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Using Carts in Healthcare:a resource guide for reducing musculoskeletal injury

in partnership with Vancouver Island Health Authority

Using Carts in Healthcare:a resource guide for reducing musculoskeletal injury

in partnership with Vancouver Island Health Authority

ABOUT OHSAHThe Occupational Health and Safety Agency for Healthcare (OHSAH) in BC, initiated in an Accord between healthcare employers and union representatives, was incorporated on July 5, 1999. OHSAH’s board of directors consists of representatives from employer and union organizations, including:

• Health Employers Association of BC (HEABC)• Hospital Employees’ Union (HEU)• Health Sciences Association (HSA) of BC • British Columbia Nurses’ Union (BCNU)• BC Government and Service Employees’ Union (BCGEU)

Our missionOHSAH’s mission is to:

• work with all members of the healthcare community to develop guidelines and programs designed to promote better health and safety practices and safe early return to work

• promote pilot programs and facilitate the sharing of best practices• develop new measures to assess the effectiveness of health and safety programs and innovations in

healthcare

For more information, contact:Occupational Health and Safety Agency for Healthcare (OHSAH) in BC301 – 1195 West BroadwayVancouver, BC V6H 3X5Tel: 778.328.8000Fax: 778.328.8001Web: www.ohsah.bc.ca

OHSAH is grateful to everyone who contributed to the development of Using Carts in Healthcare: A Resource Guide for Reducing Musculoskeletal Injury (MSI).

Special thanksSpecial thanks to Nanaimo Regional General Hospital, Trillium Lodge, and West Coast General Hospital for taking the time to implement and try some of the control measures mentioned in this book, and thanks to Vancouver Island Health Authority for leading the process.

Content review participants• ShelleyBoese,Inventory/DistributionSupervisor,NanaimoRegionalGeneralHospital•MerleBurton,Maintenance,TrilliumLodge• BrianKossey,SafetyandErgonomicsAdvisor,VancouverIslandHealthAuthority• TraceyNewlands,Managerof Occupational,Physiotherapy,andSpeechTherapy,NanaimoRegional

General Hospital• SandyRibeyre,CentralWestManagerof Facilities,Maintenance,andOperations,VancouverIsland

Health Authority•Dr.DanRobinson,Ergonomist,RobinsonErgonomicsInc.• ClaireWinfield,MSIPAdvisor,VancouverIslandHealthAuthority

OHSAH main contributors• ElaineJ.Lee,ErgonomicsProjectCoordinator•NerminHelal,Ergonomist• ChrisBack,ErgonomicsProgramManager•Dr.AnnaleeYassi,FoundingExecutiveDirector

ACKNOWLEDGMENTS

© 2005 Occupational Health and Safety Agency for Healthcare (OHSAH) in British Columbia. All rights reserved. OHSAH encourages the copying, reproduction, and distribution of sections of this document topromotemusculoskeletalinjurypreventioninhealthcare,providedthatOHSAHisacknowledged.Nopartof thispublicationmaybecopied,reproduced,ordistributedforprofitorothercommercialenterprise, nor may any part be incorporated into any other publication, without written permission of OHSAH.2005 edition Usingcartsinhealthcare:aresourceguideforreducingmusculoskeletalinjury.

Includes bibliographical references. ISBN 0-9687342-3-5

1.Alliedhealthpersonnel--Woundsandinjuries--Prevention.2.Musculoskeletalsystem--Woundsandinjuries--Prevention.3. Handcarts. I. Occupational Health and Safety Agency for Healthcare in British Columbia

RD97.5.U842005363.15’72C2005-905047-0

TABLE OF CONTENTSPart 1: Introduction 9

Keypoints 10Terms 11

Part 2: Musculoskeletal Injury 13Commonsignsandsymptomsof MSI 14Stagesof MSI 15UnderstandingMSIriskfactors 16Riskfactorsassociatedwithmanualmaterialshandling(MMH) 18Risk factors associated with using carts 20Isthereariskof MSIassociatedwithusingcartsinyourfacility? 24

Part 3: Handling and Maintaining Carts 27Safe work practices 28Work organization 31Footwear 33Cart maintenance 34

Part 4: Purchasing and Selecting Carts 35Cart dimensions 36Handles 37Shelves and drawers 42Casters 45Wheels 47Casterandwheelpositionandconfiguration 52Load weight and load capacity 58Brakes 61Motorizedpushpullers 62

Part 5: Environmental Conditions 63Floors and ground covering 64Hallways and doorways 65Inclines 66

WHO SHOULD USE THIS GUIDE?

Using Carts in Healthcare: A Resource Guide for Reducing Musculoskeletal Injury (MSI) is for anyone who needs practical information on the safe use of carts in the healthcare environment. This guide focuses on using cartstoreducethephysicaleffortrequiredfortransportingsuppliesandtheriskof MSIassociatedwithmanual materials handling.

