Histotechs in Motion

Evaluating Ergonomic Concerns for

Your Laboratory
Dale Telgenhoff, PhD, HTL (ASCP)CM
 Presentation Objectives
participants will be able to...
• Discuss causes of work related musculoskeletal
disorders
• Recognize symptoms of repetitive strain injuries
• Identify common musculoskeletal injury risks
• Learn strategies to decrease MSD injury risks
• Perform an ergonomic assessment of workplace
practices
 Ergonomics
“Study of Work”

“ergo” = work
“nomics” = laws of

“The science of fitting the job to the

worker”
 What Is Ergonomics?
– Modify jobs to fit
capabilities of people
– Reduce MSDs
• Repetitive reaching,
forceful exertions,
bending and lifting, or
working with vibrating
equipment
– Engineering controls
– Safe work practices
– PPE
What are the physical demands of your job…
 Job Risk Factors
• Working in awkward postures / positions
• Prolonged sitting and standing
• Bending, reaching, stretching
• Driving for extended periods of time
• Heavy lifting
• Awkward lifting
• Lifting in combination with twisting
• Pushing, pulling, carrying
• Accidents, slips, trips, falls
• Vibration
 Goals of Ergonomics Program…
Reduce work-related musculoskeletal disorders developed by
workers when their jobs involve...

• Awkward postures • Repetition

• Static positions • Contact stress
• Reaching • Vibration
• Bending & Lifting • Repetition
• Force

U.S. Department of Labor Occupational Safety & Health Administration

 What are MusculoSkeletal Disorders?

MSDs are injuries and illnesses that

affect muscles, nerves, tendons,
ligaments, joints or spinal discs.

U.S. Department of Labor Occupational Safety & Health Administration

 Number of total nonfatal occupational injuries and illnesses and
percent distribution of musculoskeletal disorders involving days
away from work, Private industry , 1992-2007

For 2007, occupational musculoskeletal disorders comprise 28.9% of all nonfatal injuries and illnesses involving days away from work.
Since 1992, the percentage figures varied from 33.6 to 34.7% in 2000, and have steadily declined to the current low of 28.9%. (Source:
BLS[2008].)

[Link]
 Common Body Parts Prone To
Workplace MSDs

• Back - Lower
• Neck and Upper Back
• Upper Extremities - Arms and Hands
• Lower Extremities - Legs and Feet
 Examples of MSDs

• Carpal tunnel
• Rotator cuff syndrome
• Lateral epicondylitis
- tennis elbow
• Low back pain
 MSD-Type Injuries
Repetitive Placing,
Grasping, or
Moving Objects
20%
Repetitive
Use of Tools 8%
Repetitive Motion
9% 63%
Typing or
Key Entry
 Number and percent distribution of nonfatal occupational injuries
and illnesses involving days away from work by type of injury or
illness with musculoskeletal disorders, All United States, Private
industry , 2007

Sprains, strains, and tears account for 252,590 or 75.3% of the 335,390
musculoskeletal disorders (MSDs) in 2007. (Source: BLS[2008].)
[Link]
I hate Mondays…

[Link]
 The National Institute of
Occupational Safety and Health
(NIOSH) reported that in the year
2000 roughly 50 percent of the
workforce will have experienced a
repetitive strain injury (RSI)

Proper Ergonomics Benefits Employees and the Bottom Line , Werrell

and Koutsandreas, ADVANCE, 1999.
 MSD Symptoms
– Back and neck—
shooting pain, stiffness
– Shoulders—pain,
stiffness, loss of mobility
– Arms and legs—
shooting pains,
numbness
– Elbow and knee joints—
pain, swelling, stiffness,
soreness
 MSD Symptoms (cont.)
– Hands and wrists—
swelling, numbness, loss
of strength
– Fingers—jerking
movements, or loss
of strength, mobility,
and feeling
– Thumbs—pain at
the base
– Feet and toes—
numbness, tingling,
stiffness, burning
sensation
 Outward Signs of MSDs
– Swelling or
inflammation of joints
– Vigorously
shaking hands
– Massaging hands,
wrists, or arms
– Cradling arms
– Limping
– Stiff back
Musculoskeletal Disorders: How & Why?

