Ergonomics programs should be tailored to HCWs

Computer workstations are hot area’ for injuries

If you’re seeking ways of reducing musculoskeletal injuries at your facility, forget about traditional training programs that focus on how to apply proper body mechanics to patient-lifting tasks. They don’t work.

So what can you do instead?

Two experts in health care ergonomics spoke at the recent Association of Occupational Health Professionals in Healthcare (AOHP) annual conference in Orlando, FL, and offered a range of practical advice for this persistent injury problem among health care workers.

Research shows that interventions such as providing lifting instruction and other training in the biomechanics of lifting techniques have been ineffective in reducing injuries and back pain prevalence,1-7 says Guy Fragala, PhD, PE, CSP, director of environmental health and safety at the University of Massachusetts Medical Center in Worcester. Fragala also is author of Ergonomics: How to Contain On-the-Job Injuries in Health Care (Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations; 1996).

Traditional training programs have failed for several reasons, he explains.

"It’s difficult to modify behavior and to apply optimum principles in the real work environment," Fragala tells Hospital Employee Health. "Also, there is no one best way for all workers to perform a patient lift or transfer because physical variations exist among workers, and proper technique doesn’t help when loads are too heavy."

In addition, few programs monitor workers to ensure they actually are using the techniques they learned in traditional training programs.

Base training on ergonomic principles

Health care is fraught with injury-producing lifting problems due to physically stressful patient-handling demands such as transfers, bending, and static postures, he points out. Loads are often too heavy, unpredictable, and require awkward postures.

Effective training programs must be based on ergonomic principles, and the key to success for a health care facility’s program is eliminating heavy lifts as other industries have done. Fragala recommends a five-step ergonomic system approach (see box, p. 20, for additional details):

• Identify and assess high-risk jobs and tasks through general observation, employee discussions, employee questionnaires, review of medical data, quantitative evaluations, and fatigue and job consistency evaluations over the course of a work shift.

• Analyze risks by determining where the problems are, identify specific risk factors and ways to change them, and prioritize where change is needed.

• Formulate recommendations for administrative (additional staff, reorganized work schedules, use of proper procedures) and engineering (redesigned jobs, lifting equipment) controls.

• Implement recommendations, which requires such elements as top management support, familiarity with past efforts to reduce injuries, cooperation of all departments involved in patient care, and medical and case management.

• Measure and assess program impact to document successes and failures leading to further action and continuous improvement.

Musculoskeletal disorders are a major problem in health care facilities, and patient handling is the major culprit, but ergonomics expert R.J. Banks, MS, CIE, says injury risks lurk in every area: janitorial, housekeeping, food service, laundry, pharmacy, and clerical, as well as nursing and other patient care departments.

"Hospitals are like little cities, so [employee] health professionals have to look at every area. They are like first-line triage for these injuries before they get to a doctor, so they need to know where the risk factors are, not just in patient lifting, but everywhere," says Banks, an ergonomics consultant for State Compensation Insurance Fund of California, a San Francisco-based workers’ compensation insurance carrier whose 250,000 policy holders include health care workers.

Think prehab,’ not rehab’

Banks’ message is that employers need to focus on "prehab," not "rehab" — to emphasize injury prevention instead of reacting after injuries occur.

California recently adopted the nation’s first ergonomics standard (see Hospital Employee Health, August 1997, p. 96), but Banks calls it "ridiculous."

"The standard is very reactive because it doesn’t even kick in until two injuries are reported. It’s counter to what workers’ compensation is," she says. "Why is it OK to wait for two people to be injured before you do anything?"

Every hospital should have an awareness program to identify "hot areas" and focus on them, she states. "Ergonomics should be viewed as a normal part of a safety program, as a preventative, vs. waiting for injuries to build up to the point that you’re in a rehab mode; then, you’re reactive."

A newly emerging "hot area" for injuries in hospitals is computer workstations, Banks says. Injuries are bound to occur when workers of various sizes and shapes are using the same video display terminals (VDTs), desks, chairs, and other equipment in three different shifts around the clock.

"Hospitals are becoming much more computerized, with even nurses and technicians having to use them, so the adjustability of computer workstations is an issue," she explains.

Taking a proactive approach includes assessing workstations and ensuring that they are adjustable for different users. (See "VDT Quick Check Workstation Assessment" form, p. 19, and "Personal Ergonomic Checklist" for workers, inserted in this issue.)

"Injuries are going to occur at computer workstations if they are not adjustable," Banks says. "This is true not only for clerical staff but also for nurses, who might have to sit there for periods of time or may have to enter information fairly quickly, so they need to have equipment they can adjust. They have the same concerns and needs as a clerical worker who would be sitting there for eight hours. We have the potential for seeing injury numbers rise due to the need for computer input, which nurses previously haven’t had to do."

EHPs and other safety personnel in every hospital should conduct periodic inspections to determine where injuries might happen, not just where they are happening, she emphasizes. Risk factor analyses of worksites should then be used to prioritize jobs that need to be modified immediately to prevent injuries. (See "Risk Factor Analysis" form inserted in this issue.)

"If you’re looking only at work stations where injuries are occurring, you’re reactive," Banks states. "Ergonomics should not be considered a separate part of safety program. It should be incorporated and written into it."


1. Dehlin O, Hedenrud B, Horal J. Back symptoms in nursing aides in a geriatric hospital. Scand J Rehabil Med 1976; 8:47-53.

2. Snook S. A study of three preventive approaches to low back pain injury. J Occ Med 1978; 20:478-481.

3. Anderson J. Back pain and occupation. In Jayson MIV (ed). The Lumbar Spine and Back Pain (2nd ed). . London: Pitman Medical Ltd.; 1980.

4. Stubbs DA, Buckle PW, Hudson MP, et al. Back pain in the nursing profession I: Epidemiology and pilot methodology. Ergonomics 1983; 26:755-765.

5. Stubbs DA, Buckle PW, Hudson MP, et al. Back pain in the nursing profession II: The effectiveness of training. Ergonomics 1983; 26:767-779.

6. Owen B, Garg A. Reducing risk for back pain in nursing personnel. AAOHN J 1991; 39:24-33.

7. Harber P, Pena L, Hsu P, et al. Personal history, training, and worksite as predictors of back pain of nurses. Am J Ind Med 1994; 25:519-526.