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Oct 23, 2018 · The aim of these methods is to reduce the physical strain to the musculoskeletal system, thus reducing risk of injury. Meanwhile, organisational ergonomic interventions consist of allowing optimum workplace and rest time for the musculoskeletal system to recover from fatigue, thus reducing the risk of long‐term injury.
- Victor C.W. Hoe, Donna M. Urquhart, Helen L. Kelsall, Eva N. Zamri, Malcolm R. Sim
- 10.1002/14651858.CD008570.pub3
- 2018
- 2018
- Table of contents
- Introduction
- Purpose of the guide
- MSI prevention - Getting started
- Implementation plan
- Step 1: Consultation and participation
- Step 2: Employee education
- Step 3: Methodology for hazard identification and assessment
- Step 4: Hazard identification and assessment
•Introduction
•Purpose of the guide
•MSI prevention - getting started
•Implementation plan
•Step 1: Consultation and participation
•Step 2: Employee education
Many hazards in the work place can lead to employee injuries. Part XIX of the Canada Occupational Health and Safety Regulations outlines a hazard prevention program for employers under federal jurisdiction. In December 2007, Part XIX (commonly known as the Hazard Prevention Program Regulations) was amended to include ergonomics-related hazards, which can cause musculoskeletal injuries.
A musculoskeletal injury (MSI) is an injury or disorder of the musculoskeletal system. The musculoskeletal system includes muscles, tendons, blood vessels, ligaments, nerves, joints, spinal discs and related soft tissue.
Other common terms used for musculoskeletal injuries are:
•Musculoskeletal disorders (MSD);
•Cumulative trauma disorder (CTD);
•Repetitive strain injury (RSI);
The purpose of the Guide on the Prevention of Musculoskeletal Injuries (MSIs) is to help work places establish a MSI prevention program that is effective and will meet the requirements of the Hazard Prevention Program Regulations (HPPR) with respect to ergonomics-related hazards.
In each section of the Guide, the applicable sections of the Regulations are provided for reference. The Guide also includes best practices for developing and implementing an MSI prevention program. The words "should" and "recommended" are used to identify these best practices.
Some work places already have a MSI prevention program. In that case, the Guide can be helpful in evaluating whether the program includes everything the Regulations require with respect to ergonomics-related hazards. The Guide may also draw attention to areas where the program can be improved.
For work places that do not yet have a MSI prevention program, the Guide can be used as a roadmap for developing and implementing a program that will meet the regulatory requirements.
Section 19.1 of the Regulations
The employer shall, in consultation with and with the participation of the policy committee, or, if there is no policy committee, the work place committee or the health and safety representative, develop, implement and monitor a program for the prevention of hazards, including ergonomics-related hazards, in the work place that is appropriate to the size of the work place and the nature of the hazards and that includes the following components: an implementation plan; a hazard identification and assessment methodology; hazard identification and assessment; preventive measures; employee education; and a program evaluation. Subsection (1) applies in respect of every work place controlled by the employer and, in respect of every work activity carried out by an employee in a work place that is not controlled by the employer, to the extent that the employer controls the activity. Under the Regulations, the program must be developed, implemented and monitored "in consultation with and with the participation of" the policy committee. (If there is no policy committee, the employer shall call upon the work place committee or the health and safety representative.) In addition, the program must include a number of parts: An implementation plan; Hazard identification and assessment methodology; Hazard identification and assessment; Preventive measures; Employee education; Program evaluation. The first step is to establish an implementation plan that includes all these parts, in a logical order that will make the process easier. Section 19.3(1) of the Regulations requires several sources of information to be taken into account in developing the methodology. To ensure that information from these sources is useful and will make the program more effective, employee education should take place early in the implementation process. Employee education includes training for those who conduct work place inspections, such as health and safety committee members. The flow chart below entitled Hazard Prevention Program for Ergonomics-Related Hazards gives an overview of the implementation process recommended in this Guide.
