health and safety upper limb disorders

7/27/2019 Health and Safety Upper Limb Disorders

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Health and Safety

Executive

Upper limb disorders in the

workplace

This is a free-to-download, web-friendly version of HSG60

(Second edition, published 2002). This version has been adapted for online

use from HSEs current printed version.

Youcanbuythebookatwww.hsebooks.co.ukandmostgoodbookshops.

ISBN 978 0 7176 1978 8

Price 9.50

Whereveryouworkthereisachancethatupperlimbdisorderscouldaffectyou.

Theycancausepainandevenpermanentinjurytotheneck,shoulders,arms,

wristsorhands.Inmostcasestheyarepreventableandthisbookshowsyouhow

toassessandminimisetherisksthroughpositiveaction.Itshouldhelpyouto

complywiththelawandmakeyourworkplacesafer.

HSE Books


2/89Page2of89

Health and Safety

Executive

Crown copyright 2002

Firstpublished1990

ISBN9780717619788

Allrightsreserved.Nopartofthispublicationmaybereproduced,storedin

aretrievalsystem,ortransmittedinanyformorbyanymeans(electronic,

mechanical,photocopying,recordingorotherwise)withoutthepriorwritten

permissionofthecopyrightowner.

Applicationsforreproductionshouldbemadeinwritingto:

TheOfficeofPublicSectorInformation,InformationPolicyTeam,

Kew,Richmond,SurreyTW94DUore-mail:[email protected]

ThisguidanceisissuedbytheHealthandSafetyExecutive.Followingtheguidance

isnotcompulsoryandyouarefreetotakeotheraction.Butifyoudofollowtheguidanceyouwillnormallybedoingenoughtocomplywiththelaw.Healthand

safetyinspectorsseektosecurecompliancewiththelawandmayrefertothis

guidanceasillustratinggoodpractice.


3/89Upperlimbdisordersintheworkplace Page3of89

Health and Safety

Executive

ContentsPreface 5

Introduction 6

Upper limb disorders: Understand the issues and commit to action 8

Understandtheissues 8

Committoaction 11

Create the right organisational environment 13

Participationandinvolvement 13

Communication 14

Competence 14

Allocationofresponsibilities 14

Assess the risk of ULDs in your workplace 15

Whatisanergonomicsapproach? 15

Identifyingproblemtasks 15

Riskassessment 16

ULDriskfactors 17

Reduce the risk of ULDs 24

Lookingforhigherordersolutions 24

Usinganergonomicsapproach 24

Basicprinciplesinimplementingsolutions 25

Individualdifferences 25

Suggestionsforreducingtherisk 25Otherguidanceonsolutions 25

Afterimplementation 26

Educate and inform your workforce 27

Trainingasacontrolmeasure 27

Whoshouldreceiveeducation? 27

Whatshouldtrainingcover? 27

Makingtrainingmoreeffective 28

Evaluationandfollowup 28

Manage any episodes of ULDs 29

Reportingandrecording 29

Referral 29Diagnosisandreturntowork 30

Surveillance 31

Carry out regular checks on programme effectiveness 32

Whymonitororreview? 32

Monitoring 32

Approachestomonitoring 32

Examplesofpassiveandactivemonitoring 33

Monitoringoutcomes 33

Reviewing 34

Appendices 35Appendix1: Casestudies 35

Appendix2: RiskFilter,RiskAssessmentWorksheets,suggestionsforreducing

therisk 46

Appendix3: Medicalaspectsofupperlimbdisorders 68



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Appendix4: Legalrequirements 76

References 81

Further information 89



Health and Safety

Executive

PrefaceTheHealthandSafetyCommission(HSC)hasastrategyfortackling

musculoskeletaldisorders(MSDs)*includingupperlimbdisorders.Thestrategy

adoptstheprinciplesofSecuringHealth Together: A long-term occupational

health strategy for England, Scotland and Wales.1Thisformsanintegralpartof

Revitalising Health and Safety.2

Governmentdepartmentsinco-operationwithemployers,employees,tradeunions,

employersorganisations,healthprofessionalsandvoluntarygroupshaveset

severalchallengingtargetsaspartof Securing Health Together.Thesehavebeen

usedinestablishinganHSCpriorityprogrammeformusculoskeletaldisorderswith

thefollowingtargets,tobeachievedby2010:

n 20%reductioninincidenceofwork-relatedillhealthcausedbyMSDs;

n 30%reductioninthenumberofworkingdayslostduetoMSDs.

Thepriorityprogrammeaimstoimprovecompliancewiththelaw,topromote

continuousimprovement,andtodevelopthenecessaryknowledge,skillsand

supportsystemstoachievetheMSDtargets.Thisguidanceformsonestrandof

thesupporttobeprovidedforemployers,employeesandthosewhoadvisethem.

Itaimstoensurethattheyhavetherightinformationandadvicetopreventand

manageupperlimbdisordersintheworkplace.

* Thetermmusculoskeletaldisorders(MSDs)referstoproblemsaffectingthemuscles,tendons,

ligaments,nervesorothersofttissuesandjoints.UpperlimbdisordersareasubcategoryofMSDs.


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1 Thisdocumentdescribeshowmanagers,togetherwiththeiremployees,can

cooperatetominimisetherisksofupperlimbdisorders(ULDs)througha

positivemanagementapproach.Itgivesgeneralguidanceontheprocesses

involvedandincludesariskassessmentfilterandworksheetsaswellas

informationonthemedicalaspectsofULDsandthelegalrequirements.

2 ULDsareconditionswhichaffectthemuscles,tendons,ligaments,nerves

orothersofttissuesandjoints.Theupperlimbincludestheneck,shoulders,

arms,wrists,handsandfingers.ULDscanoccurinalmostanyworkplaceand

theycanusuallybeprevented.Whenpreventionhasnotworked,systems

areneededtomakesuretheyarepromptlyreported,properlydiagnosedand

treated.Employerslegalresponsibilitytopreventwork-relatedaccidentsand

illhealthalsoappliestoULDs.

3 ThisguidancereplacesWork-related upper limb disorders: A guide to

preventionandreflectsthechangesinourunderstandingofriskfactors

andcontrolstrategieswhichhaveemergedfromresearchoverthelastdecade.Thishasshowntheimportanceofpsychosocialriskfactorsacting

inconjunctionwithphysicalriskfactors.Ithasdemonstratedtheneedfor

anintegratedapproachtothemanagementofULDriskswhichaddresses

bothorganisationalandphysicalaspectsoftheindividualstaskandwork

environment.

4 Thisguidancepresentsanapproachwhichisbasedonsevenstagesina

managementcycle.Thestagesare:

n understandtheissuesandcommittoaction;

n createtherightorganisationalenvironment;

n

assesstheriskofULDsinyourworkplace;n reducetherisksofULDs;

n educateandinformyourworkforce;

n manageanyepisodesofULDs;

n carryoutregularchecksonprogrammeeffectiveness.

5 Eachstageisconsideredinaseparatesectionoftheguidance.Anoverview

oftheapproachisshowninFigure1.(seealsoparagraph30)

6 Appendices1-4includethefollowing:

n Appendix1:illustratesreallifeexampleswheretherisksofULDshave

beenmanaged.

n Appendix2:providespracticalhelpwithriskassessmentandcontainsaRiskAssessmentFilterandWorksheetsandsuggestionsforreducingthe

risk.

n Appendix3:givesbackgroundinformationonmedicalaspectsofULDs.

n Appendix4:setsouttherangeoflegaldutieswhichapplytothe

preventionofULDs.

7 Vibrationisincludedinthisdocumentwhereitcontributestothedevelopment

ofULDs,buttheguidancedoesnotcoverallaspectsofthepreventionof

vibration-inducedillnesses,suchasvibrationwhitefinger. 3,4Inaddition,the

risksofupperlimbdisordersduetoDisplayScreenEquipment(DSE)useare

coveredbytheDSEregulations,andseparateHSEguidanceisspecifically

availableonthistopic.5,6

DutyholdersmustcomplywiththeDSEregulations;howeverthisULDguidancemaybeusedtoprovidesupplementary

information.



Health and Safety

Executive

Upper limb disorders: Understand

the issues and commit to actionn IstheriskofULDsrecognisedinyourworkplace?

n IsmanagementcommittedtopreventingorminimisingtheriskofULDs?

n Arethereadequatemanagementsystemsandpoliciestosupportthe

commitment?

Understand the issues

Whatareupperlimbdisorders?

8 Thephraseupperlimbdisordersisagenerallabelwhichisusedtorefertoarangeofmedicalconditionswhichcanbecausedormadeworsebywork.

Therearea numberofcommontermswhicharealsoinusetodescribethe

sameconditions,ofwhichthemostwellknownisrepetitivestraininjury.

Otherlesserknowntermsarecumulativetraumadisorder,oroccupational

overusesyndrome.Thesecommontermscanbemisleadingwithregardto

themanyfactorswhichcancontributetotheonsetoftheconditions,andfor

thisreasonthemoregeneraldescriptionofupperlimbdisordersisusedin

thisguidance.

9 Thetermupperlimbrefersto:

n

thepartofthebody:thearmandhand,coveringaregionextendingfromthetipsofthefingerstotheshoulderandextendingintotheneck;

n thetissues:thesoft-tissues,musclesandconnectivetissues(tendons

andligaments)andthebonystructures,aswellastheskin,alongwiththe

circulatoryandnervesupplytothelimb.

10 Thetermdisorderreferstotheclinicaleffectsproducedbyunderlying

changesinthetissues.Thesecomprisesymptomssuchaspain,experienced

bytheperson,andsignswhichareabnormalities,egintheappearanceof

thelimb,whichmaybeapparenttothepersonormayonlybefoundon

examinationbyadoctor.Theseclinicaleffectsareaccompaniedbyfunctional

changes,egareductionintheabilitytousetheaffectedpartofthelimband

areoftenassociatedwitharestrictionintherangeorspeedofmovement.

Strengthandsensationmayalsobeaffected.Althoughtheclinicalandfunctionaleffectsareconfinedtothelimbitself,theirpresencewilloftenlead

toareductioninanindividualsassessmentoftheirgeneralhealthandtoa

reductionintheirqualityoflife.

Figure 2



Health and Safety

Executive

11 Upperlimbdisorderscanbedescribedbythepartofthebodyaffected,orby

thepresumedpathologicalmechanism.Therearecommontermsformany

oftheindividualconditions,suchastenniselbowandfrozenshoulder.

Asimpleguidetothemorecommonupperlimbdisordersiscontainedin

Appendix3.

12 PainisacommonsymptomofULDsbuttheexperienceofpainintheupper

limbisalsocommonamongstthegeneralpopulation.Therefore,feelingpain

intheupperlimbisnotinitselfanindicationofthepresenceofanULD,and

suchsymptomsmaybedifficulttoattributetoworkwithanycertainty.

13 Paincanalsobeexperiencedintheformofstiffnessorsorenessof

themusclesaccompaniedbytemporaryfatigue.Thesesymptomsare

comparabletothosefollowingunaccustomedexertionwherenopermanent

pathologicalconditionresults.Fullrecoveryusuallyoccursafterappropriate

rest.

