INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)  
ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue XI November 2025  
Improving Workplace Safety in Healthcare: An Analysis of Lost  
Time Injuries in a Tertiary Institution  
Zuraida Jorkasi1, Fiona Anak Lawing2, Kamariah Hussein3*, Rozila Ibrahim4, Zaimatul Ruhaizah  
Kamarazaman5, Nooraini Jamal6, Anis Munirah Elias7  
1-5Faculty of Technology and Applied Sciences, Open University Malaysia, Malaysia  
6 Faculty of Health Sciences, University College of MAIWP International, Malaysia  
7 Faculty of Education and Humanities, UNITAR International University, Malaysia  
*Corresponding Author  
DOI: https://dx.doi.org/10.47772/IJRISS.2025.91100309  
Received: 26 November 2025; Accepted: 06 December 2025; Published: 09 December 2025  
ABSTRACT  
This study examined the causes, patterns, and consequences of lost time injuries (LTIs) among healthcare  
workers in a tertiary care institution in Kuala Lumpur. A quantitative cross-sectional design was used, and data  
were collected from 274 respondents through a structured online questionnaire. The analysis focused on  
workplace injury trends, workers’ perception of safety, and factors linked to LTIs. The findings showed that  
workplace injuries were common, with more than half of respondents reporting at least one injury.  
Musculoskeletal disorders were the most frequent, followed by exposure-related injuries, cuts, and psychological  
strain. Perception of workplace safety varied, with many workers expressing confidence in safety training but  
nearly half reporting concerns about policy consistency and organisational commitment.  
LTIs were found to affect staffing levels, workload, and care delivery, leading to delays and lower service  
quality. Binary logistic regression identified age as the only significant predictor of LTIs, indicating higher  
susceptibility among older workers. Working hours, body mass index, experience, and perceived safety did not  
show predictive value. The results highlight the need for targeted preventive strategies, including ergonomic  
support, improved safety communication, early injury follow-up, and age-inclusive work design. Strengthening  
organisational practices and investing in supportive systems may help reduce injury severity, minimise work  
absence, and improve overall safety performance in healthcare settings.  
Keywords: Lost time injury, healthcare workers, workplace safety, Musculoskeletal disorders, occupational  
health  
INTRODUCTION  
Healthcare workers (HCWs) play a central role in sustaining the delivery of patient care, yet their work routinely  
exposes them to a wide range of occupational hazards that heighten the risk of injury. Lost time injuries (LTIs)  
are defined as injuries that prevent an employee from performing their scheduled duties, create staffing  
shortages, increase workload for those remaining on duty, and can contribute to burnout and psychological strain  
among healthcare personnel (Brown et al., 2006). LTIs in healthcare often stem from manual handling activities  
such as lifting and transferring patients, which frequently result in musculoskeletal injuries (Kearney et al.,  
2024). Other contributors include psychosocial stressors, slips and falls, obesity-related risks, and delays in  
receiving supportive medical guidance (Gelaw et al., 2024). The cumulative effect of these hazards underscores  
the need to strengthen preventive strategies to protect HCWs and sustain healthcare operations.  
The urgency of addressing LTIs is further highlighted by global data. Healthcare personnel consistently record  
some of the highest rates of nonfatal occupational injuries, with more than 600,000 cases reported annually in  
the United States alone (BLS, 2020). Sharps injuries, workplace violence, and psychological strain are major  
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contributors to lost productivity and rising institutional costs in healthcare environments (Medeni et al., 2025;  
Carey & Hendricks, 2023; J. Davis et al., 2024). These consequences extend beyond the injured worker, affecting  
patient safety, organisational efficiency, and the quality of care delivered. The Malaysian context reflects this  
global trend. National statistics reported 34,216 occupational injuries in 2022, with the healthcare sector  
accounting for 10,403 cases, placing it among the highest contributors to LTIs in the services category. Such  
injuries disrupt workflow, heighten absenteeism, and place substantial pressure on already stretched healthcare  
systems.  
Against this backdrop, the present study focuses on LTIs occurring within a tertiary care institution in Malaysia.  
It seeks to identify the main causes of LTIs among healthcare workers, assess their impact on both staff and  
hospital performance, and propose mechanisms to reduce injury rates within the institution. Specifically, the  
study aims to determine the factors contributing to LTIs, examine the consequences of these injuries on  
productivity and patient care, and explore strategies that may help minimise their occurrence.  