• Related to intensity of work

• Have biomechanical and physiological factors
• Can occur after weeks, months, years on job
• Can take weeks, months, years to resolve
• Have occupational and non occupational
causes

French & Zecha, 2005

 Musculoskeletal Disorders: How & Why?
listening to our body…
• Disruption in balance between breakdown and
recovery
• 1st sx….fatigue (of body part)
• 2nd sx…ache
• 3rd sx…pain
• Leading to loss of function

French & Zecha, 2005

 Adaptation vs. Injury
the fork in the road…
• Adapt • Injury
– Soft tissue remodels – Soft tissue breaks
– More strength down
– Less strength
– More stability
– Less stability
– More endurance – Less tolerance for
– Discomfort decreases use
– Discomfort increases
French & Zecha, 2005

If a company is able to provide education and training about RSIs, most strains/injuries
will be recognized early enough that nonsurgical rehabilitation is a viable treatment
option. When the injury goes undetected for longer periods of time, often surgery or
other invasive--and, hence, more expensive--procedures must be used.
Proper Ergonomics Benefits Employees and the Bottom Line , Werrell
and Koutsandreas, ADVANCE, 1999.
 Cost of RSIs
• Average RSI claim = $22,000 (Bureau of Labor Statistics, 1999)
• Disruption of workflow
– Work is not completed
– Work is done by someone else (OT, Temp)

• 2007 OERC Study – Employers providing good

ergonomic furniture and training realized
about $367 per day per employee
[Link]
Back Injury…
From an Ergonomic View
Common Back Disorders

• General joint stiffness

• Acute strains and sprains
• Degenerative disk disease
• Bulging disc
• Herniated disc
• Osteoarthritis
 Anatomy Review…
the spine

• Bones
• Joints
• Discs
• Muscles and ligaments
• Nerves
Anatomy Review…
the curves of the spine
 Leading Causes of Back Problems

• Poor Body Mechanics

• Stressful Living & Working
• Loss of Flexibility
• Loss of Strength
• Accidents
How do we take care of our back?

• Body Mechanics
• Proper Lifting Techniques
• Exercise
• Stretching
• Improved postures
 Body Mechanics
“It’s not how much you lift or move, but the way you do it”!

General Rules: 1) Push vs. Pull

2) Keep Work Within “Strike Zone”
3) Keep Load Close To Body
4) Use Abdominal Bracing
5) Pivot with Feet - Avoid Twisting
6) Team Work vs. Mule Work
 Proper Lifting Technique

Power Position:
• Wide base of support
• Feet shoulder width apart
• Back straight
• Head and shoulders up
• Bend at hips and knees - NOT BACK!
• Keep load close to body
• Tighten stomach muscles
• Use leg, hip and buttock muscles
• Breathe out with lift
 Posture check
Increased stress, decreased circulation…

Higher risk Lower risk

 Posture check
ask yourself…
Do you use a headset rather than cradling the
telephone between your head and shoulder?
 Posture check
ask yourself…

• Are you sitting against

the back of your chair
while you work?
• Is your head/neck
upright and centered over
your shoulders when you
look at the screen or
documents?
• Are your shoulders
relaxed when keying and
using the mouse?
• Are your arms close by
your sides when you use
the keyboard or pointer?
Computer Ergonomics, Lange, ADVANCE, 2008.
 Posture check
ask yourself…

• Are your elbows relaxed

(100 degree angle) when
using the keyboard or
mouse?
• Are your wrists in a
neutral position (aligned
with your forearm) when
keying or using the
pointer?
• Are you avoiding
awkward postures such
as an extended finger or
thumb when keying or
using the mouse?
Equipment set-up example
risk identification…
 Equipment set-up example
risk identification…

Elbow and shoulder away from body, reaching increased

strain on shoulder and wrist
 A word on repetition

• Key issue is recovery time

- the time required for tissue to restore nutrition, replace
cells, dissipate byproducts
- rest breaks
• Some newer research demonstrates that repetition
is significantly less of a problem vs. posture
 A word on contact stress
At your workstation notice where your body comes
into contact with objects…

Where are your:

• Front & back of

knees
• Elbows
• Wrists
• Back
• Behind
• Calves, feet, ankles
Is my “ergonomic” potato chip really ergonomic?

• To be ergonomic a design must…

• Fit the user
• Be easy to use
• Improve comfort
• Improve performance
• Improve health and safety
• Not just bells and whistles!
 Computer workstation ergonomics

• Chair • Glare
• Monitor • Eye strain
• Keyboard • Footrests
• Mouse • Wrists pads
• Document holders • Keyboard trays
• Lumbar pads/pillows
• Laptops
• Arm rests
 Chair Basics

• Good lumbar (low back) support

• Comfortable sitting for at least 2 hours
• Chair has 5 point base
• Adjustable arm rests (or none)
• Seat pan is comfortable
• Easily adjustable while sitting
• Appropriate height & depth of seat pan
 Monitor issues and glare
protect your eyes !