14 Atanyonetimeitispossibletoexperiencesymptomsintheupperlimbwhich

resultfromanumberofdifferentcauses.Thisguidanceisprimarilyconcerned

withULDsforwhichthereisevidencetobelievethattheconditionscanbe

causedby,ormadeworsebyworkactivity.

Areallupperlimbdisorderswork-related?

15 Thesimpleanswerisno,butexperiencehasshownthatULDsareoften

directlylinkedtoworkplaceactivitiesorifduetoanon-workcause,made

worsebywork.

16 Itisimportanttorecognisethatthemusculoskeletalsystemiswellsuitedtoproducingrepeatedmotionsatlowforcelevels.Undesirableforcesmay,

however,beimposedonmuscles,tendonsandjointsbysomejobdemands

andworkingpractices.Suchstressesareusuallywithinthephysicalcapability

orstrengthofthetissues,providedtheforcesareofshortdurationandrest

periodsareadequate.Prolongedtissueloadingcausedbystaticpostureor

performanceofveryfrequentexertionscan,however,beharmful.

17 ThereareestablishedassociationsbetweenmanytypesofULDsandwork

tasks,orspecificriskfactorswithinthesetasks. 7Evidencecomesfrom:

n anecdotalreportswhichhavehistoricallylinkedspecificoccupationsand

particularconditions;8

n clinicalcasestudiesandreportingschemesforoccupationaldiseases; 9,10n workplacesurveysofsymptoms;11

n epidemiologicalreviews7,12andpopulationsurveys;13,14

n laboratorystudiesofthephysiologicalimpactofexperimentallyimposed

physicalstresses.15,16,17

18 Thereviewsoftheepidemiologicalliterature7,18providegoodevidenceofthe

associationsbetweenworkplaceriskfactorsandULDs,particularlywhere

workersarehighlyexposedtotheseriskfactors.

19 Non-workactivities,suchasdomesticactivityandhobbies,maycontain

similartypesofriskasarefoundinworkactivities.Thesetasksaregenerally

notasrepetitive,forceful,orprolongedasareworktasks.Also,theindividualhasahighdegreeofcontrolastowhentheactivitycanbetemporarily

stoppedorabandonedaltogether.



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Howbigistheproblem?

20 Musculoskeletaldisordersarethemostcommonworkrelatedailment

afflictingthegeneralpopulationinGreatBritain.Theyaccountformorethan

halfofallself-reportedoccupationalillhealth(morethan1millioncases). 13

Theseproblemsarenotconfinedtoparticularjobsorsectorsandarefound

throughoutmostmanufacturingandserviceindustries.

21 Basedonahouseholdsurveydonein1995,anestimated506000people

weresufferingfromamusculoskeletaldisorderwhichaffectedtheupperlimbs

orneck.

22 Anestimatedminimum4.2millionworkingdayswerelostinBritaindueto

musculoskeletaldisordersaffectingtheupperlimbsorneckin1995,with

eachaffectedemployeetaking,onaverage,13daysoffwork. 14Coststo

employersofmusculoskeletaldisordersoftheupperlimbsorneckwere

estimatedtobeatleast200million.

Whattypesofjobcarryparticularrisks?

23 EvidencegatheredoverrecentyearsshowsthatULDsarenotconfinedtoany

oneparticulargroupofworkersorindustrialactivity,butarewidespreadinthe

workforce.Thefollowinglistofgroupswhichhavereportedhighlevelsofarm

painillustratesthispoint.Acommonfeatureofthejobsisthattheirtaskshave

recognisedriskfactors:

n assemblylineworkers;

n cleaninganddomesticstaff;

n constructionworkers;

n garmentmachinists;

n

hairdressers;

24 Thislistisnotexhaustive,andtherearemanyotherjobsthatcarryariskof

ULDs.Similarly,thepresenceofjobsonthislistdoesnotimplythattheriskof

injurytotheseworkerscannotbeadequatelycontrolled.

WhyshouldIbeconcerned?

25 IfworkwhichcarriestheriskofULDsisnotmanagedproperlythenthe

consequencesareseenin:

n thehumancostofpainandsufferingexperiencedbyemployeesandtheir

familiesthroughillhealth;

n lossofearnings;

n lossoftheabilitytowork;n problemsinqualitycontrolandproductivity;

n decreaseinefficiency;

n sicknessabsence;

n costsofstaffreplacementandtraining;

n theriskoflitigation;

n theriskofbadpublicity;

n ariseininsurancepremiumsandcostsofcompensationtoinjured

workers.

26 Anywarningsignsmaybethetipoftheiceberg.Onepersonwithsymptoms

maymeantherearenumerousotherworkersalsoexposedtoriskfactors,

andwhoareintheprocessofdevelopingadisorder.

Whataremylegalresponsibilities?

27 TherearegeneraldutiesonallemployersundertheHealthandSafetyat

WorketcAct197419andtheManagementofHealthandSafetyatWork

n meatandpoultryprocessors;

n mushroompickers;

n potteryworkers;

n secretaries/temps;

n

textileworkers.



Health and Safety

Executive

Regulations199920whichrequiretherisksofULDstobeaddressed.These,

andotherlegalresponsibilitiesareoutlinedinAppendix4.

28 ULDshavealsobeenthesubjectofmuchcivillitigationoverthepasttwenty

years.21Althoughthelegalprocesshassometimesappearedinconsistent

thereisnodoubtthattheemployersdutyofcaretowardstheiremployees

withrespecttoULDsisnowwellestablishedinthecivilcourts.Thiscivillaw

dutyrunsparalleltotheemployersstatutoryresponsibilityunderhealthand

safetylegislation.

Commit to action

29 RealisingthatULDsmaybeariskwithin,andto,yourbusinessisnotenough.

Itisessentialtoturnthatawarenessandunderstandingintoacommitment

totakeactiontomanagetherisks.TheframeworkinFigure1outlinesseven

stageswhichformasoundbasisfordevelopinganeffectiveprogrammeforthemanagementofULDrisks.

30 Thestagesareasfollows:

n Understand the issues and commit to action:Managementand

workersshouldhaveanunderstandingofULDsandbecommitted

toactiononprevention.Thiscommitmentmaybeexpressedthrough

positiveleadershiponthetopic,bygeneratinganeffectivehealthand

safetypolicyonULDsandbyhavingappropriatesystemsinplace.These

actionswillhelptopromoteapositivehealthandsafetycultureinthe

workplace.

n Create the right organisational environment:Theorganisational

environmentshouldfosteractiveworkerparticipationandinvolvement,

haveclearandopenlinesofcommunicationandencouragepartnership

workinginthenextfivesteps.Thiswillinvolvedevelopingthe

competenciesofworkers,supervisorsandmanagersfortheirdiffering

roles.

n Assess the risks of ULDs in your workplace:Acorefeatureofthe

managementprogrammeistoassesstheriskofULDs.Itneedstobe

doneinasystematicwaybymanagersandworkerssothatthemainrisks

intheworkplacecanbeidentifiedandprioritisedforaction.Asrisksare

potentiallywidespread,simplechecks,includingafilterquestionnairecan

beusedtoidentifyjobswhichrequireamoredetailedassessment.

n Reduce the risks of ULDs:Onceriskshavebeenassessedand

prioritisedacoherentprocessofriskreductionshouldbeundertaken

usinganergonomicsapproach.Possiblerisksshouldbereduced

oreliminatedatsource.Implementationshouldincludeworkforce

participationasthisisknowntoleadtobettersolutionsandmore

effective,sustainedchanges.

n Educate and inform your workforce:Toenableparticipationand

involvementoftheworkforceandforindividualstoassumetheirproper

responsibilities,provisionofeducationandinformationisvital.Training

willsupportallaspectsofthemanagementprogramme,andshouldbeconsideredasanongoingactivityandnotasaone-offtask.

n Manage any episodes of ULDs:Itisimportanttohaveasystemto

manageanyepisodesofULDs.Employeesshouldbeencouragedto



Health and Safety

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identifyanysymptomsandtoreportthembeforetheybecomepersistent.

Managersneedtorespondquicklybyreviewingrisksandintroducing

moreeffectivecontrols,ifnecessary.Theyalsoneedtoreassure

employeesthatreportingofsymptomswillnotprejudicetheirjobor

position.Earlymedicalmanagementcanstopestablishedcasesfrom

deterioratingandalsohelptheprocessofreturntowork.

n Carry out regular checks on programme effectiveness:Toensure

thatthisprogrammecontinuestoworkproperlyovertimeregularchecks

ofeffectivenessshouldbecarriedout.Thiswillhelptoensurethat

controlsonULDrisksremaineffectiveandwillallowyoutoprogressively

improvetheireffectiveness.

Managementcommitment

31 Ifthisprogrammeofcontrolistoworkeffectivelythenitisimportantto

demonstratemanagementcommitmenttothewholeprocess.Effective

managementofoccupationalhealthrisksischaracterisedby:

n visibleseniormanagementinvolvement;

n openmanagementstyle;

n goodcommunicationswhichengenderownershipofproblems(ie

personalresponsibilityandparticipation);

n anappropriatebalancebetweenhealthandsafetyandproductiongoals.

Supportingpoliciesandsystems

32 AclearpolicyforthemanagementofULDssetsthedirectionforthe

organisationandmeansthatpeoplethroughouttheorganisation,however

largeorsmallitis,willknowthatthepreventionofULDsisanissuewhich

hastobeaddressedinallstagesofbusinessplanning,bothforday-to-dayoperationsandinthelongerterm.

33 TheframeworkinFigure1andtheguidanceinthefollowingsectionsarea

meanstoturnyourintentionsintorealityandtokeeptheseintentionsunder

scrutiny.



Health and Safety

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Create the right organisational

environmentn Isworkerparticipationactivelysoughtandvalued?

n Aresafetyrepresentativesinvolved?

n Arealldepartmentsawareofthecontributiontheycanmake?

n Iscompetenceensured?

n Haveyouallocatedresponsibilities?

34 TheeffectivemanagementofULDsrequiresseniormanagementcommitment.

Inaddition,itneedsthepresenceintheorganisationofsharedandinterlinked

beliefs,attitudesandbehavioursthatallowthemanagementofrisksto

proceedeffectively.Theseelementsmakeupwhathasbeenreferredtoasthehealthandsafetyclimateorculture.Keyfeaturescrucialtodevelopinga

positiveenvironmentfordealingwithULDproblemsinclude:

n participationandinvolvement;

n communication;

n competence;

n allocationofresponsibilities.

Participation and involvement

35 Involvingstaffintheplanningandorganisationalprocessescanbean

importantwayofincreasingthelikelihoodofsuccessofyourriskcontrol

strategy.Workershavefirst-handknowledgeandanalmostunique

understandingaboutparticularaspectsofthetaskstheyperform.Itmay

howeverbeimportanttoprovideeducationandtrainingonULDsbefore

expectingemployeestocontributefullytotheprocessofassessmentand

control.KeyindividualsareSafetyRepresentativesastheyprovideaneffective

channelforcommunicationwiththeworkforcetheyrepresentandtheycan

usetheirfunctionstoprovidearealitychecktoensurethattheproposed

controlmeasuresmightactuallywork.TheHealthandSafety(Consultation

withEmployees)Regulations1996, 22SafetyRepresentativesandSafety

CommitteesRegulations1996, 23andtheOffshoreInstallations(Safety

RepresentativesandSafetyCommittees)Regulations1989 24requireyoutoconsultwithyouremployeesontheirhealthandsafetyatwork.Thiswould

extendtoactionsyouintendtotaketotackleULDs.Furtherinformation

aboutemployeeparticipationcanbefoundin Development of a framework

for participatory ergonomics25andalso Handle with care - assessing

musculoskeletal risks in the chemical industry.26

36 Asupportivecompanycultureandopennesswillbeimportantfactorsin

ensuringthattheadverseeffectsofULDsarenothiddenfrommanagement.

