1. Preventing Musculoskeletal Disorders Anne Duffy

2. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 2 Objectives Increase awareness of MSD signs and symptoms Recognize MSD risk factors Understand how to eliminate or control MSD risks Describe the systematic approach to workplace MSD program development

3. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 3 2004 LTI Accident Types Community & Health Care Data Source: WSIB Firm Experience Snapshot Period: September 2005

4. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 4 Client Handling vs MSD Client handling requires a unique approach because: Weights being handled are beyond acceptable levels Handling bodies is different than boxes The human can be unpredictable and uncooperative

5. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 5 MSD Definition ‘MSD are injuries and disorders of the musculoskeletal system where exposure to various risk factors present in the workplace may have contributed to the development or aggravated a pre-existing condition.’ ‘MSD includes the muscles, tendons, tendon sheaths, nerves, bursa, blood vessels, joints and ligaments’ (OHSCO, 2005)

6. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 6 What’s in a name? Repetitive Strain Injury (RSI) Cumulative Trauma Disorder (CTD) Strain & Sprain Workplace Musculoskeletal Disorders (WMSD) Musculoskeletal Injuries (MSI)

7. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 7 Primary Risk Factors High force – how much is too much? Awkward posture – working beyond optimal range of motion, static/dynamic Repetition – frequency, duration

8. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 8 Secondary Risk Factors Contact stress Local or whole body vibration Cold temperatures Work organization Work methods

9. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 9 Exercise Identify the potential risk factors associated with the product you have.

10. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 10 Safety Group Approach 1.Set a standard 2.Communicate the standard 3.Train to the standard 4.Review and revise 5.Recognize success

11. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 11 Set a Standard for MSD Prevention Through a systematic means of recognizing, assessing and controlling hazards, Name of organization will minimize the risk to its employees in developing work related musculoskeletal disorders. The recognition of MSD risks will be accomplished through supervisors conducting workplace inspections that includes recognition of MSD risk factors and through employees reporting signs and symptoms of MSD early on to their supervisors. The assessment of MSD risks will be accomplished through collection of information on the magnitude of MSD risk, the potential of the risk and the severity of the risk. Controls will be implemented to eliminate or minimize MSD risks by promptly attending to identified risks, incorporating the potential for MSD risks in future purchasing considerations, job design, workplace design, return to work, etc….

12. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 12 R.A.C. MSD prevention Recognize Assess Control

13. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 13 Recognizing MSD Collecting Data Passive Surveillance Incident data/claims costs Hazard/near miss reports PDA/job hazard analysis Absenteeism records Active Surveillance JHSC/manager inspections Signs & Symptoms survey MSD risk identification checklist

14. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 14 Recognize MSD Signs and Symptoms “Sign” meaning you can “see” tissue change SwellingSwelling, redness, loss of skin colour “Symptoms” meaning you can “feel” changes Aching, burning, cramping, numbness, pain, weakness

15. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 15 Recognize MSD Stages 1.Experience symptoms at work – can continue to work – decrease with rest, ice 2.Symptoms & signs come and go more frequently, even after work – usually seeks medical Rx 3.Symptoms & signs do not leave, disturbed sleep pattern, pain even while resting.

16. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 16 Signs & Symptom Survey OHSAH – Signs and Symptoms Survey The purpose of the tool is to increase staff employee awareness, to detect potential MSD early before medical aid is required, and to make possible job improvements.

17. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 17 PDA Gathering information on the job demands Summarizes the job as a whole Collect objective measurements where possible (weights, dimensions, repetitions) Not as detailed as a task analysis Proactive

18. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 18 MSD Risk ID MSD Risk Factor Identification Worksheet

19. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 19 Assessing MSD Why Assess? To prioritize the greatest risk Magnitude – how many people Potential - likelihood Severity – how serious will the injury be Can be simple or complex Subjective or Objective Quantitative or Qualitative

20. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 20 When to Assess MSD A work process/work practice is introduced or modified Opportunities for improvements exist as a result of redevelopment or new construction Identify MSD risks during observation of work activities or inspections Increase in worker symptoms Injury has been reported Proactive Reactive

21. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 21 Controlling MSD Applying Controls Involve the staff Be practical Does not have to be expensive Test possibilities Follow - up

22. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 22 Controlling MSD Applying Controls Ask yourself why do the risk factors exist? Workstation – proper set-up, adjustability Equipment – ergonomic design, size, operation Work organization – timelines, task rotation, shift work, control, stress Environment - lighting, noise, flooring, temperature Work practices - compliance, fitness level, wellness

23. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 23 Workstation Design Keep the load close to the body Minimize bending and reaching Reaches should be between shoulder and knee level Waist height is most desirable

24. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 24 Workstation Reach envelopes 50 cm 25 cm 50 cm80 cm USUAL WORK: Forearm Length OCCASSIONAL WORK: Full Arm Length NON-WORK AREA: Beyond Arm Length Adapted from: CCOHS Ergonomic Infogram E-A01

25. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 25 Workstation Heights

26. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 26 Tools Size Shape Vibration Balance Weight

27. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 27 Posture Bend the tool, not the wrist Workplace layout

28. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 28 Controls Engineering Administration Work practices Personal Protective Equipment

29. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 29 MSD Controls EngineeringAdministrativeWork PracticesPPE ForceProvide lift assist Improve casters Type of flooring Height of the lift Overall Range of lift Safe work practice Purchase smaller quantities Shelf heights Weights labeled Push rather than pull Lift training Compliance Hold load close to body Testing the load Good Visibility Use 2 hands! NO to back belts!! PostureFalse bottom i.e. laundry bin, Tilt equipment Workstation/ table height Adjustability Size of cart Swivel Adjustable chair Anti-fatigue mat Purchase ergonomic equipment Work organization Preventative maintenance Wellness Program Breaks Stretch MSD Awareness education Change postures often Insoles RepetitionMechanizeJob enlargement Employee rotation Micro-breaksNo wrist supports!!

30. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 30 Exercise Which tool would be more “ergonomically” sound?

31. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 31 MSD Program Development Sr. Management Commitment Risk Assessment Develop Program Components Implement the Program Evaluate

32. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 32 Program Development 1. Management Commitment Developing clear goals and objectives Defining accountability mechanisms Assigning responsibilities Providing necessary resources Monitoring progress towards goals/objectives

33. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 33 Program Development Employee Involvement Encourage suggestions or reporting of concerns Dialogue about the workplace and work methods Seek input into design of work, equipment, procedures, risk assessment processes, purchases and training Evaluation and/or trials of equipment Employee surveys Task group participation Participation in developing the ergonomics process

34. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 34 2. Risk Assessment Passive and Active Surveillance Tools

35. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 35 3. Develop MSD Program Components OSACH - Sample MSD Policy & Procedures

36. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 36 4. Implement the Program Safety Group Steps 2 & 3 Communication Education and Training Involve employees in design of the education/training program Learning by doing - "hands-on" methods of knowledge and skill acquisition Use multiple technologies and methods- audio-visual, computer, video, exercises, discussions Combine classroom and on-the-job training

37. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 37 5. Evaluation Leading indicators MSD risks Work productivity Evaluation of new equipment, tools and processes Evaluation of existing workstations/jobs Education and training

38. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 38 5. Evaluation Lagging indicators Injury statistics – MSD WSIB costs – MSD Absenteeism rates STD, LTD rates RTW statistics

39. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 39 Initial Next Steps Who will coordinate MSD prevention? How will you obtain Sr. Management commitment for this initiative? Who else will be involved? When will you meet? How are you going to recognize MSD?

40. © Copyright 2006 Ontario Safety Association for Community & Healthcare. All rights reserved/tous droits réservés. Reproduction in whole or in part by any means without express written consent of Ontario Safety Association for Community & Healthcare is prohibited by law. 40 Questions? Concerns? Comments?