Identify Who Has Occupational Exposure

A majority of workers in the health care field routinely come into contact with blood and body fluids that potentially contain bloodborne pathogens. These workers are known to be at-risk. Other occupations where workers may be exposed to BBP and must be covered by an employer's exposure control plan include the following.

Emergency Responders, Firefighters, And Law Enforcement Personnel

For emergency responders such as firefighters, law enforcement agents, and other emergency response personnel, the potential sources of contamination from bloodborne pathogens are varied. Emergency responders assist when there is illness and at accidents and fires where there frequently is trauma, such as open wounds. Also, exposure and potential infection can result from handling discarded emergency medical items such as needles and sharps, bandages, or gauze.

Today's firefighters and emergency responders play a greater role in emergency situations, frequently as health care providers, and are often the first to arrive at the scene of an accident. For example, up to 80 percent of all field emergency medical care today is provided by fire service personnel. Although not officially classified as health care workers, fire and rescue personnel are consistently faced with the potential for exposure to infectious blood, blood products, blood components, and body fluids.

Emergency responders frequently face unpredictable, uncontrollable, dangerous, and life-threatening circumstances. Anything can happen in an emergency situation, including exposure to blood and contaminated equipment. This especially applies to fire and rescue personnel and, in many instances, law enforcement personnel who often operate under hostile circumstances. There is an extremely diverse range of potential situations that can put law enforcement officers at risk.

At crime scenes, when processing suspects, or as a result of fights and/or assaults, law enforcement officers may be at risk of exposure. The informed judgment and awareness of the individual officer is critical when unusual circumstances or events arise that can jeopardize his/her safety or health. It is the responsibility of emergency responders' employers to ensure that their employees are properly informed and adequately protected at the work site and in emergency situations.

In-Plant First Aid Responders

Employees who are trained and designated as responsible for rendering first aid or medical assistance as part of their job duties have the potential for exposure and must receive bloodborne pathogens training.

Maintenance Workers

While OSHA does not generally consider maintenance personnel and janitorial staff employed in non-health care facilities to have occupational exposure, it is the employer's responsibility to determine which job classifications or specific tasks and procedures involve occupational exposure. For instance, if maintenance or janitorial personnel are required to clean up following an incident involving body fluids, they would need bloodborne pathogens training.

Also, OSHA expects products such as used sanitary napkins to be discarded into waste containers which are lined in such a way as to prevent contact with the contents. But at the same time, the employer must determine if employees can come into contact with blood during the normal handling of such products from initial pick-up through disposal in the outgoing trash.

Note

Occupational exposure is defined as "reasonable anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of an employee's duties." The definition of "other potentially infectious materials" includes any body fluid that is visibly contaminated with blood. Urine, feces, sweat, tears, nasal secretions, and vomitus which are not visibly contaminated with blood are not considered to by "other potentially infectious materials."

Personnel Service/Contract Workers

If your company uses personnel service workers and you, as the the host employer, exercise day-to-day supervision over those workers, then they are considered the employees of the host employer, as well as of the personnel service. In this situation, the host employer must comply with all provisions of the BBP standard with respect to these workers.

Regarding Hepatitis B vaccination, post-exposure evaluation and follow-up, recordkeeping, and generic training, the host employer's obligation is to take reasonable measures to assure that the personnel service firm has complied with these provisions.

Independent contractors that provide a service, such as a cleaning service, provide supervisory personnel, as well as rank-and-file workers to carry out the services. These companies and the host employers are responsible for complying with all provisions of the BBP standard according to OSHA's multi-employer worksite guidelines.

The Exposure Control Plan | Bloodborne Pathogens

A written exposure control plan is necessary for the safety and health of workers. Covered employers must develop a plan that identifies and documents the tasks, procedures, and job classifications covering instances where there is exposure to blood or other potentially infectious materials.

The written exposure control plan must document the following key elements:

• Job classifications: Identify job classifications and, in some cases, the tasks where there is exposure to blood and other potentially infectious materials.

• Schedule: Outline how and when the provisions of the standard will be implemented, including schedules and methods for communication of hazards to employees, hepatitis B vaccination and post-exposure evaluation and follow-up, recordkeeping and implementation of the methods of compliance, such as:

  • Engineering and work practice controls,

  • Personal protective equipment, and

  • Housekeeping.

• Evaluation: Procedures for evaluating the circumstances of an exposure incident.

The schedule of how and when the provisions of the standard will be implemented may be a calendar with brief notes describing the methods, an annotated copy of the standard, or part of another document, such as the infection control plan.