Encouragingearlyreportingofworkrelatedachesandpainstosupervisors

orlinemanagers,andinturntotheoccupationalhealthservice(ifyouhave

oneavailable)canprovidesignificantbenefitsforboththeemployeeand

thecompany.Oneofthemaindifficultieswithreportingisthefearoftheoutcome,egpossiblybeingdeclaredunfitforwork.Thisiswhereanopen,

positiveculturebecomesimportant.Employeesoughttofeelsafetoreport

achesandpainsearlyintheironset.



Health and Safety

Executive

Communication

37 Goodcommunicationwillensurethatstaffmembersineverydepartment

ofyourbusinessareawareoftherisksofULDsandwhattheycando

tohelpreducethem.Productdesignstaffwillinfluencethedetailsofthe

manufacturingprocessandthedecisionsofmarketingstaffwilldetermine

thenatureofthepackagingrequired.Purchasingdepartmentswillcontrol

thesourcingoftheequipmentusedandgeneralmanagementwilldetermine

termsandconditionsincludingworkingschedules.Insomecases,factors

whichinfluencetheserisksmaybecontrolledatadistanceinaparent

organisation.Arangeofmethodsshouldbeusedtoensurethateveryoneis

keptinformedofhowtheirrolescanimpactonotherworkersandalsothe

companysprogrammeonthepreventionofULDs.Thesearelikelytoinclude

seminars,meetings,postersandarticlesinthehousejournalornewsletter.

Theinternetalsoprovidessomeusefulwebsites,someofwhichareincluded

intheFurtherInformationsection.

38 Anopensystemofcommunicationshouldprovideopportunitiestodistribute

informationtoemployeesandalsoopportunitiesforfeedback.Thiscanbe

informal(egtosupervisors)ormorestructured,forexamplethroughregular

surveys.Ifcomplaintsoccurtheyshouldbeinvestigated.

Competence

39 ItisimportantthatpeoplearecompetenttopreventULDswithintheir

technicalareasofresponsibility.Healthandsafetytrainingisimportant,

payingparticularattentiontotheriskfactorsforULDsandhowthesemay

beavoided.Somegroupsofstaffmayrequirespecialisedtraining,eginthe

applicationofergonomicprinciples,evaluationofworkplacechangesorthe

recognitionofupperlimbhealthcomplaints.

40 Theneedforcompetencealsoextendstoareassuchastheoperationof

recruitmentandplacementproceduresandsystemstoidentifytrainingneeds

whenworkpracticesandtechnologieschange.Staffdevelopmentsystems

canbeusedtoensurethatindividualshaveaccesstothetrainingthey

require,andtheiroperationcanformpartoftheregularchecksonprogramme

effectiveness.

Allocation of responsibilities

41 AsmanypeoplewillhavearoleinyourprogrammetopreventULDs,it

isimportanttobeclearaboutwhoisresponsibleforwhatfunctions.For

example,supervisorswhounderstandtheriskscantakeanactiverolein

helpingtocontrolthem,andinencouragingstafftoreportanyproblems.You

mayneedtosetupsystemstodealwithanyproblemswhichmayoccur,to

ensureanearlyresponsetothem.

42 Settingobjectivesforyourorganisation,withclearrolesandaccountabilities

willhelpkeepyouontarget.Youmaybeabletousebenchmarkingasa

wayofcheckingprogress,egbetweendepartmentsorwithneighbouring

businesses.



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Executive

Assess the risk of ULDs in your

workplacen AreanyULDhazardsidentifiedthroughsimplechecks?

n AreriskfactorsforULDspresent?

n Repetition,workingposture,force,durationofexposure,working

environment,psychosocialfactors,individualdifferences,

43 AssessingtheriskassociatedwithULDsinvolvestwomajorstepsnamely:

n identifyingproblemtasks;and

n riskassessment.

44 Anexampleofamethodfortacklingtheabovetwostepscanbefoundin

Appendix2.

45 Inordertobeabletogetthemostbenefitfromtheprocess,youandyour

workforceneedtobeabletoworktogethertoidentify,assessandcontrol

theriskofULDs.Thisprocessshouldinvolveanergonomicsapproachand

shouldincludetheparticipationofworkers.

What is an ergonomics approach?

46 Ergonomics(orhumanfactors),isconcernedwithensuringworkisdesigned

totakeaccountofpeople,theircapabilitiesandlimitations.Itsobjectiveisto

optimisehealth,safetyandproductivity.Anergonomicsapproachisthemost

effectivewayofdealingwithULDproblems.Thisisbecauseitencourages

youtotakeaccountofalltherelevantpartsoftheworksystemandrequires

workerparticipation.

Identifying problem tasks

47 Therearetwomainapproachesyoucanusetoidentifyifyouhaveaproblem

inyourworkplace.Firstlymanagersandworkerscanlookforanysignsof

problemsorsymptomsamongsttheworkforce.Secondly,youcanobserveworktasksthemselvestoseeifriskfactorsforULDsarepresent.Thiscanbe

doneusingasimpleinitialassessmentofriskssuchastheriskfilterapproach

foundinAppendix2.Sourcesofinformationthatmayhelpincludeexpert

advice,industrystandardsandlegislativestandards.

Warning signs

48 WarningsignscanindicatethepresenceofhazardsrelatingtoULDs.Signsof

existingULDproblemscaninclude:

n injuryandillnessrecords;

n jobswhichworkersarereluctanttodo;

n jobswhereworkerscomplainofdiscomfort;n workershavingmadeadaptationstoworkstations,toolsorchairs;

n workersrequestingtobere-deployedortakenoffajob;

n splintsorbandagesbeingworn,and/or;

n useofpainkillers.



Health and Safety

Executive

Figure 3

49 Paragraphs120-128outlineotherwaysofmonitoringthenumberofworkers

whoareexperiencingupperlimbpainordiscomfort.

Risk Filter

50 Adetailedassessmentofeveryjobcouldbeamajorundertakingand

mightbeanunnecessaryeffort.Tohelpidentifysituationswhereadetailed

assessmentisnecessary,aFilterforaninitialscreeningoftaskshasbeen

devised.WheretheFilteridentifiesseveralriskfactorsincombination,theriskofULDsislikelytobegreater.AcopyoftheRiskFilterandinstructionsfor

usecanbefoundinAppendix2.

Risk assessment

51 OnceyouhaveidentifiedthatcertaintasksmaybecreatingariskofULDs(by

lookingforsignsandsymptomsandusingtheriskfilter),amoredetailedrisk

assessmentshouldbeconducted,involvingmanagersandworkers,inorder

toascertainthelikelihoodandseverityofrisk.ULDassessmentworksheets

thatcanassistinrecognisingandrecordingriskfactors,canbefoundin

Appendix2.

The risk assessment process

52 Ajoboftenconsistsofseriesoftasks.Performingyourriskassessmentcan

besimplifiedbythinkingintermsofthesetasksandtheirsubsidiaryelements.

Toillustratethispoint,Figure4describesthejobofaprocessworkerthat

consistsofthreedifferenttasksonanassemblyline:

n station1:attachingahandle;

n station2:grinding,and;

n station3:packing.

53 Ascanbeseeninthisexample,thesetaskscanalsobefurtherbrokendown

intoelements,whicharedistinctsequencesofmovementwithinthetask.

54 Lookingattaskelementscanhelpbothinidentifyingthecausesofrisks

andindevisingpotentialsolutions.Forexample,inthecaseoftheprocess

workertheriskfiltermightidentifythetaskofattachingahandle(station1)as

posingapossiblerisk.Themoredetailedassessmentusingtheworksheet

wouldidentifyrepeateduseofapinchgripwhenpickingupandpositioning

thescrews(elements1and2),andawkwardarmpostureouttothesideof

thebodywhendrilling(element3).Whenconsideringthetaskinthiswayit

iseasiertolinktheriskstoparticularactionsoroperations,whichthenhelps

whenconsideringriskreductionmeasures.

55 Inthiscasebetterpositioningoftheassemblylineinrelationtotheworker,andre-orientatingtheobjectswillreducetherisktotherightarmand

shoulder.Reducingthedurationspentonthetaskandintroducingmore

frequentbreakswillreducetheriskassociatedwithusingthepinchgrip.



Health and Safety

Executive

Figure 4 Thetasksandelementsofaprocessworkersrole

56 Remembertoconsiderwhetherworkersperformanumberofpotentiallyrisky

tasks(iethathavebeenhighlightedbytheriskfilter),inagivenshift.Ifthisis

thecase,itisessentialthatyourriskassessmentconsiderstheoverallimpact

ofperformingthecombinationoftasksinyourriskassessment.Inpractice,

thiswouldusuallymeanthataseparatefilterandriskassessmentworksheet

wouldbefilledoutforeachtask,andthatthecompletedworksheetswouldbeconsideredincombinationwhendecidingontheoveralllevelofriskfor

thoseworkers.Detailedinstructionsfortheriskfilterandriskassessment

worksheetscanbefoundinAppendix2.

57 Otherriskassessmenttoolsareavailable.27,28,29,30Theserangefrom

standardisedorquantitativetoolsthatareusuallyrequiredtobeundertaken

byacompetentperson,tosimplechecklists.Engagingacompetentperson

maybeappropriateformorecomplexriskassessments.

ULD risk factors

58 Riskfactorscanbethoughtofastask,environment,orworker-relatedwithin

anergonomicapproach.TheprincipalULDriskfactorsare:



Health and Safety

Executive

59 Eachoftheseriskfactors,includingtheirdefinitionsandwhytheycreatethe

riskofULDs,willbediscussedinmoredetailinthefollowingparagraphs.

60 Riskfactorscommonlyinteractwitheachotherincreatingtheoverallrisk

ofULDs.Forexample,thetaskofgrippingaheavypowertoolwithalargehandleforsixhourswouldresultinanawkward,forcefulgrippingpostureand

exposuretovibrationoveraprolongedperiod.Thereforeworkingpostures,

duration,forceandworkingenvironmentareallriskfactorsforinjuryinthis

task.

61 Incontrast,ifthistaskwasonlydoneforashortperiodineachshift,the

riskofinjurymaynotbehigh.Thisisdespitethefactthattheriskfactorsof

workingpostures;forceandvibrationarestillpresent.

62 Generally,thereisanincreasedriskofinjurywhenthereareanumberof

riskfactorsactingincombination.However,oneriskfactoractingalonecan

createanunacceptableriskofinjuryifitissufficientlygreatinmagnitude,

frequencyorduration.

