Ergonomics — Healthcare

Scope

Healthcare employers are responsible for providing a safe and healthful workplace for their workers. Awkward postures, patient position and ability, and inadequate assistance can cause both costly and significant injuries and illnesses to nurses, doctors, CNAs, dentists, emergency medical responders, and other healthcare staff.

Regulatory citations

• General Duty Clause 5(a)(1)

Key definitions

• Awkward postures: The position your body is in, which in most cases, affects muscle groups that are involved in physical activity. Awkward postures include repeated or prolonged reaching, twisting, bending, kneeling, squatting, working overhead with your hands or arms, or holding fixed positions.
• Forceful exertions: The amount of physical effort required to perform a task, such as heavy lifting or pushing/pulling, or to maintain control of equipment or tools. The amount of force depends on the type of grip, the weight of an object, body posture, the type of activity, and the duration of the task.
• Contact stress: Occurs while pressing the body against a hard or sharp edge which can result in placing too much pressure on nerves, tendons, and blood vessels. For example, resting your wrist on the edge of the desk can put pressure on the nerves leading into the hand.
• Repetition: The action of performing the same motions over and over again, placing stress on the muscles and tendons. The severity of risk depends on how often the action is repeated, the speed of movement, the number of muscles involved, and the required force.
• Musculoskeletal disorders (MSDs): Injuries and disorders of the soft tissues (muscles, tendons, ligaments, joints, and cartilage) and nervous system of the upper and lower limbs, neck, and lower back that are caused, precipitated, or exacerbated by sudden exertion or prolonged exposure to physical factors such as repetition, force, vibration, or awkward posture. Here are some common MSDs.
  • Carpal tunnel syndrome: A disorder affecting the hands and wrists, is the compression and entrapment of the median nerve where it passes through the wrist into the hand in the carpal tunnel.
  • DeQuervain’s disease: A disease in which the tendon sheath of the thumb is inflamed.
  • Raynaud’s syndrome: Occurs when the blood vessels of the hand are damaged as a result of repeated exposure to vibration for long periods of time. The skin and muscles are unable to get the necessary oxygen from the blood and eventually die.
  • Tendinitis: Tendon inflammation that occurs when a muscle or tendon is repeatedly tensed from overuse, vibration, or unaccustomed usage of the wrist and shoulder. With further exertion, some of the fibers that make up the tendon can actually fray or tear apart.
  • Tenosynovitis: Inflammation or injury to the synovial sheath surrounding the tendon.

Summary of requirements

• Define clear goals and objectives for the ergonomic process, discuss them with workers, and communicate clearly with the workforce.
• Assess workstations, tools, equipment, and procedures for ergonomic hazards.
• Look for tools without ergonomic grips, workstations that aren’t adjustable, awkward postures during procedures.
• Replace non ergonomic tools and equipment with ergonomic tools and equipment.
• Evaluate patient handling practices and identify high-risk situations.
• Create and utilize a patient handing program.
• Identify engineering controls such as the type of equipment that will best support patients and minimize risk to workers.
• Provide adjustable equipment such as chairs, monitor arms, and patient handling equipment.
• Implement methods to control hazards such as lifting, transferring, and repositioning patients.
• Train employees on ergonomics and how to adjust the work area to meet their needs.
• Setup workstations and work areas to allow for the:
  • Sufficient room for movement in and around the work area.
  • Hands, wrists, and forearms are straight, in-line and roughly parallel to the floor.
  • Head is level, forward facing, and balanced, generally it is in-line with the torso.
  • Shoulders to be relaxed and upper arms can hang normally at the side of the body.
  • Feet to be fully supported by the floor.
  • Back is fully supported with appropriate lumbar support when sitting vertical or leaning back slightly.
  • Thighs and hips are supported and generally parallel to the floor.
  • Knees are about the same height as the hips with the feet slightly forward when sitting.
• Encourage employees to report ergonomic concerns.
• Ensure employees report symptoms or injuries related to MSDs including, but not limited to, carpal tunnel syndrome, tendinitis, and shoulder pain.
• Establish administrative controls such as procedures for when to require a lift assist.
• Involve employees in work-site assessments, solution development and implementation.