The written exposure control plan must be accessible to employees and must be reviewed and updated at least annually and whenever necessary to reflect new or modified tasks and procedures which affect occupational exposure and to reflect new or revised employee positions with occupational exposure. The review and update must also:

• Reflect changes in technology that eliminate or reduce exposure to bloodborne pathogens; and

• Document annually consideration and implementation of appropriate commercially available and effective safer medical devices designed to eliminate or minimize occupational exposure.

The employer must also request input from non-managerial employees responsible for direct patient care who are potentially exposed to injuries from contaminated sharps in the identification, evaluation, and selection of effective engineering and work practice controls. This process must be documented in the exposure control plan. Planning begins with identifying employees who have occupational exposure.

Who is Covered? | Bloodborne Pathogens

The standard applies to every employer with one or more employees who can reasonably be expected to come into contact with blood and other specified body fluids in carrying out or in performing their duties.

The approximately 5.6 million workers covered by the bloodborne pathogens standard include 4.4 million health care workers in facilities such as hospitals and physicians' and dentists' offices and 1.2 million non-health care workers in law enforcement, fire and rescue, correctional facilities, research laboratories, and the funeral industry.

Although the majority of at-risk workers are in the healthcare field, exposures can also occur to workers in general industrial and office settings. In these facilities, employees at greatest risk for contacting blood or body fluids are those whose jobs include:

• Medical and first aid response,

• Maintenance and clean-up work,

• Housekeeping and laundries.

Employers having at least one employee with one or more at-risk responsibilities must develop a blood-borne pathogens exposure control program. The program must evaluate tasks and procedures in the workplace that may involve exposure to blood or other potentially infectious materials; identify workers performing these tasks; and implement a variety of methods to reduce the risks involved with exposure.

Blood and OPIM Definitions

In the bloodborne pathogens rule, OSHA defines "blood" as human blood, blood products, or blood components. "Other potentially infectious materials" (OPIM) are defined as including human body fluids such as saliva in dental procedures, semen, vaginal secretions; cerebrospinal, synovial, pleural, pericardial, peritoneal, and amniotic fluids; any body fluids visibly contaminated with blood; unfixed human tissues or organs; HIV-containing cell or tissue cultures; and HIV or HBV-containing culture mediums or other solutions; and all body fluids in situations where it is difficult or impossible to differentiate between body fluids.

Occupational Exposure

Occupational exposure is defined as a "reasonably anticipated skin, eye, mucous membrane, or parenteral contact with blood or other potentially infectious materials that may result from the performance of the employee's duties." Determining occupational exposure and instituting control methods and work practices appropriate for specific job assignments are key requirements of the BBP standard. The required written control plan and methods of compliance show how employee exposure can be minimized or eliminated.

Bloodborne Pathogens

The Occupational Safety and Health Administration (OSHA) estimates that about 5.6 million workers in health care and other facilities are at risk of exposure to bloodborne pathogens such as the human immuno-deficiency (HIV) and hepatitis B (HBV) viruses and other potentially infectious materials. Workers who have occupational exposure to bloodborne pathogens include, but are not limited to, nurses, physicians, dentists and other dental workers, laboratory and blood bank technologists and technicians, medical examiners, morticians, phlebotomists, emergency room personnel, intensive care and operating room nurses and technicians, orderlies, housekeeping personnel, and laundry workers.

Others also at risk include law enforcement personnel, firefighters, paramedics, emergency medical technicians, and anyone whose job might require providing first-response medical care in which there is a reasonable expectation of contact with blood or other potentially infectious materials.

OSHA's bloodborne pathogens (BBP) standard, §1910.1030, prescribes safeguards to protect workers against the health hazards from exposure to blood and certain body fluids that may contain bloodborne pathogens and to reduce their exposure risk.

The information in this chapter summarizes the requirements of the bloodborne pathogens standard; provides answers to the most frequently asked questions concerning BBP compliance; and contains a sample exposure control plan. Compliance information from OSHA on how they are enforcing the standard is also included.

Employers having employees who are at risk of bloodborne pathogens exposure are required to prepare a written exposure control program. The plan must evaluate routine tasks and procedures in the workplace that involve exposure to blood or other potentially infectious materials (OPIM); identify workers performing such tasks; and use a variety of methods to reduce the risks.

OSHA's standard specifies the need for engineering and work practice controls; personal protective equipment; housekeeping procedures; post-exposure evaluation and follow-up; recordkeeping; and communicating hazards to personnel. The ultimate goal is to provide safe working conditions that protect employees from unnecessary exposure to bloodborne pathogens health hazards.

