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Does Slip-Resistant Footwear Reduce Slips, Trips, and Falls in Food Service?

Posted on by Jennifer L. Bell, PhD; Jim Collins, PhD, MSME; Sharon Chiou, PhD; and Sydney Webb, PhD

Slips, trips, and falls are the second most common type of fatal work-related injuries and the third most common type of non-fatal work-related injuries in the United States (1, 2). Although falls from heights are more likely to result in a fatality, falls on the same level (which often start as a slip or trip) occur more frequently and can cause injury. Recent US Bureau of Labor Statistics data show that 50% of all same-level falls resulted in more than 10 days away from work (1, 2, 3). Sprains, strains, dislocations, and tears to the lower extremities are the most common injuries after a same-level slip, trip, or fall (4–7). These injuries are estimated to cost nearly $13 billion in direct workers’ compensation-related costs each year, and are the most expensive category of injuries (8).

Laboratory studies of slip-resistant footwear to reduce slips, trips, and falls have shown promise in reducing slips, but limited field research made it difficult to demonstrate if slip-resistant footwear actually reduced injuries. NIOSH researchers evaluated the effectiveness of a no-cost-to-workers, highly-rated slip-resistant shoe program in preventing workers’ compensation injury claims caused by slipping on wet or greasy floors among food services workers. The study, Effectiveness of a no-cost-to-workers, slip-resistant footwear program for reducing slipping-related injuries in food service workers: a cluster randomized trial,  was recently published in the Scandinavian Journal of Work, Environment and Health.

Approximately 17,000 food services workers from 226 school districts, serving students in kindergarten through 12th grade participated in the study. Workers were clustered by school district and the districts were randomly assigned either to a group that received no-cost, 5-star rated slip-resistant shoes or to a group that generally bought their own slip-resistant shoes.

Investigators looked specifically at workers’ compensation injury claims caused by slipping on wet or greasy surfaces, the type of incident that the shoes were designed to prevent. The school districts provided with highly-rated slip-resistant shoes saw a 67% reduction in claims for slip injuries; whereas, there was no decline seen in the group who did not receive the highly-rated slip-resistant shoes. See the infographic above. The findings revealed a baseline measure of 3.54 slipping injuries per 10,000 months worked among the intervention group, which was reduced to 1.18 slipping injuries per 10,000 months worked in the follow-up period when slip-resistant shoes were provided.

Another finding from this research was that prior to the no-cost slip-resistant footwear intervention, workers over 55 years old had a higher probability of a slip-related workers’ compensation injury claim (4.2 injuries per 10,000 worker months) than workers under age 55 (2.3 injuries per 10,000 worker months). This is of public health significance because more workers over age 55 continue to remain active in the US workforce (9). Without intervention, slipping injuries may be an increasing injury problem for older workers.

To our knowledge, this is the first randomized controlled trial evaluating the effectiveness of a no-cost –to-workers slip-resistant footwear program for reducing slipping-related workers’ compensation injury claims in food service workers in the field. This research helps to bridge the gap between understanding the performance of slip-resistant footwear in laboratory settings to understanding the effectiveness of slip-resistant footwear at preventing injuries in a functional work envi­ronment. Additionally, this study attempted to isolate the effect of a single intervention as much as possible through the study design.

The findings from this study provide evidence of the effectiveness of slip-resistant footwear and may assist employers, manag­ers, and workers in their decision on whether to invest time and resources in a slip-resistant footwear program.

This study examined the effectiveness of slip-resistant footwear among food service workers. What other industries or workers could benefit from the use of slip-resistant footwear? If you have used slip-resistant footwear at work please share your experiences below.

A Spanish translation of this blog is available here.

 

Jennifer L. Bell, PhD, is a Research Epidemiologist in the NIOSH Division of Safety Research.

Jim Collins, PhD, MSME, is a Branch Chief in the NIOSH Division of Safety Research.

Sharon Chiou, PhD, is a Health Scientist in the NIOSH Office of Extramural Programs.

Sydney Webb, PhD, is a Health Communication Specialist in the NIOSH Division of Safety Research.

 

More Information from NIOSH

Falls in the Workplace

Slip-Resistant Shoes Reduce Food Services Worker Slip Injuries

Preventing Slips, Trips, and Falls in Wholesale and Retail Trade Establishments

Slip, Trip, and Fall Prevention for Healthcare Workers

Preventing Slips, Trips, and Falls in Mining

 

