSHA, contaminants on the floor are the leading cause of STF incidents in healthcare facilities. Water, grease, and other fluids can make walking surfaces slippery. Well-documented housekeeping procedures, correct floor cleaning, proper usage of mats and signs, accessible clean-up materials, and slip-resistant shoes will help to minimize the risk of slipping.

Water on floor caused by pipe splashing water.

Where Does the Hazard Occur?

  • Food services areas: kitchen, cafeteria, serving line, buffet, ice machines, freezers, dishwashers,
  • sinks, and drains
  • Decontamination area: when wet equipment is transferred from one area to another
  • Soap dispensers
  • Drinking fountains
  • Building entrances, where rain and snow are tracked inside

Prevention Strategies

To prevent injuries, you should provide and maintain a written housekeeping program. This can help ensure the quality and consistency of housekeeping procedures. A copy of the housekeeping program should be provided to all employees and they should know where to find additional copies.

The program should describe the following things:

  • how to immediately contact the housekeeping department
  • where and how cleaning materials and products are stored
  • when to use wet floor signs and barriers and where signs are stored
  • when specific areas of the healthcare facility need to be cleaned
  • what cleaning methods are appropriate for different areas and surfaces

2. According to OSHA, what is the leading cause of STF incidents in healthcare facilities?

a. Contaminants on the floor
b. Snow and ice on walkways
c. Poor drainage on sidewalks
d. Walking surface irregularities

Next Section

Contaminants on the Floor (Continued)

cleaning solutions
Wall-mounted spill pads for use by employees and visitors

Keep Floors Clean and Dry

Click on the button to see best practices that help to prevent injuries created by contaminants on floors.

  • Encourage workers to cover, clean, or report spills promptly.
  • Hang or place spill pads, paper towel holders, pop-up-tent wet floor signs in convenient locations throughout the healthcare facility so employees have easy access to products to clean, cover, and highlight a spill.
  • Advertise phone/pager numbers for housekeeping through emails, posters, and general awareness campaigns.
  • cleaning solutions
    Dripless and brush-free cleaning solution provided at sinks minimizes drips and water splashes
  • Place water-absorbent walk-off mats where water, ice, or soap may drip onto the floor.
  • Use beveled-edge, flat, and continuous mats.
  • Provide walk-off mats, paper towel holders, trash cans, and umbrella bags near entrances and water fountains to minimize wet floors.
  • Mats should be large enough so that several footsteps will take place on the mat; if there is water around or beyond the mat, it means that the mat is not large enough and/or is saturated and needs to be replaced.
  • Secure mats from moving and make sure they have slip-resistant backing. Remind staff to lay mats in the correct position daily, and use visual cues such as tape on the floor if necessary.
  • Make sure that drip pans of ice machines and food carts are properly maintained so that water does not spill onto the floor.

Use Proper Cleaning Procedures for Floors

Optimal floor cleaning procedures may prevent slips and falls. Research has shown a two-step mopping process is better than damp-mopping. In the two-step process,

  1. cleaning solution is applied on a section of the floor with a dripping mop, and
  2. after a few minutes, the cleaning solution is removed with a wrung mop, before the solution dries.

You will also need to make sure the cleaning product can be used on common floor contaminants and the cleaning products are mixed according to manufacturer’s directions.

3. What is the first step to properly clean hospital floors?

a. Remove cleaning solution with a mop
b. Apply cleaning solution with a dripping mop
c. Wait for someone else to clean up the spill first
d. Find out how the spill occurred

Next Section

Contaminants on the Floor (Continued)

Wear Slip-Resistant Shoes

Slip-resistant shoes are an important component of a comprehensive STF prevention program. All healthcare facility employees may benefit from these type of shoes. Food services, housekeeping, and maintenance staff are at greatest risk for a STF due to exposure to water, grease, or slippery walking surfaces.

Shoe fit, comfort, and style are important factors that determine whether employees will actually wear the slip-resistant shoes. Therefore, employees should have an opportunity to try them on to find the proper fit before purchasing.

Prevent Entry into Wet Areas

Use highly-visible cautions signs to inform employees and visitors to be careful and avoid contaminated areas. You may want to also block off areas during floor cleaning, stripping, and waxing to prevent injuries. Use barrier products, such as those shown below, or caution tape to prevent employees from entering an area being cleaned or from stepping on a spill.