Repetition

63 Workisrepetitivewhenitrequiresthesamemusclegroupstobeused

overandoveragainduringtheworkingdayorwhenitrequiresfrequent

movementstobeperformedforprolongedperiods.

64 Rapidorprolongedrepetitionmaynotallowsufficienttimeforrecovery

andcancausemusclefatigueduetodepletionofenergyandabuildupof

metabolicwastematerials.Repeatedloadingofsofttissuesisalsoassociated

withinflammation,degenerationandmicroscopicchanges.Fastmovements

andaccelerationrequirehighmuscleforces.

Figure 5

Taskrelatedfactorsn repetition;

n workingpostures;

n force;

n durationofexposure.

Environment-relatedfactorsn workingenvironment;

n psychosocialfactors.

Worker-relatedfactorsn individualdifferences.



Health and Safety

Executive

Workingposture

65 Workingposturescanincreasetheriskofinjurywhentheyareawkwardand/

orheldforprolongedperiodsinastaticorfixedposition.

Figure 6

Awkward postures

66 Anawkwardpostureiswhereapartofthebody(egalimbjoint)isused

wellbeyonditsneutralposition.Aneutralpositioniswherethetrunkandheadareupright,thearmsarebythesideofthebody,forearmsarehanging

straightoratarightangletotheupperarm,andthehandisinthehandshake

position.Forexample,whenapersonsarmishangingstraightdownwiththe

elbowbythesideofthebody,theshoulderisinaneutralposition.However,

whenemployeesareperformingoverheadwork(egrepairingequipmentor

accessingobjectsfromahighshelf)theirshouldersarefarfromtheneutral

position.

67 Whenawkwardposturesareadopted,additionalmusculareffortisneededto

maintainbodypositions,asmusclesarelessefficientattheextremesofthe

jointrange.Resultingfrictionandcompressionofsofttissuestructurescan

alsoleadtoinjury.

Static postures

68 Staticposturesoccurwhenapartofthebodyisheldinaparticularposition

forextendedperiodsoftimewithoutthesofttissuesbeingallowedtorelax.

Whenholdingabox,forexample,itislikelythatthehandsandarmsareina

staticposture.

69 Staticloadingsrestrictbloodflowtothemusclesandtendonsresultinginless

opportunityforrecoveryandmetabolicwasteremoval.Musclesheldinstatic

posturesfatigueveryquickly.

70 Inboththeabovetypesofposture(awkwardandstatic),theriskofULDs

willberelatedtothenumberoftimesthepostureisrepeated,theamountofforcerequired,and/orthelengthoftimeitisheld.Aswithalltheriskfactors

forULDs,theimpactoftheworkingpostureneedstobeunderstoodin

relationtootherriskfactors.

Force

71 Forcecanbeappliedtothemuscles,tendons,nervesandjointsoftheupper

limbby:

n handlingheavyobjectswhenperformingtasks,ieanexternalload;

n fastmovementorexcessiveforcegeneratedbythemusclesofthebody

oftentobetransmittedtoanexternalload,egtryingtoundoastiffbolt;n localforceandstressfromitemscomingintocontactwithpartsofthe

upperlimb,suchasthehandleofapairofpliersdiggingintothepalmof

thehand.



Health and Safety

Executive

Figure 7

72 Thelevelofforcethatisgeneratedbythemusclesisaffectedbyanumberof

factorsincluding:

n workingposture:thelevelofmusculareffortrequiredincreaseswhena

partofthebodyisinanawkwardposture;

n thesizeandweightofobjectsbeinghandled;n thespeedofmovement:asextraforceisneededatthebeginningand

endoffastmovementssuchashammering;and

n vibratingtoolsorequipment:asoperatorsneedtouseincreasedgrip

forceinworkingwithvibratingequipment.

73 Useofexcessiveforcecanleadtofatigueandifsustained,toinjury,either

throughasingle-eventstraininjuryorthroughthecumulativeeffectofthe

repeateduseofsuchforce.Localforceandstresscanalsocausedirect

pressureonthenervesand/orbloodvesselsandincreasetheriskof

discomfortandinjury.

Force in gripping74 Theneedtogriprawmaterials,productortoolsisapotentialriskfactor

ifexcessiveforceisused.Theamountofforcerequiredtogripcanbe

influencedbythetypeofgripused,thepostureofthewrist,exposuretocold

andvibrationandtheeffectsofwearinggloves.

75 Theforcerequiredtogripobjectsisalsodependentuponthematerialoritem

beinggripped.Forexample,ascrewdriverhandlewithaflexiblegriprequires

lessforcewhenbeingusedthanonewithaharderhandle.Thesizeofthe

objectbeinggrippedcanalsoaffecttheforcerequired.Forexample,pliers

withtoowideortoonarrowaspanwillbemoredifficulttogrip.

76 Muscleforceisgreatestwhenapowergrip(eggrippingahandleinthepalm

withfingersandthumb)isusedas,thisallowsalargesurfaceareaofthehandtobeutilised.Thestrongestgripstrengthoccurswhenthewristisclose

tothehandshakepositionandisslightlybentupwards.

Durationofexposure

77 Durationreferstothelengthoftimeforwhichataskisperformed.It

includesthelengthoftimethatthetaskisundertakenineachshift,plusthe

numberofworkingdaysthetaskisperformed(egfourhoursperday,five

daysperweek).Durationisanimportantconceptinassessingtheriskof

musculoskeletaldisorders.

78 Itisgenerallyacceptedthatmanytypesofupperlimbdisordersare

cumulativeinnature.Therefore,whendurationtimeisincreasedtheriskofinjuryisincreased.Thisisbecausewhenpartsofthebodyundertake

workforperiodswithoutrest,theremaybeinsufficienttimeforrecovery.

Consequently,timefortheindividualsbodytorecoverfromaspecifictaskor

tasksisimportant.



Health and Safety

Executive

79 Shortexposuresareunlikelytocreatesignificantriskofinjury,exceptwhere

thetaskisexceptionallydemandingand/ortheworkerhasnotbeenallowed

tobuilduptoitsdemandsoveraperiodoftime.Thiscanoccurafterreturnto

workfromholidaysorwithanincreaseinworkpace.

Figure 8

Workingenvironment

80 Workingenvironmentreferstoaspectsofthephysicalworkenvironmentthat

canincreasetheriskofULDs.Thisincludesfactorssuchasvibration,cold

andlighting.

Vibration

81 Exposuretohand-armvibrationresultsfromtheuseofhand-held/guided

powertoolsandequipmentorfixedmachinerysuchasbenchgrinderswhere

theworkpieceisheldbytheworker.VibrationcanincreasetheriskofULDs

andisknowntocausevibrationwhitefingerandcarpaltunnelsyndrome,

lossofsenseoftouchortemperature,painfuljointsandlossofgripstrength.Informationaboutthedose(ievibrationmagnitudeandexposuretime)of

vibrationisneededinordertoaccuratelyassesstherisk.Furtherinformation

onvibrationcanbefoundin Hand-arm vibration3,ISO5349-24andAppendix

3.

Figure 9

Cold

82 Workingincoldtemperatures,handlingcoldproductsorhavingcoldair

blowingonpartsofthebodycanplaceadditionaldemandsonthebodyas

wellaspossiblyrequiringtheuseofpersonalprotectiveequipment(which

cancompoundtheriskbyrequiringadditionalforcetogrip).Exposuretocold

canresultindecreasedbloodflowtothehandsandupperlimbs,decreased

sensationanddexterity,decreasedmaximumgripstrengthandincreasedmuscleactivity(whichispartofthebodysnaturalresponsetobeingcold).



Health and Safety

Executive

Figure 10

Lighting

83 Thevisualdemandsofthetaskareanimportantconsideration,sincea

workersposturecanbelargelydictatedbywhattheyneedtosee.Dimlight,

shadow,glareorflickeringlightcanencourageworkerstoadoptabentneckandpoorshoulderposturesinordertoseetheirwork,therebyexacerbating

theeffectsofotherriskfactors.Furtherinformationonlightingcanbefoundin

Lightingatwork.31

Figure 11

Psychosocialfactors

84 Physicalriskfactorsexerttheirharmfulinfluencethroughphysiologicaland

biomechanicalloadingoftheupperlimb.Ofequalimportanceisthelarge

bodyofworkshowingthataworkerspsychologicalresponsetoworkand

workplaceconditionshasanimportantinfluenceonhealthingeneraland

musculoskeletalhealthinparticular;thatis,workasexperiencedbyworkers.

Thesearereferredtoaspsychosocialriskfactors.Theyincludethedesign,

organisationandmanagementofworkandtheoverallsocialenvironment

ingeneral(thecontextofwork)andalsothespecificimpactofjobfactors

(thecontentofwork).Itisverylikelythatphysicalandpsychosocialrisk

factorscombineandthatthegreatestbenefitwillbeachievedwhenbothare

identifiedandcontrolled.Manyoftheeffectsofthesepsychosocialfactors

occurviastress-relatedprocesseswhichincludedirectbiochemicaland

physiologicalchanges.Alsoincludedareinstanceswhereindividualstryto

copewithstressfuldemandswithbehavioursthat,inthelongterm,maybe

detrimentaltohealth.Anexamplewouldbewhereanindividual,because

ofhighworkloadordeadlines,foregoestherestbreakstowhichtheyare

entitled.

85 Psychosocialriskfactorsarecommoninsectorswhereupperlimbdisordersoccur13.Importantaspectsofworkdesignincludetheamountofcontrol

peoplehaveintheirjobs,thelevelofworkdemands,thevarietyoftasksthat

theyhavetocarryoutandthesupporttheyreceivefromsupervisorsand



Health and Safety

Executive

co-workers.Manyjobsarenotwelldesignedandincludesomeorallofthe

followingundesirablefeatureswhere:

n workershavelittlecontrolovertheirworkandworkmethods(including

shiftpatterns);

n tasksrequirehighlevelsofattentionandconcentrationespeciallyin

conditionswheretheworkerhaslittlecontrolovertheallocationofeffort

tothetask;

n workersareunabletomakefulluseoftheirskills;

n theyarenot,asarule,involvedinmakingdecisionsthataffectthem;

n theyareexpectedtocarryoutrepetitive,monotonoustasksexclusively;

n workismachineorsystempaced(andmaybemonitoredinappropriately);

n workdemandsareperceivedasexcessive;

n paymentsystemsencourageworkingtooquicklyorwithoutbreaks;

n worksystemslimitopportunitiesforsocialinteraction;

n highlevelsofeffortarenotbalancedbysufficientreward(resources,

remuneration,self-esteem,status);

Aswithphysicalriskfactors,psychosocialissuesarebestaddressedwithfull

consultationandinvolvementoftheworkforce.

Individualdifferences

86 Allindividualsaredifferentandforbiologicalreasonstheremaybesome

peoplewhoaremoreorlesslikelytodevelopanULD.Individualdifferences

mayalsohaveimplicationsforemployeesreportingULDtypeconditions.