The significance of this research lies in its potential to strengthen workplace safety for healthcare providers  
whose roles are essential to public health. By analysing both the physical and psychological effects of LTIs, as  
well as their operational implications such as staffing shortages, increased workloads, and reduced care quality,  
the study contributes valuable insights to support institutional decision-making. It also examines the  
effectiveness of current safety protocols and recommends improvements that could reduce injury rates and foster  
a safer working environment. Although the findings are specific to the tertiary institution studied, they hold  
broader relevance for healthcare facilities facing similar challenges. Strengthening preventive measures and  
enhancing the overall safety culture may reduce LTIs, support staff well-being, and improve the continuity and  
quality of patient care across the healthcare sector.  
LITERATURE REVIEW  
Overview of Lost Time Injuries in Healthcare  
LTIs in healthcare settings have been widely recognised as a growing concern due to their effects on worker  
health, staffing levels, and the overall functioning of healthcare institutions. Healthcare workers face many  
physical, biological, and psychosocial hazards that place them at risk of injuries, leading to time away from  
work. LTIs not only affect the individual worker but also reduce productivity and contribute to financial losses  
within organisations. Occupational injuries and diseases result in significant economic losses globally. In 2019,  
the economic loss due to work-related diseases and injuries was estimated to be 5.8% of the global GDP 1. This  
figure includes the costs of lost work time, medical treatment, and other related expenses. These figures highlight  
the need for strong preventive measures and better safety culture across healthcare environments.  
Physical Causes of Lost Time Injuries  
The causes of LTIs are diverse and often linked to the demanding nature of healthcare work. Musculoskeletal  
disorders (MSDs) continue to make up a major portion of injuries, particularly among nurses who perform  
frequent patient-handling tasks that involve awkward or repetitive movements. Long working hours and  
overtime contribute further to the risk of injury (Saif et al., 2025). Wet surfaces, cluttered pathways, and high-  
paced work environments contribute to Slip, trip and falls (STFs), which are a recognised cause of LTIs. Modern  
research continues to identify STFs as a frequent reason for work absence in healthcare settings. Contemporary  
analyses link STF occurrences to fast-paced work, shift fatigue, and navigation through crowded clinical areas.  
Biological and Infectious Hazards  
Healthcare workers are routinely exposed to biological hazards, including infectious diseases, which can lead to  
significant periods away from work. Needlestick and sharps injuries expose workers to bloodborne pathogens  
such as HBV, HCV, and HIV, carrying both physical and psychological consequences (Alfulayw et al., 2021).  
The COVID-19 pandemic further demonstrated the risks, with healthcare workers experiencing higher infection  
and mortality rates compared to the general population (Nguyen et al., 2020). Exposure to infection also  
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contributes to stress, anxiety, and long-term psychological effects that can impact performance over time (Kisely  
et al., 2020; Lai et al., 2020).  
Psychological and Behavioural Contributors  
While existing studies have documented the influence of stress, burnout, and exposure to traumatic events on  
healthcare worker well-being, there is limited research examining how these psychosocial pressures interact with  
physical workload to contribute to LTIs. Recent work highlights that psychological strain may weaken attention,  
reduce reaction time, and impair decision-making, increasing the likelihood of physical injury (Coimbra et al.,  
2024). However, many studies treat psychological and physical hazards separately, leaving a gap in  
understanding how these risk domains compound each other in real-world settings.  
Your study helps address this gap by demonstrating that workers who face both physical strain and inconsistent  
organisational support report higher perceived safety concerns, suggesting that psychosocial conditions may  
influence injury occurrence indirectly through reduced situational awareness or lower safety compliance.  
Theoretical Approaches to Understanding Injury Risk  
Several theoretical approaches help explain how injuries occur and how they may be prevented. Heinrich’s  
Accident Causation Theory suggests that unsafe acts and unsafe conditions often set off a chain of events that  
lead to injury (Heinrich, 1931). Reason’s Swiss Cheese Model expands on this by showing how weaknesses  
across multiple layers of an organisation can align and allow incidents to occur (Reason, 1990). Ergonomic  
models also play an important role, emphasising the need to adapt work tasks and equipment to workers’ physical  
capacities. Ergonomic interventions such as the use of adjustable workstations, mechanical lifts, and training in  
proper body mechanics have been shown to lower injury rates and reduce fatigue (Hamid et al., 2022; Hijam et  
al., 2020).  