•Employerswillfindinformationthatwillhelpthemcollaboratewithhealthcareworkerstopreventinjuryrelatedtotheuseof carts.ThisinformationwillhelpthemdetectpotentialMSIrisksandimplement effective control measures (for example, designing or selecting suitable carts).

•Workerswillfindspecifichealthandsafetyinformationthatwillhelpthemcarryouttheirday-to-daytaskssafelyandefficiently.

•Purchaserswillfindinformationtohelpselectcartsthatareappropriateandeffective.

•FacilitiesmaintenanceworkerswillfindinformationrelatedtotheirroleinpreventingMSIinworkerswho use carts.

Lookforopportunitiestomanagetheriskof MSIassociatedwithusingcartswheneveryou:• designnewcarts•modifyexistingcarts• purchasenewcarts• respondtoincidentsrelatedtocarts• developandimplementaproactiveriskmanagementprogram

Manyof therecommendationsinthisguidehavebeendevelopedandimplementedsuccessfullyincollaborationwithhealthcareworkersthroughoutBC.Youcanphotocopyandusematerialfromtheappendices (the checklists, tools, and templates) as working copies at your facility.

If you found this guide useful, be sure to check out our other ergonomic publications. Samples of these resources can be downloaded from the OHSAH website (www.ohsah.bc.ca).

1Introduction

This part includes the following sections:•Keypoints•Terms

TABLE OF CONTENTSPart 6: Education and Training 69

SampleeducationmoduleforMSIpreventionforworkersusingcarts 70Guidelines for occupational health and safety training 72

Part 7: Implementation and Evaluation 73Pre-implementationriskidentificationandassessment 74Implementation of the control measure 76Post-implementationevaluation 77

Appendices 79Appendix 1

Signs and symptoms survey 80Appendix 2

Riskfactoridentificationchecklist 83Appendix 3

WorkSafeBC ergonomics requirements 85Appendix 4

Pre-purchasechecklistsandflowcharts 88Appendix 5

Sample calculations using load weight and load capacity 99Appendix 6

Cartidentificationform(existingcarts) 103Appendix 7

Implementation guideline 104Appendix 8

Stretching routine 105Appendix 9

References 106

UsingCartsinHealthcare:AResourceGuideforReducingMusculoskeletalInjury(MSI)10 PartOne:Introduction 11

ErgonomicsErgonomics is the application of knowledge about human capabilities and limitations to the design of work, equipment, tools, work environments, and work organization to optimize human well-being and performance.

Musculoskeletal injury (MSI)TheOccupationalHealthandSafetyRegulationdefinesmusculoskeletalinjury(MSI)as“aninjuryordisorderof themuscles,tendons,ligaments,joints,nerves,bloodvesselsorrelatedsofttissueincludingasprain,strainandinflammation,thatmaybecausedoraggravatedbywork.”MSIissometimes also referred to as work-related musculoskeletal disorder, cumulative trauma disorder, repetitivestraininjury,oractivity-relatedsofttissuedisorder.SomecommonMSIsassociatedwithcartsincludethefollowing:

• fingersorhandscaughtin,on,orbetweenacartandanotherobject• toes,feet,orlowerlegsbumpedorcrushedbyacart• arm,shoulder,orbackstrain

MSI risk factorsMSIriskfactorsarethephysicaldemandsof ataskthatcontributetotheoverallriskof MSI.

Control measureAcontrolmeasureisasolutionthatisimplementedtoeliminateorminimizetheriskof MSI.Alwaystry to eliminate the hazard wherever practicable. Control measures may include the following:

1. engineering controls2. administrative controls3.personalprotectiveequipment(PPE)

TERMS

Here is a summary of the key points that are covered in more detail throughout this guide:• Commonsignsandsymptomsof MSIincluderedness,swelling,pain,tenderness,tingling,

weakness, and clumsiness.• BasicriskfactorsforMSIincludeforce,repetition,awkwardposture,staticposture,and

contact stress.• Riskfactorsmayalsoberelatedtomanualmaterialshandling(MMH),includingthefollowing

tasks:-lifting,carrying,andhandlingobjects- pushing, pulling, and manoeuvring carts

• Itisimportanttoidentifyhigh-risktasksandanticipatetheriskfactorsassociatedwithalltasks.

• Reduceasmanyof theriskfactorswithineachtaskaspossible.Riskcontrolcanbesimpleandinexpensive.

• Evaluationandworkerconsultationareimportanttoensurethatimplementedcontrolmeasures are effective and that they have a positive impact for all workers.

• CartscanreducetheriskassociatedwithMMH,if theyareselectedcarefullyandmaintained.

KEY POINTS

UsingCartsinHealthcare:AResourceGuideforReducingMusculoskeletalInjury(MSI)12

2Musculoskeletal

Injury (MSI) This part provides information on musculoskeletalinjury(MSI).Itincludesthefollowing sections:

•Commonsignsandsymptomsof MSI•Stagesof MSI•UnderstandingMSIriskfactors•Riskfactorsassociatedwithmanualmaterialshandling(MMH)•Riskfactorsassociatedwithusingcarts•Isthereariskof MSIassociatedwithusingcartsinyourfacility?