Section 19.2 of the Regulations
The employer shall: develop an implementation plan that specifies the time frame for each phase of the development and implementation of the prevention program; monitor the progress of the implementation of the preventive measures; and review the time frame of the implementation plan regularly and, as necessary, revise it. In implementing the prevention program, the employer shall ensure that ergonomics-related hazards are identified and assessed and that they are eliminated or reduced, as required by subsection 19.5(1), as much as reasonably possible and that any person assigned to identify and assess ergonomics-related hazards has the necessary instruction and training. The implementation plan for the MSI prevention program must include the following components, in this recommended order: Step 1: Process for consultation with and participation of the policy committee (or the work place committee or the health and safety representative) during each step of the program. Step 2: Education of employees and health and safety committee members. Step 3: Methodology for hazard identification and assessment. Step 4: Hazard identification and assessment. Step 5: Preventive measures. Step 6: Program evaluation. The implementation plan must establish time frames for each phase in the development and implementation of the program. Be realistic in establishing the schedule. If the hazard prevention program at the work place has never included MSI prevention, it may take a few years to address all the ergonomics-related hazards. The size and complexity of the work place, as well as other health and safety priorities, will be factors in the time required. If most employees in the work place perform roughly the same tasks, it may not take as long to implement the program and address the ergonomics-related hazards. The implementation plan must be monitored periodically to ensure that the process is on schedule. If for some unforeseen reason the time frames in the implementation plan cannot be met, they may need to be revised. Hazard Prevention Program for Ergonomics-Related Hazards Steps flow chart Description of Hazard Prevention Program for Ergonomics-Related Hazards Steps flow chart Step 1 Consultation with and with the participation of the Health & Safety Committee. Establish framework and set-up the process for each step. Step 2 Health & Safety Committee: education and training for members Employee Education Step 3 Hazard ID and Assessment Methodology Investigation Reports Work Place Inspections First Aid and Claims Employee Reports/ Survey Other Sources Priority Setting Process Priority A, B, C, D, E, F, G, H, I (just started - reference to priority C) Step 4 Hazard Identification and Assessment (Preventive measure not already known or not obvious) (in progress - reference to priority B) Step 5 Preventive measure implementation and evaluation of the effectiveness of the preventive measure (completed - reference to priority A) Step 6 Program Evaluation End flow chart description
The Canada Labour Code, Part II and the Canada Occupational Health and Safety Regulations are based on a system of internal responsibility. In such a system, the employer works in cooperation with employee representatives to address work place hazards and reduce risks to employees. This means the employer must consult and involve the policy committee (or, if there is no policy committee, the work place committee or the health and safety representative) at each stage in developing, implementing and monitoring the MSI prevention program.
It is a good idea for health and safety committee members involved in the work place program to have a good knowledge of MSI prevention principles, for several reasons. First, it will help them contribute more effectively when they take part in developing and implementing the hazard prevention program. Second, it will assist them during inquiries, investigations, studies and inspections they must help carry out pertaining to ergonomics-related hazards. Information from these activities is to be taken into account in the development of the methodology for hazard identification and assessment.