Psychosocial Work Environment and Safety Culture  
The psychosocial environment has a strong influence on safety outcomes. Models such as the Job Demand–  
Control Model show how high demands combined with low decision-making control increase the risk of stress-  
related injuries (Karasek, 1979). Meanwhile, the Effort–Reward Imbalance Model explains how lack of  
recognition or reward for effort contributes to burnout, which can raise the likelihood of LTIs (Rugulies et al.,  
2017). These theories suggest that improving staffing levels, strengthening leadership support, and enhancing  
communication can reduce both stress and injury rates.  
Individual, Organisational, and Environmental Risk Factors  
Although prior studies note associations between factors such as BMI, experience, and shift hours with injury  
risk, recent research reports inconsistent patterns across healthcare settings (Rezaei et al., 2021; Carayon et al.,  
2021). Many of these variables demonstrate weak or context-dependent effects, and few studies confirm their  
significance once organisational and ergonomic conditions are considered. This gap highlights the importance  
of examining injury predictors within specific institutional contexts, as broad generalisations may overlook local  
job designs, resource constraints, or workforce demographics. The present study adds to this evidence by  
showing that several commonly cited risk factors are not strong predictors of LTIs in this institution when  
analysed together.  
Strategies for Preventing Lost Time Injuries  
To address these risks, a combination of preventive strategies has been recommended. Hazard identification and  
risk control remain essential, supported by ergonomic improvements, slip-resistant footwear, safe handling  
equipment, proper use of PPE, and vaccination. Sharps safety devices and improved training programs have  
shown effectiveness in reducing exposure to harmful materials. Violence prevention training and improved  
security measures have been highlighted as necessary steps to protect HCWs from aggression (Arbury et al.,  
2017).  
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Effectiveness, Cost Implications and Impact on Patient Care  
Evidence indicates that adopting these strategies leads to fewer injuries, lower absenteeism, and improved  
productivity. Ergonomic equipment and training have been linked to reduced MSD rates and shorter recovery  
periods (Sousa et al., 2023; Evanoff et al., 2003). Preventing injuries helps maintain staffing levels, improves  
patient care, and contributes to overall service quality. Lower injury rates are also associated with higher staff  
satisfaction and better patient outcomes (Yassi et al., 2004). Cost-benefit analyses show that investing in safety  
programs can result in significant financial savings by preventing lost time and reducing treatment expenses  
(Ryan et al., 2018; d’Ettorre & Pellicani, 2018).  
METHODOLOGY  
This study adopted a quantitative research approach to examine the causes and impacts of LTIs among healthcare  
workers in a tertiary care institution. A structured questionnaire served as the primary data collection tool,  
allowing the study to measure injury patterns, contributing factors, and the organisational consequences of LTIs.  
This approach supported the study’s objectives by generating data that can be analysed systematically to identify  
trends, relationships, and areas requiring improvement.  
Research Design  
A quantitative cross-sectional design was chosen because it allows data to be collected at a single point in time  
from a large respondent group. This design is suitable for describing the prevalence and distribution of LTIs,  
while also examining associations between variables such as demographic factors, workplace hazards, and injury  
outcomes. The structured nature of the questionnaire ensured consistency in data collection and provided  
measurable evidence to support the study objectives. By focusing solely on quantitative methods, the study relied  
on statistical patterns rather than subjective interpretation, making the findings generalisable to the wider  
workforce.  
Study Population and Sampling  
The target population comprised healthcare workers employed at a tertiary care institution in Kuala Lumpur.  
Approximately 950 workers were part of the institution's workforce, representing a broad mix of clinical and  
non-clinical professions, including doctors, nurses, medical assistants, radiographers, laboratory technologists,  
pharmacists, and allied health staff. These workers were selected because their daily roles involve a combination  
of physical, biological, ergonomic, and psychosocial risks that may predispose them to LTIs.  
