Performing surgery is a heavy job
A new instrument handle will change all this.
The OR nurse is exposed to heavy physical stress during surgery. This is not surprising as the instruments have not changed in more than a hundred years. A recently developed ergonomic handle will change this for the better.
The total cost of repetitive strain injuries (RSI) amounts to more than 2 billion Euros per annum in the Netherlands (TNO, 2005) and RSI is especially common among health service employees so there is obviously room for improvement.
Although much research has been done, the impact in daily practice is minimal: the results have not been put to good use. There are various reasons for this; a lack of interest from employees, and little understanding between external researchers and health professionals. RSI symptoms have a lengthy latency period and their relation to work is difficult to prove. Many OR nurses are part-timers. Implementation of ergonomic tools in the OR is difficult because of strict hygienic demands.
Construction workers
It is a great pity that so little is being done with all the research results. Two out of three OR nurses have musculoskeletal complaints. In order to keep the wound open the OR nurse has to stand or sit in a difficult position for a lengthy period of time (Meijsen 2004). 3.8 to 6.2 % of sick leave among OR nurses is attributed to RSI. More than two thirds complain of tiredness. The work is seen as heavy; most complaints are located in the loco motor chains of leg-hipback- neck-shoulder. 14 % have arm-hand complaints, 53 % have neck problems, and 48 % have headaches on a regular basis. Between 51and 91 % of the OR nurses link them directly to the job. The complaints are moderately severe, and have a frequency of once to four times a week. Sick leave among OR nurses is about 7 %, and therefore more than the national average (5 %) in the Netherlands. This is comparable to the percentage figure from heavy physical work, e.g. construction work.
Ergonomic handle
The shape of the handles of surgical instruments has not changed since the 19th century, not meeting with today’s ergonomic requirements. Research has been carried out to modify the handle of surgical instruments in order to deal with the problem of the strenuous physical stress among OR nurses. In collaboration with the industrial design department of the Technical University of Delft, the Netherlands, new handles were developed, and tested.
During the operation the OR nurse has to adopt a strenuous static posture. Static posture is defined as a position which is maintained for more than four seconds. A surgical retractor is being held in different positions; straight, oblique, over the arm and under the arm. In all positions the handle has to have maximal contact with the hand palm and fingers. A good position begins with a comfortable hand pose! In this way less energy and effort is required to keep the wound open.
A rounded form with an eccentrically placed stem was chosen from different wooden prototypes. The handle is asymmetric. Subjective testing of the handle resulted in a score of 75; in a scale ranging from 0 (very uncomfortable) to100 (very comfortable). The traditional handle has a score of 15. The handle is protected by a patent, is already available on the market and can be used with practically every retractor, even a Hohmann retractor. A smaller type is available for small retractors; Cushing and Gilles retractors.
The material is stainless steel, similar to the traditional ones. Storage, cleaning, and sterilization is the same as for traditional instruments.
The photographs show the use of these new instruments during surgery. As with many things in life, one has to experience the difference. We now at least have an alternative for the traditional instrument handle.
> Original article (in dutch)
The OR nurse is exposed to heavy physical stress during surgery. This is not surprising as the instruments have not changed in more than a hundred years. A recently developed ergonomic handle will change this for the better.
The total cost of repetitive strain injuries (RSI) amounts to more than 2 billion Euros per annum in the Netherlands (TNO, 2005) and RSI is especially common among health service employees so there is obviously room for improvement.
Although much research has been done, the impact in daily practice is minimal: the results have not been put to good use. There are various reasons for this; a lack of interest from employees, and little understanding between external researchers and health professionals. RSI symptoms have a lengthy latency period and their relation to work is difficult to prove. Many OR nurses are part-timers. Implementation of ergonomic tools in the OR is difficult because of strict hygienic demands.
Construction workers
It is a great pity that so little is being done with all the research results. Two out of three OR nurses have musculoskeletal complaints. In order to keep the wound open the OR nurse has to stand or sit in a difficult position for a lengthy period of time (Meijsen 2004). 3.8 to 6.2 % of sick leave among OR nurses is attributed to RSI. More than two thirds complain of tiredness. The work is seen as heavy; most complaints are located in the loco motor chains of leg-hipback- neck-shoulder. 14 % have arm-hand complaints, 53 % have neck problems, and 48 % have headaches on a regular basis. Between 51and 91 % of the OR nurses link them directly to the job. The complaints are moderately severe, and have a frequency of once to four times a week. Sick leave among OR nurses is about 7 %, and therefore more than the national average (5 %) in the Netherlands. This is comparable to the percentage figure from heavy physical work, e.g. construction work.
Ergonomic handle
The shape of the handles of surgical instruments has not changed since the 19th century, not meeting with today’s ergonomic requirements. Research has been carried out to modify the handle of surgical instruments in order to deal with the problem of the strenuous physical stress among OR nurses. In collaboration with the industrial design department of the Technical University of Delft, the Netherlands, new handles were developed, and tested.
During the operation the OR nurse has to adopt a strenuous static posture. Static posture is defined as a position which is maintained for more than four seconds. A surgical retractor is being held in different positions; straight, oblique, over the arm and under the arm. In all positions the handle has to have maximal contact with the hand palm and fingers. A good position begins with a comfortable hand pose! In this way less energy and effort is required to keep the wound open.
A rounded form with an eccentrically placed stem was chosen from different wooden prototypes. The handle is asymmetric. Subjective testing of the handle resulted in a score of 75; in a scale ranging from 0 (very uncomfortable) to100 (very comfortable). The traditional handle has a score of 15. The handle is protected by a patent, is already available on the market and can be used with practically every retractor, even a Hohmann retractor. A smaller type is available for small retractors; Cushing and Gilles retractors.
The material is stainless steel, similar to the traditional ones. Storage, cleaning, and sterilization is the same as for traditional instruments.
The photographs show the use of these new instruments during surgery. As with many things in life, one has to experience the difference. We now at least have an alternative for the traditional instrument handle.
> Original article (in dutch)