For the program to be successful, it is therefore recommended that the committee members who participate in the process be given the training that will enable them to carry out their responsibilities proficiently. These committee members should:
•Understand the implementation plan;
•Be able to identify ergonomics-related hazards in the work place in order to participate in MSI investigations, work place inspections and similar tasks;
•Understand and be able to conduct basic assessment of ergonomics-related hazards so that they can be effective in performing their duties as committee members; and
Section 19.6 of the Regulations
The employer shall provide health and safety education, including education relating to ergonomics, to each employee which shall include the following: the hazard prevention program implemented in accordance with this Part to prevent hazards applicable to the employee, including the hazard identification and assessment methodology and the preventive measures taken by the employer; the nature of the work place and the hazards associated with it; the employee's duty to report under paragraphs 126(1)(g) and (h) of the Act and under section 15.3; and an overview of the Act and these Regulations. The employer shall provide education to an employee whenever new hazard information in respect of a hazard in the work place becomes available to the employer; and shortly before the employee is assigned a new activity or exposed to a new hazard. The employer shall review the employee education program, and, if necessary, revise it at least every three years; whenever there is a change in conditions in respect of the hazards; and whenever new hazard information in respect of a hazard in the work place becomes available to the employer. Each time education is provided to an employee, the employee shall acknowledge in writing that they received it, and the employer shall acknowledge in writing that they provided it. The employer shall keep, in paper or computerized form, records of the education provided to each employee, which shall be kept for a period of two years after the employee ceases to be exposed to a hazard. A booklet entitled Guide to Employee Education on Musculoskeletal Injuries from the Labour Program is available to help employers teach employees about ergonomics, with a focus on MSI prevention. It outlines: The regulatory requirements specific to ergonomics-related hazards; The program approach to MSI prevention; The components of the MSI prevention program; Common ergonomics-related hazards in the work place; and The employees' duty to report ergonomics-related hazards.
Section 19.3 of the Regulations
The employer shall develop a hazard identification and assessment methodology, including an identification and assessment methodology for ergonomics-related hazards, taking into account the following documents and information: any hazardous occurrence investigation reports; first aid records and minor injury records; work place health protection programs; any results of work place inspections; any employee reports made under paragraph 126(1)(g) or (h) of the Act or under section 15.3; any government or employer reports, studies and tests concerning the health and safety of employees; any reports made under the Safety and Health Committees and Representatives Regulations; the record of hazardous substances; and any other relevant information, including ergonomics-related information. The hazard identification and assessment methodology shall include the steps and time frame for identifying and assessing the hazards; the keeping of a record of the hazards; and a time frame for reviewing and, if necessary, revising the methodology.
Key documents and information
Under the Regulations, the hazard identification and assessment methodology must take into account some key documents and information. 1. Hazardous occurrence investigation reports [section 19.3(1)(a)]: For the information in these reports to be of value, the investigations must be conducted by people who know about ergonomics-related hazards and the problems and injuries that can result from exposure to these hazards. The work place committee members who participate in these investigations must therefore receive the required education and training. For employers needing assistance, a Guide for Investigating Musculoskeletal Injuries is available from the Labour Program. 2. Results of work place inspections [section 19.3(1)(d)] Again, for the information in inspection reports to be useful in this process, the inspections must be conducted by people who know how to identify and assess ergonomics-related hazards. The work place committee members who participate in these inspections must therefore receive the required education and training. For employers needing guidance, a General Guide for Identifying Ergonomics-Related Hazards is available from the Labour Program. Some ergonomics-related hazards are associated with lifting, reaching and/or repeating the same movements. These are also normal life activities that are considered healthy when performed in moderation. To help in properly identifying the risks in the work place, the General Guide therefore suggests some basic assessment parameters, such as: Magnitude ("how much"); Duration ("how long"); and Frequency ("how often"). In most cases, this level of identification and assessment is sufficient to arrive at preventive measures. 3. Employee reports [section 19.3(1)(e)] Employees are required to tell the employer about anything in the work place that is likely to be hazardous to their own health or safety or to the health and safety of others. Sometimes employees will themselves notice potential hazards in their environment or experience signs or symptoms of MSI. The education provided under Step 2 should further increase awareness in the work place and enable employees to identify potentially hazardous circumstances. When trying to determine which jobs require preventive measures or detailed hazard assessment, the employer may wish to be proactive and ask employees for their input. To assist employers, a guide entitled Employee Input on Potential Ergonomics-Related Hazards is available from the Labour Program. It is important for employees to be aware that their reports and input represent only one of several sources of information that will be considered in prioritizing tasks or jobs for hazard assessment and preventive measures.