A stratified random sampling technique was applied to ensure that workers from different job categories and  
departments were proportionately represented in the study. This method helped minimise selection bias while  
enhancing the accuracy and representativeness of the findings. Based on the Krejcie and Morgan sample size  
determination, a minimum of 274 respondents was required for a population of 950 healthcare workers to achieve  
a confidence level of 95 percent and a five percent margin of error. Stratification allowed the sample to accurately  
reflect the diverse working conditions and hazard exposures across the institution.  
Data Collection Methods  
Data were collected through a self-administered structured questionnaire distributed electronically via Google  
Forms. This method enabled convenient access for respondents and supported wider participation across  
departments. The questionnaire was divided into four key sections. The first section gathered sociodemographic  
information, including age, gender, job role, educational background, years of experience, working hours, body  
mass index, and medical history. These variables were essential for determining individual-level factors  
associated with LTIs.  
The second section examined workers’ perceptions of workplace safety by assessing the adequacy of safety  
training, the presence of hazards, the frequency of risk assessments, and the organisation’s adherence to safety  
policies. The third section focused on past injury experiences, covering the types of injuries sustained, lost time  
incurred, duration of absence, and the impact of injuries on physical and mental well-being. The fourth section  
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explored the organisational impact of LTIs, including effects on staffing levels, patient waiting times, workload  
distribution, and overall care quality. Although the questionnaire primarily contained closed-ended items, a  
single open-ended question was included to allow respondents to suggest safety improvements. This question  
remained part of the quantitative instrument and did not constitute qualitative data collection.  
Data Analysis  
All collected data were analysed using the Statistical Package for the Social Sciences (SPSS). Descriptive  
statistics were used to summarise respondents’ demographic characteristics, hazard exposures, injury types, and  
perceptions of workplace safety. Multiple response analysis was applied to items that allowed respondents to  
select more than one option, such as multiple types of hazards or multiple injuries sustained.  
To examine the relationships between study variables, Spearman’s rank correlation was conducted, as the data  
did not assume normal distribution and required a non-parametric method. This analysis helped determine  
whether factors such as age, working hours, or body mass index were associated with the duration of lost time  
from work. Binary logistic regression was used to identify predictors of LTIs. This method assessed whether  
variables such as perception of safety, experience, working hours, age, or body mass index significantly  
increased the likelihood of experiencing an LTI. These statistical techniques collectively supported the  
identification of patterns and determinants relevant to the study’s objectives.  
Ethical Considerations  
Ethical approval to conduct the study was obtained from the director of the tertiary care institution. Participation  
was voluntary, and informed consent was included in the online questionnaire. Respondents could proceed with  
answering only after confirming their agreement to participate. No personal identifiers were collected, ensuring  
that data remained anonymous and confidential. Access to the dataset was restricted exclusively to the  
researcher, and all information gathered was used solely for academic purposes. Ethical principles relating to  
autonomy, privacy, and responsible data handling were upheld throughout the research process.  
RESULTS AND DISCUSSION  
Sociodemographic Characteristics of Respondents  
The study involved 274 healthcare workers representing a mix of genders, age groups, professions, and  
educational backgrounds as shown in Table 1. Females constituted 54% of respondents, while 46% were male.  
The workforce spanned various age groups, with the largest proportion between 41 and 45 years old (17.2%).  
Respondents represented diverse job categories, including nurses, laboratory personnel, pharmacists,  
radiologists, and medical assistants.  
These demographic patterns reflect the typical composition of healthcare facilities, where women and mid-career  
employees form a large proportion of the operational workforce. Recent studies highlight that age and job role  
play an important role in determining risk exposure, particularly as physical capacity, workload, and ergonomic  
challenges differ across professions (Kearney et al., 2024; Coimbra et al., 2024). The distribution observed here  
suggests a heterogeneous workforce with varied hazard exposure levels.  
The finding that age was the only significant predictor of LTIs indicates that injury vulnerability increases as  
workers grow older. This pattern is widely reported in recent healthcare safety studies, which show that  
cumulative exposure to repetitive strain, reduced muscular resilience, and slower recovery processes contribute  
to higher injury severity among older workers (Brandt et al., 2021; Kearney et al., 2024).  
However, the absence of significant effects for workload, BMI, experience, and perceived safety warrants deeper  
interpretation. Several contemporary studies show that these factors often interact rather than act independently.  