Videotape Guidelines and Analysis

Video Guidelines for Ergonomic Evaluations

Obtaining good video documentation for ergonomic evaluations can be difficult — as the tasks are often performed in inaccessible areas with poor lighting conditions and a lot of extraneous movement taking place. This guide presents suggestions for capturing effective video documentation of potential ergonomic hazards.

Preparation

Use the OSHA Form 200 logs and 101s (and after January 1, 2002 the OSHA Form 300 series), complaint information, and interviews to help prioritize areas for taping. It is desirable to have at least a two-person team when performing an evaluation. One person can operate the video camera while the other can record task and employee information.

The equipment needed for an ergonomic inspection will generally include:

• Video camera with extra tapes and charged batteries,

• Tape measure,

• Small notebook,

• Fanny pack,

• Small scale (Chattillon or fish scale that can measure pull forces),

• Bungee cord or small piece of rope, and

• Questionnaires for employee interviews concerning ergonomic factors.

Other useful items may include:

• Stop watch,

• Lens cleaning paper,

• Extra batteries for internal clock, and

• Skylight UV filter. This is a must in a dirty environment if you do not have a protective case.

The following are general suggestions on camera usage which, if reviewed prior to going on-site, will provide the best video documentation for the analyst and ensure that all pertinent information is obtained and documented.

• Become familiar with the camera and read the operators manual. Shoot some test footage so you are familiar with all the functions of the camera.

• Always activate the date and time mechanism on the camera so that this information is displayed on the video during the entire taping series. This will provide additional reference points with which to correlate written information with the videotape footage. Be aware of the position of the date and time printout on the video footage to make sure that it is not superimposed over the top of important features of the video documentation.

• For operations with extraneous movement it may be necessary to use the manual focus to avoid the camera refocusing on irrelevant moving objects. Determine where the focus point is for the camera you are using. It may not be in the center of the viewfinder. To make this determination place the camera on auto focus and try to focus on a small item such as a hanging pendant that has nothing else in the same plane. Hang the item from a doorway and try to focus by moving the item back and forth in the field of the viewfinder. You have found the focus point when the camera focuses on the item.

• If the camera has a high speed shutter, turn it off and use the auto shutter. high speed requires too much light for most industrial tasks. If you are taping a worker with dark clothes against a light background (such as a window, or a white wall), activate the "back lit" capability on the camera.

• Practice visual slating of information. This should be done by filming a piece of paper with information clearly written on it just prior to or directly after videotaping the task. Use a marker or dark pen that can be clearly seen. The macro-zoom on your camera will permit use of a small notebook or journal to be used as a slate. A small notebook is easy to carry and any pertinent notes can be recorded on the slate sheet for easy correlation and future reference. Macro-zoom is also helpful for documentation of small informational areas such as labels.

• If visual slating is absolutely not possible, cover the lens with your hand and record the information verbally before the actual job taping begins. Be aware that you will need to speak directly into the camera microphone to be clearly understood. Use of an external microphone can be helpful in audio slating.

• Hold the camera as still as possible or use a tripod if available. Don't walk with the camera unless absolutely necessary to record the task. When you change location, move slowly and minimize camera movement. Use the zoom instead of walking whenever possible. Use the manual focus whenever there is extraneous movement in the frame of action to ensure the focus will be on the items of interest.

Videotaping Tasks

The following items outline the procedures used for obtaining useful video documentation.

• If possible tape the operation in the order of production. Do the beginning of the production process first and proceed through all tasks of interest.

• Visually slate at least the name of the task just prior to or directly after videotaping the task.

• Tape 5–10 minutes for all jobs including approximately 10 cycles. A cycle is considered to be a set of repeated motions during which one part or assembly is processed. Jobs that have relatively long cycle times in excess of 30–60 seconds may require fewer than 10 cycles if all aspects of the job are recorded at least 3–4 times.

• Begin each task with a whole-body view of the worker from the side including the chair and/or the floor. Hold this view for 2–3 cycles and then zoom the camera in for a closer view of the area of principal interest. Tape from a variety of angles to allow a determination of wrist deviation, arm postures, back angles, etc. Tape from both sides and the front if possible. The total footage may be distributed between these different angles.

• Videotape the operation from a distance to give perspective to the analyst about workstation layout.