References

  1. Bureau of Labor Statistics (BLS). Table A-1. Fatal occupational injuries by industry and event or exposure, all United States, 2015. 2015a. Bureau of Labor Statistics, U.S. Department of Labor, Washington, DC., Survey of Occupational Injuries and Illnesses in cooperation with participating State agencies.
  2. Bureau of Labor Statistics (BLS). Table R8. Incidence rates for nonfatal occupational injuries and illnesses involving days away from work per 10,000 full-time workers by industry and selected events or exposures leading to injury or illness, 2014. 2015b. Bureau of Labor Statistics, U.S. Department of Labor, Washington, DC., Survey of Occupational Injuries and Illnesses in cooperation with participating State agencies.
  3. Bureau of Labor Statistics (BLS). Table R70. Number of nonfatal occupational injuries and illnesses involving days away from work by event or exposures leading to injury or illness and number of days away from work, 2015. 2015c. Bureau of Labor Statistics, U.S. Department of Labor, Washington, DC., Survey of Occupational Injuries and Illnesses in cooperation with participating State agencies.
  4. Bell JL, Collins JW, Wolf L, Grönqvist R, Chiou S, Chang WR et al. Evaluation of a comprehensive slip, trip and fall prevention programme for hospital employees. Ergonomics 2008 Dec;51(12):1906–25. https://doi. org/10.1080/00140130802248092.
  5. Bell JL, Collins JW, Tiesman HM, Ridenour M, Konda S, Wolf L et al. Slip, trip, and fall injuries among nursing care facility workers. Workplace Health Saf 2013 Apr;61(4):147– 52. https://doi.org/10.1177/216507991306100402.
  6. Nenonen N. Analysing factors related to slipping, stumbling, and falling accidents at work: application of data mining methods to Finnish occupational accidents and diseases statistics database. Appl Ergon 2013 Mar;44(2):215–24. https://doi.org/10.1016/j.apergo.2012.07.001.
  7. Lipscomb HJ, Glazner JE, Bondy J, Guarini K, Lezotte D. Injuries from slips and trips in construction. Appl Ergon 2006 May;37(3):267–74. https://doi.org/10.1016/j. apergo.2005.07.008.
  8. Liberty Mutual Research Institute for Safety. Liberty Mutual Workplace Safety Index. 2016. Liberty Mutual, Hopkinton, MA.
  9. Toossi M, Torpey E. Older workers: Labor force trends and career options. Career Outlook, U.S. Bureau of Labor Statistics, May 2017. Accessed 21 July 2017. Available from: https://www.bls.gov/careeroutlook/2017/article/older-workers.htm.

 

Posted on by Jennifer L. Bell, PhD; Jim Collins, PhD, MSME; Sharon Chiou, PhD; and Sydney Webb, PhD

8 comments on “Does Slip-Resistant Footwear Reduce Slips, Trips, and Falls in Food Service?”

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this site is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

    Clearly, your findings in this important study could be very useful to workers in many different jobs and also to members of an increasingly aging population who are not actively working but who are prone to falls with serious, often life-threatening consequences.

    Given the results you reported, the control group of workers who bought their own “slip-resistant” shoes apparently were not buying shoes that met the quality of those you provided to half of the workers in this study.

    Could they have purchased 5-star slip-resistant shoes in the consumer market?

    And so, would they have known that the shoes they purchased had been rated as 5 star shoes?

    Were the shoes slip-resistant shoes you provided a brand that is sold in the consumer market?

    If yes, did any of the workers happen to buy the same or comparable 5-star rated shoes?

    Did all of those in the control group wear some kind of “slip-resistant” shoe throughout the study?

    What were the significant differences between the 5-star rated shoes you provided and the “slip-resistant” shoes workers purchased on their own?

    How would those workers as well as others, such as the very large and increeasing number of older people who are more prone to falls, be able to identify and purchase
    “5-star rated slip-resistant shoes” such as those you provided to school cafeteria workers in your study?

    A google search shows that there are a number of shoe brands that advertise “slip-resistant” shoes. What are the characteristics of a “5-star” rated slip-resistant shoe versus other shoes promoted as “slip-resistant”?

    Which organization(s) rates slip-resistant shoes such as the “5-star” rated shoes you provided to half of the workers in the study?

    As you must know, your findings are highly relevant to a much larger population than the population you studied.

    For that reason alone, I hope you will make public the potentially life-saving information you have about how/where others can identify and purchase “5-star slip resistant shoes”.

    Thank you–and congratulations on your important study.

    NIOSH selected one brand of slip-resistant footwear (SRF) for use in this study based on highly ranked performance in wet, greasy conditions. We used the GRIP slip resistance rating scheme for footwear (https://www.hsl.gov.uk/publications-and-products/grip). We also considered the availability of a variety of sizes and styles of the upper portion of the shoe, and availability for purchase by the general public.
    The partnering food service company had a pre-existing SRF policy as well as a payroll deduction program in place for the entire duration of the study, for both intervention and control groups. The payroll deduction program allowed workers to order the same brand of 5-star rated SRF as was used by NIOSH for the intervention group, but generally workers in the control group had to purchase the SRF through payroll deduction. It is unknown whether workers were aware of the rating scheme. Workers in the study were also able to purchase SRF of any brand they chose, as long as it was labelled “slip-resistant”. Researchers were able to determine if the study and payroll deduction brand of SRF were ordered, but were not able to track the ordering of any other brand of SRF. SRF use at the individual worker level was not monitored by researchers. This study did not compare one brand of shoe to another but rather looked at whether offering highly-rated slip resistant shoes reduced injury claims.
    We are getting the word out about this research through this blog and the infographic. We encourage readers to distribute this information to those who could benefit from it.