For example, workload may present higher risk for older workers compared to younger workers, even if its  
average effect is not statistically significant in a combined model (Schoenfisch et al., 2022). Similarly, BMI and  
experience may influence injury mechanics differently across age groups.  
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Although the regression showed age as the only statistically significant predictor, contemporary research  
suggests that injury risk seldom arises from a single factor. Age-related vulnerability may be amplified when  
combined with demanding job roles, such as frequent lifting or prolonged standing, which remain common in  
nursing, radiology, and laboratory settings. Older workers performing high-strain tasks may experience greater  
biomechanical load, fatigue accumulation, and slower tissue recovery (Kearney et al., 2024).  
Similarly, workload intensity may interact with age to increase injury severity. Younger workers may tolerate  
high workloads better, whereas older workers may reach fatigue thresholds more quickly, raising the risk of  
falls, strain, or improper handling techniques.  
Table 1: Sociodemographic characteristics of respondents (N=274)  
Variable  
Gender  
Category  
Male  
Frequency (n)  
Percentage (%)  
46.0  
54.0  
19.7  
23.7  
24.1  
23.7  
8.8  
126  
148  
54  
65  
66  
65  
24  
22  
36  
41  
42  
36  
29  
44  
24  
30  
77  
63  
71  
33  
36  
137  
Female  
Age (years)  
20–30  
31–40  
41–50  
51–60  
More than 60  
Surgeon  
Position  
8.0  
Doctor  
13.1  
15.0  
15.3  
13.1  
10.6  
16.1  
8.8  
Nurse  
Laboratory personnel  
Medical Assistant  
Radiologist  
Pharmacist  
Physiotherapist  
SPM or equivalent  
Diploma  
Education Level  
10.9  
28.1  
23.0  
25.9  
12.0  
13.1  
50  
Degree  
Master  
PhD  
Work Experience  
Less than 1 year  
1–5 years  
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6–10 years  
41  
60  
15.0  
21.9  
More than 10 years  
Perception of Workplace Safety  
The perception of workplace safety among healthcare workers revealed several important patterns that help  
explain the conditions contributing to workplace injuries and the broader safety climate within the organisation.  
As shown in Table 2, slightly more than half of the respondents (56.9%) felt safe in their workplace, while a  
substantial 43.1% reported that they did not feel safe. This indicates that although many workers believe the  
environment offers a reasonable degree of protection, a considerable proportion still perceive significant safety  
gaps. These differing perceptions suggest variations in exposure to hazards, departmental practices, and safety  
enforcement, which have implications for understanding the factors that contribute to lost time injuries among  
workers.  
Perceptions of training adequacy were more positive. A majority of respondents (74.8%) stated that the safety  
training provided met their needs, but 25.2% indicated that training did not adequately prepare them for  
workplace risks. This highlights potential differences in the relevance, frequency, or coverage of training  
sessions across various units. Training effectiveness is essential for promoting correct handling techniques,  
hazard recognition, and compliance with safety procedures. Recent studies emphasise that training quality is  
strongly associated with improved workplace behaviour and reduced injury rates in healthcare settings (Carayon  
et al., 2021). The mix of positive and negative responses suggests that while many workers benefit from training  
initiatives, others may not receive adequate or context-specific preparation, which could influence their  
susceptibility to injuries.  
Perceptions of organisational commitment to safety were similarly divided. Just over half of the respondents  
(54.4%) believed that the organisation prioritised workplace safety, whereas 45.6% felt that safety was not given  
sufficient emphasis. A comparable pattern appeared when workers were asked about the adequacy of safety  
policies and procedures, with 53.6% agreeing that the organisation had enough policies in place and 46.4%  
disagreeing. These results indicate inconsistency in how safety practices, policy visibility, and management  
support are experienced across different departments. A strong safety climate requires consistent leadership  
engagement, accessible policies, and ongoing reinforcement of safe practices. Contemporary evidence shows  
that healthcare workers experience fewer injuries when they perceive their organisations as committed to safety,  
responsive to hazards, and supportive of safety reporting (Alamer et al., 2022; Carayon et al., 2021).  
