Hospital Laboratory Ergonomics

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Hospital Laboratory Ergonomics

• Theodore J. Hogan, PhD, CIH
• Theodore J. Hogan Associates, Inc.
• Lemont, IL 60439
• 630-257-3939
• www.tjhinc.com

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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

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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

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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
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Example Assessments

• Tissue Embedding
• Cutting
• Harvesting
• Automated Operations

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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

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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

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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

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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

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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

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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

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CuttingRecommendations

• 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

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Harvesting (cytology)

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

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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

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HarvestingObservations 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

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Automation

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

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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

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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

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Control Noise

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

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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

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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

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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

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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

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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

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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

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