• Find an entity of known dimension in the frame of the picture and measure it for reference purposes. The employee's forearm from the wrist to the elbow is a convenient landmark since it is in most frames and is measurable on the television screen. If possible place a piece of contrasting tape on the reference points to provide a more distinct and identifiable location point. Record the reference dimensions either by visually slating the information or verbally recording the data. If using a ruler or tape measure as your reference point, ensure that the increments are clearly visible.

• Obtain video footage of tools or machinery that are used on the job. Videotape labels from hand tools, machinery, weight from boxes, etc.

Additionally, the following information should be visually slated at the beginning of each individual task or recorded in a written supplemental factors checklist.

• The name of the task and employee.

• Anthropometry (height) of the employee.

• Ambient conditions when working in extreme areas (freezers, furnaces, etc.).

• Clothing and PPE (materials, etc.).

• The period of time in which the task is performed including work-rest schedules.

• The nature of injuries as determined from the 200's, 101's, 300's, or interviews.

• Weight and dimension of loads lifted.

• Dimensions of the work items seen in the shot (i.e., pallets, tables, shelving units, etc.).

• Vertical distance between origin and destination of lift. Horizontal distance the load is held from the body at the beginning and end of the lift. These distances can be estimated directly from the video documentation if measuring will significantly interfere with the operation. To do this there must be a clear view of the entire body and the work space, preferably in profile. Provide dimensional information on as many work items seen in the footage as possible.

• Distance loads must be carried.

• Production data to aid in determining if the video segment is representative of normal activity.

• Conditions that might affect grip or traction (ie., sand on the floor, ice on boxes being lifted, etc.).

Components of the Equation | Ergonomics

Horizontal Values Range between 10 Inches and 25 Inches

If the horizontal distance is less than 10 inches (25 cm), then H is set at 10 inches (25 cm). Although objects can be carried or held closer than 10 inches from the ankles, most objects that are closer than this cannot be lifted without interference with the body. The maximum value of H is 25 inches (63 cm). Objects at a distance of more than 25 inches from the ankles normally cannot be lifted vertically without some loss of balance.

Vertical Values Range between 0 and 70 Inches

The vertical location is limited by the floor surface and the upper limit of vertical reach for lifting (i.e. 70 inches or 175 cm). The vertical location should be measured at the origin and the destination of the lift to determine the travel distance (D).

Distance Values Range between 10 Inches and 70 Inches

The variable D is assumed to be at least 10 inches (25 cm), and no greater than 70 inches (175 cm). If the vertical travel distance is less than 10 inches (25 cm), then D should be set at the minimum distance of 10 inches (25 cm).

Asymmetry Values

The angle A is limited to the range from 0° to 135°. If A > 135°, then AM is set equal to zero, which results in a RWL of zero, or no load.

Frequency Value Range

Lifting frequency (F) for repetitive lifting may range from 0.2 lifts/minute to a maximum frequency that is dependent on the vertical location of the object (V) and the duration of lifting. Lifting above the maximum frequency results in a RWL of 0.0, except for discontinuous lifting where the maximum frequency is 15 lifts/minute.

Classification of Gripping Method (Coupling)

The hand-to-object coupling or gripping method (C) affects not only the maximum force a worker can or must exert on the object, but also the vertical location of the hands during the lift. A good coupling will reduce the maximum grasp forces required and increase the acceptable weight for lifting, while a poor coupling will generally require higher maximum grasp forces and decrease the acceptable weight for lifting. The entire range of the lift should be considered when classifying hand-to-object couplings, with classification based on overall effectiveness. The coupling must be classified as good, fair, or poor. If there is any doubt about a particular classification, select the more stressful classification.

Lifting Index (LI)

The Lifting Index (LI) provides a relative estimate of the physical stress associated with a manual lifting job. The equation for the (LI) is:

How to Use the RWL and LI to Guide Ergonomic Design

The recommended weight limit (RWL) and lifting index (LI) can be used to guide ergonomic design in several ways:

• The individual multipliers can be used to identify specific job-related problems. The relative magnitude of each multiplier indicates the relative contribution of each task factor (e.g., horizontal, vertical, frequency, etc.).

• The RWL can be used to guide the redesign of existing manual lifting jobs or to design new manual lifting jobs. For example, if the task variables are fixed, then the maximum weight of the load could be selected so as not to exceed the RWL; if the weight is fixed, then the task variables could be optimized so as not to exceed the RWL.

• The LI can be used to estimate the relative magnitude of physical stress for a task or job. The greater the LI, the smaller the fraction of workers capable of safely sustaining the level of activity. Thus, two or more job designs could be compared.