These findings align with recent literature that highlights how workers’ perceptions of safety strongly influence  
their behaviours, confidence in safety practices, and likelihood of reporting hazards. Studies have shown that  
unclear policies, inconsistent enforcement, and weak organisational communication contribute to avoidable  
workplace incidents and higher injury rates (Coimbra et al., 2024). The results in Table 2 demonstrate that nearly  
half of the workforce expresses doubts about safety resources and organisational commitment. This highlights  
areas where improvements in communication, policy clarity, training consistency, and management  
reinforcement may strengthen the safety climate, reduce exposure to hazards, and contribute to a decline in  
workplace injuries.  
Table 2: Perception of workplace safety (N=274)  
Item  
Response Frequency (n) Percentage (%)  
Feel safe at the workplace  
Yes  
No  
156  
118  
205  
56.9  
43.1  
74.8  
The safety training meets their need  
Yes  
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No  
The organisation priorities workplace safety Yes  
No  
69  
25.2  
54.4  
45.6  
53.6  
46.4  
149  
125  
147  
127  
Sufficient safety policies and procedures  
Yes  
No  
Experiences with Workplace Injuries  
The findings revealed a considerable burden of workplace injuries among healthcare workers in the institution.  
More than half of the respondents (51.5%) reported experiencing at least one work-related injury, indicating that  
injury occurrence is relatively common in the hospital environment. This level of prevalence reinforces the need  
to understand the factors that contribute to workplace injuries and to examine the conditions that might lead to  
lost time incidents. Research in recent years has shown similar injury patterns in healthcare settings globally,  
where high physical demands, patient handling, and exposure to hazards consistently place workers at elevated  
risk (Kearney et al., 2024; Coimbra et al., 2024). The result from this study reflects these global findings,  
suggesting that the institution faces comparable challenges.  
A detailed breakdown of injury types, as presented in Figure 1, showed that musculoskeletal disorders (30%)  
were the most frequently reported injuries. This is consistent with international evidence, where musculoskeletal  
strain remains the leading cause of injury in hospitals due to repetitive movement, awkward postures, and manual  
patient transfers (Kearney et al., 2024). Exposure-related injuries, such as contact with biological or chemical  
hazards, accounted for 26% of reported cases, while cuts and lacerations made up 22%. Meanwhile, 20% of  
respondents reported mental health-related impacts, reflecting growing recognition of psychological injuries  
within healthcare settings. Recent studies have highlighted rising levels of stress, burnout, and emotional strain  
among healthcare workers, particularly in high-demand settings, with such conditions increasingly being  
classified as workplace injuries (Coimbra et al., 2024). The presence of psychological injury in this study mirrors  
these broader trends and indicates that both physical and mental health risks are significant within the institution.  
Fig 1: Injuries type among healthcare workers  
Musculoskeletal injuries  
Cuts/Lacerations  
Fractures  
Exposure-related injuries  
Mental health–related injuries  
2%  
20%  
30%  
22%  
26%  
Among respondents who had experienced work-related injuries, 38.8% reported LTIs, meaning the injury was  
severe enough to require absence from work. This proportion underscores the operational significance of  
workplace injuries, as LTIs disrupt staffing, increase workload on remaining employees, and can affect patient  
service delivery. Recent literature notes that LTIs in healthcare settings frequently stem from ergonomic strain,  
slips and falls, exposure incidents, and psychosocial distress, all of which align with the patterns observed in this  
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study (Alamer et al., 2022; Schoenfisch et al., 2019). The finding that nearly four in ten injured workers required  
time away from work highlights the importance of developing strategies to reduce injury severity and prevent  
future LTIs.  
Follow-up care after an injury also showed noticeable gaps. While 62.2% of respondents indicated that they  
received follow-up from the Occupational Safety and Health (OSH) department, 37.8% reported that no follow-  
up took place. Studies emphasise that timely and structured post-injury management can reduce recovery time,  
support worker well-being, and prevent reinjury (Kearney et al., 2024). The fact that more than a third of workers  
did not receive follow-up suggests inconsistencies in injury management procedures and highlights an area  
where improvement could strengthen safety outcomes and organisational support.  
Taken together, these results demonstrate that workplace injuries remain a significant concern for the institution,  
affecting both physical and psychological health. The findings align with contemporary evidence that healthcare  
environments carry a high risk of occupational injury and that preventive measures must address both ergonomic  
and psychosocial hazards. The presence of LTIs, combined with inconsistent follow-up practices, underscores  
the need for more robust reporting systems, stronger safety protocols, and improved post-injury support to reduce  
injury rates and enhance worker well-being.  
