title: Rushing, distraction, walking on contaminated floors and risk of slipping in limited-service restaurants: a case--crossover study.
abstract: OBJECTIVE
  This nested case-crossover study examined the association between rushing, distraction and walking on a contaminated floor and the rate of slipping, and whether the effects varied according to weekly hours worked, job tenure and use of slip-resistant shoes.
  
  
  METHODS
  At baseline, workers from 30 limited-service restaurants in the USA reported average work hours, average weekly duration of exposure to each transient risk factor and job tenure at the current location. Use of slip-resistant shoes was determined. During the following 12 weeks, participants reported weekly their slip experience and exposures to the three transient exposures at the time of slipping. The case-crossover design was used to estimate the rate ratios using the Mantel-Haenszel estimator for person-time data.
  
  
  RESULTS
  Among 396 participants providing baseline information, 210 reported one or more slips with a total of 989 slips. Rate of slipping was 2.9 times higher when rushing as compared to working at a normal pace (95% CI 2.5 to 3.3). Rate of slipping was also significantly increased by distraction (rate ratio (RR) 1.7, 95% CI 1.5 to 2.0) and walking on a contaminated floor (RR 14.6, 95% CI 12.6 to 17.0). Use of slip-resistant shoes decreased the effects of rushing and walking on a contaminated floor. Rate ratios for all three transient factors decreased monotonically as job tenure increased.
  
  
  CONCLUSIONS
  The results suggest the importance of these transient risk factors, particularly floor contamination, on rate of slipping in limited-service restaurant workers. Stable characteristics, such as slip-resistant shoes, reduced the effects of transient exposures.
authors.affiliation: Center for Injury Epidemiology, Liberty Mutual Research Institute for Safety, Hopkinton, Massachusetts, USA.
authors.forename: Santosh K
authors.initials: SK
authors.lastname: Verma
authors.forename: David A
authors.initials: DA
authors.lastname: Lombardi
authors.forename: Wen Ruey
authors.initials: WR
authors.lastname: Chang
authors.forename: Theodore K
authors.initials: TK
authors.lastname: Courtney
authors.forename: Yueng-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.forename: Melanye J
authors.initials: MJ
authors.lastname: Brennan
authors.forename: Murray A
authors.initials: MA
authors.lastname: Mittleman
authors.forename: James H
authors.initials: JH
authors.lastname: Ware
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Perry
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000062:Accidents, Occupational / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D001288:Attention; D004812:Epidemiologic Methods; D005260:Female; D005430:Floors and Floorcoverings; D006801:Humans; D008297:Male; D008875:Middle Aged; D010561:Personnel Staffing and Scheduling / Q000706:statistics & numerical data; D012147:Restaurants / Q000706:statistics & numerical data*; D012775:Shoes; D013499:Surface Properties; D014481:United States / Q000453:epidemiology; D055815:Young Adult