• Eye-to-screen distance at least 18 inches

• Top of screen at eye level or slightly below
• Don’t stare…blink frequently to lubricate
eyes
• Use blinds to control outside light
• Screen colors: dark letters on light
background (IBM blue)
 Work technique
ask yourself…

• Do you avoid leaning on the wrist rest while keying and

mousing?
• Are you using a light touch to key?
• Are you holding your mouse loosely with your hand and
fingers in a relaxed position?
• Do you let go of the mouse when not using it?
• Do you take 20 second breaks after every 20 minutes
of keying?
 Work technique
ask yourself…

• Do you take eye breaks and look at a distance every 20

minutes?
• Do you blink while you look at the screen?
• Do you take stretch breaks throughout the day?
• Have you set up your work to encourage alternating
sitting and standing throughout the day?
• Have you optimized your settings on your computer to
make your work easier? (i.e. flicker rate, mouse speed,
font size)
• Do you know how to adjust your keyboard tray and
chair?
 Laptops
a few words…

Risk Factors Risk Reduction Measures

Harder on eyes and neck • External keyboards
• Smaller screens • Docking stations
• Lower quality displays • Practice good posture on road
• Lower viewing angle
Harder on wrists on arms
• Narrow keyboard
• Awkward postures
Harder on back
• Carrying can strain back
 Watch those deadlines!
tension and stress - ask yourself…

                                      
Ergonomics in the Lab
• At risk procedures
– Pipetting
– Microscopy
– Operating microtomes
– Fume hoods
– Keyboarding
– Static positions
 NSH Health & Safety Information
Packet (2010)
• Computer keyboard work
• Changing solutions on the processor
• Embedding
• Sectioning
• Manual staining
• Manual coverslipping
• Cryomicrotomy
• Microscopy
 Ergonomics in the Lab
• Ergonomics is one of our most common risks!
– 15% of histology professionals suffer chronic pain from RMIs*
• Risk Factors:
– Repetition
– Awkward postures (especially when lifting)
– Static postures (sitting to long)
• Warning Signs:
– Pain (all types, burning, aching, throbbing, etc.)
– Numbness
– Tingling

*Laboratory Ergonomics - The Answer to CTD Prevention, Caskey,

ADVANCE, 2000.
 Repetitive Pipetting
• Use pipettes with newer trigger mechanisms requiring less
force to activate, and use the pointer finger to aspirate and
the thumb to dispense

• Use pipettes that fit comfortably in the user's hand.

• For tasks such as mixing or aliquotting, use an electronic

pipettor with mixing functions.
 Microscopy
• Try pulling the microscope toward the edge
of the work surface to position the
operator in a more upright posture.
• Try elevating the microscope. This can help
position the operator in a more upright
posture and reduce rounding of the
shoulders and neck.
• Maintain neutral spine.
• Use an ergonomically designed chair that
provides adequate back support, adjustable
height, and adjustable seat angle.
• Use armrests to support the operator's
forearms while using adjustment knobs on
the microscope.
Ergonomics Under The Microscope, Warner, ADVANCE, 2010.
Microscopy
 Biosafety Cabinets and Laboratory Workbenches

• Remove drawers, supplies, refrigerators, etc. from under the

workbenches and cabinet doors from under biosafety
cabinets (provides leg room).
• Use a turntable to store equipment near the worker. This
reduces excessive reaching and twisting, which places an
increased load on the low back.
• Use anti-fatigue matting for laboratory personnel who must
stand for extended periods of time.
• Take frequent micro-breaks to perform stretching exercises
Microtome or Cryostat

• Lower the workstation to keep

arms closer to body.

• Apply padding to the front edge

of work surface to eliminate
sharp edges and increase the
amount of blood flow to the
hands.

• Retrofit the existing handle with

an adapter that will allow the
operator to use the handwheel in
a pistol grip position. This will
alleviate repetitive wrist flexion
and extension.
 Rapid Upper Limb Assessment
(RULA)
• Tool for screening biomechanical and postural
loading
• Three step process
– Select action and observe movements
– Score and record posture
– Determine action level
• [Link]

McAtamney and Corlett, Applied Ergonomics, 24 (2), 91-99 (1993)

 RULA – Microtome Use
Scores:

1-2: Ergonomically
correct

3-4: Area of concern

5-6: Investigation and

changes are required
soon
Risk Identification
 Micro-Manipulation & Fine Motor Skills