Make sure you also use a barrier device to prevent water and other fluids from entering hallways and cleaning rooms. Use these devices along with a tension bar or other blocking device so the floor barrier does not become a tripping hazard.

Note: You will need to remove all signs once the floor is clean and dry so they do not become commonplace and ignored by staff members.

wet floor
Caution wet floor warning tape
tension bar
Spring-loaded tension bar holds warning sign to block access to room during cleaning
wet floor
Barrier device to block fluids at doorway, use with a tension bar

4. Which of the four categories of healthcare employees listed below are at the greatest risk of slips, trips, or falls?

a. Doctors
b. Nurses
c. Housekeepers
d. Administrators

Next Section

Poor Drainage: Pipes and Drains

wet floor
Pipe is not aligned properly with the drain causing standing water on the floor

Drains and water pipes that are improperly aligned can cause liquid to spill onto walking surfaces, while clogged drains can cause water to back up onto the floor.

Where Does the Hazard Occur?

  • Drains inside the healthcare facility where liquids accumulate (particularly in kitchens and decontamination areas)
  • Down spouts that spill rainwater onto sidewalks

Prevention Strategies

  • Check that pipes are correctly aligned with the drain they are emptying into.
  • Unclog drains regularly as needed, particularly in kitchens.
  • Redirect downspouts away from sidewalks with high-pedestrian traffic.

5. How often should you unclog drains, particularly in kitchens?

a. Regularly
b. Weekly
c. Annually
d. Monthly

Next Section

Indoor Walking Surface Irregularities

Indoor Walking Surface Irregularities
Floor mats can easily become a tripping hazard.

Damaged, warped, buckled, or uneven flooring surfaces inside healthcare facilities can cause employees to stumble, trip, slip, or fall.

Where Does the Hazard Occur?

  • Building entrances
  • Patient rooms
  • Operating rooms
  • Hallways
  • Around drains in the floor
  • Floor matting

Prevention Strategies

  • Replace or re-stretch loose or buckled carpeting.
  • Remove, patch underneath, and replace indented or blistered vinyl tile.
  • Patch or fill cracks in indoor walkways greater than ¼ inch wide.
  • Make sure elevators are leveled properly so elevator floors line up evenly with hallway floors.

6. What is the recommended procedure for replacing indented vinyl tile?

a. Replace cracks greater than 1 inch
b. Remove, patch underneath, and replace
c. Place a warning sign nearby
d. Remove if the tile is broken

Next Section

Outdoor Walking Surface Irregularities

A change in elevation (greater than ½”) in a walkway outside a hospital building needs to be fixed.

Poorly maintained, uneven ground, protruding structures, holes, rocks, leaves, and other debris can cause employees to stumble, trip, slip, or fall.

Where Does the Hazard Occur?

  • Entrances
  • Lawns
  • Parking garages and lots
  • Walkways
  • Around drains in the ground

Prevention Strategies

  • Patch or fill cracks in walkways greater than ½" wide.
  • Patch, fill, or repave outdoor areas that have deep grooves, cracks, or holes.
  • Create visual cues. Highlight changes in curb or walkway elevation with Safety Yellow warning paint.
  • Vehicle Parking Space: Wheel stops in parking lots can be a tripping hazard and should not block adjacent accessible routes. (see 2010 ADA and ICC/ANSI A117.1-2017)
  • Remove stones and debris from walking surfaces.
  • Ensure that underground watering system structures are covered or highlighted.

7. Patch of fill cracks in outdoor walkways that are greater than _____.

a. 1/2 inch
b. 1/4 inch
c. 1/8 inch
d. 1/16 inch

Next Section

Weather Conditions: Ice and Snow

plastic bins
Plastic bin to hold ice-melt chemicals and scoop

Ice and snow can cause employees and visitors to slip and fall.

Where Does the Hazard Occur?

  • Entrances
  • Parking garages and lots
  • Walkways
  • Outside stairs

Prevention Strategies

Click on the button to see successful strategies to prevent injuries created by snow, ice, and other winter conditions.

