1.Ergonomic Evaluation - Sterile Process Department Instructor: Dr. Sang Choi, Ph.D., CSP, CPE Presented By: Eric Brown Philip Porter Nick Bradley Omari Taylor Sam Stauber Gary Young

2. Agenda Introduction & Background Work-Related Musculoskeletal Disorders Ergonomic Assessment Techniques/Tools Methods Job Task Analysis Recommendations 3. Introduction & Background Injury and Illness Rates (DOL, 2010) - Healthcare industry had higher rates of injury and illness than manufacturing. - Healthcare industry had the highest rates of work-related musculoskeletal disorders of all occupations. - Work-related musculoskeletal disorders (MSDs) account for over 600,000 injuries and illness in the U.S (OSHA, 2013). 4. Work-Related Musculoskeletal Disorders Bursitis (joints/ shoulder) Carpal Tunnel Syndrome Cubital Tunnel Syndrome DeQuervains Disease Dry Eye Syndrome Lumbosacral (strain/sprain) Sciatica (lower back/ legs) Tendonitis (joints, elbow, wrist) Tension Neck Syndrome 5. Risk Factors for Work-Related MSDs AWKWARD POSTURES FREQUENT REPETITIVE MOTIONS HEAVY AND AWKWARD LIFTING FORCE AND PRESSURE CONTACT STRESS 6. Why Does Ergonomics Matter? 1/3 of all workers comp. costs are associated with MSDs Employers spend over $20 billion annually on direct costs and five times that amount on indirect costs (hiring & training replacement workers). Cost to an organization: Workers compensation Medical Bills Lost revenue Employee morale 7. Essential Job Functions: Reprocesses all instruments and equipment for the organization Picks case carts and supports the daily operations of the surgery department. Maintains and orders inventory to adequate par levels. Work Tasks Sterile Reprocessing Technician 8. Ergonomic Assessment Techniques OBJECTIVE: RULA- Rapid Upper Limb Assessment REBA Rapid Entire Body Assessment JSI - Job Strain Index NIOSH Lifting Equation SUBJECTIVE: Body Mapping Informal Interviews 9. Rapid Upper Limb Assessment (RULA) Developed by Dr. Corlett and Dr. McAtamney in 1993 Survey method developed focusing on ergonomic investigation of the workplace. RULA is a screening tool that measures biomechanical and postural loading on the whole body with specific consideration to the neck, trunk and upper limbs. RULA is an ergonomic technique that evaluates an individuals exposure to postures, forces and muscle activities that can contribute to WMSDs. 10. Scoring Classifications Action Level 1 (1 or 2) Posture is acceptable if it is not maintained or repeated for long periods of time Action Level 2 (3 or 4) Further investigation is needed and changes may be required Action Level 3 (5 or 6) Further investigation and changes may be required soon Action Level 4 (7) Indicates that investigation and changes are required immediately Rapid Upper Limb Assessment (RULA) 11. RULA Assessment Worksheet 12. Developed by Dr. Hignett and McAtamney in 2000. Useful in assessing unpredictable working postures found in the health care and service industries. Data is collected to assess: Body Posture Forces used Types of movements or action Repetition Coupling Rapid Upper Body Assessment (REBA) 13. Rapid Upper Body Assessment (REBA) Focuses on the wrists, forearms, elbows, neck, trunk, back, legs and knees. 14. Rapid Upper Body Assessment (REBA) Scoring Classification Final Score: 1: the risk level is negligible and no action is considered necessary (Action Level =0 ) 2-3: low and further action may be needed if it is indicated by other information (Action Level = 1) 4-7: medium and further action is considered to be necessary (Action Level =2) 8-10: high and further action is considered to be necessary soon (Action Level = 3) 11-15: very high and further action is considered to be necessary now (Action Level = 4) 15. NIOSH Lifting Equation Improper lifting techniques can lead to MSDs with special regard to low back pain. The NIOSH lifting equation was revised in 1993 it is used to evaluate the physical demands of Manual Materials Handling (MMH) The equation breaks down several variables of a task into an quantitative equation and by using a formula we can determine the risk of the task 16. Data Collection and Analysis The two final variables are the RWL and LI which is used to determine the level of risk associated with the task The formula for the NIOSH lifting equation is: LC x HM x VM x DM x AM x FM x CM = RWL After this we determine the Lifting Index (LI) by Dividing the RWL by the Weight of the object being lifted: Weight/RWL = LI 17. Data Collection LC is always 51 pounds HM Horizontal Location VM Vertical distance DM The vertical travel AM Asymmetric Angle CM Coupling (handles) FM Frequency measure 18. Job Strain Index Moore & Garg (1995) published in American Industrial Hygiene Association Journal Job Strain Index (JSI) is a means to assess jobs for risk factors for work-related musculoskeletal disorders (MSDs) of upper extremities: Hands Wrists Elbow Forearm Divide the job into tasks For each task and for each hand, you must assess the six job risk factors by assigning it to a category. 