The Fit Between Ergonomics: the Job and the Worker Human Diversity - PDF document

Learning Objectives  Define what a musculoskeletal disorder (MSD) is and provide healthcare-related examples.  Describe the ergonomic assessment process and the tools involved. Ergonomics  Identify strategies that can reduce MSD risk to healthcare workers. Marge McFarlane, PhD, MT(ASCP), CHSP, CHFM, CJCP, HEM, MEP 2 The Fit Between Ergonomics: the Job and the Worker Human Diversity and Change When there is a mismatch between the The capacity to perform physical work demands physical requirements of the job and the varies considerably not only from individual to individual, but within any given individual over physical capacity of the worker… Work- time… the limitations of this capacity are complex Related Musculoskeletal Disorders can result and interrelated. (WMSD’s). (NIOSH) 3 4 1

Common Terminology OSHA Definition  ASTD – Activity-related Soft Tissue Disorder An injury or an illness of the muscles, tendons,  MIS – MusculoSkeletal Injury ligaments, peripheral nerves, joints, cartilage (including interverterbral discs), bones and/or  OEI – Over-Exertion Injury supporting blood vessels in either the upper or lower extremities, or back, which is associated  WMSD – Work-Related MusculoSkeletal with musculoskeletal disorder workplace risk Disorder factors and which is not the result of acute or  RSI – Repetitive Strain Injury instantaneous events (e.g., slips or falls).  CTD Cumulative Trauma Disorder  RMI or RMD – Repetitive Motion Injury/Disease 6 5 “What factors contribute to OSHA National Emphasis Program WMSDs?  CPL 03‐00‐016, June 2015  The task is not designed to accommodate  Ergonomics related to patient handling the physical and/or cognitive limitations of the worker  HCW 6.4 work related injuries/100 FTE 2013  3.3/100 FTE all U.S. industries combined  Poor body mechanics and personal physical/health limitations  2013, 34% of recorded HCW injuries nationwide with days away from work were  Gradual wear and tear associated with patient interactions 7 8 2

Common Susceptible Common Denominators to Areas and Disorders WMSDs in Healthcare Affected Body Cervicothoracic Scapulae / Distal UE / Lumbosacral Region Spine Proximal UE Wrist - Hand Spine Activity and / Repetitive and / Scapular Forceful and / Patient Handling or Posture or Sustained Stabilization or Sustained Unsupported Sit Flexion and / or Pinch / Grip Repetitive and / Retraction - Rep Motion or sustained flex Healthcare Surgery Patient Care Surgery Patient Care Examples Lab Materials Lab Lab Radio / Spec Dx Env. Services Bus Office Transport Business Office Dietary Patient Care Env. Services Common Postural Fatigue Accessory Overuse Inflexibility Physiological Deconditioning Weakness Onset >1 yr Deconditioning Predisposition Reduced Stress Postural Fatigue Postural Fatigue Tolerance Deconditioning Onset > 1yr. 9 10 Healthcare Work and Healthcare Lifting Workforce Characteristics Work Worker  Lifting inanimate objects as done by support  Wide diversity of  Career duration. staff versus situational exposures  Typically hired by skill  Lifting a patient/resident  Handling of unstable load level vs. physical (human beings) ability.  Completely different set of problems  Extended work hours  “Self‐sacrificing”  patient movement commonplace. mentality.  patient fear/ apprehension  Shift work commonplace.  “Western Medicine” mentality. 11 12 3

Accumulation of Trauma The CTD ( Cumulative Trauma Disorder ) Stress Response Model Contributors to Sources of Stress Patho- Diminished Symptoms Injury @ Work Mechanics Compression Adaptability 3400 – 6400N Limit Primary Stressors Environmental Systemic • Decreased Cumulative • Force Circulation • Temperature Tenderness Trauma • Posture Swelling Syndrome • Fatigue • Tissue Irritation Biological Tightness Secondary i.e. Overuse Injury • Overstrain of • Strength Behavioral • Carpal Tunnel Stressors: Structure • Fatigue • Disc Injury Compensate • Shoulder Strain • Environment Anterior/Posterior Sheer • Tools Behavioral Posture Weakness • Processes 1000N Limit Lateral Sheer • Habits Disuse of injured • Skills area Other Stressors 1000N Limit • Attitudes • Expectations • Conflict • Culture 14 Ergonomics and Lifting 9000 8000  ACGIH has proposed lifting guidelines in the 7000 2001 TLV booklet Maximum Compression Tolerance 6000 Limits  Based upon 5000  duration of task 4000 Minimum Compression  frequency of lifting Tolerance 3000 Limits  lifting height zone 2000 Wheelchair Bed to Wheelchair Bed to Chair to Commode  location of lift in relation midpoint of the body w/o Arm to Wheelchair to Bed Wheelchair Commode to Chair Bed w/o Arm One-Person Two-Person 16 Adapted from Marras et al 1999 4