  • Have an aggressive program to promptly remove ice and snow from parking lots, garages, and sidewalks.
  • Distribute winter weather warnings via email to staff when ice and snow are predicted. For staff who do not have access to email, provide notices on bulletin boards.
  • Place freezing weather warning monitors at entrances to employee parking areas.
  • Display the phone or pager number for the maintenance department via posters and emails to encourage employees to report icy conditions.
  • Place labeled bins filled with ice melting chemicals and scoops that anyone can use immediately on icy patches. Consider placing bins in areas of heavy pedestrian traffic such as the top and bottom of outdoor stairways, parking garage exits and entrances, and healthcare facility entrances. The bins should be labeled with the appropriate Safety Data Sheets (SDS) and include instructions for handling ice melting chemicals. Bins should be secured so they cannot be removed.
  • Provide additional mats in entrances during winter months and when it rains.
  • Consider slip-resistant footwear (including ice cleats) for employees who work or travel outdoors as part of their jobs.

8. When should additional mats be used to prevent slips, trips, and falls?

a. When it is windy and cold
b. During the summer months
c. During winter and when it rains
d. When it is foggy outside

Next Section

Inadequate Lighting

dim lighting
This image shows dim lighting in the parking area. The light fixture is also partially obscured by ceiling beams.

Inadequate lighting impairs vision and the ability to see hazards. Proper lighting, on the other hand, allows employees to see their surroundings and notice unsafe conditions in time to avoid them.

Where Does the Hazard Occur?

  • Parking structures
  • Storage rooms
  • Hallways
  • Stairwells
  • Walkways both inside and outside the facility

Prevention Strategies

  • Install more light fixtures in poorly lit areas.
  • Verify light bulbs have an appropriate brightness.
  • Install light fixtures that emit light from all sides.

9. Which of the following is a good prevention strategy for inadequate lighting?

a. Verify light bulbs have appropriate brightness
b. Install light fixtures that emit light from just two sides
c. Close the area off to employees
d. Provide security guards

Next Section

Stairs and Handrails

The handrail in this image was lowered in order to hang large picture above. The handrail is too low to be of use.

Each year stairway accidents cause over one million injuries and 12,000 deaths at home, work, and other locations. Proper construction and maintenance of stairs and handrails can reduce hazards. Stairs that are poorly marked or uneven, as well as handrails that are not the appropriate height, size, or are poorly maintained can lead to missteps and cause employees to trip and fall.

You don't have to fall far to suffer a fatality when descending stairs. An employee was descending a staircase when he fell down the first few stairs to the landing below and hit his head on the floor causing blunt force trauma. He was taken to a local hospital, where he died. (OSHA Accident Report - 1/4/2021)

Where does the hazard occur?

  • Indoor and outdoor stairs
  • Steps inside classrooms or conference rooms
  • Elevated and/or sloping walkways
  • Parking structures
  • Ramps

Prevention Strategies

Click on the button to see successful strategies to prevent injuries created by stairs and stairways.

Tread and Nosing.
  • Create visual cues. Paint safety yellow or other high contrast paint, tape, or highlight the edge (nosing) of each step, including the top and bottom, to provide a cue of a change in elevation.
  • Check that stair treads and nosing are slip resistant and along the whole tread. This is especially important for outside stairs exposed to the elements or stairways exposed to wet conditions.
  • Ensure that stairs are kept free of ice, snow, water, and other slippery contaminants.
  • Check that stairwells have adequate lighting.
  • Consider adding a handrail at locations that have less than 4 steps (such as employee shuttle bus stop, building entrances, conference theaters).
  • Confirm all handrails are within an appropriate height range (34 to 38 inches from the stepping surface).
  • Check that discontinuous handrails are of a consistent height.
  • Check that handrails extend full length of stair and extend 12 inches at top and one tread depth at bottom.
  • Check that handrails are available on both sides. For stairs greater than 44 inches wide, two handrails are recommended. For stairs less than 44 inches, at least one handrail on the right side descending stairway should be available.
  • For open stairways, check to ensure a two-rail system is present; a top rail at 42 inches and a second handrail at 34 inches minimum and 38 inches maximum vertically above stair nosings. Protect the open area under the top rail to the stairway steps by installing a fixed barrier.

