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Look beyond patient care for ergo risks
Costly injuries occur in dietary and other areas
If you've implemented safe patient handling but serious musculoskeletal disorder (MSD) injuries persist at your hospital, perhaps you haven't gone far enough. Employees in many nonpatient care areas also face significant risks.
In an analysis of more than 100 reviews of workers' compensation loss data, Woody Dwyer, MS, CPE, CIE, senior ergonomics consultant in Human Factors and Ergonomics at Travelers Risk Control in Orange, CA, found 40% to 60% of injuries in health care related to sprains, strains, and other MSD injuries. Nonpatient-handling injuries often represented a significant portion, he says. In one hospital, for example, he found that about half of the MSD injuries were in nonpatient care areas.
"The first thing you need to do is look at your data," advises Dwyer. But hospitals also need to assess job tasks for major ergonomic risk factors: awkward postures, force, frequency or repetition of task, and duration (such as holding static postures), he says.
"It's a challenge to consider change when someone has not been injured. What's the value of the solution?" says Dwyer. "The solution should mitigate risk. Risk is the precursor of injury."
Dwyer also notes that before the risk leads to injuries, it may contribute to poor employee morale, impaired productivity, or turnover.
A Citrus Valley Health Partners in West Covina, CA, ergonomics coordinator Dora Shaieb, MPT, CEAS, partnered with department managers and sought to demonstrate cost-effective solutions. "We have to prove ourselves to upper management by saying, 'We're focusing on the areas that cost you money,'" she says.
Some ergonomic solutions require a change in work practices but little investment in new equipment. Hospitals should work with their workers' compensation insurers to identify solutions and develop a budget and plan for reducing risk. "We're going to pinpoint solutions that are going to give them the best value, the ones that will mitigate the most risk," says Dwyer.
Here are some areas that have common MSD risks and potential solutions:
Dietary/Food Service: Citrus Valley Health Partners spent about $200,000 on slip-and-fall injuries in 2005 at the system's three hospitals, many of them related to wet or oily food service areas. "We decided to put money into proper footwear and provide that to staff," says Shaieb. The health system set aside $10,000 for shoe costs and arranged for a footwear mobile van to visit the hospitals. About 280 at-risk employees in dietary service or environmental services were required to wear slip-resistant shoes. If they choose not to select shoes from the mobile van, they can purchase their own and be reimbursed, as long as they meet the same standards of slip-resistance, says Shaieb.
The shoes, which must be worn only at the hospital, are replaced annually. While Shaieb originally absorbed the cost in the employee health budget, individual departments now provide the funding. In 2008, the hospital spent only $1,600 on workers' compensation claims related to slips and falls.
How to avoid common ergo risks for office workers
(Editor's note: Travelers Risk Control in St. Paul, MN, a division of Travelers Insurance, provides these tips for improving office ergonomics and avoiding injury. Further information is available at www.travelers.com/riskcontrol.)
Stress and fatigue symptoms from working at computer terminals can be avoided with good posture, good work habits, and adjustments to the equipment on which you work. The following tips should help minimize these symptoms and maximize your personal comfort:
All body angles hips, knees, and elbows should be at or around 90 degrees.
Sit up with chair tilted back slightly.
Your head should be upright, facing forward.
The backs of your knees should not be in contact with the chair seat with thighs approximately parallel to the floor.
Your shoulders should be relaxed.
Your feet should be flat on the floor, or on a footrest.
Your back should be firmly supported.
Your arms should rest lightly on the armrests of the chair.
Your wrists should be straight and flat, not bent backwards.
Your keyboard angle should be adjusted as flat as possible or slightly downhill, and the keyboard should be at elbow height.
Your mouse or other input device should be at elbow height, next to your keyboard.
Your monitor and keyboard should be square, or parallel to each other to help you avoid awkward and uncomfortable body positions.
The top of your monitor should be slightly below eye level.
Adjust your chair and the height of your keyboard so you can follow the above posture guidelines.
Use a wrist rest if you find it difficult or tiring to hold your wrists level. Never plant your wrists on the wrist rest while you key. Use it to support your palms between keying activities.
Adjust your monitor so the contrast is high, the brightness low. You may need to adjust it several times during the day, as room light changes.
Adjust the angle of your monitor to reduce glare or reflection. Try to have your monitor at right angles to windows or long banks of light.
Keep the screen free of dust and fingerprints.
If the display is blurry or jittery, report it to your supervisor.
Use a lighter touch on the keyboard to reduce shock to your wrists.
Use a document holder if you often type material from other sources. Task lighting may be necessary to read the material.
Periodically focus your eyes on something at least 20 feet away.
Take a minute every so often to stretch and vary your routine.
Periodically change your posture throughout the day.
Build dynamic work into your day. You should perform 15 minutes of nonkeying activity for every two hours of keying.
Do not cradle the telephone between your shoulder and neck while keying.
Other risks in the dietary area include the handling of large containers of produce and food and pushing heavy carts. Carts should have two swivel casters and two fixed casters, Dwyer says. Employees also should have training in the proper use of knives, he says.
Environmental Services: "Make sure the linen bags are not overfilled," says Dwyer. Use carts that have a spring-loaded bottom and/or drop side, so employees don't have to reach into the bottom. Education about proper posture and body mechanics also is important although that can be a challenge, says Shaieb. "It's a very physical job, and a lot of people aren't necessarily in top shape to begin with," she says. "You sometimes have language barriers that come into play." For example, employees need to understand that they shouldn't try to pull a cart with one arm, but instead should push it down the hall, she says.
Laboratory: Often, lab workers are hunched over a desk, peering into a microscope or looking at Petri dishes. Their posture can be improved by better workstation design, says Dwyer. Shaieb assessed the lab and found "they don't have enough room for all their supplies and storage, so they start putting their things where you're supposed to have your legs," she notes. That solution simply involved rearranging the work space. Lab workers also may need new adjustable-height stools, footrests, or a counter that provides more space for the employees' knees, says Dwyer.
Materials handling: Handlers need to have powered pallet jacks for lifting and carrying pallets in storage areas, says Dwyer. Even a box of fluids can be a lifting hazard due to its weight. Check out hand trucks, carts, and dollies for their ease of use, he advises.
Office: Compared to transporting patients or lifting heavy bags of linen or trash, sitting at a computer may seem like risk-free work. But office workers may develop back or neck discomfort or tendonitis in the hand, wrist, or elbow, says Dwyer. For example, while the common desk height is 29 inches, an average woman's elbow height may be 26 or 27 inches. "We either have to raise the chair and get a footrest or get a keyboard tray," he says. Shaieb was able to replace chairs and keyboards in the business office by budgeting the expenditure over a half-year period, buying four or five chairs at a time.