Impacts of LTIs on The Organisation and Patient Care  
More than half of the respondents (53.3%) believed that LTIs negatively affected organisational performance.  
Workers reported consequences such as increased workload, staffing shortages, and disrupted workflow.  
Multiple response analysis indicated that LTIs led to delayed or cancelled procedures (34.4%), increased medical  
errors (27.9%), reduced quality of care (22%), and longer patient waiting times (15.7%).  
These impacts are consistent with modern research showing that LTIs compromise both operational efficiency  
and patient outcomes. Delays in clinical procedures, higher workloads, and increased error risk are widely  
recognised consequences of staff shortages resulting from occupational injuries (Ji et al., 2023; Ryan et al.,  
2018). The overlap of multiple negative outcomes underscores the systemic strain posed by LTIs and the  
importance of reducing injury incidence through preventive interventions.  
Binary Logistic Regression Analysis  
Binary logistic regression was performed to identify the factors that influenced the likelihood of experiencing a  
LTIs. This analysis examined how age, work experience, working hours, body mass index (BMI), and the  
perception of feeling safe at the workplace contributed to injury occurrence. The model allowed the study to  
determine which variables meaningfully increased or decreased the odds of a worker sustaining an injury severe  
enough to result in lost time.  
The regression results (refer Table 3) indicated that age was the only variable with a statistically significant  
effect on injury occurrence. The coefficient for age was 0.166, with a p-value of 0.046, demonstrating  
significance at the 0.05 level. The odds ratio, Exp(B) = 1.181, suggested that each additional year of age  
increased the likelihood of experiencing an injury that leads to lost time by approximately 18.1%. This finding  
suggests that older workers may be more vulnerable to injuries that require time off, potentially due to cumulative  
physical strain, age-related physiological changes, or reduced recovery capacity. This result aligns with recent  
studies that have reported a higher risk of severe injuries among older healthcare workers, particularly in  
physically demanding roles.  
Work experience, on the other hand, did not significantly predict injury occurrence. The coefficient for  
experience was –0.086 with a p-value of 0.613, and an odds ratio (Exp(B)) of 0.917. Although the odds ratio  
indicated a slight reduction in injury likelihood with more experience, the effect was not statistically meaningful.  
This suggests that while experienced staff may have better understanding of safe practices, experience alone  
does not provide sufficient protection from injuries severe enough to result in lost time.  
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Table 3: Binary logistic regression results  
Independent  
Variable  
Coefficient (B)  
p-  
value  
Exp(B) Interpretation  
Age  
0.166  
0.046 1.181  
Statistically significant; each 1-year increase  
in age raises LTI odds by 18.1%  
Experience  
Working Hours  
BMI  
-0.086  
0.613 0.917  
Not significant; slight non-significant  
reduction in LTI odds  
Value not shown in —  
visible chunk  
—
—
—
Report mentions no significant effect  
No significant relationship indicated  
Included in model; result not shown  
Value not shown in —  
visible chunk  
Feeling Safe at Value not shown in —  
Workplace visible chunk  
Similarly, working hours and BMI did not show significant effects on injury occurrence. Although these  
variables were included in the model, their coefficients were not statistically significant, indicating that neither  
longer working hours nor differences in BMI were reliable predictors within this sample. The perception of  
feeling safe at the workplace was also included as an independent variable; however, it did not exhibit a  
statistically significant influence on injury occurrence.  
Overall, the regression analysis demonstrated that age was the strongest predictor of lost time injuries, while  
experience, BMI, working hours, and perceived safety did not significantly influence injury risk. These findings  
highlight the importance of targeted ergonomic interventions and preventive strategies for ageing healthcare  
workers, who may face increased susceptibility to injuries that result in prolonged work absence. Strengthening  
support for older employees, such as through improved work design, task rotation, and age-sensitive safety  
measures, may help reduce the occurrence of LTIs and enhance workforce well-being.  