• Practice using the forceps

between the 1st and 2nd digits
instead of using the thumb and
1st digit. Then try alternating
between the two positions to
reduce the use of the thumb.
The thumb is used repetitively
with almost every job task
performed in the laboratory
 Ergonomics Management
– Job assessment
– MSD reporting and response system
– Designated coordinator
– Training
– Encourage employee participation and reporting
of MSDs
 Identifying and
Controlling MSD Hazards
– Determine whether
MSD hazards exist
and degree of risk
– Devise a control
strategy with your
input
– Implement control
measures
– Training
 Control Methods
– Install engineering controls including workstation
layout and proper tools
– Institute work practice controls including neutral
postures for performing tasks
– Administrative controls including rescheduling to
reduce frequency or duration of exposure to MSDs
– Personal protective equipment (PPE) to provide a
protective barrier between worker and MSD
 How to Protect Yourself
– Change positions often;
take stretch breaks
– Maintain neutral posture
whenever possible
– Eliminate or reduce MSD
risk factors
– Use material-handling
aids
– Report MSD symptoms
 MSD Prevention and Control—Any
Questions?
– Do you think you
understand what you
need to know about
the methods to
manage, prevent, and
control MSDs?
– Recognize MSD signs and symptoms
– Understand MSD hazards
– Take steps to control MSD hazards
– Participate in the Ergonomics Program
Back Safety & Ergonomics
isn’t just a work thing!
The big picture…
Conducting a Workplace
Assessment
 Overview

• What is a hazard assessment?

• When is one required?
• How do I conduct one?
 Definition
A hazard assessment is an evaluation of a work
place, or work situation, as to the potential for
hazards that an employee may encounter while
performing the job.

Elimination
Awareness
Accommodation
 Requirements
Employers are required (by OSHA) to certify in
writing that they have assessed the work place
to determine if hazards are present or likely that
would require personal protective equipment
(PPE)and/or medical monitoring, or other
requirements.
 Where do you begin?
• It may be difficult to begin assessing every
location, job title, or job task. The most logical
place to begin is to review your accident and
illness reports.
• –Is there a work area that seems to have more
accidents and injuries than others?
• –Is there a type of injury that seems to occur
more frequently than others?
 Where do you begin?
• If injury and illness reports do not point you
towards a place to begin, consider beginning
with:
• –Close calls or near misses
• –New tasks or positions
• –Tasks that have changed
• –Non-routine jobs
• –Routine jobs
 Identify the Hazards - Questions
1. What type of posture does the job require? This could be
prolonged sitting, standing, bending over a microscope or
holding your shoulders statically under a hood.
2. Does the task entail using force or vibration? (pipetting in the
lab, working with power tools, working with a computer
mouse, etc.)
3. What other body mechanics are necessary to do the job?
(bending, lifting, reaching, etc.)
4. Does the job require any repetitive movements? (counting
money, processing bills, typing, cutting, assembling parts,
pipetting, etc.)
Proper Ergonomics Benefits Employees and the Bottom Line , Werrell
and Koutsandreas, ADVANCE, 1999.
 Step 2

• Once the hazard has been identified, you must

implement an effective control to eliminate
the hazard, reduce the hazard to an
acceptable manner, or protect the employee.
 Step 3
• Evaluate the level of risk for each hazard to
help determine what type of control should be
implemented to reduce exposure.
 Step 4
Select an appropriate solution to each hazard.
• –Always consider eliminating the hazard (if
possible) first.
• –If elimination is not possible, consider
reducing the hazard to an acceptable level.
• –If an acceptable level cannot be reached,
select and provide appropriate personal
protective equipment for the employee.
 Engineering Controls
Engineering controls eliminate exposure to the
hazard. They are:
• –relatively permanent,
• –can be costly, and
• –can be time-consuming

• Is there new (or existing) technology on the

market for the product which, by it’s design,
protects the person using it?
Automation
 Work Area Layout
• Can a hazardous work area layout be
improved?
– Move chairs to proper heights
– Use correct posture
– Avoid over-reaching
– Use a foot support
Ergonomics Preventing Pain in the Workplace , Patton, ADVANCE, 2003.
 Administrative Controls
Administrative controls reduce employee
exposure to a hazard.
• –They do not eliminate the hazard, but they
provide an acceptable way to work around the
hazard.
• Reduction - Can you reduce the frequency of
performing the hazardous task?
– Mini-breaks, stretching
 Administrative Controls
• Rotation - Can employees be rotated to
reduce exposure time?

• Training - Can employees be trained to

recognize hazards and employ safe work
practices?
Questions?