Ergonomics and regulatory politics: the Washington State case

The ACGIH TLV for lifting: Estimated TLVs for torso asymmetry beyond 30 degrees

BACKGROUND

The American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Values (TLVs) for Lifting is a manual material handling (MMH) assessment method to identify weight limits that nearly all workers may be exposed to without developing work-related low back disorders (LBD). However, this assessment method only applies to lifting with the torso within 30° asymmetry of the sagittal plane.

OBJECTIVE

Estimate TLV weight limits while lifting with torso asymmetry greater than 30° beyond the sagittal plane.

METHODS

Lifting tasks were performed from various horizontal and vertical locations, at torso asymmetry angles of 0°, 15°, 30°, 45°, 60°, 75° and 90°, using ACGIH identified TLVs. Validated MMH assessment methods (NIOSH Lifting Equation, Ohio State University LBD Risk Model) were utilized to estimate TLVs at torso asymmetries greater than 30°.

RESULTS

The current ACGIH TLVs resulted in low- to moderate-risk risk levels for torso asymmetries from 0° to 30°, and the risk incrementally increased as torso asymmetry increased to 90°. With the intention to keep the risk levels to that found at 30° torso asymmetry, lower TLV weight limits in the vertical and horizontal zones investigated were estimated for torso asymmetries from 45° to 90°. The resulting adjusted TLVs were consistent with weight limits identified for similar lifting conditions from other assessment methods that account for torso asymmetry.

CONCLUSIONS

This research found current ACGIH-defined TLVs possess less than high-risk for LBD, and provided guidance to practitioners for reduced TLVs when torso asymmetry is greater than 30° from the sagittal plane.

Wearable Motion Capture Devices for the Prevention of Work-Related Musculoskeletal Disorders in Ergonomics-An Overview of Current Applications, Challenges, and Future Opportunities

Work-related musculoskeletal disorders (WMSDs) are a major contributor to disability worldwide and substantial societal costs. The use of wearable motion capture instruments has a role in preventing WMSDs by contributing to improvements in exposure and risk assessment and potentially improved effectiveness in work technique training. Given the versatile potential for wearables, this article aims to provide an overview of their application related to the prevention of WMSDs of the trunk and upper limbs and discusses challenges for the technology to support prevention measures and future opportunities, including future research needs. The relevant literature was identified from a screening of recent systematic literature reviews and overviews, and more recent studies were identified by a literature search using the Web of Science platform. Wearable technology enables continuous measurements of multiple body segments of superior accuracy and precision compared to observational tools. The technology also enables real-time visualization of exposures, automatic analyses, and real-time feedback to the user. While miniaturization and improved usability and wearability can expand the use also to more occupational settings and increase use among occupational safety and health practitioners, several fundamental challenges remain to be resolved. The future opportunities of increased usage of wearable motion capture devices for the prevention of work-related musculoskeletal disorders may require more international collaborations for creating common standards for measurements, analyses, and exposure metrics, which can be related to epidemiologically based risk categories for work-related musculoskeletal disorders.

A Conceptual Model for the Impact of Occupational Standing on Enterprise Outcomes Using an Inductive Content Analysis of California Lawsuits

OCCUPATIONAL APPLICATIONSIn this paper, we provide a framework for practitioners when (re)designing tasks that historically have required standing in the workplace. While the goal is not to remove standing from all jobs, practitioners must work with management to align health and safety outcomes related to standing at work with the enterprise's main outcomes. Practitioners should also be made aware that in many of these jobs, standing has been required because, in the enterprise's judgment, it improves performance and customer service. Understanding common beliefs about customer interactions and job performance in the workplace will be vital to implementing changes that have previously been difficult to navigate.

Worker Injuries in Southern California's Warehousing Industry: How to Better Protect Workers in This Burgeoning Industry?