Manual materials handling (MMH)Manualmaterialshandling(MMH)isthetransportorsupportof loadsbyhandorbodilyforce.MMHoften combines pushing, pulling, lifting, lowering, carrying, and holding. Approximately three out of everyfourCanadianswhosejobsinvolveMMHsustainabackinjuryatsomepointintheirworkinglives.

CartsAcartisatypeof MMHdeviceusedtominimizethephysicaleffortrequiredtoperformMMHtasks.For example, rather than lift and carry ten individual boxes from one location to another, a worker can use a wheeled cart to support the weight of the boxes.

Acute injuriesAcuteinjuriesareinjuriesthatoccurimmediatelyasaresultof asingletraumaticevent.Examplesof incidentsthatcouldcauseacuteinjuriesinclude:

• itemsfallingoff acartandlandingonyourfoot• slippingonawetfloorandtwistingyourankle

Chronic injuries Chronicinjuriesareinjuriesthatdevelopovertimeasaresultof repeatedtraumaoroveruseof abodypart.Symptomsdevelopintheaffectedpartandtheinjurymaypersistorgetworseif nottreatedproperly.Examplesof chronicinjuriesthatmaydevelopovertimeinclude:

• shoulder,elbow,orwristtendinitisresultingfrompushingaheavycartfrequently• wristpainresultingfromsupportingtheweightof objectsonadolly• backpainresultingfrompushingaloadedplatformtruckeveryshift

Theworst-casescenarioisaninjurythatleavestheworkerunabletoperformhisorhereverydayduties and tasks, both at the workplace and elsewhere.

TERMS

UsingCartsinHealthcare:AResourceGuideforReducingMusculoskeletalInjury(MSI)14 PartTwo:MusculoskeletalInjury(MSI) 15

Aching

or fatigue may be

present while performing tasks

at work but lessens or disappears with rest (for

example, during rest breaks, overnight, or on weekends).

No effects on work performance are usually noticed, nor are there any other

signs of a problem. This stage may last for weeks or months.

STAGES OF MSI

MSIsignsandsymptomstendtofollowthestagesdescribedinTable2.1.SomeMSIsprogressrapidlyfromearlytolatestages.Aworkerwhoexperiencesearlysignsorsymptomsof MSIshouldreportthemtoasupervisorormanagerimmediatelyandfilloutaninjuryorincidentreportform.If signsorsymptoms persist for more than a few days, the worker should see a medical professional.

Pain, aching, and fatigue may continue after completing tasks at work and may be present at home. Signs of MSI may also be present. Signs and symptoms may not disappear with rest. Performance of activities may be somewhat affected. This stage may last for several months.

Pain, aching, and fatigue may be present even when the affected body part is rested. Signs of MSI are present. Performance of work duties and sleep are significantly affected. This stage may last for months or years.

Early sta

ge

Middle stage

Late stage

Time

Inte

nsity

and

freq

uenc

y of

sig

ns a

nd s

ympt

oms

Table 2.1 Stages of MSI

Encouraging workers to report early signs and symptoms of MSI is an important part of MSI prevention. A survey can help establish how many workers and which workers are experiencing signs and symptoms that they have not yet considered severe enough to report. See Appendix 1 for a sample survey.

COMMON SIGNS AND SYMPTOMS OF MSI

Work-relatedMSIcanmakenormalworkroutinesuncomfortableandevenpainful.Thiscanleadtostress or dissatisfaction at work, reduced productivity, an inability to perform some or all work duties, andevendifficultywithactivitiesathome.Earlyrecognitionof commonsignsandsymptomsof MSIcanhelppreventinjuriesfromgettingworse.

Signs are things you can see, such as swelling or redness. Typical signs of MSI include the following:

• redness of the skin• swelling around the injured

area• loss of full, normal joint

movement

signsSymptoms are things you can feel but cannot see, such as numbness, tingling, or pain. Typical symptoms of MSI include the following:

• clumsiness • weakness• tenderness• tingling• numbness• heaviness• heat or burning• pain (dull, sharp, or

shooting)

symptoms


UNDERSTANDING MSI RISK FACTORS

Static postureStatic posture is a body position held for a prolonged period. The level of risk that static posture presents depends on the level of muscular exertion and the posture itself. For example, bending forward to push a platform truck with a handle that is too low places the back in a static (as wellasawkward)posture.Musclesthatareexertingforce may tire more quickly in a static posture than when moving.

Contact stressContact stress occurs when body parts come intocontactwithhardorsharpobjects,whichconcentrates force on the underlying tissues. This interfereswithnormalbloodflowandnervefunction.Thistypeof stresscanresultininjurytotissues beneath the skin. For example, handling the edge of a cart because it has no handle can cause contact stress on the hands.

Figure 2.1 Leading a cart by pulling with one arm can place the shoulder in an awkward posture.