• The LI can be used to prioritize ergonomic redesign. For example, a series of suspected hazardous jobs could be ranked according to the LI and a control strategy could be developed according to the rank ordering (i.e., jobs with lifting indices above 1.0 or higher would benefit the most from redesign).

This Lifting Index can be used to identify potentially hazardous lifting jobs or to compare the relative severity of two jobs for the purpose of evaluating and redesigning them. Lifting tasks with a LI > 1.0 pose an increased risk for lifting-related low back pain for a fraction of the workforce. Therefore, the goal should be to design all lifting jobs to achieve a LI of 1.0 or less.

Preventing and Controlling Back Injuries

Low back pain and injuries attributed to manual lifting activities continue as one of the leading occupational health and safety issues facing preventive medicine. Although no approach has been found to totally eliminate back injuries caused by lifting, an effective training program and ergonomically designed work tasks and equipment will help to prevent a substantial number of this type of injury.

Implementing administrative and work practice controls involves carefully selecting and training workers so they know how to safely perform lifting tasks. Engineering controls are used to redesign a job or use mechanical lifting equipment so the lift becomes less hazardous.

Suggested administrative and work practice controls include:

• Strength testing of existing workers, which has been shown to prevent up to one-third of work-related injuries by discouraging the assignment of workers to jobs that exceed their strength capabilities.

• Training employees to utilize lifting techniques that place minimum stress on the lower back.

• Physical conditioning or stretching programs to reduce the risk of muscle strain.

• Use of two-person lift teams when mechanical lifts are not available.

• Observing micro-breaks to minimize muscle fatigue.

Suggested engineering controls include:

• A reduction in the size or weight of the object lifted.

• Adjusting the height of a pallet or shelf. Lifting which occurs below knee height or above shoulder height is more strenuous than lifting between these limits. Obstructions which prevent an employee's body contact with the object being lifted also generally increase the risk of injury.

• Installation of mechanical aids such as pneumatic lifts, conveyors, and automated materials handling equipment.

Other lift factors to be considered to help reduce the risk of injury include frequency of lifting, duration of lifting activities, and type of lifting, as well as individual variables such as age, sex, body size, state of health, and general physical fitness.

The National Institute for Occupational Safety and Health (NIOSH) has issued a revised formula for the design and evaluation of manual lifting tasks. This updated equation provides methods for evaluating asymmetrical lifting tasks and lifts of objects with less than optimal connection between the object and the worker's hands. It also provides guidelines for a larger range of work durations and lifting frequencies than the previous formula. It is not, however, designed to be applied to situations such as one-handed lifting, lifting extremely hot or cold objects, or to factors that may increase the risk of a slip or fall.

By evaluating on-the-job lifting tasks and using the NIOSH formula to reduce the physical stresses associated with each task, the incidence of low back injuries to workers can be reduced.

Evaluating and Redesigning Workstations

Workstations should be ergonomically designed to accommodate the full range of required movements among workers. They should be designed to accommodate the workers who are actually using them to perform the job, not just for the "average" or "typical" worker. Many workstations, particularly those in factories, were designed for men, even though they may be primarily used by women.

The workstation should be designed to permit the worker to adopt several different but equally healthful and safe postures that still permit performance of the job; sufficient space should be provided for the knees and feet. Work tables and chairs should be height-adjustable to provide proper back and leg support. Seat cushions can be used to compensate for height variation when chairs or stools are not adjustable. Tools and materials should have a definite and fixed space for storage. Machine controls should be reachable and equally accessible by both right- and left-handed operators.

When evaluating or redesigning a workstation, give special attention to the following items:

• Static loading of muscles (prolonged or sustained exertion of a body part without movement) causes rapid fatiguing of the muscles. Requiring a worker to constantly hold a tool, even when not in use, is a good example of static loading.

• Proper work activity height can help control postural risk. Activity height can be adjusted by providing an adjustable work surface; by lowering the work surface and placing the work piece in a fixture that raises it to a proper height; or by raising the worker to the work surface.

• The reach at which tasks are performed affects the strength, precision capability, stress, and other biomechanical aspects of the worker. Therefore, maximum reach distance should be kept within the normal reaching distance, somewhere between 14 and 18 inches. The distance depends on the difficulty of the task, the forces exerted, and the frequency of the activity. Reaches above the shoulder, behind the worker, and far in front or to the side of the worker should be avoided.

• Force requirements should be reduced or minimized when possible. The worker should not be required to exert high forces. Work can often be performed more efficiently and more safely by providing a mechanical advantage, so mechanical solutions should be incorporated into the work station when possible. If workers are required to exert high forces, the work piece should be located and stabilized so that the forces are optimal and minimized. Force can sometimes be reduced by using fixtures and proper workstation height.