Dangerous conditions and worker injuries in the rapidly growing warehousing industry have gained attention in recent years, with accounts typically drawing on worker reports and investigative journalism. We analyzed workers' compensation injury claims and California Division of Occupational Safety and Health (Cal/OSHA) citations in Southern California's large warehousing sector. Claims increased from 2014 to 2018, with a majority of injuries caused by repetitive motion, lifting and other ergonomic risk factors. Cal/OSHA cited employers for violating standards to protect workers from unsafe vehicle operations, dangerous machinery and equipment, and falls; and for failing to implement injury prevention programs. These citations address the causes of some worker injuries; however, no Cal/OSHA citations were issued for violating the state's Repetitive Motion Injuries prevention standard. Nor do enforcement activities address the underlying causes highlighted by workers-high production quotas and a relentless work pace-that characterize the industry. We discuss the value and limitations of our approach and the implications of our results.

Ergonomics in Surgery: A Review

OBJECTIVE

Work-related musculoskeletal disorders (WMSDs) are prevalent among surgeons and may result in practice modification. We aimed to perform a comprehensive review of the English-language literature regarding ergonomic risk, prevalence of WMSDs, and unique ergonomic considerations by route of surgery.

METHODS

Multiple searches were performed of PubMed and University library resources to access English-language publications related to surgeon ergonomics. Combinations of keywords were used for each mode of surgery, including the following: "ergonomics," "guidelines," "injury," "operating room," "safety," "surgeon," and "work-related musculoskeletal disorders." Each citation was read in detail, and references were reviewed.

RESULTS

Surgeon WMSDs are prevalent, with rates ranging from 66% to 94% for open surgery, 73% to 100% for conventional laparoscopy, 54% to 87% for vaginal surgery, and 23% to 80% for robotic-assisted surgery. Risk factors for injury in open surgery include use of loupes, headlamps, and microscopes. Unique risks in laparoscopic surgery include table and monitor position, long-shafted instruments, and poor instrument handle design. In vaginal surgery, improper table height and twisted trunk position create injury risk. Although robotic surgery offers some advantages, it remains associated with trunk, wrist, and finger strain. Surgeon WMSDs often result in disability but are under-reported to institutions. Additionally, existing research tools face limitations in the operating room environment.

CONCLUSIONS

Work-related musculoskeletal disorders are prevalent among surgeons but have received little attention owing to under-reporting of injury and logistical constraints of studying surgical ergonomics. Future research must aim to develop objective surgical ergonomics instruments and guidelines and to correlate ergonomics assessments with pain and tissue-level damage in surgeons with WMSDs. Ergonomics training should be developed to protect surgeons from preventable, potentially career-altering injuries.

Job Hazard Analyses for Musculoskeletal Disorder Risk Factors in Pressing Operations of Dry-cleaning Establishments

Job hazard analyses were conducted to assess exposure to musculoskeletal disorder (MSD) risk factors in seven workers of three dry-cleaning establishments. In accordance with the Washington State Ergonomics Rule, the analyses were performed in two separate steps: (1) observation and checklist approaches were made to identify a "caution zone job" in the seven workers' pressing operations across the three shops; and (2) detailed posture and motion analyses were undertaken to determine a "MSD hazard" in one worker's operation using a video technique. One "caution zone job" was identified and it was the pressing operation job in which five physical risk factors were found in the pressing operations. The detailed analyses confirmed that one "MSD hazard", i.e., awkward posture in shoulders, was prevalent in the pressing operations of the three dry-cleaning facilities. It would be desirable to reduce MSD risk factors including awkward shoulder posture in the dry-cleaning industry.

Policy-Making Theory as an Analytical Framework in Policy Analysis: Implications for Research Design and Professional Advocacy

Policy studies are a recent addition to the American Physical Therapy Association's Research Agenda and are critical to our understanding of various federal, state, local, and organizational policies on the provision of physical therapist services across the continuum of care. Policy analyses that help to advance the profession's various policy agendas will require relevant theoretical frameworks to be credible. The purpose of this perspective article is to: (1) demonstrate the use of a policy-making theory as an analytical framework in a policy analysis and (2) discuss how sound policy analysis can assist physical therapists in becoming more effective change agents, policy advocates, and partners with other relevant stakeholder groups. An exploratory study of state agency policy responses to address work-related musculoskeletal disorders is provided as a contemporary example to illustrate key points and to demonstrate the importance of selecting a relevant analytical framework based on the context of the policy issue under investigation.