19. Job Strain Index Elements Intensity of exertions (force) Duration of Exertion (% cycle) Efforts per minute Hand/wrist posture Speed of work Duration of task per day (hours) 20. BodyMap Assessment What is a Body Map Assessment? An aid in assessing potential ergonomic concerns or leading indicators for musculoskeletal disorder risk. By comparing the different symptoms of members working in the same department or performing the same task you can identify trends. Cluster of common problems and their causes (area of causes). Gives employees an understanding of shared risk factors. Provides anonymity and gives the workforce a voice/involvement. Can be used to identify and help to develop practical solutions. 21. BodyMap Assessment Form 25 points of interest with a subjective score 22. BodyMap Score Sheet DLFQ 0 1 2 3 0 1 2 3 4 5 6 7 8 9 10 Green zone: not likely to seek treatment Yellow zone: somewhat likely to seek treatment Red zone: very likely to seek treatment Infeasible zone (no recording) 23. RULA: STORAGE PROCESSING 24. Right Side = 7 Very High Risk Change Now RULA 25. 5 1 2 1 5 0 0 5 4 1 1 5 0 0 56 Storage #1 26. RULA SCORE = 5 Medium Risk Further Investigation, Change Soon RAPID UPPER BODY ASSESSMNENT 27. 5 1 1 1 5 0 1 6 2 3 4 0 1 1 56 Task #2 28. RULA SCORE = 4 RAPID UPPER BODY ASSESSMENT 29. 4 3 1 1 4 0 0 4 2 3 4 1 0 44 0 Task #3 30. Cart Wash and Drying REBA ASSESSMENT #1 31. REBA Assessment #2 32. Genesis Tool Set: Storage Manual handling of Genesis tool set Weighs roughly 25 lbs. Removed from shelving units of various heights Placed onto cart for transportation 33. NIOSH Lifting Equation 56 22 32 34. NIOSH Lifting Equation LC x HM x VM x DM x AM x FM x CM = RWL 35. Results Based upon the results: The weight at the origin is acceptable The weight at the destination creates the potential for WMSDs One of the major issues with the destination RWL is that the horizontal multiplier (H) is low The cause of this is the extension of the arms necessary to load the Genesis unit onto the cart (when the cart is to the workers side). By directly facing the cart while loading the worker can avoid this extension. The result will be less distance between the load and the body and a higher H value. 36. REBA: Loading onto Cart REBA was conducted for both the removal of the carts from storage and for placement onto carts 37. 9 = High risk, investigate and implement change 38. REBA: SHELF LIFT 39. 5: Medium risk, further investigation, change soon 40. Recommendations REBA SHELF LIFT Hazard may increase when units are taken from higher shelves Carts with adjustable heights may solve the problem Employee could slide the unit onto the cart, eliminating the lift almost entirely Adjustable carts may not meet the requirement of equipment in the sterile processing operation; could also result in increased washing times 41. Basin Wrapping Task 42. RULA Basin Wrapping Task Final Score of 6: Further investigation, changes may be needed. 43. Peel Packing 44. RULA Peel Packing Final Score of 6: Further investigation, changes may be needed. 45. Basin Wrapping Task Improve workstation by bringing peel packing device closer to the worker to reduce reach and wrist strain. Peel Packing Raise workstation tables to reduce reaching strain for basin wrapping. Recommendations from RULA 46. Lifting a Genesis Box 47. Lifting a Genesis Box The task in question is the lifting of a surgical basin onto the top shelf of a cart This task can by performed up to 24 times in a shift The table is 36 inches high and the top of the cart is 52 inches off the ground 48. Multipliers Multiplier Load Constant LC Horizontal Multiplier HM (10/H) Vertical Multiplier VM 1-(.0075|V-30|) Distance Multiplier DM .82 + (1.8/D) Asymmetric Multiplier AM 1-(.0032A) Frequency Multiplier FM From Table Coupling Multiplier CM From Table 49. Frequency Table 1 < 2 hours > 2 < 8 hours Frequency lifts/min (F) V < 30+ V > 30 V < 30 V > 30 V < 30 V > 30 15 0 0 0 0 0 0 50. Coupling Table Coupling Multiplier Coupling type V < 30 inches V > 30 inches Good 1 1 Fair 0.95 1 Poor 0.9 0.9 51. Results Origin Destination Measurement Multiplier Measurement Multiplier Load (L) pounds 23 lbs 23 lbs Load Constant (pounds) 51 lbs 51 51 lbs 51 Horizontal Location (HM) inches 12 inches 0.83 16 inches 0.625 Vertical Location (VM) (inches) 38 inches 0.94 56 inches 0.805 Vertical Distance Travel (Vo - Vd) 18 inches 0.92 18 inches 0.92 Asymmetry Angle (A) (degrees) 90 degrees 0.712 90 degrees 0.712 Lifting Duration (hours) 8 hours 8 hours Lifting Frequency (F) (lifts/minute) 0.05 0.85 0.05 0.85 Coupling (CM) Fair .95 Fair .95 RWL 21.04 13.57 LI 1.09 1.69 52. Results According to this study the task of lifting a genesis box onto the top of cart. The origin of the lift is 1.09 which is very close to be acceptable The destination of the lift is 1.69 which makes it an increased risk for MSDs. Recommendations The genesis box should not be placed on the top shelf. Only the bottom and second highest shelf. The handles should be replaced to ones that are a little sturdier. 53. Peel Packing 54. JSI - Peel Packing 55. Somewhat Hard 2 3 37% 3 1.5 >4 1 0.5 Fair 3 1.5 Fast 1.5 4