UNDERSTANDING MSI RISK FACTORS

UnderstandingriskfactorsandidentifyingwheretheymightoccuristhefirststepinpreventingMSI.When assessing the degree of risk, it is important to ask three basic questions:

1.Whatistheintensityormagnitudeof exposuretotheriskfactor(howmuch)?2.Whatisthefrequencyof exposuretotheriskfactor(howoften)?3.Whatisthedurationof exposuretotheriskfactor(howlong)?

If a task presents high levels of any one risk factor or presents multiple risk factors, the level of risk can increase greatly. This section describes the following risk factors:

• force• repetition• awkwardposture• staticposture• contactstress

ForceForceful exertion increases the body’s energy demands and physically stresses the muscles, tendons, ligaments,andjoints,whichincreasestheriskof injury.Forexample,pushingaheavycartoveranobstacle such as a hose or electrical cord requires forceful exertion.

RepetitionA repetitive task is a task that uses the same muscles repeatedly. For example, continually turning a cart to navigate through a cluttered hall can be repetitive.

Awkward postureAwkward posture occurs when the body has to work in a position that is not considered neutral. Neutralposturesarethoseinwhichthemuscles,tendons,ligaments,andjointsfunctionoptimallyand require the least amount of effort to maintain. Awkward posture increases the amount of stress onmuscles,tendons,ligaments,andjoints;itisof greatestconcernwhenitissustainedforprolongedperiods or combined with other risk factors. What is considered awkward is different for each body part.


• taskrequirements(amountof forceappliedanddurationof exertion)• handlingtechnique(bendingatthelowerbackorthekneesandhips;usingoneortwohands;

foot distance and stance)• environmentalconditions(heightsof shelvesorobstacles)

Static postureStaticposturemaybeariskfactorduringMMHif positionsareheldforalongtime(forexample,when carrying a load over a long distance). Static posture is most likely to affect the back, shoulders, wrists, and hands. Static posture may be affected by the following:

• durationthepositionisheld• amountof forceapplied

Contact stressContactstressmaybeariskfactorduringMMHif theobjectbeinghandledhashardorsharpedges(for example, handles cut into the side of a cardboard box). Contact stress may also be a risk factor if kneeling or resting the elbows on a hard surface is required. Contact stress is most likely to affect the hands, elbows, and knees.

RISK FACTORS ASSOCIATED WITH MANUAL MATERIALS HANDLING (MMH)

RISK FACTORS ASSOCIATED WITH MANUAL MATERIALS HANDLING (MMH)

Manualmaterialshandling(MMH)includespushing,pulling,lifting,lowering,carrying,andholdingloads. These activities may present any of the basic risk factors: force, repetition, awkward posture, static posture, and contact stress. This section discusses risk factors related to handling materials without the use of carts.

ForceTheamountof forceexertedduringMMHdependsonthefollowing:

• workercharacteristics(bodyweightandheight)• loadcharacteristics(weight,size,andshape)• taskrequirements(amountof forceappliedanddurationof exertion)• handlingtechnique(usingoneortwohands;footdistanceandstance)• environmentalconditions(typeof floorsurface)

Forceful exertion is most likely to affect the back, shoulders, wrists, and hands.

RepetitionRepetitionmaybeariskfactorduringMMHif similartasksarerepeatedthroughoutthedaysuchas folding linen or stocking shelves. These tasks may affect the worker’s back, shoulders, and wrists. Tasks that require kneeling, squatting, or crouching may also affect the legs. The amount of risk that repetition presents depends on the following:

• frequencyof tasks• amountof restbetweentasks• bodypartsused

Awkward postureMMHmayresultinawkwardpostureif thetaskinvolvesreachingortwisting.Forexample,bendingatthewaisttoliftsomethingfromthegroundmaycauseanawkwardbackposture;pullingaboxfromanoverheadshelf maycauseanawkwardshoulderposture.MMHmayalsoresultinawkwardpostures of the neck, wrists, and hands. Awkward posture may be affected by the following:

• workercharacteristics(bodyheight)• loadcharacteristics(weight,size,shape,andhandles)


Awkward postureThepositionsof handlesandshelvesoncartshavethegreatestinfluenceonworkerposture.Awkward posture may be affected by the following:

• cartcharacteristics(size,designandlocationof handles,andlocationof shelves)• loadcharacteristics(sizeandshape,andwhethertheloadobstructstheworker’sview)• locationonthecartwhereforceisapplied•methodof pushingorpulling• abilityof workerstoseeoveroraroundthecartwhenpushing

Static posturePushing,pulling,orsteadyingcartsoverlongdistancesorforlongdurationsmayresultinstaticpostures of the back, neck, shoulders, wrists, and hands. Static posture may be affected by the following:

• durationthepositionisheld• amountof forceapplied

Contact stressContact stress may be a risk factor with carts that have hard or sharp edges such as a square corner on the cart handle. Contact stress may also be a risk factor if workers kneel or rest their elbows (for example, to access the cart load). When workers are using carts, contact stress is most likely to affect the hands, forearms, elbows, and knees.

