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November 26, 2014
What's in Cal/OSHA's new patient-handling standard? 3 things hospitals need

In 2011, Governor Brown signed Assembly Bill (A.B.) 1136, the Hospital Patient and Health Care Worker Injury Protection Act. It created a new Section 6403.5 in the Labor Code, requiring all general acute care hospitals to adopt “a patient protection and healthcare worker back and musculoskeletal injury prevention plan”—and requiring the state Occupational Safety and Health Standards Board (OSHSB) to create an implementing regulation for employers.

The new regulation, General Industry Safety Orders (GISO) Section 5120, was finalized by the OSHSB in September 2014 and took effect on October 1, 2014. We’ll explain what general acute care hospitals are now required to do to prevent employee injuries caused by patient handling.

Written plans

Under the new regulation, each hospital must create a written safe patient-handling plan that includes:

  • An effective safe patient-handling policy.
  • The names and/or job titles of the individuals responsible for implementing the plan.
  • The methods the hospital will use to coordinate implementation of the plan with contractors, including those who perform or assist in patient-handling activities.
  • Procedures to ensure that supervisory and nonsupervisory employees comply with the plan.
  • Procedures for identifying and evaluating patient-handling hazards.
  • Procedures for investigating musculoskeletal injuries related to patient handling.
  • Procedures for correcting hazards related to patient handling.
  • Procedures for communicating with employees about safe patient-handling matters.
  • Procedures for providing training to employees who may be present in patient care units.
  • A list of patient-handling equipment that cannot be implemented by the standard’s effective date that includes, for each listed item, the reason for the delay, the date by which the equipment will be put into use, and alternative measures to protect employees until the equipment is put into use.
  • Procedures for reviewing, at least annually, the plan’s effectiveness in each patient care unit, including a review of injury data and trends.


GISO Section 5120 does not apply to hospitals within the Department of Corrections or the Department of Developmental Services or to separately licensed units within a general acute care hospital.

Training must be provided to all employees whose work assignments include being present on a patient care unit. Covered hospitals must satisfy specific requirements for initial training, annual refresher training, and awareness training as well as training requirements for supervisors and nurses who evaluate patients. Trainees must be given the chance for live question-and-answer sessions with knowledgeable trainers.

Initial and refresher training for designated healthcare workers, lift team members, designated registered nurses, and their supervisors must cover:

  • The kinds of injuries caused by manual patient handling that make early recognition of risk and risk management so important.
  • How patient risk factors (such as the patient’s ability and willingness to cooperate) are assessed and controlled during patient handling.
  • How to communicate with patients regarding the use of patient-handling procedures and equipment.
  • The equipment that will be used to reduce injuries to patients and employees—and provide an opportunity to practice with it.
  • Safe procedures for manual patient handling and when they are necessary.
  • How to report their concerns about the effectiveness of the program, including availability of staff and equipment, or about a specific lift, and how to request additional training.
  • The elements of the employer’s plan and safe patient-handling policy and how the plan will be made available to employees.
  • The right to refuse to lift, reposition, mobilize, or transfer a patient because of concerns about patient or worker safety or the lack of trained personnel or equipment.
  • The roles of the designated registered nurse and the supervisor.

Besides the requirements above, supervisors must also understand that a healthcare worker may not be disciplined for refusal to lift, reposition, or transfer a patient due to concerns about patient or worker safety or the lack of trained designated healthcare workers or equipment. Designated registered nurses who will assess patients must receive additional training in patient assessment and in how to communicate effectively with everyone involved in the patient’s care.

All workers whose job assignment includes being present on patient care units must receive awareness training that enables them to recognize situations when the services of trained workers or lift teams are needed and obtain appropriate assistance. They should also know what to do if there is a patient-handling emergency.


Required records include records of inspections, training, and injury investigations.

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