labergonomics

Hospital Laboratory Ergonomics: 

Hospital Laboratory Ergonomics Theodore J. Hogan, PhD, CIH Theodore J. Hogan & Associates, Inc. Lemont, IL 60439 630-257-3939 www.tjhinc.com

Labs are Different: 

Labs are Different Patient care High physical demand, low frequency Move around a lot Labs Low physical demand, high frequency Static postures Highly trained workers performing repetitive tasks

Laboratory Ergonomics and CAP Accreditation: 

Laboratory Ergonomics and CAP Accreditation “Is there a documented ergonomics program to prevent musculoskeletal disorders (MSDs) in the workplace through prevention and engineering controls?” Source : College of American Pathologists (CAP) Laboratory Accreditation Program 03/30/2005

Laboratory Ergonomics and CAP Accreditation: 

Laboratory Ergonomics and CAP Accreditation “ A comprehensive ergonomics program to prevent the occurrence of work-related MSDs may include training of employees about risk factors, identifying physical work activities or conditions of the job commonly associated with work-related MSDs, and recommendations for eliminating MSD hazards. Laboratory activity, workplace and equipment (e.g. chairs, laboratory workstations, computer keyboards, and displays) should be designed to reduce the risks of ergonomic distress disorders and accidents.” Source : College of American Pathologists (CAP) Laboratory Accreditation Program 03/30/2005

Example Assessments: 

Example Assessments Tissue Embedding Cutting Harvesting Automated Operations

Tissue Embedding: 

Tissue Embedding Using forceps, employee places small pieces of tissue into hot paraffin High precision required to identify and properly position tissue in each sample Each technician handles about 250 samples in about a three-hour period There may be multiple tissues in each sample, and each must be properly oriented

Tissue Embedding Posture and Existing Controls: 

Tissue Embedding Posture and Existing Controls Posture Sitting on a stool, with feet propped on materials under bench (or dangling), employees have bent shoulders as they lean into work, wrists are bent One embedding station at a lower bench allowed employee to comfortably sit on a regular chair Existing Control Measures Employees take four quick breaks during the period. Some employees do stretching exercises on breaks Task not typically rotated

Tissue Embedding Observations and Recommendations: 

Tissue Embedding Observations and Recommendations Observations Some employees report neck and shoulder pain Bench too high for task being performed. Two are in the 37-38” range. The third, which employees agree was the most comfortable, was 31” Materials stored under workbench (such as solvent cans) interfere with worker positioning Recommendations Lower the benches holding the embedders (consider adjustable benches as various workers perform this task) Consider task rotation

Cutting: 

Cutting Employee operates manually driven cutting machines. Employee precisely slices the sample to obtain sections. Using forceps, brush or other tools, employee places sections onto a water bath. Then the sample is captured onto slide by drawing through water. Under certain circumstances, production reportedly can be as high as 100 blocks a day for one employee. This is equivalent to about 200-300 slides

Cutting Posture and Existing Control Measures: 

Cutting Posture and Existing Control Measures Posture One employee rests arm on waterbath during cutting – finds it more comfortable another positions elbow on bench top occasionally Some maintain neutral wrist, others do not Chairs – concern – awkward height – chairs not readily available for height required, employees report they are either too high or low Control Measures Some job rotation Task usually not performed for the complete shift Stools, seat, pitch adjustable, back height adjustable

Cutting Observations: 

Cutting Observations Observations Some cutters wheels go forwards, some backwards. Workers cannot easily change between types A number of employees reportedly have upper body pain (including wrist, thumb, back) and have seen their personal doctors Some employees wore hand braces Need more space to perform all tasks, for example some employees label slides by placing them on edge of water bath

CuttingRecommendations: 

Cutting Recommendations Recommendations Obtain some trial combined electronic/manual control cutters to gauge worker acceptance to new technology Provide storage space to remove laboratory clutter Provide trial chairs for evaluation Longer term, consider reconfiguring lab area to allow for closer access to machines, more work area, and more legroom underneath

Harvesting (cytology): 

Harvesting (cytology) Sample preparation includes media preparation, feeding, and harvesting. Harvesting requires employee to electronically pipette in precise controlled manner for about 2 hours.

Harvesting Posture and Existing Control Measures: 

Harvesting Posture and Existing Control Measures Posture Arm and twisted wrist held in static position Control Measures Weekly job rotation There are regular five minute breaks built into the process Floor mat available and used

HarvestingObservations and Recommendations: 

Harvesting Observations and Recommendations Observations Employees felt this was the most stressful job in cytology While stool is available, employees do not use it because they feel it is not suited to task. Note there is no leg space under bench Recommendations Consider machine harvester Provide adequate workspace in preparation laboratory

Automation: 

Automation Can reduce repetitive motion Can also concentrate tasks on one person Increased noise Crowding Increased computer usage

Computer Usage: 

Computer Usage Minimize mouse usage as much as possible Teach and use keyboard shortcuts Review software interface to evaluate possibility of other shortcuts like automatic tabbing Consider longer login time before automatic log-off Ensure touch screens and keyboards placed on stable surfaces Provide rounded edges on benches and desks

Computer Usage: 

Computer Usage Provide small wrist pads for keyboard usage where possible (understanding that lab personnel often use the area in front of their keyboard for writing) Reduce obstructions under desks. Be sure to consider leg clearance and obstructions before purchasing new equipment Move items of frequent use within reach of arm without shoulder twisting Provide handset rests for employees that desire them

Control Noise: 

Control Noise Noise can interfere with communication and create stress Reduce noise at the source Isolation Insulation Reduce reflected noise Sound absorptive ceiling tiles

Control Noise: 

Control Noise Avoid placing vibrating equipment on tables or surfaces containing reverberant surfaces (such as thin metal) Ensure regular maintenance of equipment to reduce noise from compressors, fans, and other rotating equipment Reduce/eliminate use of dot-matrix printers

Resolving Ergonomic Issues Takes Time: 

Resolving Ergonomic Issues Takes Time Ergonomic issues take time to implement and resolve Employees need to participate in selecting control measures and accept the measures Often necessary to experiment with different approaches as ergonomic Control measures can take some time to find optimal solutions. This will be particularly important where each work station is used by many personnel

Involve Employees: 

Involve Employees Conduct detailed interviews with workers and managers before redesigning or moving laboratories Involve employees in selection and testing of solutions Train workers on basic ergonomics principles so that they can participate in solutions development Employees should trained on how to configure their workspace to their own requirements

Go Slow: 

Go Slow Take particular care before changing equipment and furnishings Sometimes equipment used to reduce employee impact can introduce new concerns For example, while a power processing unit greatly reduce pipetting, it may concentrate the recapping task on a fewer number of personnel

Plan: 

Plan Address the simple items first Plan a six-month to one-year calendar to gradually implement the other changes Prioritize those groups that have higher injury rates Provide for flexible laboratory designs to accommodate rapidly changing technology Some architects specialize in clinical laboratory design

Laboratory Ergonomics is Good Business: 

Laboratory Ergonomics is Good Business Worker comfort and productivity are important economic considerations in laboratories Increasing sample loads An aging workforce Difficulties obtaining additional personnel Increasing employee comfort Reduces errors Increases productivity