    I have worked in the restaurant industry for many years. It is important what type of non-slip shoes you buy. I tell my staff to get the oil and grease sole which does not work at all in the freezer or on cold water. I have been using the cheap [name removed] shoes and they have worked great, the uppers don’t last a long time but they are less than 1/2 the price of the other shoes and after about 6months you want to get rid of them anyway.

    Shoe manufacturers offer a range of footwear designed for a variety of environmental conditions. Asking the manufacturer for guidance on which model of upper shoe and type of sole might work best for your specific work conditions could prove helpful.
    While the shoes used in our study were designed to prevent slipping on liquid and grease contaminants, generally around room temperature, there are other types of shoe soles designed to prevent slips in cold, ice, and snowy conditions. One organization that tests cold weather footwear is iDAPT. iDAPT is the research arm of the Toronto Rehabilitation Institute – University Health Network located in Toronto, Canada, and they work with a broad range of clinicians, engineers, scientists, researchers, and students to find practical solutions to common problems, including slips, trips and falls. iDAPT tests cold weather footwear and publishes findings for use by the public
    http://www.ratemytreads.com/.
    Mention of specific products and ratings on this web site are not an endorsement by NIOSH or the U.S. Government.

    Great research and findings. Thanks for reporting this. The other industrial sectors which may benefit from such intervention include janitorial services, community health care, home care, retail, grocery and municipal workers as well as landscaping workers. However, how did the research team measure compliance? Were the intervention workers really wearing and using these shoes as advised? How were the workers educated and motivated to participate? Also, why only workers’ compensation claims were used to measure impact? Previous research shows compensation claims only capture a portion of all workplace injuries. Near-miss and first aid injuries and denied claims should have been examined as well. It seems the team was interested about the direct costs only measured through compensation claims; we know that a bug burden of injury costs gets transferred to the workers and their families as out of pocket expenses.

    Thank you for your feedback on other industries and occupations that could benefit from slip-resistant footwear. Many of the questions you asked are addressed in the article.

    The partnering food services company had a pre-existing slip, trip, and fall prevention program that included information on SRF and a requirement that workers wear SRF. A voluntary payroll deduction program was available where onsite managers helped facilitate workers’ purchase of shoes through an approved SRF vendor. Workers could also purchase SRF from other sources of their own choosing. Because of this, researchers assumed that onsite managers would monitor SRF by workers in accordance with company policy. Assumptions were made about workers’ SRF usage in that if workers went through the effort to enroll in the voluntary no-cost SRF program, most workers would wear the shoes. This assumption is based on data from a previous research study done in food services where workers’ visually verified use of SRF was highest (with 91% of workers wearing them) in restaurants where footwear was provided by and paid for by the employer. We assumed our study would have a similar usage rate because the intervention was no cost. Our study found 94% of workers at the intervention sites were ordering high quality SRF as compared to 20% of workers ordering the same footwear at control sites.

    Workers’ compensation injury claims were used as an outcome measure in this study because, as a social insurance program, the workers’ compensation injury system covers the majority (an estimated 86.5%) of workplaces with employees in the US. Additionally, a company’s worker injury burden can play a role in its profitability, therefore businesses often use this metric in their decision-making processes. Workers’ compensation injury claims data, despite some limitations, are a widely-accepted and useful tool to monitor injuries and evaluate safety and health programs in the workplace.

    Verma SK, Courtney TK, Corns HL, Huang YH, Lombardi DA, Chang WR et al. Factors associated with use of slip-resistant shoes in US limited-service restaurant workers. Inj Prev 2012 Jun;18(3):176–81. https://doi.org/10.1136/ injuryprev-2011-040094.

    McLaren CF, Baldwin ML, Boden LI. 2018. Workers’ compensation: benefits, coverage, and costs (2016) data. National Academy of Social Insurance, October 2018, Washington, DC.

    Moore LL, Wurzelbacher SJ, Shockey TM. Workers’ compensation insurer risk control systems: opportunities for public health collaborations. J Safety Res 2018 Sep;66:141– 50. https://doi.org/10.1016/j.jsr.2018.07.004.

    McInnes JA, Akram M, MacFarlane EM, Keegel T, Sim MR, Smith P. Association between high ambient temperature and acute work-related injury: a case-crossover analysis using workers’ compensation claims data. Scand J Work Environ Health 2017 Jan;43(1):86–94. https://doi. org/10.5271/sjweh.3602.

    Wurzelbacher SJ, Al-Tarawneh IS, Meyers AR, Bushnell PT, Lampl MP, Robins DC et al. Development of methods for using workers’ compensation data for surveillance and prevention of occupational injuries among State-insured private employers in Ohio. Am J Ind Med 2016 Dec;59(12):1087–104. https://doi.org/10.1002/ajim.22653.

    Leigh JP, Robbins JA. Occupational disease and workers’ compensation: coverage, costs, and consequences. Milbank Q 2004;82(4):689–721. https://doi.org/10.1111/j.0887- 378X.2004.00328.x.

    Fan ZJ, Bonauto DK, Foley MP, Silverstein BA. Underreporting of work-related injury or illness to workers’ compensation: individual and industry factors. J Occup Environ Med 2006 Sep;48(9):914–22. https://doi. org/10.1097/01.jom.0000226253.54138.1e.

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