Other elements that influence risk factorsOther elements that may affect the level of risk associated with using carts are divided into the following categories: worker characteristics, choices made by workers, cart and equipment design, organization of work, and environmental conditions.

RISK FACTORS ASSOCIATED WITH USING CARTS

Figure 2.2 Square or sharp-edged cart handles may present a risk of contact stress.


CartsareoftenusedtominimizethephysicaleffortrequiredtoperformMMHtasks.Forexample,rather than lift and carry a piece of heavy equipment from one location to another, a worker may use a cart to move it. Although using a cart is a control measure that reduces the amount of carrying required, it is still consideredanMMHtask.RiskfactorsassociatedwithMMHarenoteliminatedbyusingacart,butthey can be minimized by selecting the appropriate cart for the task and using it properly.

Loading a cart involves lifting, lowering, and carrying tasks. Manoeuvringacartinvolvespushingandpullingtasks.TheseactivitiesmaypresentthesameriskfactorsasanyotherMMHactivity: force, repetition, awkward posture, static posture, and contact stress. This section discusses these risk factors as they relate to the use of carts for handling materials.

ForceHandling carts may require forceful exertion when loading, unloading, pushing, pulling or manoeuvring. The amount of force exerted depends on the following:

• cartcharacteristics(weight,size,locationof handles,andtypeof casters)• loadcharacteristics(weight,size,andshape)• handlingtechnique(usingoneortwohands)• taskrequirements(distancetravelledandmethodof loadingandunloading)• environmentalconditions(typeof floorsurface,andinclinesorobstacles)

RepetitionRepeated handling and manoeuvring of carts may result in repetitive shoulder and wrist motions. Loading and unloading a large amount of materials from carts may also result in repetitive motions.

Although using a cart is a control measure, it is still a manual materials handling task that presents some risk of injury.


Environmental conditions• characteristicsof surfaces(forexample,thetypesof flooringandfloortransitions)• inclines• hazards(forexample,dirt,garbage,water,raiseddoorframes,andotherobstacles)• temperature• lighting


Worker characteristics• heightandweight• age• gender• strength• posture• physicalfitness• historyof injury

Choices made by workers• equipmentselection• selectionof procedures,

techniques, and postures• educationandtraining

Cart and equipment design • stability• sizeandweight• heightof handles• orientationof handles(for

example, horizontal or vertical)

• typeof handles(forexample,square, rounded, or conical)

• designandconfigurationof castersandwheels(forexample,numberof wheelsandswivelorrigid casters)

Organization of work• workrecoverycycles• taskvariability• workrate


Task characteristics

Various elements can influence risk factors including task characteristics. Some of the influences are as follows:

• distance the cart is moved• force required to start moving the cart,

keep it moving, or stop it • direction and nature of movement

(navigation requirements)• duration and frequency of pushing and

pulling tasks• relationship of pushing and pulling tasks

to other job activities• types of materials loaded onto and

unloaded from the cart• timing and sequence of loading and

unloading requirements


Step 5. Risk controlRisk control measures generally fall into one of three categories listed below. Whenever possible, engineeringcontrolsoradministrativecontrolsshouldbeusedfirsttoeliminateorminimizeexposureto the risk factors. If those types of control measures are not feasible, personal protective equipment (PPE)canbeconsideredasacontrolmeasure.

1. Engineering controlsCanyouphysicallymodifytheequipmentorenvironment?Forexample,modifycarthandlestoallow taller and shorter workers to use them comfortably.

2. Administrative controlsDoesthetaskneedtobedone(elimination)?Isthereadifferentapproachtoachievethesameobjective(substitution)?Forexample,insteadof havingsuppliesdeliveredtoacentralreceivingarea to be distributed by your facility staff, have the supplier deliver them directly to the wards wheretheyareneeded.Cantheworkbeorganizedorperformeddifferently?Forexample,usejobrotationtoreduceeachworker’sdurationof exposuretoaspecificrisk,orimproveworktechniques so that workers use different body parts during shifts.

3. Personal protective equipment (PPE)Personalprotectiveequipmentshouldonlybeusedasalastresort,whenengineeringoradministrative controls are not practicable. For example, ensure that workers wear appropriate footwear to prevent slipping when manoeuvring carts and wear gloves to protect against contact stress when pushing.

Step 6. TrainingTrainworkerstousethecontrolmeasurestomaketheirjobssafer.

Step 7. EvaluationConduct an evaluation in any of the following instances:

• afterimplementingcontrolmeasures(includingtheuseof cartstocontrolrisksassociatedwithMMH)—todeterminetheireffectivenessatminimizingtheriskof exposuretoMSI

•wheneverworkloadsorprocesseschange—toassesschangesintheriskof MSI•wheneveraninjuryorotherincidentoccurs—topreventreoccurrence

IS THERE A RISK OF MSI ASSOCIATED WITH USING CARTS IN YOUR FACILITY?

Employersshouldfollowthisseven-stepergonomicsprocesstoeliminateorminimizerisksof MSIassociated with using carts.