Setting priorities
In most work places there are limited resources available, so it is helpful to have a way of identifying the tasks for which preventive measures are the most urgent. Situations where employees have already suffered MSIs or are reporting signs or symptoms of MSIs should be dealt with first. Each work place should establish a system for prioritizing tasks for preventive measures, based on the specific circumstances for the work site. Once the order of priority has been established, the tasks should be assessed one by one so that preventive measures can be taken to reduce the risk to employees as much as is reasonably possible. Criteria for determining what is reasonably possible include: The number of employees affected; The availability of options and technology to reduce the hazard; and The severity of the hazard compared with the cost of the preventive measures. Work places that have not previously had a MSI prevention program will find that there are many tasks with ergonomics-related hazards that must be looked at. The best approach is to work through them one at a time, in order of priority, at a pace that takes into account the severity of the hazards, the number of employees affected, and other health and safety issues that are being addressed at the same time in the work place. Work places may wish to pick certain tasks on which quick action can be taken, to demonstrate their commitment to MSI prevention. This can be done where the preventive measures for a particular ergonomics-related hazard are obvious and have been proven by past experience in that work place or similar work places. In such cases, the process can be "fast-tracked" from Step 3 (Methodology) to Step 5 (Preventive Measures).
Section 19.4 of the Regulations
The employer shall identify and assess the hazards in the work place, including ergonomics-related hazards, in accordance with the methodology developed under section 19.3 taking into account the nature of the hazard; (a.1) In the case of ergonomics-related hazards, all ergonomics-related factors such as the physical demands of the work activities, the work environment, the work procedures, the organization of the work and the circumstances in which the work activities are performed, and the characteristics of materials, goods, persons, animals, things and work spaces and features of tools and equipment; the employees' level of exposure to the hazard; the frequency and duration of employees' exposure to the hazard; the effects, real or apprehended, of the exposure on the health and safety of employees; the preventive measures in place to address the hazard; any employee reports made under paragraph 126(1)(g) or (h) of the Act or under section 15.3; and any other relevant information.
Ergonomics-related factors
Many factors must be considered in hazard identification and assessment. The following are some ergonomics-related factors that can cause or contribute to MSIs. When an employee is exposed to two or more factors at the same time, the risk of injury is higher. (a) Physical demands of work activities The primary factors that impose physical demands on an employee are force, fixed or awkward postures, contact stress, and repetition. Force: Force is the effort exerted by the employee to do the work. All work requires some level of force and in most cases the work can be done without harmful effects. However, if the force exerted (for example, when lifting an extremely heavy object) is more than the musculoskeletal system can handle it can lead to injury. The risk of injury increases if a fairly high level of force is exerted repeatedly over a long period. There is even more risk of injury if the work is also done in an awkward posture (for example, lifting objects repeatedly with a twisting motion). In addition to lifting, other common types of work associated with forceful exertion are pushing, pulling, gripping and carrying. Holding things may be more difficult when the hands are cold or the object being manipulated is heavy. In addition, extra effort may be needed because of the nature of the task to be performed (for example, holding a knife to cut through a dense object). Here are some examples of tasks requiring increased grip force: Holding a slippery object ; Gripping a small tool or holding an object for precision work; Holding an object that is too large for a comfortable grip (i.e. fingers do not slightly overlap); Handling something using the fingers and the thumb (a pinch grip) instead of the whole hand (a power grip); Grasping an odd-shaped object that is difficult to hold; Holding vibrating tools or objects. Static (fixed) or awkward postures: Posture refers to the position of a body part, in relation to nearby body parts, during an activity. Joint position inside the comfortable range of motion is known as the neutral position. Awkward posture results when a joint in the body bends or twists excessively, outside the comfortable range shown in the diagram below. Muscles, ligaments and tendons work harder to support the affected body