• Hard or sharp edges can be a hazard in a workstation. When the worker's arm or hand repeatedly comes in contact with a hard or sharp edge, damage to the tissues, including nerve or blood vessel damage, can result. Control measures include rounding edges, padding edges, or relocating equipment so people will not hit the edges.

• Contact with thermally conducting work surfaces can be responsible for loss of heat in the hands and arms. This can cause discomfort and, if the wrist and fingers become cold, the tendons and joints become stiff. This may cause symptoms of cumulative trauma disorders to develop.

• Proper seating should be made available to workers where the job permits. This is possible in many jobs where tradition has dictated that standing is the only way to do the job. It is also important to provide support for the limbs, both arms and legs. Arm and footrests help to reduce worker stress and fatigue.

• Work piece orientation can cause numerous problems, including higher than necessary repetitions, higher than necessary forces, and static and awkward postures. Care should be taken to ensure that the work piece is in such a position that the required tasks do not expose the workers to unnecessary hazards. Proper workstation height and proper fixtures and orientation devices can reduce or eliminate this problem.

• Work piece holding is a simple solution to ergonomic hazards which is often overlooked. Fixtures that hold the work piece and orient it for ease of work can greatly reduce the stress of the job and often increase productivity.

• Layout of a workstation has an impact on all of the preceding points of workstation design. A good layout will facilitate the flow of materials and product through the station.

Training and Education | Ergonomics

One of the purposes of training and education is to ensure that employees are sufficiently informed about the ergonomic hazards to which they may be exposed so they are better able to participate actively in their own protection. Suggestions and input from workers who are educated about ergonomic hazards can be very helpful in designing improved work practices to reduce ergonomic hazards.

A good ergonomics education and training program will teach employees how to properly use equipment, tools, and machine controls, as well as the correct way to do a variety of job tasks. For example, to minimize or prevent back disorders, workers can be taught proper postures and lifting techniques. Using correct posture is important whether an employee is sitting, standing, pulling, pushing, lifting, or using tools or equipment or whether the job is in a factory setting or an office setting.

Provide MSD Information

Employees need access to MSD information in order to be alert to the onset of signs or symptoms and to effectively participate in the ergonomics program, as well as to protect themselves while at work. You should provide the information periodically, that is on a regular basis appropriate for the conditions in the workplace.

That means as often as needed, such as when significant changes are made in the workplace that may result in increased exposure to MSD hazards. Examples of significant changes in the workplace include the introduction of new equipment, new processes, or new production demands that may increase the likelihood that employees will be exposed to MSD hazards.

The information provided to current and new employees (either written or oral) should include:

• Common MSD hazards;

• The signs and symptoms of MSDs and the importance of reporting them early; and

• How to report MSD signs and symptoms.

Presentation Methods

There are many practical ways to present the information. One method that aids the understanding of technical information is to allow employees an opportunity to ask questions and receive answers. Examples include question and answer sessions that are:

• Organized classroom style;

• Part of regularly scheduled meetings with employees and their supervisors;

• An outgrowth of informal talks with employees; and

• Incorporated into safety meetings.

Merely arranging for employees to view a videotape on common MSD hazards, without an opportunity for discussion or questions and answers, won't ensure that the information has been effectively communicated. Provide the information in the language and at levels that employees comprehend.

While training and education are an important part of an ergonomic hazard prevention program, they should not be considered the sole solution to the problem. Training in good lifting techniques, for example, is only likely to change existing employee habits for a short period of time. After that, people begin to forget and old habits return. Regular retraining is necessary in order to refresh memories.

Also, training will have a limited impact on an employee whose job still requires a great deal of repetitive motion, twisting, or heavy lifting. In these instances, the problem lies not with the person performing the job, but with the job itself. Other prevention strategies will need to be used in addition to training in order to improve the job such as tool or workstation redesign.

Treatment for Musculoskeletal Disorders

Health care professionals are responsible for determining the physical capabilities and work restrictions of the affected workers and the employer must give the employee a task consistent with these restrictions.

Until effective controls are installed, employee exposure to ergonomic stressors can be reduced through restricted duty and/or temporary job transfer. Complete removal from the work environment should be avoided unless the employer is unable to accommodate the prescribed work restrictions.

Splints and Supports

Immobilization devices, such as splints or supports, can provide relief to the symptomatic area in some cases. These devices are especially effective off-the-job, particularly during sleep. They should not be used as prophylactic PPE to prevent the development of MSDs. Therefore, these devices should be dispensed to individuals with MSDs only by HCPs who have knowledge of the benefits and possible negatives of these devices.