Whereanergonomicapproachisfollowed,thisshouldensurethattasksare

withinthecapabilitiesoftheentireworkforce.Somefactorsmayincreasethe

riskofdevelopingsymptomsandshouldbeconsideredinthemanagement

programme.Theseinclude:

n newemployeesmayneedtimetoacquirethenecessaryworkskillsand/

orrateofwork;

n differenceincompetenceandskills;

n workersofvaryingbodysizes,ieheight,reachetc.Thiscanleadto

adoptingpoorpostureswhenworkingatsharedworkstations;

n vulnerablegroups,egolder,youngerworkersandneworexpectant

mothers;32

n healthstatusanddisability;

n individualattitudesorcharacteristicsthatmayaffectcompliancewithsafe

workingpracticesorreportingofsymptoms.



Health and Safety

Executive

Reduce the risk of ULDs

n HaveyouprioritisedyouractionstocontroltherisksofULDs?

n Haveyoulookedforhigherordersolutions?

n Haveyouutilisedanergonomicsapproach?

n Haveyouimplementedsolutions?

87 Havingassessedtheworktodeterminethelikelihoodandscaleoftherisks

associatedwitheachoftherelevanttasks(andthetasksincombination

whereapplicable),youmustimplementcontrolsinordertoreducetheserisks

asfarasisreasonablypracticable.

88 Prioritiseactionssothat,forexample,seriousrisksaffectinganumberof

employeesaretackledbeforeanisolatedcomplaintofminordiscomfort.

Look for higher order solutions

89 Ahierarchicalapproachtoriskreductionandcontrolshouldbefollowed

wherepriorityisgiventoeliminationofriskatsource.Firstly,considerifitis

reasonablypracticabletoeliminatethehazard,egbyredesignofthework

task,bysubstitutionorreplacementoftoolsorcomponents,orthrough

automationofthetask.Insomecasesitmaybepossibletoisolatetherisks

atsourcebyengineeringcontrolsorprotectivemeasures,egbyshieldingthe

workerfromdraughtsorbypreventingexposuretovibration.Wheretheseare

notviable,thelowestorderinthehierarchyofcontrolsistominimiseriskby

designingsuitablesystemsofwork,usingPPEifappropriateandtoprovide

training.

Using an ergonomics approach

90 Asinriskassessment,anergonomicsapproachisimportantindeveloping

yourinterventionstoreducerisk.Aparticipativeapproachtosolutionfinding

isconsideredtobethemosteffectivemethodforinterventiondevelopment. 18

Interventionsmayinvolvechangestothetask,theworkingenvironment,or

theindividual(orworkgroup)ortoallofthese.Researchhasshownthat

interventionsthattakeaccountofalltheseaspectsaremoreeffectivein

reducingrisk:

n Changestothework task(s)mayincluderedesignoftheworkstation

andworkequipment.Itmayincludetheprovisionofappropriatefurniture,

equipmentortoolsthathavebeenmatchedtotheneedsoftheworkers

andthetask.Jobrotationorautomationmaybebeneficialinreducing

ULDrisks.

n Changestotheenvironmentcouldincludemodificationstothethermal

conditions,vibrationexposureorlightinglevels.Changestoinfluence

psychosocialfactorsmayberequired.Areviewoftheworkorganisation

andstructuresuchasreductionofworkhoursorchangestoscheduling

ofbreaks,ormodifyingpacingorincentiveschemesmayalsobehelpful.

n Trainingandprovisionofinformationto individualsorworkgroupsmayalsobeneededtosupportotherchanges.



Health and Safety

Executive

Basic principles in implementing solutions

91 Riskscanberemovedorreducedthroughsystematicattentiontosomeorall

ofthefactorsmentionedpreviously.Somehelpfulprinciplesare:

n greatbenefitoftenresultsfromsimpleandlowcostinterventions(eg

changesinworkingheight)whicharegenerallymorepracticalandeasier

toimplement;

n consideranumberofpossiblesolutions,preferablytryingthemoutona

smallscalebeforedecidingononetoimplement;

n employeescanbeespeciallygoodatdevisingeffectiveandpractical

improvementmeasures;

n checkthatanychangesdonotcreatenewhealthandsafetyrisks

elsewhere;

n successfulimplementationoftenrequirestheinvolvementofallemployees

fromthetopleveldownwards.Evensoundergonomicsolutionsmay

notbesuccessfuliftheyareimposed.Involvingworkersinproblemsolvingandtheimplementationprocesses,givesanenhancedsenseof

ownershipofthesolutionsandmaycreateagreatercommitmenttotheir

effectiveimplementation;

n inlarge,geographicallyspreadorganisations,incorporateshort-termlocal

initiativesintothecompanysoverallhealthandsafetystrategy;

n refertocasestudiesfromothersources,egfromtradeassociationsorthe

Internet,forideasconcerningbestpracticesolutions.

Individual differences

92 Alltasksshouldbedesignedsotheycanbeundertakenwithoutcreatinga

riskofULDs.Thereisnoscientificallyvalidscreeningtestwhichcanpredict

thefuturedevelopmentofULDsinanindividual.Placementprocedures

shouldtakeaccountoftheriskassessment,jobrequirementsandthe

individualdifferencesoutlinedintheprevioussection.

93 Newemployees,particularlyyoungworkers,andthosereturningtoworkfrom

aholiday,sicknessorinjury,mayneedtobeintroducedtoaslowerrateof

productionthantheexistingworkforce,followedbyagradualincreasein

pace.Thisworksbest,forexample,byonlyworkingforalimitedtimeperday

atproductionspeed,increasingasappropriate.Introducingnewcomersat

aslowerpaceenablesthemtodevelopgoodworkpracticesbeforehaving

toconcentrateonworkingfastandhelpsthemtoassimilatetrainingmore

effectively:ideally,earlytrainingshouldbedoneoff-line.Regulation12intheManagementofHealthandSafetyatWorkRegulations1999 20details

requirementsconcerningnewemployees.

Suggestions for reducing the risk

94 Someexamplesofapproachesthatmaybeusefulforreducingtheriskof

ULDsarelistedinAppendix2.

Other guidance on solutions

95 HSEhasproducedanumberofpublicationsthatprovideguidanceon

reducingworkplacemusculoskeletaldisorders.Thisincludesguidancebased

oncasestudies33,34aswellassomethatisindustry-specific.Informationcan

alsobefoundontheHSE,andsomeotherwebsites.Seefurtherinformation

forsources.



Health and Safety

Executive

96 Ifyouareunsureofhowtoapproachimplementingchangeswithinthe

workplace,youmaywishtoconsiderseekingspecialistadvicefroman

ergonomistorotherworkplacehealthandsafetyconsultant.

After implementation

97 Finally,itisimportanttomonitorthesituationtomakesuresolutionsarestill

effectiveatalaterdate(particularlywheretheirsuccessdependsonsome

formoflearningorbehaviourchange).Keepabreastofnewdevelopments(eg

whennewmachineryorstaffareintroducedintotheworkplaceorwhenother

alternativeriskcontrolmeasuresaredeveloped).Monitoringandreviewingare

explainedinparagraphs120-132.



Health and Safety

Executive

Educate and inform your

workforcen Haveyoueducatedandinformedyourworkforcetohelpprevention?

n Haveyouinvolvedsafetyrepresentativesincommunicatinginformation

aboutULDriskfactors?

n Whatstepshaveyoutakentoensurethattrainingreinforcessafeworking

practicesandcontrolmeasures?

98 Educationandtrainingarecomplementarytoallotheraspectsofyour

programmeforthepreventionofULDsandindeedarecriticaltoitssuccess.

InformingstaffaboutsignsandsymptomsofULDs,riskfactors,controlmeasuresandtheneedforearlyreportingandactionwillimprovetheoverall

effectivenessofyourprogrammeandwillencourageemployeestobecome

activelyinvolvedinidentifyingandcontrollingULDrisks.

Training as a control measure

99 Trainingshouldnotbereliedonastheprimarymeansofcontrollingtherisk

ofULDs.Influencingthewayworkersperformtasksthroughtrainingisan

essentialpartofriskcontrol,butrelyingonthisalonehasbeenshownto

havelimitedsuccessinprevention.Trainingshouldideallycomplementother

higherordercontrolsthathavealreadybeenimplemented(ieredesignofthe

worktask,substitutionorreplacementoftoolsorcomponents,isolatingthe

riskatthesourceetc).Itcanbeverybeneficialtoinvolveemployeesinthe

developmentandpresentationoftraining.

Who should receive education?

100 Allworkers,supervisorsandmanagersshouldreceiveeducationonULDsto

enablethemtoidentifytheearlywarningsignsofpotentialULDriskfactors.

Educationshouldalsoextendtopurchasingstaff,engineers,maintenanceand

supportstaff,particularlywheretheyareinvolvedinspecifying,designingor

modifyingworkequipmentinordertoincreasetheirawarenessofergonomic

issuesandULDriskfactors.

What should training cover?

101 TrainingcanbedesignedbothtoraisegeneralawarenessofULDissues

andtoaddressthespecificneedsofaparticularjobortask.Generaltraining

shouldaimto:

n increaseawarenessandknowledgeofULDissues/problemsinthe

workplace;

n reducethelikelihoodofULDproblemsbyprovidingadequateinformation:

recognitionofsymptomsofULDs(seeAppendix3); riskfactorspresentintheworkplace;

safeworkingmethods;

correctoperationofcontrolmeasures;

theimportanceofproceduresfortheearlyreportingofULDsymptoms.



Health and Safety

Executive

102 Task-specifictrainingshouldconsiderULDriskfactorsassociatedwiththejob

ingreaterdetail.Suchtrainingshouldincludeareviewofriskfactorsrelatedto

tasksandsafeworkingmethodsforthatparticulartask.Anyspecificcontrol

measuresassociatedwiththejob,includingpersonalprotectiveequipment

shouldalsobecovered.

Making training more effective

103 Trainingthatinvolvesnomorethansittingwithanexperiencedemployeewho

doesnothaveappropriateunderstandingofULDsisunlikelytobesatisfactory

sincebadhabitsandpracticescaneasilybepassedontothenewemployee.

Whenattemptingtoalterworkerbehaviour,programmeswillneedto

consider:

n adversetraditionalmethodsandingrainedhabits;

n productionpressures;n anyperceptionthatnewmethodsaredifficultortimeconsuming;

n anylackofunderstandingofriskfactorsforULDs;

n situationswhereimprovementsinjobmethodsmaybeconstrainedby

poorworkplacelayout,materials,equipmentand/orjobdesign;

n employeeinvolvement.Thisisfundamentaltothesuccessofanytraining

programme.Employersshouldpromoteparticipationbyencouraging

discussion,askingemployeesforsuggestionsandcommentsontraining

issuesand,whereappropriate,involvingemployeesinthepresentationof

trainingmaterial;

n theroleofsafetyrepresentativesinpromotingsafeworkingpracticesand

reinforcingtrainingmessages;

n

theneedtoprovideopportunitiesforimmediatepracticeandfeedbacksoastocorrectperformanceandtoensurethatskilllevelscanbe

maintainedfollowingtraining.Principlescoveredintrainingsessions

shouldbereinforcedbysupervisors,safetyrepresentativesandpeerson

aregularbasis;

n theneedforperiodicrefreshertrainingforallemployees.