Step 1. ConsultationDuringeachstep,consultwithyour:

• JointOccupationalHealthandSafetyCommittee(orworkerhealthandsafetyrepresentative)•HealthandSafetyDepartment(forexample,anoccupationalhealthandsafetyadvisoror

ergonomist)• workers,whocanhelpidentifyconcernsandcontributetopurchasingdecisionsrelatedto

carts Youarenotexpectedtoconsultwitheveryworker.Selectarepresentativesampleof workerswhocarryouttheworkbeingassessed,includingworkerswithsignsorsymptomsof MSI.Consultationmayalsoincludemanagers,supervisors,firstaidattendants,andunionrepresentatives.

Step 2. EducationEducate workers so that they can do the following:

• identifyriskfactorsassociatedwithMMHtasksandusingcarts• recognizeearlysignsandsymptomsof MSI• recognizethepotentialhealtheffectsof MSI

Step 3. Risk identificationIdentifytheMMHtasksandcart-handlingtasksthatposeariskof MSI,andidentifytheriskfactorsassociatedwiththosetasks.SeeAppendix2forariskfactoridentificationchecklist.

Step 4. Risk assessmentAssessidentifiedriskfactorstodeterminethedegreeof risktoworkers.Todeterminethedegreeof risk,askthethreebasicquestions(seepage16)relatingtointensityof exposure(howmuch?),durationof exposure(howoften?),andfrequencyof exposure(howlong?).

IS THERE A RISK OF MSI ASSOCIATE D WITH USING CARTS IN YOUR FACILITY?

3Handling and

Maintaining CartsThis part provides information that will helpminimizetheriskof MSIwhenusingcarts. It includes the following sections:

•Safeworkpractices•Workorganization•Footwear•Cartmaintenance

Thefirstthreesectionsdescribepotentialcontrol measures for eliminating or minimizing risk factors. Implement thecontrolmeasuresthatbestfityourneeds. See Appendix 2 for a risk factor identificationchecklistthatwillhelpyoudetermine which aspects of cart use are exposingworkerstoriskfactorsforMSI.See Appendix 4 for a pre-purchase checklist that will help you make informed decisions when purchasing new carts.

UsingCartsinHealthcare:AResourceGuideforReducingMusculoskeletalInjury(MSI)28 PartThree:HandlingandMaintainingCarts 29

SAFE WORK PRACTICESxFigure 3.2 Keeping your elbows close to your body will help prevent shoulder strain.

• Tightenyourabdominalmusclesslightlybeforebeginningtopush.Youshouldbeabletobreathe and talk, but maintain some tightness in your abdomen to help stabilize your lower back.

• Facethecart.Pointyourtoesinthedirectionyouaremovingtoavoidtwistingyourback.• Alwaysusetwohandswhenpushingorpulling. x

Figure 3.3 Facing the cart and pushing with two hands rather than pulling with one arm will help prevent shoulder strain.

• Putonefootinfrontof theother.Shiftyourbodyweightfromthebacklegtothefrontlegtostart moving the cart.

• Takesmallstepswhenturningcornerstoavoidtwistingyourback.•Keepyourbodyclosetothecart.• Standuprightwhilepushing.

SAFE WORK PRACTICES

Good body mechanics can help workers use less force to carry out tasks and prevent awkward postures,bothof whichwillreducetheriskof MSI.Thissectionincludessafeworkpracticesthatwillhelp promote good body mechanics when pushing and pulling carts.

Workers should consider the following recommendations for pushing and pulling carts:• Planyourroutebeforemovingtheload.• Pushratherthanpullwheneverpossible. x

Figure 3.1 Pushing is generally safer than pulling. Pulling puts more strain on the lower back and shoulders.

• Bendyourkneesslightlyandmovetheloadbyshiftingyourweight.Movetheloadwithyourwhole body by walking forward, rather than planting your feet and pushing with your arms only.

•Keepyourelbowsclosetoyourbody.Keepyourhandsatorslightlybelowelbowheight.Keepyour feet shoulder width apart.


WORK ORGANIZATION

Thewayinwhichworkisorganizedinfluencestheamountof forceexerted,theposturesrequired,the duration of tasks, and the rate of repetition of tasks. Workers should consider the following generalguidelinestoreducetheriskof MSIassociatedwithmanualmaterialshandling:

•Makeseveralsmaller,lightertripswhenmovingmaterials,ratherthanonelarge,heavytrip.• Alternateoreliminatetaskstodecreasethefrequencyof handlingcarts.• Paceyourself whenperformingrepetitivetasks.• Storeitemsbetweenkneeandshoulderheightwheneverpossible.Storefrequentlyuseditems

at approximately waist height.

Job rotationRotate workers through a variety of tasks or duties to help vary postures, to reduce exposure to stressful tasks, and to reduce exposure to risk factors (as well as prevent boredom). Employers and workersshouldconsiderthefollowingjobrotationrecommendations:

• Varytaskssuchashandlingcartsandpaperworkthroughouttheday.• Alternatebetweentasksthatcallforstandingorwalkingandtasksthatallowsitting.• Rotateworkersthroughtheheaviestpushingandpullingtaskstoreducetherisktoanyone

worker.