Wrist splints, typically worn by patients with possible carpal tunnel syndrome, should not be worn at work unless the HCP determines that the employee's job tasks do not require wrist bending. Employees who struggle to perform a task requiring wrist bending with a splint designed to prevent wrist bending can exacerbate symptoms in the wrist because of the increased force needed to overcome the splint. Splinting may also cause other joint areas (elbows or shoulders) to become symptomatic as work techniques are altered.

Recommended periods of immobilization vary from several weeks to months depending on the nature and severity of the disorder. Any immobilization should be monitored carefully to prevent complications (e.g., muscle atrophy caused by nonuse).

The HCP should advise affected employees about the potential risk of continuing hobbies, recreational activities, or other personal habits that may adversely affect their condition as well as the risk of continuing work without job modifications.

Work Restrictions

Provide temporary work restrictions, where necessary, to employees with covered MSDs that are serious enough to require some kind of restrictions. Work restrictions are restrictions on the way in which a job is performed or on the activities that the injured employee performs during the recovery period. Work restrictions include changes to the employee's existing job, such as limiting the tasks the employee may perform. Restrictions also include temporary transfer to a restricted duty job or removal from the workplace during the recovery period or a portion of it.

If a HCP has recommended restricted work, you should consider such restrictions necessary to prevent the employee's condition from worsening and to allow the employee's injured tissues to recover. In those instances where the employee has been referred to a HCP, follow the temporary work restriction recommendations, if any, included in the HCP's written opinion.

Evaluate Control's Effectiveness

A follow-up evaluation is necessary to ensure that the controls reduced or eliminated the ergonomic risk factors and that new risk factors were not introduced. This evaluation should use the same risk factor checklist or other method of job analysis that first documented the presence of ergonomic risk factors. If the hazards are not substantially reduced or eliminated, the problem-solving process is not finished.

Because some changes in work methods may actually make employees feel sore or tired for a few days, follow-up should occur no sooner than one to two weeks after implementation, and a month is preferable. Recognizing this fact may help avoid discarding an otherwise good solution.

In addition to the short-term evaluations using job analysis methods and symptom surveys, long-term indicators of the effectiveness of an ergonomics program can include:

• Reduction in the incidence rate of musculoskeletal disorders.

• Reduction in the severity rate of musculoskeletal disorders.

• Increase in productivity or the quality of products and services.

• Reduction in job turnover or absenteeism.

Company health care management strategies and policies and health care providers can be an important part of the overall ergonomics program.

Medical Management | Ergonomics

In general, health care management emphasizes the prevention of impairment and disability through early detection, prompt treatment, and timely recovery. Medical management responsibilities fall on employers, employees, and health care professionals (HCPs). A medical management program can help to either eliminate or substantially reduce the risk of development of ergonomics-related problems and symptoms through early identification and treatment.

Identifying and addressing signs and symptoms at an early stage helps to slow or halt the progression of the disorder. When MSDs are caught early, they are more likely to be reversible, to resolve quickly, and not to result in disability or permanent damage. Early intervention plays a big part in reducing the need for surgery.

Employer Responsibilities

An employer's basic obligation is to make MSD management available promptly to employees with work-related MSDs. In other words, MSD management means that you have established a process for assuring that employees receive timely attention for it, including, if appropriate, work restrictions or job accommodation and follow-up.

Where there is no onsite HCP, an individual should be designated to receive and respond promptly to reports of MSD signs, symptoms, and hazards. Where there is an onsite HCP, he or she would be the likely person to have responsibility for MSD management, including referral as appropriate.

An effective MSD management program has:

1. A method for identifying available appropriate work restrictions and promptly providing them when necessary;

2. A method for ensuring that an injured employee has received appropriate evaluation, management, and follow-up in the workplace;

3. A process for input from persons contributing to the successful resolution of an employee's covered MSD; and

4. A method for providing relevant information and communicating with the safety and health professionals and HCPs involved in the process.

Employee Responsibilities

Employees should participate in the health care management process by:

• Following applicable workplace safety and health rules,

• Following work practice procedures related to their jobs, and

• Reporting early signs and symptoms of MSDs.

Employees may be faced with conflicting job demands or requirements. Safe work practices or rules may conflict with pressures or incentives to be more productive.