part when in an awkward posture. The farther a joint moves away from the neutral position, the greater the effort required by the supporting soft tissues. If a posture is held fixed, or static, for a long time, the muscles get tired because the lack of movement stops them from getting enough blood flow to keep them supplied with energy. This results in aches and pains. Some common awkward postures are illustrated below: Here are some examples of office tasks that can result in awkward postures: Awkward shoulder posture Reaching overhead to get books or files on a high shelf; Reaching across the desk to use a telephone placed on the far side; Awkward neck posture Twisting the neck to talk to someone seated to the side while using a keyboard directly in front; Bending the neck down to do detailed drawings on paper laid flat on the desk; Looking up frequently at a security screen high on the wall to monitor access points to the building, while working on a desktop computer; Awkward back posture Leaning sideways to reach into a low drawer while sitting; Bending down and sorting documents on the floor. Contact Stress: Contact stress occurs when a hard or sharp object comes in contact with the skin. Soft tissues, including nerves and blood vessels, can be injured due to the pressure caused by contact stress. Here are some things that can lead to contact stress: Using body parts to strike hard surfaces Using the hand to knock metal parts into place while assembling machinery; Kicking the carpet-stretcher with the part of the leg right above the knee when installing carpet; Kneeling on hard surfaces Kneeling on cement while setting floor tiles; Kneeling on a metal surface while stacking baggage inside the hold of a small aircraft; Kneeling on wood flooring while putting together a piece of furniture. Having the sharp edge of a desk dig into the forearm or wrist while typing Having ridges on a tool handle dig into the hand when the tool is held tightly Repetition: Using the same muscles, tendons and other soft tissues repeatedly with little chance for rest or recovery can lead to musculoskeletal injury when the muscles get tired. Repetition increases the risk of injury when other factors such as forceful exertion and awkward posture are also present. Highly repetitious tasks can affect large muscles (for example, repeatedly lifting and stacking heavy objects) as well as small muscles (repeatedly operating a small syringe assembly). Other factors that impose physical demands: Hand-arm vibration (HAV) Small hand tools such as drills and sanders produce vibrations that are transferred to the hands of the employee holding them. This also happens with larger tools such as chain saws and pneumatic chippers and drills. Depending on the level and frequency of the vibration and the duration of exposure, the nerve and circulatory system in the hands and fingers may be harmed. Exposing cold hands to vibration (for example, using a chain saw outside in the winter) raises the risk of hand-arm vibration syndrome. Whole-body vibration When a worker is sitting or standing on a vibrating surface, such as a surface directly attached to a large diesel engine, the vibration can be transmitted to his whole body. The same thing occurs when driving vehicles over rough surfaces. Depending on the level, frequency and duration of exposure, whole-body vibration can contribute to back pain and performance problems. (b) Work environment The primary factors to be considered are cold temperatures and hot working conditions. When exposed to cold, muscles and tendons become less flexible and do not work as efficiently. The blood circulation in the hands and arms is reduced and the worker will lose some of the feeling in his hands and fingers. The worker will have to use more grip force to grasp objects. The increased effort can lead to greater strain on muscles and tendons. Cold can be an issue when handling cold objects or if the air temperature is low. Here are some examples where cold is a factor: Handling tools that are stored outside during the winter; Handling frozen or refrigerated food; Working outside during the winter; and Having cold air from the exhaust of a pneumatic drill blow over the hands and fingers. Working in a hot or humid environment also imposes strain on the body. It increases the body temperature and causes dehydration, leading to muscle tiredness. People working in commercial kitchens or working outside during the summer are exposed to hot, humid work environments. (c) Work procedures and the organization of work Work procedures and organization of work can minimize the harmful effects of the factors listed above. For example, physically demanding tasks can be spread among more employees through job rotation, thereby reducing the demands placed on any one person. Outside work during the hot summer months can be scheduled to begin early and finish early in the day, thereby reducing the heat load on employees. Other possibilities are for employees to pace themselves when doing physically demanding tasks and for