1. Long Term Care Worker Protection Program This training and related materials are provided under Susan Harwood Program Grant Number SH-22247-11-60-F-48 from the Occupational Safety and Health Administration U.S. Department of Labor. It does not necessarily reflect the views or policies of the U.S. Department of Labor nor does mention of trade names commercial products, or organizations imply endorsement by the U.S. Government.

2. Minimizing Hazards in the Workplace June 21, 2012 www.ltcworkersafety.com

3. Content Expert Kathy Wismer, RN, COHN-S Employee Health, Texas Health Presbyterian Hospital Plano Kathy graduated from Texas Women’s University with a BSN in 1995; has worked at THR for 16 years, moved into Occupational Health in 2007. Currently certified in Occupational Health, and is passionate about performing ergonomic evaluations for staff.

4. The CDC (Center for Disease Control) describes ergonomics as the scientific study of people at work. OSHA (Occupational Safety and Health Administration) describes ergonomics is the science of fitting workplace conditions and job demands to the capabilities of the working population.

5. Per the CDC the goal of ergonomics is to reduce stress and eliminate injuries and disorders associated with the overuse of muscles, bad posture and repeated tasks.

6. Engineering Controls Administrative Controls Personal Protective Equipment

7. Preferred way to reduce hazards Equipment Design Ventilation Lighting Sufficient space for movement

8. Training Monitoring Scheduled Breaks Work Hours

9. The least effective way of control. Respirators Ear Plugs Safety Goggles/Masks Gowns/Scrubs

10. To yourself as well as other

11. Nerves Muscles Tendons Joints Cartilage Spinal discs Examples are: Tendinitis Carpal Tunnel Syndrome Back injury Disorders associated with repetitive trauma

12. According to OSHA ergonomic risk factors occurs in jobs that require: Repetitive, forceful or prolonged exertions of the hands. Frequent or heavy lifting. Pushing/ pulling. Carrying heavy objects. Working in prolonged awkward positions. Vibration and cold may add to risk. Jobs that present multiply risk factors will have higher probability of causing musculoskeletal problems. Level of risk depends on the intensity, frequency and duration of activities

13. Mental Physical Use of Ergonomics

14. Awareness Position Surroundings Knowledge Use of equipment Stress Concentration

15. Use of proper body mechanics Overall physical wellness Proper sleep/rest Hydration Nutrition

16. General environment: Adequate lighting and comfortable temperatures and humidity. Workstations and chairs that are adjustable Layout of the work that reduces reaching and twisting Postures that promotes neutral positions. Reduce repetition/vary task. Forces: Reduce the size and weight of held objects. Eliminate vibration if possible. Mechanical stresses: Eliminate sharp edges. Lifting: reduce frictions and provide assistance devices. Work organization: Adequate staffing. Alternate physical and mental demanding task.

17. Patient Lifting Computerized Charting

18. Repetition Awkward positions Done using great deal of force Lifting heavy objects Combination of the above factors

19. OSHA recommends minimizing lifting of patients/residents in all cases and eliminate lifting when possible.

20. Never transfer Patients when off balanced. Lift close to the body Use lift teams or mechanical devises Limit the number of lifts per worker per day (More than 20 increases injury.) Limit heavy lifting (alone/patient cannot support own weight) Training in mechanical devises.

21. Lifting equipment (e.g. sling type full lifts, sliding boards/hover mats, Lean stand assist). Shower chairs. Toilet seat risers. Height adjustable electric beds. Trapeze lifts. Wheelchairs.

22. Repetition. Awkward positioning. Improper lighting/glare. Layout of work is awkward and out of reach. Chairs that are ill fitting/not adjustable. Cramped workspace. Lack of keyboard trays and wrist rest. Improper spacing between monitor and worker’s eyes.

23. Keyboards should have keyboard trays with padded wrist rest. Monitor should be eye level with user. Monitor should be at least 16 to 22 inches away from user’s eyes to reduce eye strain. Head held in neutral position to reduce neck stain. Gaze should avert from computer screen every hour for a few seconds of blinking to reduce eye stain. Adequate lighting. Reduce any glare on monitor screen. There should be at least 2 inches of space between the keyboard tray and the user’s thighs.

24. Seat pans that fit the user. Lumbar support. Height adjustable. The user’s knees should be at 90 degrees to thighs. Feet should be flat on the floor or a foot rest should be available. Chair arms should be both adjustable and have padding. The chair base has 5 wheel support.

25. Reduces the risk of repetitive stress injuries. Take a micro break of a few seconds every hour. Keep hydrated. Change positions. Get up/stretch/reposition. Take bathroom breaks when needed. Do a few seconds of ergonomic exercise. Do not perform any hand /wrist stretches if you have numbness in your hand. Consult with your doctor if you have been diagnosed with any musculoskeletal disorder/ injuries before doing any exercises. Stop if any pain occurs while performing any movement.

26. Place palms together. Raise elbows. Roll shoulders back.

27. Upper arm at side, keep elbow bent, palm up. Using fingers, apply pressure slowly to bend back palm. Stop pressure when you feel a gentle pull. Repeat on other hand.

28. Position 1 Wrist neutral, fingers & thumb flexed Position 2 Wrist neutral, fingers & thumb extended Position 3 Wrist, fingers & thumb extended back Position 4 Same as Position 3 with fingers & thumb spread apart Position 5 Wrist in neutral, fingers & thumb same as Position 4 Position 6 Gently stretch thumb. H a n d & W r i s t S e r i e s P o s i t i o n 1 W ri st in n e u tr al, fi n g e r s & t h u m b in fl e xi o n P o s i t i o n 2 W ri st in n e u tr al, fi n g e r s & t h u m b e xt e n d e d P o s i t i o n 4 S a m e a s P o si ti o n 3 w it h fi n g e r s & t h u m b s p r e a d a p a rt P o s i t i o n 5 W ri st in n e u tr al, fi n g e r s & t h u m b s a m e a s P o si ti o n 4

29. Focus on an object 20 feet a way. (repeat 3 times) Place cupped hand over eyes.(hold for up to one minute) Rotate eyes: Look up, right, down and left (X 3) Look up, left, down and right (X 3)

30. Set up your home computer using ergonomics. Practice the same micro breaks techniques at home as well at work. Vary your positions and you tasks. Stretch. Practice proper body mechanics when doing household chores. Exercise for at least 30 minutes most days of the week; incorporate both aerobic and strengthening exercises. Decrease stress by enjoying a hobby or socializing with family and friends.

31. Jeffress, C. (2000, October). Beacon Biodynamics and Ergonomics Symposium. OSHA Archive, retrieved from http://www.osha.gov/pls/oshaweb/owadisp.show document?p id=346&p table=speeches http://www.osha.gov/pls/oshaweb/owadisp.show Salazar, M. (2006). Core Curriculum for Occupational Environmental Health Nursing (3rd ed.). Seattle, Washington: Mosby Inc. Guidelines for Nursing Homes: Ergonomic for the Prevention of Musculoskeletal Disorders, OSHA 3182-3R, 2009.