Health Care Professional Responsibilities

Health care professionals who evaluate employees, determine employees' functional capabilities, and prepare opinions regarding work relatedness should be familiar with employee jobs and job tasks. With specific knowledge of the physical demands involved in various jobs and the physical capabilities or limitations of employees, the HCP can match the employees' capabilities with appropriate jobs. Being familiar with employee jobs not only assists the HCP in making informed case management decisions but also assists with the identification of ergonomic hazards and alternative job tasks.

The health care professional should:

• Acquire experience and training in the evaluation and treatment of MSDs.

• Seek information and review materials regarding employee job activities.

• Ensure employee privacy and confidentiality to the fullest extent permitted by law.

• Evaluate symptomatic employees including:

  • Medical histories with a complete description of symptoms,

  • Descriptions of work activities as reported by the employees,

  • Physical examinations appropriate to the presenting symptoms and histories,

  • Initial assessments or diagnoses,

  • Opinions as to whether occupational risk factors caused, contributed to, or exacerbated the conditions, and

  • Examinations to follow-up symptomatic employees and document symptom improvements or resolutions.

Implement the Controls

Ideas for controls can be derived from a variety of sources. These ideas are in addition to those gained from brainstorming with employees who perform the jobs or from work teams engaged in such problem solving.

• Trade associations may have information about good control practices for addressing different problem operations within an industry.

• Insurance companies that offer loss control services to their policyholders.

• Consultants and vendors who deal in ergonomic speciality services and products.

• Visits to other worksites known to have dealt with similar problem operations.

Implementing controls normally consists of trials or tests of the selected solutions, making modifications or revisions, full-scale implementation, and follow-up on evaluating control effectiveness.

Testing and evaluation verify that the proposed solution actually works and identifies any additional enhancements or modifications that may be needed. Employees who perform the job can provide valuable input into the testing and evaluation process. Worker acceptance of the changes put into place is important to the success of the intervention.

After the initial testing period, the proposed solution may need to be modified. If so, further testing should be conducted to ensure that the correct changes have been made, followed by full-scale implementation. Designating the personnel responsible, creating a timetable, and considering the logistics necessary for implementation are elements of the planning needed to ensure the timely implementation of controls.

In a number of jobs, workplaces, and physical work activities, it may not be possible to eliminate MSDs. One of the goals of your ergonomics program is to have a good working system in place so that quick and effective action can be taken when MSDs occur.

Evaluate Control Effectiveness

A follow-up evaluation is necessary to ensure that the controls reduced or eliminated the ergonomic risk factors and that new risk factors were not introduced. It should use the same risk factor checklist or other method of job analysis that first documented the presence of ergonomic risk factors. If the hazards are not substantially reduced or eliminated, the problem-solving process is not finished. Employees who perform the job can provide valuable input into the testing and evaluation process. Worker acceptance of the changes put into place is important to the success of the intervention.

The follow-up may also include a symptom survey, which can be completed in conjunction with the risk-factor checklist or other job analysis method. The results of the follow-up symptom survey can then be compared with the results of the initial symptom survey (if one was performed) to determine the effectiveness of the implemented solutions in reducing symptoms.

When to Conduct the Follow-Up

Because some changes in work methods (and the use of different muscle groups) may actually make employees feel sore or tired for a few days, follow-up should occur no sooner than one to two weeks after implementation, and a month is preferable. Recognizing this fact may help avoid discarding an otherwise good solution.

Follow-up is also essential in those cases where there is a need to prioritize the control of hazards. It tells whether you are on schedule with abatement plans. And, it's a good way of determining whether the elements of the program are functioning properly. For example, evaluating controls, especially work practice controls, is one way to determine whether the ergonomics training has been effective. Many employers evaluate controls within 30 to 60 days after implementation. This gives employees enough time to get accustomed to the controls and to see whether the controls have introduced other problems into the job.

In addition to the short-term evaluations using job analysis methods and symptom surveys, long-term indicators of the effectiveness of an ergonomics program can include:

• Reduction in the incidence rate of musculoskeletal disorders,

• Reduction in the severity rate of musculoskeletal disorders,

• Increase in productivity or the quality of products and services, or

• Reduction in job turnover or absenteeism.

These indicators offer bottom-line results in evaluating interventions that have been put into place. Other indicators may also be used that represent in-process or interim accomplishments achieved on the path to building an ergonomic program. For example, the extent of the ergonomic training given the workforce, the number of jobs analyzed for potential problems, and the number of workplace solutions being implemented are indicators for evaluating the success of your interventions. While bottom-line results are most telling in terms of defining a successful program, the interim measures allow the total development to be monitored.