StretchingStretching improves blood circulation through the muscles. It may help relieve muscle tension, developflexibility,andincreasebodyawareness.Workersshouldstretchonaregularbasisthroughouttheday(especiallyif theyareworkinginstaticpostures),notjustwhentheyfeelmuscletensionordiscomfort. For a stretching routine, look for the OHSAH Stretch It Out! poster, which may be displayed in your facility, or see Appendix 8 for a reproduction of this poster.

Stretchingisonlyonecomponentof injuryprevention.Generalfitness,includingaerobicexerciseandmusclestrengthening,isalsoimportant.Beforebeginningastretchingorfitnessroutine,consultwithyourdoctor,especiallyif youhaveanexistinginjuryorcondition.

SAFE WORK PRACTICES xFigure 3.4 Standing upright while pushing will help prevent an awkward static posture.

•Usesmoothmotions;avoidjerkymovements.•Graspthehandlesof thecarttoavoidawkwardhandposturesassociatedwithgrippingthe

corners of the cart.•Avoidleaningagainsttheedgeof thecartorpushingitwithyourkneesorthighs.• Changeyourgripbyvaryingbetweenpalmsupandpalmsdown,aswellasalternatingbetween

horizontal and vertical grips.•Alternateworkingpositionstoavoidoverusinganysinglemuscleorgroupof muscles.•Maintainclearvisibilitywhenpushingthecart.Poorvisibilitymaycauseyoutotwistoruseawkwardpostures.Donotpileitemssotheyinterferewithvisibility.Amaximumloadheightof 140cm(55in.)willaccommodatemostworkers;otherwisethecartshouldbedesignedforpulling or for two workers to push from the sides.

• Shiftyourbodyweightfromthefrontlegtothebacklegtostopmovingthecart.

Figure 3.5 If clear visibility is not possible, use a cart designed for two workers to push from the sides.


FOOTWEAR

Footwear may affect a worker’s ability to use a cart safely. For example, footwear with poor or worn treads may increase the likelihood of slipping. Footwear should provide enough cushioning and supporttorelievestressonthebackandlegs.Footwearshouldfitproperlyandhavenon-slipsoles.

Tips for buying footwearConsider these guidelines when buying footwear:

• Buyfootwearlateintheafternoonwhenyourfeetareswollenandattheirmaximumsize.• Bringalonganoldpairof workshoestocompare.• If youwearorthotics,bringthemalongandtryontheshoeswiththeorthoticsinserted.• If yourfeetaredifferentsizes,buyshoestofitthelargerfoot.• Shoesshouldfitsnuglywithoutbeingtootight.Thereshouldbeabout1.25cm(0.5in.)of

room between your big toe and the end of the shoe.• Ensurethatthefootwearmeetsworkplacestandards[forexample,localpoliciesor

WorkSafeBC (the Workers’ Compensation Board) requirements].

Wear and tearThe frequency with which footwear needs to be replaced depends on how fast wear and tear occurs. Theslipresistanceof theoutsolesmaystarttodeclineaftertheshoesarewornforthefirsttime.Over time, the outsoles will deteriorate and the midsoles will break down and lose their cushioning capabilities.

Preferredoutsolesincludevinylwithneopreneandsupplerubber.If walkingisrequiredinwetareas,useshoeswithpronouncedtread;hard-soledshoeswithshallowtreadarenotrecommended.

upper

midsole

insert

outsole

Figure 3.6 Footwear should meet any applicable workplace standards and be constructed of durable materials.

Workers should consider the following stretching recommendations:•Warmupfirstbyslowlyswingingyourarmsandmovingyourlegsforabout20–30seconds.• Stretchforafewminutesbeforestartingworktoprepareyourmusclesforwork.•Holdeachstretchfor20–30seconds.• Stretchmusclesthatarebeingusedforaparticularjobortask.• Stretchonlyasfarasiscomfortable.Stretchingshouldnothurt.• If youfeelpain,stopthestretch.If thepainpersists,consultwithyourfacility’sfirstaid

attendant or your doctor.•Alwaysstretchusingslowandcontrolledmotions.Neverbounceorstretchrapidly.

Rest breaks and micro-pausesWorkers should take rest breaks and stretch regularly throughout the day to prevent fatigue and give musclesachancetorecover.Takefrequentmicro-pausesof 10–15seconds.Duringmicro-pauses,changeyourpostureandstretchbriefly.Amicro-pausestretchisshorterindurationthananormalstretchbutisstillbeneficial.Itisalsoimportanttotakelongerbreakswhenyoufeelfatiguedoryourmuscles are sore.