employers to phase out piecework. When work procedures and organization of work do not take the work environment and the physical demands of the tasks into consideration, there is a higher risk of injury. (d) Circumstances in which work activities are performed When working in hazardous environments or responding to emergencies, workers must use various kinds of personal protective equipment. Waterproof coveralls that do not "breathe" can add to stress from heat. The filters in air purifying respirators increase the physical demands involved in breathing by cutting down on air flow. Using a self-contained breathing apparatus can add significant weight and bulk, making it harder to climb stairs and manoeuvre around objects. (e) Characteristics and features that affect handling Shape, bulkiness, surface texture and availability of handles are some of the characteristics that affect how easy it is to pick up and move materials, goods or things. For example, things that are wet and slippery can be hard to hold. The characteristics of people and animals have a similar effect. Unfortunately, people and animals do not come with handles. They can be heavy and awkward to lift or move. In addition, both people and animals can be highly unpredictable. They may startle when touched or struggle to get away. This increases the risk to employees whose work involves manual handling of people or animals. Characteristics of the work space, such as layout, can increase the physical demands of the work activities. For example, employees may have to reach to get materials they need, or they may use improper postures or body mechanics because they do not have enough space to move around. Features of tools and equipment, such as weight, handle position and vibration, can increase the risk of MSIs.
Assessment methods and tools
The methodology used in Step 3 will identify the tasks with ergonomics-related hazards. These hazards may only be potential hazards, or they may already have caused an MSI, resulted in a minor injury or in first aid treatment, or been reported by an employee. In most cases, this level of information should be sufficient to proceed to preventive measures. However, more complex assessment methods are sometimes required. This is true in cases where it is harder to assess the degree of hazard associated with a particular task or when comparing similar tasks. Example: An employee is assigned to transfer items from one conveyor to another. When is he most likely to injure himself? If he spends 4 hours moving boxes weighing 20 kg twice a minute? If he spends 4 hours moving boxes weighing 10 kg four times a minute? If he spends 2 hours moving boxes weighing 20 kg four times a minute? Determining the relative hazard involved in performing the same quantity of work requires the use of fairly advanced or detailed assessment methods. So does evaluating the impact of exposure to a combination of factors, such as exerting force in an awkward posture repeatedly. A list of in-depth risk assessment tools, along with brief descriptions, can be found in MSD Prevention Tool Box - More on In-Depth Risk Assessment Methods, which was developed by the Occupational Health and Safety Council of Ontario. It is important to note that to use these tools properly, people must have the necessary training. It is the employer's responsibility to ensure that those assigned to identify and assess ergonomics-related hazards have the necessary education and training. They should be familiar with basic ergonomic principles and have experience applying them. The ergonomics principles include: Adapting the work space and the work equipment to fit the operator and the kind of work being performed, to promote preferred body postures; Providing sufficient space for body movements; Providing variety in tasks and movements to avoid body tension caused by static postures; Designing work to allow machinery to do or assist with highly repetitive tasks, leaving more variable tasks to human operators; Placing controls within easy reach; Keeping loads close to the body and handling them with neutral postures; Keeping physical demands compatible with the physical capacities of the employee; Using mechanical assistance if the strength demanded exceeds the capacity of muscle groups.
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Musculoskeletal Injury (MSI) Many of the ways work is done - such as lifting, reaching, or repeating the same movements - may strain the body. Wear and tear on muscles, tissues, ligaments and joints can injure the neck, shoulders, arms, wrists, legs and back. These injuries are called musculoskeletal injuries or MSI.
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Sep 1, 2022 · Primary WMSDs 1 injury rates Secondary Absence from work Cost-related injuries: Significant reduction (p < 0.0001) of WMSDs 1 injuries was shown in the intervention group. Absence from work, in terms of time-loss days/injury (p = 0.09) and cost-related injuries (p = 0.013) decreased significantly in the intervention group. Lim et al., 2011 (2)