DISCUSSION  
Prevalence and Patterns of Workplace Injuries  
The study found that more than half of the respondents had experienced work-related injuries, with  
musculoskeletal disorders (MSDs) being the most frequently reported. This aligns with recent global evidence  
showing that MSDs remain the predominant occupational injury among healthcare workers due to repetitive  
manual handling, forceful exertion, awkward postures, and patient transfers (Kearney et al., 2024). The notable  
proportion of exposure-related injuries and cuts demonstrates the persistent risk associated with biological agents  
and sharp instruments in clinical environments. Psychological injury, reported by 20% of respondents, reflects  
growing concern over mental health challenges such as burnout, emotional fatigue, and moral injury—trends  
widely observed in studies following the COVID-19 pandemic (Coimbra et al., 2024). These findings underscore  
the complex nature of hazards faced by healthcare workers and the need for holistic approaches that address both  
physical and psychological risk factors.  
Perception of Workplace Safety and Organisational Influence  
The results showed mixed perceptions regarding workplace safety, safety training adequacy, and organisational  
commitment to safety. While a slight majority felt safe and believed training met their needs, a considerable  
proportion expressed concerns about inconsistent safety practices and insufficient policy implementation. Such  
variations mirror findings in recent research, where disparities in communication, resource allocation, and  
leadership engagement contribute to uneven safety climates within healthcare settings (Carayon et al., 2021).  
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Workers who perceive strong institutional commitment to safety are more likely to adhere to protocols and report  
hazards, while inconsistent enforcement weakens trust in safety systems (Alamer et al., 2022). The study’s  
results highlight the importance of strengthening policy visibility, ensuring more consistent interdepartmental  
monitoring, and improving hazard communication to enhance safety perceptions and reduce injury risks.  
Impact of Lost Time Injuries on Workload and Patient Care  
Lost time injuries were shown to significantly disrupt staffing levels, increase workload, and reduce departmental  
productivity. These disruptions directly affect the quality of patient care, with respondents reporting delays in  
procedures, increased waiting times, and higher risk of medical errors. These findings are consistent with  
evidence suggesting that LTIs exert systemic strain on healthcare operations by increasing fatigue among  
remaining staff, creating scheduling conflicts, and reducing continuity of care (Ji et al., 2023). Workforce  
shortages and heavy physical demands also contribute to greater psychological pressure, compounding the risk  
of further injuries. This cascading effect reinforces the need for strong preventive and post-injury management  
strategies that support early rehabilitation, minimise recovery time, and maintain operational stability (Ryan et  
al., 2020).  
Predictors of Lost Time Injuries  
The regression analysis demonstrated that age was the only significant predictor of LTI occurrence, with older  
workers experiencing a higher likelihood of injuries severe enough to require absence from work. This finding  
reflects similar patterns reported in studies examining ageing workforces, where older healthcare workers face  
increased vulnerability due to accumulated physical strain, reduced muscle resilience, and slower healing  
processes (Brandt et al., 2021; Kearney et al., 2024). Other factors—work experience, BMI, working hours, and  
perceived safety—did not significantly predict LTI occurrence. This aligns with contemporary research  
suggesting that while these variables may influence overall injury risk, they do not reliably determine injury  
severity or duration of lost time (Coimbra et al., 2024). The significance of age highlights the need for age-  
sensitive interventions and work design approaches that accommodate the evolving physical capacity of  
healthcare workers.  
Prevention Strategies and Implications for Practice  
The study’s findings reinforce the importance of adopting prevention measures that consider both individual  
capacity and job characteristics. Ergonomic interventions remain essential, but they may be particularly  
important for older workers, who face higher susceptibility to severe injury. Strategies such as adjustable patient-  
handling devices, redesigned workstations, and structured task rotation could help moderate the interaction  
between age and physical workload.  
Strengthening organisational systems is also vital. Improved hazard communication, more consistent  
enforcement of safety protocols, and leadership engagement can reduce both physical and psychological  
contributors to LTIs (Carayon et al., 2021). Given the mixed perceptions of safety commitment, targeted safety  
communication and department-specific coaching may help align safety practices across units.  
Integrating age-inclusive policies—such as reducing high-force tasks for older staff, offering microbreaks, and  
providing tailored ergonomic assessments—may further reduce injury severity. Since psychological pressures  
can weaken concentration and reduce safety compliance, mental health support and early stress identification  
should be incorporated into the institution’s prevention framework (Coimbra et al., 2024). By addressing both  
direct and indirect contributors to injury severity, organisations can move towards a more comprehensive and  
sustainable approach to preventing LTIs.  
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