Evaluation and follow up

104 Periodicevaluationofyourtrainingprogrammesshouldbeundertakenaspart

ofageneralreviewofyourULDpreventionprogramme.Employeesshouldbe

involvedinthisprocess,particularlysafetyrepresentativesandsupervisors,

whocanassesstheimpactandeffectivenessofthetrainingoffered.Trainingshouldalsobereviewedwhentherearechangesin:

n workplacelayouts,taskdesignorworkorganisationortheintroductionof

newworkequipment;

n workpracticesorcontrolmeasures;

n reportedinjurylevelsinotherworkplacesintheindustry,orinworkplaces

withsimilarjobs.



Health and Safety

Executive

Manage any episodes of ULDs

n Haveyouimplementedandsupportedasystemforearlyreportingof

ULDs?

n DoyouactivelylookforsymptomsofULDs?

n Haveyouarrangedforoccupationalhealthprovision?

n Doyouhavesystemsinplaceforemployeesreturningtoworkafteran

ULD?

105 Adequatecontrolofriskfactorswillgoalongwaytopreventtheoccurrence

ofULDs.Duetoindividualdifferencesinthebodysresponsetostressesit

isnotpossibletoensurethateverypossibleepisodeofULDswillalwaysbe

prevented.Itisnecessary,therefore,tohaveasysteminplacetomanage

anyreportsorcasesofULDsthatariseintheworkforce.Theapproachtomanagingthesecomplaintsisbroadlysimilarwhethertheyarethoughtto

havebeencausedbyworkactivity,beenmadeworsebytheworkorare

largelyunrelatedtoparticularworktasks.

Reporting and recording

106 IndividualswillvaryintheirwillingnesstoreportearlysymptomsofULDs.

Itisimportanttomaintainaclimateinwhichearlyreportingofsymptoms

isregardedpositivelyandthiswillbeencouragedifmanagersandsafety

representativesbothemphasisethebenefitsofsuchearlydetectionof

possibleharm.Educationonpossiblesymptomsandsigns,whotoseein

thecompanyandwhathelptoexpectshouldbeprovidedtoallemployees

wherethereisaresidualriskofULDs.Employeesshouldbeadvisedtohave

anyrelevantsymptomsrecordedinthecompanyaccidentbook.Anyfirstaid

providedshouldalsobedocumented.

107 Ifsymptomsaresuchthatcontinuingtoworkdoesnotmakethemworse,

thenitmaybeenoughtoprovidetheworkerwithreassurance,adviceonrisk

factors,andtoreviewtheindividualsworktaskswiththem.

108 Ifcontinuingtoworkatthesamejobcausessymptomstogetworseor

becomeprolonged,orifthepersonwasconcernedaboutthenatureofthe

symptomsthenitwouldbeappropriatetoobtainfurtheradvicebymeans

ofareferraltoahealthprofessional.AdiagnosticsupportaidforULDshasbeendevelopedandislikelytobeofbenefittoGeneralPractitioners(GPs)

andotherhealthprofessionals.35Ifsymptomsareaggravatedbyapersons

currentjobitisadvisabletolookforalternativeworkthattheycando,evenif

thisisquitedifferentfromtheirnormalduties.Thiscanpreventtheneedfor

sicknessabsenceandallowforrecoverytimebeforereturntotheirnormal

duties.

Referral

109 Onewaytoobtainhealthadviceisbyreferraltoanoccupationalhealth

service,eitheronoroffsite.Appendix3containsmoreinformationonthescopeofoccupationalhealthprovisionandhowtoaccessthis.Accessto

anoccupationalhealthservicewillusuallyallowboththeworkerandtheir

managertobegivenappropriateadvicewithminimaldelay.Theindividualwill

beadvisedonthenatureoftheircomplaintandanyappropriatetreatment



Health and Safety

Executive

andthemanagercanbeadvisedwhetherthecomplaintsarelikelyto

havebeenrelatedtoworkandtheshorttermimplicationsforcontinuing

employment.

110 IfanemployeeisoffsickwithwhatisbelievedtobeaULDthenitisusefulto

makeearlycontactwiththeperson,forexampleatelephonecall,toseewhat

youcandotohelptheirreturntowork.Appendix3listsanumberofspecific

medicaldiagnosestolookoutforifyouareconcernedaboutcomplaintsof

ULDs.

111 Ifyoudonothaveaccesstoanoccupationalhealthservicethen,withyour

employeesagreementandwrittenconsent,youcanwritetotheirGPasking

forareportwhichmayhelpyouinmanagingtheabsence.However,anysuch

communicationhastocomplywiththeprinciplesdetailedintheAccessto

MedicalReportsAct,1988. 36,37Thefollowingpointscouldberaised:

n thenatureoftheillness;n whetherthedoctorthinksitisrelatedtowork;

n iftreatmentwillbenecessaryandtimerequiredtoaccesstreatment;

n whenareturntoworkmaybeexpected;

n whetheractivitywillneedtobelimitedforaperiodafterreturningtowork;

n ifanylongtermeffectsaretobeexpectedfromtheillness.

112 Appendix3providesfurtherinformationonarangeofpossibletreatmentsfor

ULDs.

Diagnosis and return to work

113 Receiptofawrittendiagnosisofanupperlimbdisordermaytriggera

requirementtomakeareporttotherelevantenforcingauthorityunderThe

ReportingofInjuries,DiseasesandDangerousOccurrencesRegulations

(RIDDOR).38,39,40ThisrequirementappliesonlytoasmallnumberofULDs

whichariseinthecourseofspecifiedworkactivities.Appendix4provides

furtherdetails.

114 AnumberofULDsarealsoprescribedundertheSocialSecurity(Industrial

Injuries)(PrescribedDiseases)Regulations1985. 41Atthetimeofwriting,the

listofULDswhicharePrescribedDiseasesisthesameasthosewhichare

reportableunderRIDDOR.Individualsdiagnosedwithsuchdisordersshould

beadvisedthattheymightbeentitledtobenefitundertheIndustrialInjuries

Scheme.

115 ConfirmationofacaseofanULDshouldbetakenasaprompttoconsider

whetherexistingriskassessmentsandcontrolsareadequate.Thisis

especiallyimportantifthereareotherpreviouslyreportedcases.

116 Theexacttimingofanindividualsreturntoworkwilldependonthemedical

advicewhichtheyreceivewhichinturnwilldependonthenatureofthe

underlyingdisorder.Itisoftenpossibletoreturntoworkbeforesymptoms

haveresolved,and,insomecasesthismaybeadvantageous.

117 Youmayalsoneedtoreviewyourarrangementsforoccupationalhealth

advicetoassistwiththemanagementofanyfurthercaseswhichmayoccur.Thisisparticularly importantinworkwherethereisalreadyexistingevidence

ofupperlimbcomplaints.



Health and Safety

Executive

Surveillance

118 Healthsurveillancecanbeundertakenoneitheravoluntaryorastatutory

basis.TheApprovedCodeofPracticefortheManagementofHealth

andSafetyatWorkRegulations 20recommendsthathealthsurveillanceis

undertakenwherecertaincriteriaaremet.Oneoftheseisaccesstoavalid

meansofdetectingthediseaseorconditionofconcern.Atpresentitisnot

consideredthatvalidtechniquesexistforthedetectionofchangeswhich

reliablyindicatetheearlyonsetofspecificupperlimbdisorders.

119 Valuableinformationcanhoweverbeobtainedfromlessprecisemeasures

suchasreportsofsymptoms.Itisgoodpracticetoputinplacesystems

whichallowindividualstomakeearlyreportsofupperlimbcomplaints.Where

appropriatethesecanbesupplementedbyregularsurveysofsymptoms.

Furtherinformationcanbefoundin Health surveillance at work.42



Health and Safety

Executive

Carry out regular checks on

programme effectivenessn Doyouhavesystemsinplacetomonitorandreviewyourcontrolsfor

ULDs?

n DoyouhavesystemsinplacetomonitorandreviewyourULD

managementprogramme?

n Areyouawareofnewdevelopments/information?

n Doyouaimforcontinuousimprovement?

Why monitor or review?

120 Inanymanagementsystemitisimportanttochecktheeffectivenessofyour

actions,andthisisnolesssointhepreventionofULDs.Thesecheckscan

beconsideredattwolevels:

n monitoring:whichistheongoingandregularappraisaloftheprocedures

andsystemswhichyouhaveinplacetocontrolrisk;and

n reviewing:whichisalessfrequentbutmorestrategicactivitywhich

considershowwelltheoverallcontrolsareworkingandwhetherany

changesmightbebeneficialandreasonablypracticable.

Monitoring

121 Monitoringisanintegralpartofmanagementandrequirescommitment,

consultationandparticipationatalllevelsintheorganisationinordertobe

fullyeffective.MonitoringgenerallyinvolvesrecordingtrendsinULDsymptoms

andriskfactorsovertimeinordertoassesstheperformanceofexisting

controlmeasuresandtoplanandimplementnewinterventions.

122 Factorstoconsiderinplanningmonitoringandreviewingsystemsinclude:

n method;

n frequency;

n whentomonitor;

n costsandbenefits.

123 Themethodandfrequencyofmonitoringshouldbeconsideredwheninitially

planningandimplementingcontrolmeasures.Thescaleandextentof

monitoringrequiredwilldependonthedegreeofriskandtherelativecosts

andbenefitsofavailablemethods.Itisimportantthatthereisconsultation

withemployeessothattheyarefullyawareofthemonitoringprocedures

whichareinplace.

Approaches to monitoring

124 Therearetwobroadapproachestomonitoringsystemspassiveandactivemonitoring.Table1comparesthegeneralfeaturesofeachapproach.



Health and Safety

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Table 1 Generalfeaturesofpassiveandactivemonitoring

125 Someinitialvaluecanbegainedfrompassivemonitoringbutactive

monitoringbuildsonthisinformationandenablesanin-depthlookatrisk

factors,signsandsymptomsinaspecificworkplace.Consultationwith

employeesisparticularlyimportantsincethereareethicalconsiderations

relatingtothehandlingofpersonalhealthinformation.

Examples of passive and active monitoring

Someexamplesofpassiveandactivemonitoringmethodsaregivenin

Table2.

Table 2 Passiveandactivemonitoringmethods

Monitoring outcomes

126 Ininterpretinginformationobtainedfrommonitoringitisusefultolookfor

consistentpatternsin:

n commentsfromemployees;n symptomsreported;

n existingriskfactors;

n resultsofsurveys.

Passive Active

Usesexistinginformationsourcesand

methods

Activeseekingofinformationaboutsigns,

symptoms,riskfactors

Usuallyinexpensive Generallyinvolvesadditional costs

Usuallyundertakenfirst Usuallyundertakenasafollow-uptopassive

monitoringbutmaybethefirstlineapproach

wherethereisasignificantULDrisk.

Datacodingandanalysisisusuallysimple Indepthdatacodingandanalysisrequire

specialistassistance.

Non-clinical Non-clinicalandclinicalindicatorsincluded

Readilyestablishedasinformationsources

usuallydesignedforotheradministrative

purposes.

