Exoskeletons in hospitals: occupational safety for a strained system

Nurses perform physically demanding tasks every day when caring for patients. Surgeons remain in tense positions during operations. How long can staff endure this, and how can hospitals relieve the strain? Exoskeletons could be part of the answer. This is why hospitals should invest in this technology now.

Exoskeletons relieve strain on the body, reduce the risk of musculoskeletal disorders, and thus help maintain the ability to work. Their purchase is therefore not only an ergonomic issue, but also a strategic decision to support hospitals’ valuable skilled workers.

The shortage of skilled workers in the healthcare sector also affects key occupational safety issues in hospitals. Nurses and surgeons are often subjected to high levels of physical strain. Lifting, repositioning, standing for long periods, and working in static positions are part of their everyday routine. This puts strain on their backs, shoulders, and joints.

This can lead to musculoskeletal disorders, which are a common cause of absenteeism in the healthcare sector. Long-term sick leave or even early retirement place an organizational and economic burden on hospitals. Forbes magazine recently highlighted the significance of absenteeism due to occupational illnesses in the US healthcare system. As a result, hospital operators should focus on health promotion and prevention in hospitals.

Various hospitals have already tested, or are still testing, how exoskeletons can relieve the strain on staff. For example, in nursing care:

• Magdeburg University Hospital has been testing the passive back exoskeleton "BionicBack" since 2023 (German website).
• The m&i-Fachklinik Enzensberg uses exoskeletons in the neurological field to assist nursing staff in transferring patients between beds and wheelchairs (German website).
• At Nancy University Hospital, the passive "Laevo" exoskeleton was used in the intensive care unit during the COVID-19 pandemic to turn patients during ventilation.
• The Rosenheim Hospital Association uses the active exoskeleton "Apogee+" from German Bionic to assist with strenuous nursing tasks, as does the GPR Clinic in Rüsselsheim am Main (German websites).

Exoskeletons have also been used in the OR:

• Since 2020, the passive Paexo Shoulder exoskeleton from Ottobock and its successor, the IX Should Air from SUITX by Ottobock, have been providing support in operating rooms.
• In the US, a pilot study by the Mayo Clinic investigated the integration of a passive arm support system in vascular surgery.
• Another example from the US is a study by four universities. In this study, a passive upper body exoskeleton was tested for surgical assistants, which makes it easier to wear lead aprons.

The technical spectrum ranges from passive to active systems (you can find out more about the technical basics of exoskeletons in part 1 of the series). Passive models such as "Laevo" or "BionicBack" function without a drive, are therefore very light, and do not need to be charged. Active exoskeletons such as "Apogee+" have sensors and motors that control movement support. Both types can be used in hospitals, whereby the respective area of application is important for selecting the appropriate system.

There are now exoskeletons specifically designed for the healthcare sector. Models from industrial contexts, on the other hand, must be integrated into clinical processes. This applies to both the required movement profiles and hygiene requirements. The safety of patients remains essential in all situations, especially when active exoskeletons are used.

The cost of exoskeletons varies greatly depending on the technology and intended use. Passive systems cost between US$2,000 and US$7,000, while active exoskeletons can cost up to US$100,000. In addition to the cost of purchasing the equipment, there are also costs for instruction, training, and maintenance.

Although these investments represent a major hurdle to widespread use, they must be considered in the context of potentially lower absenteeism, longer working lives, and improved working conditions.

Staff acceptance depends heavily on the suitability of the systems for everyday use: they will only be accepted if they can be easily integrated into existing workflows. Clear communication in advance and training sessions that address feedback and possible reservations can be crucial for successful implementation.

Exoskeletons in hospitals are certainly no magic bullet. However, they offer a concrete starting point for improving occupational safety in the healthcare sector by helping to reduce strain and enabling people to work longer under physically demanding conditions.

It is crucial that hospitals do not view this technology as a technical add-on. Rather, they should embed its use in a comprehensive concept of health-promoting work design. Then exoskeletons can contribute to fatigue prevention and safeguard the health of the staff.