10. To help prevent stairway injuries, check that stair treads and nosing are _____.

a. not used unless they are necessary
b. slip resistant and extend the whole tread
c. painted a neutral gray color
d. identified in construction plans

Next Section

Stepstools and Ladders

portable ladder
Portable extension ladder.

Stepstools and ladders that are used to work from heights can create a hazardous situation if not used properly. There are two basic types of ladders:

  • Portable ladders help you access a work area or provide support while you work. Portable ladders make getting to a work area easy, but they can increase the potential for falls if not used properly.
  • Fixed Ladders are non-self-supporting and non-adjustable in length and permanently attached to a structure.

Prevention Strategies

  • Train employees on the proper use of ladders.
  • Wear appropriate footwear for climbing; shoes should have a closed back and sufficient tread on the sole to prevent slipping on ladder rungs or steps.
  • Place ladders and stepstools on level surfaces before climbing.
  • Check that stepladders are fully opened before climbing.
  • Maintain three points of contact with the ladder at all times while ascending and descending (two hands and one foot or one hand and two feet).

11. When working on a ladder be sure to always _____.

a. lean forward when both hands are not in contact with the ladder
b. maintain three points of contact (feet/hands) with the ladder
c. be careful carrying tools up and down the ladder
d. keep at least one foot on ladder when leaning to the side

Next Section

Tripping Hazards

Loose computer cables.

Clutter can build up in storage areas, work areas, hallways, and walkways. Clutter, loose cords, hoses, wires, and medical tubing can potentially lead to an STF incident. Exposed cords on the floor, stretched across walkways, and tangled near work spaces can catch an employee’s foot and lead to a trip or fall incident.

Where Does the Hazard Occur?

  • Nursing stations
  • Operating rooms
  • Patient rooms
  • Computer workstations
  • Storage areas
  • Hallways and walkways
  • Work stations

Prevention Strategies

Cover cords on the floor.
  • Organize storage areas to eliminate clutter.
  • Consider wall-mounted storage hooks, shelves, hose spools, etc.
  • Clear walkways.
  • Use cord organizers to bundle cords.
  • Cover cords on floor with a beveled protective cover or tape cords to flooring.
  • Use retractable cord holders.
  • Mount cords near or underneath the desk.
  • Clear walkways and work areas to allow employees to move more freely and safely.

12. Which of the following is a useful strategy to help eliminate tripping hazards in a healthcare setting?

a. Organize storage areas
b. Place equipment on the floor near your desk
c. Use signs telling employees to remove clutter
d. Mount cords on top of the desk

Next Section

Improper Use of Floor Mats and Runners

frayed carpet
Frayed, worn edges on a comfort mat can cause injury.

Mats are used to prevent STFs, to provide slip-resistant walking surfaces by absorbing liquid, and to remove dirt, debris, and liquid from shoes. But, Mats are only effective if properly used and maintained. Old or poorly placed mats can contribute to slips, trips, and falls.

Where Does the Hazard Occur?

  • Healthcare facility entrances
  • Food preparation and serving areas
  • Under sinks
  • Water fountains
  • Histology labs

Prevention Strategies

Click on the button to see successful strategies to prevent injuries created by improper use of floor mats and runners.

small mats
This mat is too small for the work being done.
small mats
This mat is not laying flat on the floor.
  • Mats and runners at healthcare facility entrances should be sufficiently large so that several footsteps fall on the mat, cleaning contaminants off the shoes, before the shoes contact the flooring.
  • Place additional mats, if necessary, in entrances during ice, snow, and rainy conditions. If there is water on the floor beyond the last mat, additional mats or runners may be necessary.
  • Use non-slip mats in areas where employees may routinely encounter wet flooring.
  • Use beveled-edge, flat, and continuous or interlocking mats.
  • Replace mats that are curled, ripped, or worn. Secure edges with carpet tape if needed
  • Secure mats from moving.
  • Paint small markers on the floor to remind staff to lay mats in the correct position every day.

13. Mats and runners at healthcare facility entrances should be sufficiently large so that _____.

a. they do not present a tripping hazard
b. they do not slip when stepped on
c. several footsteps fall on the mat
d. they accommodate at least two employees

Check your Work

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Here's a great video on how to avoid falls in a hospital setting.