Worker Engagement in the Health and Safety Regulatory Arena under Changing Models of Worker Representation

This paper examines the efforts of a labor-community-university partnership in Southern California to confront violations of workplace health and safety standards by employers of nonunion workers in low-wage jobs. A worker engagement model has opened avenues for workers and worker advocates to participate in the regulatory arena absent union representation. This approach has achieved notable successes to date, including groundbreaking Cal/OSHA citations and nascent collaboration with agency officials to target enforcement of health and safety standards. We argue this model constitutes the foundation needed to support a potentially viable form of tripartism that allows nonunion workers a voice, albeit limited, in the health and safety regulatory process.

Exploring physical exposures and identifying high-risk work tasks within the floor layer trade

INTRODUCTION

Floor layers have high rates of musculoskeletal disorders yet few studies have examined their work exposures. This study used observational methods to describe physical exposures within floor laying tasks.

METHODS

We analyzed 45 videos from 32 floor layers using Multimedia-Video Task Analysis software to determine the time in task, forces, postures, and repetitive hand movements for installation of four common flooring materials. We used the WISHA checklists to define exposure thresholds.

RESULTS

Most workers (91%) met the caution threshold for one or more exposures. Workers showed high exposures in multiple body parts with variability in exposures across tasks and for different materials. Prolonged exposures were seen for kneeling, poor neck and low back postures, and intermittent but frequent hand grip forces.

CONCLUSIONS

Floor layers experience prolonged awkward postures and high force physical exposures in multiple body parts, which probably contribute to their high rates of musculoskeletal disorders.

Musculoskeletal disorders among clerical workers in Los Angeles: a labor management approach

BACKGROUND

Musculoskeletal disorders (MSDs) persist among clerical workers despite ergonomic advances.

METHODS

A cross-sectional survey among 2,310 clerical workers investigated MSD cases, defined as musculoskeletal discomfort and seeking treatment for that discomfort in the past 12 months. A modified Poisson regression model was adopted to assess the association between work and individual factors and the risk of MSDs.

RESULTS

Over half of respondents reported musculoskeletal discomfort. The prevalence of MSD cases was: 37.2% neck/shoulders, 21.7% upper extremities, 18% lower extremities, and 34.3% back region. Elevated risk of MSDs was associated with less workstation adjustability; work schedule, gender, age, and BMI were also significant. Positive trends were observed between computer use and MSDs for the neck/shoulder region and the effect was amplified among those reporting insufficient workstation adjustability and lacking computer ergonomics training.

CONCLUSIONS

Results demonstrate the need to limit continuous computer use and to improve the human-machine interface through adjustable workstations and worker training to enhance use of adjustable features.

Impact of implementing the Washington State ergonomics rule on employer reported risk factors and hazard reduction activity

BACKGROUND

In Washington State an ergonomics rule was adopted in 2000 that focused on primary prevention. The implementation process followed a 6-year phase-in schedule where employers came into compliance based upon their size and industry. In late 2003 the rule was repealed by an industry-funded voter initiative. Evaluating the implementation of this rule offers a unique opportunity to observe the general deterrent effect of a new public health regulation and to study how employers and workers responded to new requirements.

METHODS

Weighted survey regression methods were used to analyze the results from three employer surveys covering more than 5,000 workplaces administered in 2001, 2003, and 2005. These were compared to a baseline employer survey conducted in 1998 before the rule was promulgated. Questions covered the following topics: WMSDs experienced at the workplace; levels of employee exposure to musculoskeletal hazards; steps being taken, if any, to address these hazards; results of these steps; and sources of ergonomic information/assistance used.

RESULTS

From 1998 to 2003 there was a reduction in reported exposures among workplaces in the highest hazard industries. Following the rule's repeal, however, hazard exposures increased. While more workplaces reported taking steps to reduce exposures between 1998 and 2001, this gain was reversed in 2003 and 2005. Employers who took steps reported positive results in injury and absenteeism reduction. Large workplaces in the high hazard industries were more active in taking steps and used a wide variety of resources to address ergonomics issues. Small employers relied more on trade associations and the state.