Evidence
Alert

Slip-resistant shoes would prevent injuries among NHS workers

NHS staff wearing slip-resistant footwear with proven grip are less likely to slip or fall at work than those wearing their own shoes. A new trial finds that specialist footwear could substantially reduce the risk of injury in healthcare settings. 

Previous research has found that slip-resistant footwear can prevent slips in other workplaces, among fishermen and school caterers.  But before this study, it was not known whether the specialist shoes would help in healthcare settings. 

The Stopping Slips among Healthcare Workers (SSHeW) trial examined the effect of shoes with proven grip (a five-star GRIP rating).  A group of NHS workers wearing this type of footwear had 37% fewer slips, and about half the number of falls resulting from a slip, compared to others wearing their usual shoes. 

This 14-week trial suggests that ultra-grip footwear should be considered in healthcare settings to reduce the risk of injury to staff. 

What’s the issue?

Slips, trips and falls are a major cause of injury in the workplace. They account for more than 100,000 injuries and almost one million days’ absence from work every year in the UK. The NHS has some of the highest incidents of these injuries in UK workplaces – perhaps due to smooth flooring in hospitals that can easily get wet or muddy. 

Some research suggests that wearing slip-resistant footwear can reduce the risks of slips and falls in the workplace. However, there has only been one high-quality trial to date, and it looked at food service workers in the US, rather than healthcare workers in the UK. 

The Health and Safety Executive (HSE) developed  a rating system called GRIP to determine how effective footwear is at preventing slips. The shoes in this study had the highest, five-star, GRIP rating. They had a rubber sole with an intricate tread pattern, which gave a large surface contact area and provided a high level of slip-resistance. Shoes with this rating are intended for the most challenging workplaces, such as hospitals.

Researchers at the University of York wanted to assess whether footwear that received a five-star rating was effective at preventing slips and falls in a hospital setting. 

What’s new?

This study included doctors, nurses, ward clerks, catering and cleaning staff from seven NHS Trusts in England.   The invitation to take part was accepted by about half (53%) of those invited, giving a study group of more than 4,500 workers.

Half of the participants were randomly allocated to receive a pair of HSE five-star GRIP-rated shoes. They were asked to wear the shoes at work for the 14 weeks of the study. A range of styles were offered by each trust. The other participants were asked to wear their usual work shoes. 

Every week, participants texted the researchers to let them know if they had experienced a slip at work that week.  At the end of the study, the volunteers filled in a questionnaire detailing any injuries they had experienced during the trial.  Researchers then interviewed 35 participants about their experiences of slips and slip prevention within the NHS workplace, of wearing the trial footwear and of being a trial participant. 

The study found that, on slips:

    • across both groups, two in five participants (40%) reported at least one slip and some reported more than one; there were 6743 slips in the 14 weeks of the trial
    • wearing specialist shoes led to a substantial reduction in slips (37% fewer) compared to usual footwear (2633 slips in the intervention group compared to 4110 among those in their usual shoes) 
    • nearly all slips occurred on wards, and more than three quarters on a smooth surface.

On falls:

    • across both groups, less than two in 100 slips led to a fall and most did not result in injury 
    • specialist shoes led to a large reduction (49%) in falls resulting from a slip.

On costs:

    • providing the shoes to hospital staff would be cost-saving overall. The cost to the NHS of providing the shoes would be outweighed by the benefits of reducing injuries to staff. 

Overall, participants were happy with the look and feel of the specialist footwear, describing it as ‘brilliant,’ ‘smart’ and ‘comfortable’. The prospect of getting the shoes was the main reason staff gave for taking part in the trial. Half of those who received the shoes wore them all the time at work. The more they wore the shoes, the lower their risk of a slip.

Why is this important?

To reduce slips and falls in hospitals, the first priority is to ensure that floors have minimal risk, for example by putting up a sign when they are wet.  But it is not possible to eliminate all risks. Slip-resistant footwear could reduce the number of slips and falls NHS staff have. This means NHS workers could experience fewer injuries and take less time off work.  The study found that providing shoes would be a cost-effective intervention.

Trusts may need to review their current footwear policies. Current policies state that footwear should be low-heeled and with a closed toe. Only four Trusts require non-slip footwear; none state how shoes should be assessed. Trusts could use the results from this study to help identify instances in which slip-resistant footwear should be provided. They could also provide guidance for staff on how to assess the slip-resistant properties of footwear.   

What’s next?

The researchers have informed the NHS Trusts that took part in the study about the findings, but they have not yet received feedback on any actions taken as a result. The researchers acknowledge that this is a complex issue as the cost of footwear classed as personal protective equipment (PPE) would have to be covered by the NHS.

The findings may apply in other settings. The trial could be repeated in other high-risk environments outside of health and social care.  Manufacturing and food-processing factories could similarly benefit from specialist footwear, as could settings such as the construction industry, where loose gravel or mud are common.

You may be interested to read

The full paper: Cockayne S, and others. Slip-resistant footwear to reduce slips among health-care workers: the SSHeW RCT. Public Health Research 2021;9:3

A paper based on this project: Cockayne S, and others. Slip-resistant footwear reduces slips among National Health Service workers in England: a randomised controlled trial. Occupational and Environmental Medicine, BMJ 2021;78:7 

The Health and Safety Executive: GRIP Ratings.

A US-based trial on slip-resistant footwear amongst food service workers: Bell JL, and others. Effectiveness of a no-cost-to-workers, slip-resistant footwear program for reducing slipping-related injuries in food service workers: a cluster randomised trial. Scandinavian Journal of Work, Environment and Health 2019;45:2 

 

Funding: This study is funded by the NIHR Public Health Research (PHR) and the Health and Safety Executive.

Conflicts of Interest: Shoes for Crews Ltd paid for footwear testing under the GRIP-rating scheme. 

Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Commentaries

Study author

Although the footwear being tested was called ‘slip-resistant’ at the start of the study, we didn’t know if they would actually reduce slips in the workplace.  The HSE had done some work to suggest they may work, but the footwear had never been tested in a real-life setting.  

This simple intervention could potentially have a large impact. For NHS staff, the footwear can help prevent painful injuries. For NHS management, the footwear can reduce the amount of sick leave staff take, a fact which is even more important given the current climate.

David Torgerson, Director of the York Trials Unit, University of York 

Study participants 

The floor had been mopped but there was no sign…  The person behind me slipped, really slipped… She had flat shoes on but she slipped. That’s when I became aware and thought probably these shoes prevented that.

I’ve never seen a grip like that on the bottom and when you walked on them there was no give in them, you know, you did feel safe walking in them.

Participants interviewed as part of the study 

Royal College of Nursing 

In future, NHS uniform policies may have to be updated to include environments where five star GRIP footwear should be worn. Ideally this would be directed by national guidance from NHS England. 

If slip-resistant shoes are recognised as a requirement in areas where there is a risk of slipping, then these will need to be funded as PPE which, according to the Health and Safety at Work Act, must be paid for by the employer.

Wendy Preston, Head of Nursing Practice, Royal College of Nursing