What has changed?
In 1999, nearly one million US employees took time off work to treat and recover from work-related musculoskeletal pain or impairment of function in the low back or upper extremities. Conservative estimates of the ensuing economic burden - in terms of compensation costs, lost wages, and lost productivity - are between USD 45 and USD 54 billion annually.
In October 2004, Paul Meijsen of the Catharina Hospital’s OR Department in the Dutch city of Eindhoven conducted a survey on the physical load on OR nurses. His findings revealed that in the Netherlands the percentage of absence amongst health care workers is about 7.4%, compared to the national average of 5.5%. Of these 7.4%, close to 1/3 is caused by physical problems.
Circumstances in the operating theatre (OR) have not changed much in over a century. Instruments in particular are still largely the same. The original designs are often uncomfortable and non-user friendly and have led to continued physical complaints from the OR staff using them. In the last 100 years, our environment has adapted to the needs of modern mankind. Ergonomic design is evident in our cars, our households, our workplace, but remains largely lacking in the OR. The instruments are still the same. Surgery has made a lot of progress over the past century, with larger and more complex operations being performed. As a result, increasingly higher demands are made on the OR personnel, yet the tools they use have not developed accordingly. The job of an OR nurse is very demanding, due to long static positions where the body is often twisted, the head in an uncomfortably crooked position, and the hands forced to hold ergonomically poor instruments for extended periods of time. The stress on the physical wellbeing of OR Personnel is increasing continuously.
A Dutch survey revealed that 20% of the nurses noticed an increase in the strain brought about by their job. Some 53% complained of neck pain and 14% of pain in their arms or hands. Observations in the OR showed 74% stressful neck postures, and 62% stressful shoulder postures. Two thirds of nurses have physical complaints as a direct result of their occupation. The postures of surgeons and their assistants were described as alarming, making immediate improvement of the essence.
P. Meijsen. De fysieke belasting van operatieassistenten. Veldhoven, 2004.
Ergonomics in the U.S.
The Department of Labor fosters and promotes the welfare of job seekers, wage earners, and retirees of the United States by improving their working conditions. Its mission is carried out by a number of offices and agencies, including the Occupational Safety and Health Administration (OSHA).
OSHA promotes the safety and health of workers by setting and enforcing standards; providing training, outreach and education; establishing partnerships; and encouraging continual process improvement in workplace safety and health.
OSHA has a four-pronged comprehensive approach to ergonomics, designed to quickly and effectively address musculoskeletal disorders (MSDs) in the workplace. The four segments of OSHA's strategy for reducing injuries and illnesses from MSDs in the workplace are:
Guidelines, OSHA will develop industry – or task specific guidelines for a number of industries based on current incidence rates and available information about effective and feasible solutions.
Enforcement, OSHA will conduct inspections for ergonomic hazards and issue citations under the General Duty Clause and issue ergonomic hazard alert letters where appropriate.
Outreach and Assistance, OSHA will provide assistance to businesses, particularly small businesses, and help them proactively address ergonomic issues in the workplace.
National Advisory Committee, OSHA will charter an advisory committee that, among other things, will be authorized to identify gaps in research to the application of ergonomics and ergonomic principles in the workplace.
The Committee recommended that OSHA consider developing guidelines for the 16 industries or industry groups chosen based on the Guidelines Workgroup criteria, excluding the three industries for which guidelines are already complete or are in development (* marked with an asterisk in the list).
Industries are listed below, followed by the ranking they received from the Workgroup:
- 1.Nursing Homes*
- Trucking & Courier
- Air Transport Scheduled
- Hospitals
- Groceries—Wholesale
- Motor Vehicle-Equipment
- Motor Vehicles and Car Bodies
- Plumbing, HVAC
- Department Stores
- Retail Grocery*
- Local and Suburban Transportation
- Household Furniture
- Lumber/Building Materials—Retail
- Motor Vehicle Parts and Accessories
- Fabricated Structural Metal Products
- Millwork, Plywood and Structural
- Aircraft
- Miscellaneous Plastics Products
- Poultry*
Thus currently, no guidelines have been developed for hospitals. However recommendations made by the National Advisory Committee for Ergonomics in January 2004 emphasized the importance of developing guidelines for the industry.
