A few years ago, the institutional laundry and linen management industry was expecting the Occupational Safety and Health Administration (OSHA) to require that ergonomic-related injuries be reported in a separate column on the OSHA form 300 log. However, after multiple changes were announced, anticipated and then withdrawn, OSHA required employers to continue reporting ergonomics-related injuries just like they do other injuries.
This does not mean ergonomics is not still a top priority, though.
Identifying the problem
Health facilities throughout the United States are struggling to address the high incidence of work-related musculoskeletal disorders (MSDs), cumulative trauma disorders (CTDs) and repetitive motion injuries in their workplaces. Back injuries alone account for nearly 50 percent of all workers’ compensation claims within the health care and hospitality industries.
Ergonomic issues relating to lifting and moving patients, heavy equipment and materials are currently receiving the greatest attention from safety and health professionals, insurance carriers, and research and government organizations.
These tasks require repetitive or sustained use of poorly designed handheld tools and equipment. Adding to the problem is that most facilities are not designed to produce an easy and efficient method of delivering services. Tasks involving manual handling activities are performed by workers in housekeeping and, of course, laundry operations.
While the precise cost of occupational MSDs is not known, the problem is significant both in health and economic terms.
For example, at Citizens Memorial Healthcare in Bolivar, Mo., an ergonomics component added to the existing safety and health program reportedly led to a sharp reduction in the number of OSHA-recordable lifting-related injuries. Decreases of at least 45 percent were reported in each of the following four years compared to the level of injuries prior to the ergonomics efforts.
Moreover, the number of lost workdays associated with lifting-related injuries was reported to be at least 55 percent lower than levels during each of the previous four years. Citizens Memorial reported that these reductions contributed to a direct savings of approximately $150,000 in workers’ compensation costs over a five-year period.
Observing the organization
There is growing evidence that demonstrates the effectiveness of ergonomic programs and interventions in all industries. Successful implementations of such plans depend on how well they are designed to link to and complement goals of other facility programs, such as risk management and employee safety.
Ergonomics programs are systematic methods of preventing, evaluating and managing work-related MSDs. The most successful ergonomics programs have the following four elements:
• Work site analysis. This is a safety and health audit that identifies those jobs and workstations that are potential work-related musculoskeletal hazards, the risk factors that pose the hazards and the causes of the identified risk factors.
• Injury prevention and control. This eliminates or minimizes risk factors that pose hazards determined in the work site analysis. These adaptations can be performed by changing the jobs, workstations, tools or environment to fit the worker.
• Medical management. This is the effective utilization of health care resources to prevent or manage work-related MSDs.
• Training and education. This provides necessary information to give both workers and managers an understanding of the potential risk of injuries, their causes, symptoms, prevention and treatment.
Before commencing implementation of any plan, it’s a good idea to meet with senior management to gain final approval for the plan and to assure budgets and resources.
Ergonomic program elements
In response to the widespread concern about work-related MSDs and with the knowledge that many workplaces have begun successful programs to control them, a wide variety of organizations have published ergonomics program manuals and primers.
For instance, the National Institute for Occupational Safety and Health (NIOSH) “Elements of Ergonomics Programs” reference can be an excellent guideline for facilities departments concerned with ergonomic issues (see Need ergonomic help? Try this free resource).
The primer is based on the extensive practical experience accumulated by NIOSH in conducting investigations in actual workplace settings. The seven elements of an effective program comprise a seven-step “pathway” for evaluating and addressing musculoskeletal concerns in an individual workplace.
A brief summary of the steps includes the following:
- Look for signs of a potential musculoskeletal problem in the workplace, such as frequent worker reports of aches and pains, or job tasks that require repetitive, forceful exertions.
- Show management commitment in addressing possible problems and encouraging worker involvement in problem-solving activities.
- Offer training to expand management and worker ability to evaluate potential musculoskeletal problems.
- Gather data to identify jobs or work conditions that are most problematic, using sources such as injury and illness logs, medical records and job analyses.
- Identify effective controls for tasks that pose a risk of musculoskeletal injury and evaluate these approaches once they have been instituted to see if they have reduced or eliminated the problem.
- Establish health care management to emphasize the importance of early detection and treatment of musculoskeletal disorders for preventing impairment and disability.
- Minimize risk factors for MSDs when planning new work processes and operations by building good design into the workplace. This is less costly than redesigning or retrofitting later.
Eliminating the cause of an ergonomic problem is the key to both its treatment and prevention. In many instances, the logical place to start would be with the proper equipment (see sidebar, below).
Most laundry/linen carts are big, square and heavy. These factors make moving them difficult for anybody, whether the person is short, average or tall. Pushing a cart can lead to back and neck problems, especially for people of short or average stature. Tall individuals can also suffer low back pain due to improper techniques.
Proper movement is key to a healthy, pain-free back, and pushing or pulling a laundry cart involves the worst body mechanics possible.
For instance, turning corners and pushing a load often requires spinal rotation to see what’s in the way and to keep pushing the cart. This can lead to a bulging or herniated disc. Additionally, sudden stops can involve pulling or jerking the cart, leading to more strain on the body, especially the spine.
Although back injuries are more common, the knee joints should not be overlooked. Pushing and pulling a heavy load can be damaging to knee cartilage.
Manually pulling a laundry cart can also cause stress on the shoulder joint. Any time a shoulder is in external rotation, the strain on the shoulder joint can result in small tears of the muscle or capsule, leading to major tears requiring reconstructive surgery. Recovery is slow and painful. The wrist and fingers can also be damaged from constantly gripping a cart to maintain control of it. Arthritis is a primary result when an employee must constantly be holding, pulling or pushing an object as heavy as a laundry cart.
Oklahoma City-based Integris Health, Oklahoma’s largest not-for-profit health care system, has an ergonomic program that utilizes workstation analysis to reduce stressors that cause MSDs. The system’s management provides patient care floors with lift equipment and continual training, to prevent their employees from having serious lifting and transferring injuries.
The linen department at Integris Health handles 2.5 million pounds of clean laundry and an additional 2.75 million pounds of soiled linen annually. The linen is loaded onto carts that weigh up to 700 pounds each and their department was pushing and pulling 60 carts per day manually. The annual total weight for linen distribution is 5.6 million pounds, which is divided by five full-time employees, giving each employee 1.1 million pounds to move throughout the hospital each year.
Integris Health’s Risk Management team worked closely with ERGOtech (www.ergotug.com), a Hudson, Wis.-based vendor that provides ergonomic tugs and transporters. The use of the vendor’s products eliminated the pulling and pushing aspects and allowed employees to accomplish more work in a shorter time period. The linen carts are now moved with little effort. Consequently, workers require less time off due to injuries and have lower workers’ compensation rates.
Cost-effective and efficient
Employee safety is a key goal of any hospital department, and poor ergonomics is one of the most frequent causes of injury in laundry and linen care operations.
The advice above can help linen managers eliminate some of these problems and maintain a more cost-effective and efficient department.
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