No clinical focus in proposed CTD standard

OHM review finds management focus only

The National Safety Council in Itasca, IL, is considering changes to the proposed ergonomic standard this month, after which the standard will be approved or submitted once again for public comments. A review of the proposed standard by Occupational Health Management reveals that the standard would provide a managerial structure for addressing cumulative trauma disorders (CTDs), but no real clinical guidance.

About 200 comments were received on the proposed standard when the comment period closed at the end of June, according to spokesman David Alexander of the National Safety Council. He tells OHM that the responses were evenly split between those suggesting changes and those endorsing the proposed ergonomic standard as it stands. The council's ergonomic committee will meet Oct. 29-30 in Los Angeles, following the National Safety Council's annual meeting, to discuss the comments and decide how to proceed with the proposal.

The committee must consider each individual comment and then decide to make changes or leave the proposal as it is. If there are no substantive changes, the committee can vote on whether to approve the proposal. If there are substantive changes made to the proposal, it must be made available for public comment once again.

The proposed ergonomic standard was approved by the committee on May 5, 1998, by more than a 3-to-1 margin. Intended as a guide for managers and occupational health professionals to help control work-related trauma disorders, the proposed standard was developed by 55 members on the committee representing business, labor, academia, and professional societies. In the May vote, 42 members voted for the proposed standard, eight voted against it, and five abstained. Once the committee provides final approval in the October vote or later, the standard will be accredited by the American National Standards Institute (ANSI) in Orlando, FL.

A copy of the proposed standard obtained by OHM suggests it is no more than an outline of the overall approach to addressing cumulative trauma disorders (CTDs) in the workplace, not a specific guide to preventing or controlling CTDs. If implemented as a final standard, the current proposal would serve as a justification for efforts to address the disorders, and it would provide a managerial structure for how to do so. But there is no clinical guidance or specific steps for preventing and controlling CTDs.

Focus on upper limb disorders

The committee is focusing on upper limb disorders. Though many of the concepts are applicable to CTDs in other parts of the body, the National Safety Council says it intends to address other body areas in separate substandards of the ergonomic standard.

In the proposed standard, the committee states that it is possible to quantify exposure to work-related CTD risk factors, and that it is possible to identify many work situations in which CTDs can occur. Overall, the committee concludes that CTDs can be controlled and managed to minimize impairment and disability, but the proposed standard notes that it is "not yet possible to specify precise quantitative work design parameters for a given level of risk in a given population."

These are some highlights of the steps outlined in the proposal for controlling CTDs:

r Employers should have a written program for managing CTDs.

r Employers must provide training to managers and employees regarding how to recognize the symptoms and signs of CTDs, procedures for reporting CTDs, risk factors, job interventions, and other issues.

r Employees must be given the opportunity to participate in the program.

r Employers should select health care professionals with experience in the evaluation and treatment of CTDs.

r Job analysis must be performed when it is determined that a CTD is work-related. The analysis also can be required when a CTD trend is observed in jobs that use similar tools or processes, when a problem job is identified from record reviews, when a problem persists after changes, and during the design phase of equipment, processes, or jobs.

r But a job analysis is not necessary if there is an "obvious" solution.

r Job design or redesign must be used for eliminating or reducing work-related risk factors for CTDs, "as much as technically and practically feasible."