Recommendedwhenfacedwithanoutbreak

ofULDs

Passive Active

Accidentbook/Firstaidrecord

Compensationdata

Workplacewalkthroughs

Bodymapping

Statutoryreportingsystems(RIDDOR)38 Taskanalysis

Medicalretirementreports Confidential questionnaires

Symptomsreported Healthinterviews

Sicknessabsencerecords Healthexaminations

Productionproductivityandqualitymeasures Exposurechecklist27

Staffturnover

Healthandsafetymeetings

Moraleandemployeesatisfaction



Health and Safety

Executive

127 Comparisonsbetweengroupsofemployeesindifferentlocationswithin

theorganisationmaybehelpfulparticularlywheresimilarworkisbeing

undertaken.Wherepracticable,comparingyourexperienceswithother

companiesinyoursectormayalsoassistinevaluatingtheperformanceof

yourcontrolmeasures.42,43

128 Whereproblemsareidentified,actionshouldbetakentorevisethemeasures

inyourmanagementpolicytoimprovecontroloftherisk.Employeesshould

beadvisedofthesituationandanyappropriatemedicalmanagementmade

available.Furthermonitoringwilldetermineiftheserevisedmeasureshave

beeneffective.

Reviewing

129 Reviewingprovidesanopportunitytolookattheoverallperformanceofyour

systemsformanagingULDrisksandshouldbeconsideredasanintegralpartofthemanagementprocess.Itshouldbeundertakenwhenmonitoring

suggeststhatthecurrentpolicy/programmeisnotadequatelycontrollingthe

risksorwhentechnicaldevelopmentsororganisationalchangesareplanned

whichmayalterthelevelsofrisk.

130Reviewingrelieslargelyontheuseofexistingmanagementinformationand

mayoftenbeincorporatedinaperiodicreviewofbusinesseffectiveness,eg,

aspartofaqualityprogramme.

131 Reviewing:

n

needstobesystematicinapproach;n makesfulluseofexistingmanagementresources;

n isanopportunitytolearnfromexperiencesgainedinmanagingULDrisk

factors,signsandsymptoms;

n determineswhetherinterventionscontinuetobeeffective;

n establisheswhetherriskshavebeencontrolledwherereasonably

practicable;

n providesanopportunitytoassesswhetherimprovedcontrolmeasures

shouldbeintroduced.

132 Asystemshouldbeinplacetoensurethattheoutcomesfromtherevieware

actedupon,feedingbackintothemanagementsystemasshowninFigure1.



Health and Safety

Executive

Appendices

Appendix 1: Case studies

Thesecasestudieshavebeendividedintothestagespresentedinthe

managementmodelshowninFigure1.Thishasbeendoneretrospectively

soallstagesofthemodelarenotalwaysfullyrepresented.

Case study A: Easter egg and chocolate box packing

Background

1 AlargefactoryidentifiedanumberoftasksthatcreatedariskofULDs:

n Task 1: Easter egg packingForpackingEastereggs,eightseparatecomponentswereassembledbyhand.Mostofthesecomponentsarrived

asflat-packswhichthenhadtobefoldedandbentintothecorrect

shape.Theoperatorsonthistaskwerepaidpieceworkratesdependent

uponthenumberofeggstheyassembledinaworkday.

n Task 2: Chocolate box packingDuringtheproductionofboxesof

chocolates,twolayersofchocolatesinaplasticmouldedtray,apadof

corrugatedcardboard,andtheunitkey(ietoidentifythefillinginthe

chocolate)wereneededtobepackedintodifferent-sizeboxes.Theboxes

werepresentedtotheoperatoronamovingconveyor,and,astheywent

past,differentoperatorshadtoputdifferentcomponents(thechocolates,

themouldingsinwhichtheysit,thecardboardpad,andinformation

leaflets)intotheboxesinaflowassemblyoperation.

Understandtheissuesandcommittoaction

2 Thecompanyphysiotherapistandothermedicaldepartmentstaffwereseeing

peoplefromtheeggandchocolatepackagingdepartmentwithULDs.With

thepermissionoftheemployeesconcerned,managementhadbecomeaware

ofULDreferralsandhaddirectedactionontheissue.

Createtherightorganisationalenvironment

3 Thecompanydoctor,theoperationsmanagerandtheindustrialengineerfor

thesiteworkedwithemployeesthroughouttheprocessofassessment.Trials

ofsolutionstoreducetheriskswerealsodoneinaparticipativemanner.

AssesstheriskofULDsinyourworkplace4 Ariskassessmentoftask,environmentandindividualfactorsforULDs

identifiedthefollowingriskfactors:



Health and Safety

Executive

5 Ifworkerswererotatingbetweenthetwotasks,theymayhavebeenatan

increasedriskofULDs.BothtaskspresentverysimilarriskfactorsforULDs

(repetitionofsimilarupperlimbposturesforlongperiods)andincombination,

furtherincreasetheriskofULDs.Thisexamplehighlightstheimportanceof

lookingattheriskassessmentsoftasksincombinationwhereworkersare

performingmultipletasksduringtheshift.

ReducetheriskofULDs

6 Aftertheassessmentwascompleteditwasdeterminedthatcertainelements

neededtoberedesigned:

n thepackingoperationwasredesignedtoremovetheriskelementof

cardboardbendingandthesnappingshutoftheplasticmould.This

reducedthenumberofuncomfortablewristandhandmovements;

n thepaystructurewaschangedfrompieceworktosalariedwork;n forchocolateboxassembly,engineersdevelopedamock-upworkstation

totrialwithoperatorsinwhichtherateofcompletionofthetaskwas

determinedbytheoperator,notbytheconveyor;

Task 1: Easter egg packing

Task-relatedfactors

Repetition: Thistaskwashighlyrepetitivewithworkers

performingthesamefinger,wrist,armandshouldermovementsmanytimesperminute.

Working posture: Thetaskrequiredmanymovementsofthehand

andwrist,egsidewaysbendingandbendingthe

wristsupanddownwhilefoldingthecardboard

andsnappingaplasticcoverovertheeggs.The

elbowwasoftenheldandmovedinpositionsaway

fromthebody.

Force: Snappingoftheplasticcoverovertheeggs

requiredforcewithpinchgrip.

Duration of exposure: Workersconductedthistaskforprolongedperiods

eachday.

Environment-relatedfactors:Psychological factors: Workerswerepaidonapieceworkbasiswhich

mayhaveencouragedthemtopushthemselves

beyondthepointatwhichtheyexperienced

discomfort.Thismayalsohaveinfluenced

theworkerswillingnesstoreportupperlimb

discomfortforfearofreducedworkinghours/

speedetc

Task 2: Chocolate box packing

Task-relatedfactors

Repetition: Thistaskwashighlyrepetitivewithworkers

performingthesameupperlimbmovementsmany

timesperminute.Theoperatorsworkratewasdeterminedbytheconveyorspeed.

Working posture: Theboxdesignmadeitdifficulttoplacethe

componentsaccuratelyintheboxeswhenthe

conveyorwasmovingquickly.Thismeantthat

workersassumedawkwardposturesofthe

shoulderandwrist.

Duration of exposure: Workersundertookthistaskforprolongedperiods

eachday.



Health and Safety

Executive

n asingleoperatorundertookthewholeassemblytaskratherthanputting

onecomponentinthebox(iejobenlargement);

n engineersworkedoutthebestangleforviewingthecomponents,for

takingthemofftheconveyor,andforassemblingthemwithouttwisting

andturning;

n aftertestingoutthisdesignwiththeparticipationoftheoperatorsthenew

linewasbuiltandinstalled.

ManageanyepisodesofULDs

7 Thecompanyemploysaphysiotherapistandothermedicaldepartmentstaff

inordertomanageanyepisodesofULDsandfacilitaterehabilitationand

returntoworkwherepossible.

Carryoutregularchecksonprogrammeeffectiveness

8 ForEastereggpacking:

n fewercasesofwristandhandproblemsarenowreportedtomedicalstaff;

n overallefficiencyoftheproductionlinehasimproved;

n thenumberofunitsdamagedhasdecreased,andthevisualqualityofthe

finishedproducthasimproved;

n theamountofmaterial(chocolate,plastic,cardboard)wastedhas

decreased;

n staffmoralehasimproved;

n theeggproductionworkflowiseasiertomanageandregulate;and

n thereneedstobelessstaffrotationbecausethenatureofthejobhas

improved.

9 Forthechocolateboxpacking:

n operatorcomforthasincreased,astheadjustabilityineachworkstation

canbeusedtomeeteachoperatorsneeds;

n assemblyqualityhasimproved,astheoperatorsarenolongertryingto

putthecomponentsintoamovingbox.

10 Packingoperationsareperformedmanuallyinarangeofdifferentindustries.

Asthiscasestudyillustrates,theoperatorisoftenrequiredtousepositions

ofthehandandwrist,whichcanleadtoupperlimbdisorders,especially

whencombinedwithhighforceand/orrepetition.Thecompanyhasbenefited

inbothproductionefficiencyandstaffwellbeingandhealthbyrecognising

riskswithinthetask,andinvestinginergonomicchangestothetasksand

packagingmaterials.

Case study B: Computer use in news media organisation

TheworkcoveredbythiscasestudywassubjecttotheDisplayScreen

EquipmentRegulations.Thiscasestudyshowshowthestructuredapproach

intheguidancecanhelpcomplywiththeRegulationsinanunusualsituation

withcomplexchallenges.

Background

11 Formanyyearsalargenewsmediaorganisationhadusedacomputer-basedsystemtostoreandtransfernewsstories.Thiswasgraduallybecoming

outdatedandrequiredupgradingduetodevelopmentsintheelectronic

transferofstoriesandtheneedforafastermoreefficientsystem.



Health and Safety

Executive

12 Anewoff-the-shelfpackagebasedonanexistingandwidelyusedsystem

waschosen.Someadaptationsweremadeforthecurrentorganisation

anditwasinstalledinthenewsroomandelsewhere.Accompanyingthe

rolloutwasaprogrammeofchangemanagementthatincludedadviceon

implementation,installationandtrainingforusersincludingworkstation

adjustmentandposture.


13 Theuseofthenewsystemledtounanticipatedconsequencesbecauseit

wasbeingusedforataskforwhichitwasnotdesignedthepreparation

ofsometimeslengthy,in-depthnewsstoriesratherthanshortbulletin-style

pieces.

14 Priortotheintroductionofthenewsystem,comparativelyfewcasesofULDs

hadariseneventhoughcomputerisedtechnologyhadbeeninuseformany

years.Therethenfollowedarapidsurgeinnewcasesintheorderofathree

tofourfoldincreaseoverthepreviousyears.


15 Rightfromthebeginninganopen-mindedpolicywasadoptedsothatallstaff

couldbekeptfullyinformedoftheextentoftheproblemanditsprogress.

AssesstheriskofULDsinyourworkplace

16 Assessmentoftask,environmentandindividualfactorsforULDsrevealedthat

thesoftwaredidnotcopewithpagebreaks,spellchecking,cut-and-paste

editingfacilitiesandtheneedforthenewsorganisationtocopewithnon-

Englishmaterial.Thetaskoftextinputandeditingagainstconstantdeadlines

wasnowmuchmoreonerousthanwithastandardwordprocessingstyle

package.Unfortunatelytheimplementationofthisnewsystemcoincidedwiththeoutbreakofamajorinternationalnewseventnecessitatinganenormous

increaseinworkload.Inaddition,organisationalchangeswerebeingmadeto

thebusinessinfrastructureincommonwiththosebeingmadeelsewhereat

thetime.Thisinevitablyledtouncertaintyaboutthefuture,insecurityonthe

partoftheworkforce,andtohigherlevelsofstress.