Ergonomics Ergonomics Lifting Height Zones Horizontal Location of Lift  30 cm above to 8 cm below shoulder  Midpoint - between the inner ankles to the midpoint between the hands.  Knuckle height to below the shoulder  Close lifts - origin <30 cm from midpoint  Middle shin to knuckle height  Intermediate Lifts - origin 30 to 60 cm from midpoint  Floor to middle shin  Extended Lifts - origin >60 to 80 cm from  No routine lifting tasks greater than 30 cm midpoint lifting tasks should not be started at above the shoulder or more than 180 cm a horizontal reach more than 80 cm above the floor 17 18 NIOSH Lifting for Healthcare Ergonomics and Lifting  “ The revised equation can be used to calculate a recommended weight limit for many patient‐lifting activities when the following conditions are met:  Based on the location of the lift a acceptable  The patient can follow directions and is not combative. weight to be lifted can be determined  The amount of weight the caregiver handles can be estimated.  The lifting is smooth and slow.  However there are some limitations  The geometry of the lift ‐the body and hand positions in relation to the  no factorials for age object being lifted ‐and the amount of weight lifted are not subject to change.  no factorials for sex  For most patient‐lifting tasks, the maximum recommended weight limit is 35 lbs.‐but even less when the task is performed under less than ideal circumstances, such as  based on lifting well defined static objects lifting with extended arms, lifting when near the floor, lifting when sitting or kneeling, lifting with the trunk twisted or the load off to the side of the body, lifting with one hand or in a restricted space, or lifting during a shift lasting longer than eight hours.” 19 20 5

Lifting Guidelines (Weight) For A Single Individual Other References for Lifting Lifting Aids Sex/Age No Restriction? Training Required? Not Recommended Required? Calculations and Solutions Male <50 0-40 lbs. 41-60 lbs. 61- 130 lbs. >130 lbs. Male =>50 0-30 lbs. 31-50 lbs. 51-105 lbs. >105 lbs. Female* <50 0-25 lbs. 26-40 lbs. 41-80 lbs. >80 lbs.  Cornell University Ergonomics Female* =>50 0-20 lbs. 21-30 lbs. 31-60 lbs. >60 lbs. * females who are pregnant should not lift more than 25 lbs.  Alan Hedge  http://ergo.human.cornell.edu/ References:  Healthcare Specific Tools Applications Manual for the Revised Lifting Equation, US Department of Health and Human Services, DHHS (NIOSH) Publication 94-110, NTIS, Springfield, VA 1994.  http://ergo.human.cornell.edu/cuHealthcaretools.html Grandjean, Etinne Fitting the Task to the Man, A Textbook of Occupational Ergonomics, 4th edition,  University of South Florida Taylor & Francis Inc., Philadelphia, Pa 1988. The Ergonomics Group, Health and Environmental Laboratories, Eastman Kodak Company, Ergonomic  Tom Bernard Design for People at Work, Volume 2, Van Nostrand Reinhold, New York, NY, 1986.  http://personal.health.usf.edu/tbernard/ergotools/index.html at Work, Volume 2 ,Van Nostrand Reinhold, New York, NY, 1986. 21 22 Management Leadership Ergonomics Program Elements  Management must commit to the program!!!!  Management Leadership  Personnel  Employee participation  Funding  Ergonomic Assessment and Corrective Measures  Medical resources  Education & Training  Corrective actions  Medical Management  Early reporting  Program evaluation  No disincentives 23 24 6

Employee Participation Employee Participation (cont.) An effective ergonomic program is a two way venture The employee must feel confident that if they raise  Management willing to find and correct a concern that problems  Employees willing to accept honest evaluation  It will be taken seriously and corrections  It will be evaluated without bias Employees must feel that  That appropriate corrective actions the program will empower will be implemented them to facilitate their own wellness  That there will be no repercussions 25 26 Education & Training Education & Training Education & training should be designed to impart the information you want the employees to know Education & training should also be one of the interventions (corrective measures)  How to register a concern implemented based on your assessments .  What procedures will be followed  The likely outcomes We’ll revisit this later!!!!  How successful is the program 27 28 7