17 IdentifiedriskfactorsforULDsincluded:

Task-relatedfactors

Repetition: Staffwereperformingmultiplemouseclicksas

wellashighlyrepetitivekeying.

Working posture: Positionofthekeyboard,mouseandmonitormeantthatstaticcontractionoftheshoulder

andneckmuscleswasoccurringwhen

workerswereusingtheinputdevicesand/or

lookingatthescreen.Wristpostureswerealso

problematicforsomeworkers.

Duration of exposure: Textinputandeditingtaskswereperformedfor

prolongedperiodseachday.Theoutbreakof

themajorongoingnewseventmeantthatmany

workerswereworkinglongerhours.

Environment-relatedfactors

Psychosocial factors: Organisationalchanges,strictdeadlinesand

workloadassociatedwiththemajornewsevent

wereallidentifiedaspsychosocialriskfactors.



Health and Safety

Executive

ReducetheriskofULDs

18 ControlstoreducetheriskofULDswereimplementedasfollows:

n computerrelatedequipmentwhichincludedhardware,softwareand

furniturewasreviewedbythesafetymanager;

n changestoworkstationlayoutweremadetoimproveworkingpostures,

particularlyinrelationtotheupperlimbandmouseandkeyboarduse.

n Thisfocusedontheriskfactorofworkingposture;

n changesweremadetothesoftwaretoreducerepetition;

n themanageralteredtheworkorganisationincludingworkpatternsand

shifts.Thisrectifiedanyadverseworkpracticesandincludedcontrolover

workqualityanddeadlines.Thesecontrolsfocusedontheriskfactorsof

durationandpsychosocialfactors.


19 Earlyreportingofindividualcasestotheoccupationalhealthdepartmentwasencouragedsothatstepscouldbetakenbymanagerstominimisetheimpact

ofsymptoms.Threemainroutesofmanagementweredrawnup:

n aself-helprouteincludingarangeofphysicaltherapiesandrelaxation

exercises;

n atherapeuticroutetoinvestigatesymptomsandsigns,carryout

diagnosticandotherinvestigationsandrefer,asappropriate,fortreatment

optionsdonebytheoccupationalhealthdepartment.Treatmentcould

includemedication,onwardreferraltoGPorspecialist,physiotherapyor

counselling;

n frominitialonsetorreportingofsymptoms,acycleoffourweekswas

allowedfortheabovetobeaccomplished,afterwhichacaseconference/reviewmeetingwouldtakeplacetodetermineiftheindividualwasnow

fitandcouldreturntowork,wasimprovingandcouldreturntomodified

workorwheretheprogrammehadfailedandajobchangewasrequired.


20 Afterseveralyearsfromtheinitialoutbreakthenumberoforiginalcaseshad

halved,ofwhichmorethan60%weredeemedtobecuredordormant.

21 Thisstudyshowsthattheoutlookforthemajorityofcasesshouldbegood

solongasaprogrammeisadoptedwhichencouragesearlyreportingand

managementofcaseswithoutfearofprejudice,inanenvironmentofmutual

co-operationbetweenemployees,managers,unions,safetyofficers,IT

specialistsandoccupationalhealthprofessionals.

Case Study C: Healthcare product packing

Background

22 Alargemanufacturingcompanywithseveralfactorysitesproducesand

packsawiderangeofcosmeticandskincareproducts.Theseoftenhave

shortpackingruntimes,andsomeproductlinesaredifficulttoautomate.The

companyrecognisedthatthehighlymanualpackagingtaskspresentedarisk

ofULDsandtookmeasurestotacklethese.

Understandingtheissuesandcommittoaction23 ThecompanyidentifiedtheneedtotakeactiontoreducetheriskofULDs

andforaproactivesystemtomanageULDreferrals/casesacrossthedifferent

factorysites.ThiswasmetthroughthedevelopmentofacompanyULD

policy.Acompanyergonomistwasalsorecruitedtodevelopandfacilitatean

ergonomicsprogramme.



Health and Safety

Executive


24 ManagersandoperatorshadbeenawareofreportedsymptomsofULDsand

weresupportiveofmeasurestoreducethese.Fromthestarttheergonomist

workedcloselywithoccupationalhealthstaffandmanagement.

25 Packingteamleadersandseniorteammemberswithresponsibilityforthe

healthandsafetyoftheirparticularareaweretrainedinsafetyriskassessment

andtheidentificationofpossibleriskreductionmeasures.

AssesstheriskofULDsintheworkplace

26 Athree-stageriskassessmentprocesswassetup:

n detailedriskassessmentsofthepackagingtaskswereundertaken

usingtherapidupperlimbassessment(RULA)method 28andabody

partdiscomfortandpsychosocialsurvey.Theseformedthebasisfor

prioritisingriskreductionrecommendations;

n seniorteammembersregularlyassesstheriskofULDsduringroutineriskassessmentsoftheirpackinglines.Theyareencouragedtoidentify

andimplementriskreductionmeasuresandcanseekadvicefromthe

companyergonomist;

n whenanewproductistobeintroducedtoaline,achangecontrol

assessmentisundertakentoidentifyanyspecificproblemswhichmay

relatetothepackingofthatproduct,andpossiblesolutions.

Anexampleofataskidentifiedduringapackingtrialriskassessmentas

posingaULDriskwassealingatwo-pieceglassjarusingawiremetalclasp.

Thetaskrequiredrepetitiveactivityandtheapplicationofforcetoclosethe

clasp.Therewasalsotheriskofpressurepointsonthepalmfromthewire.

TheriskofULDsassociatedwiththetaskwasreducedbyencouragingoperatorstostandratherthansittomakeiteasiertoapplyforce;providing

aleatherpalmprotector;ensuringtwopeopleundertookthetasktoreduce

durationofexposureandincreaserecoverytime;andprovidingguidanceon

taskprocedure.Afterimplementation,noULDsymptomswerereportedfrom

thispackingoperation.

ReducetheriskofULDs

27 Thefollowingmeasuresapplytoallpackinglines:

n allpackingemployeesrotatetoadifferenttaskevery30minutes.Where

possible,rotatedtasksaresignificantlydifferentintermsofupperlimb

movementsrequired;n increasedautomation,standardisationofpackaging,andwaysofreducing

repetitivemovementsaresoughtatthedesignstage(egreducingthe

numberofturnsrequiredtofastenalid);

n developmentofproceduresthatencourageoperatorstoadoptgood

posturesandmovementsonpackingtasks;

n thedevelopmentandavailabilityofriskreducingaids(egtoolsand

equipment);

n increasedawarenessofULDissuesamongtheworkforce,and

encouragementofallemployeestoparticipateinidentifyingriskreduction

measuresandsolutions.

Educateandinformyourworkforce28 AleafletonULDs,coveringcausesofULDs,howtoidentifysignsand

symptoms,andwhattodoiftheseareexperienced,wasissuedtoallstaff

withafollow-upissueafter18months.



Health and Safety

Executive

29 Whereappropriate,awarenesstrainingisprovidedbythecompany

ergonomisttopromotesuitableworkingtechniquesthatcanbeusedto

reduceULDrisk.


30 ThecompanypolicyrequiresemployeestoreportanyULDsymptomsto

theirteamleaderwhorefersthemtotheoccupationalhealthservice.Their

workstationandtasksareassessedinlightoftheproblemsexperiencedand

appropriaterecommendationsgiven.Theteamleaderreviewsthesituation

weekly,andoccupationalhealthstaffregularlymonitortheemployees

symptoms.


31 Regularhealthandsafetygroupmeetings(involvingseniormanagement,

occupationalhealthstaff,thecompanyergonomist,factoryengineersand

safetyrepresentatives)reviewriskmanagementissuesandtheimpact

ofriskreductionmeasurestaken.Theyalsoprovideeffectiveroutesofcommunicationbetweenstaffinvolved.

32 Followingtheinitialawarenessraisingcampaign(whichincludedissueofthe

ULDleaflet)therewasanexpectedincreaseinreferralstotheoccupational

healthservice.Thiswasfollowedbyasteadyreductioninreferralrateoverthe

followingtwoyears.Whentheleafletwasre-issuedtheanticipatedincreasein

referralswasnotexperienced.

33 Thereareongoingreviewsofoccupationalhealthdata,andafollow-upbody

partdiscomfortsurveyisplannedtoevaluatetheimpactoftheriskreduction

programme.

Case Study D: New counter design for cashiers

Background

34 Aleadingbookmakersgroupwithover11000staffand2000shops

plannedtoroll-outaradicallynewdesignofelectronicpoint-of-sales

(EPOS)systemandassociatedcounter.PreventionofULDriskswasa

majorconsiderationintheselectionofequipment,designofthecounter,

furnitureandsoftware.Thenewdesignandmanagementprogrammehadto

accommodatearangeofshopenvironments,staffregularlymovingbetween

premisesanddifferentcashierworkstations.

35 Thecashierstaskforwhichthenewdesignwasspecifiedmainlyinvolvessittingattheworkstationanddealingwithtransactions(handlingbettingslips

andmoney).TheEPOSsysteminvolvessomecomputerwork(keyboardand

mouseuse)tohandleandprocessbets.


36 ManagementrecognisedthatULDriskfactorswerepresentinthecashiers

taskegrepetitivelyreachingtothecountertopandawkwardstretchesto

reachequipment.Seniormanagementwassupportiveoftheplantointroduce

newcounterdesignguidelinesandrecognisedthepotentialimpacton

occupationalhealth.

Createtherightorganisationalenvironment37 Itwasagreedthatthenewcounterdesignandlayoutshouldbebasedon

ergonomicscriteria.Managementalsorecognisedthatprovidinginformation

toemployeesandhavingameansofidentifyinganyhealthproblemswas

essentialinmanagingoccupationalhealth.Aprojectteamwasassembled



Health and Safety

Executive

withrepresentativesfromfacilitiesmanagement,healthandsafety,ITandIT

development,linemanagement,andthegeneralworkforcetospecifyand

developthenewcounterlayoutandassociatedequipment.

AssesstheriskofULDsintheworkplace

38 Ariskassessmentidentifiedthatcertainmovementsandtaskswouldbe

required(reachingtocountertop,cashdrawer,handlingmoneyetc)which

containedtheULDriskfactorsofrepetition,reachingandawkwardposture.

Thisenabledergonomicscriteriatobespecifiedforthecounterdesign.

ReducetheriskofULDs

39 ToreducetherisksofULDs:

n ergonomicsadvicewassoughtforbodydimensioncriteriaonwhichto

basethecounterdesign;

n mock-upsofcountersweretrialledbycashiers;

n computerrelatedequipmentincludingscanner,printerandscreen,andtheirlayoutwerereviewedandtrialledtoreducetheriskofULDsand

ensuretheireaseofuse,(egscanningratherthankeyboardusewas

selectedfordataentryandequipmentwasplacedwithinthezoneof

comfort

health and safety upper limb disorders

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