WORK ORGANIZATION


4Purchasing and Selecting Carts

This part is divided into sections that deal withspecificcomponentsandfeaturesoncarts. Each section provides information on designs and available features that will help guide you when you are purchasing or selecting carts to minimize risk factors forMSI.Thispartincludesthefollowingsections:

•Cartdimensions•Handles•Shelvesanddrawers•Casters•Wheels•Tires•Casterandwheelpositionandconfiguration•Loadweightandloadcapacity•Brakes•Motorizedpush-pullers

CART MAINTENANCE

Regularcartmaintenancewillhelpensurethatallwornorbrokenpartsarereplacedinanefficientandtimelymanner.Propermaintenanceanduseof acartwillextenditslifeandmakeitmoreeffectiveand safer.

Cart maintenance should include the following components:• identificationof carts• regularlyscheduledpreventivemaintenance• aclearprocedureforidentifyingandlabellingdamagedormalfunctioning(out-of-service)

equipment• timelyrepairandreplacementof damagedequipment

Identification Allcartsfromeachdepartmentshouldbeidentified.Themake,model,supplier,andsuppliersupport(for example, regular maintenance) information should be placed in a location that is accessible to all workers.SeeAppendix6forausablecartidentificationform.

Preventive maintenance programEstablish a regularly scheduled preventive maintenance program, with input from equipment manufacturers.Preventivemaintenanceshouldincludethefollowing:

• Cleanwheelsandbearingsonhandcartsandothermechanicalaids.• Lubricatecastersandwheelsasnecessary.•Monitortreadwear,corrosion,andotherchangesthatmightbindthewheelsandincreasethe

forces required to move the carts.• Replacewornordefectivewheelsandcasters.• Checkthatallmechanicalaidsareworkingefficiently(forexample,brakesordirectionallocks).•Maintaintirepressureinpneumatictires.

Out-of-service cartsEstablishan“out-of-service”policyfortaggingequipmentthatdoesnotwork.Workersshouldreportout-of-service carts immediately to supervisors and maintenance workers. Out-of-service equipment must be repaired before being used again.

UsingCartsinHealthcare:AResourceGuideforReducingMusculoskeletalInjury(MSI)36 PartFour:PurchasingandSelectingCarts 3737

HANDLES

All carts should have a designated handle or handhold to help workers manoeuvre the cart safely. The presence and design of handles are two of the most important elements for promoting good posture when workers are handling a cart. Handle design also affects the amount of force that workers must exertwhenhandlingthecart.Thissectionincludesinformationonhandleorientation;height,width,andpositioning;diameter;andmaterial.

Orientation Horizontal and VerticalA horizontal handle running between two vertical grips allows for a variety of postures and variation in the width of hand placement. Horizontal handles allow workers to determine their own gripping distances according to their size and strength.

Figure 4.2 A horizontal handle running between two vertical grips allows the worker to use a variety of gripping postures.

36

CART DIMENSIONS

Thesizeandshapeof acartwillinfluencethewayworkershandleitandtheamountof forcetheywill exert to move it. Consider the following guidelines when selecting or purchasing a cart:

• Thecartshouldbenowiderthan1m(39in.)andnolongerthan1.3m(51in.)toensurethatworkers can turn it in most aisles.

• Thecartshouldbenotallerthan1.4m(55in.)whenloadedtoensurethatworkerscanseeover the cart while pushing.

1.4 m

1.3 m

1.0 m

Figure 4.1 The dimensions of a cart, when loaded, should not exceed 1 m wide, 1.3 m long and 1.4 m tall.


Height, width, and positioningHandles should be located between waist and shoulder height, at a height that allows a comfortable standing posture. Typically this is 91–112 cm (36–44 in.) from the ground. In general, the more weight there is on a cart, the higher the handle should be within the recommended height range. Handles shouldbenarrowerthanthecartitself tominimizescrapingandpinchingof fingers.

Handles should be positioned on the end of the cart that has swivelling wheels. However, it is useful to have handles at both ends so workers can change their pushing direction without having to turn the cart around.

HANDLES

Figure 4.4 If a cart only has a handle on one end, the handle should be positioned over the swivelling wheels.

swivel caster

rigid caster

Vertical If a horizontal handle is not possible, a vertical handle is a good option because it allows workers to choose a handle height that is appropriate for them. Vertical handles are best used on carts that are narrower than 51 cm (20 in.).

HANDLES

Figure 4.3 Vertical handles allow both shorter and taller workers to minimize awkward postures while using the same cart.


HANDLES

DiameterThe diameter of a handle can affect the effort required to grasp it. Handle diameters should be approximately 4 cm (1.5 in.). Handles should also have rounded edges to minimize contact stress.

4 cm (1.5 in.) Figure 4.7 Handles should be rounded, with a diameter of approximately 4 cm (1.5 in.).

MaterialHandlesshouldbetexturedtoimprovegrip.Avoidhandleswithfingergroovesbecausetheyoftendonot accommodate a range of hand sizes. Cushioned handles will reduce contact stress and increase comfort when workers are handling the cart for long periods or with a heavy load. Cushioned handles can also reduce vibration on the hands.

Figure 4.8 Cushioned handles can reduce contact stress and vibration, and increase worker comfort.

with cushioning without cushioning

If the load on the cart obstructs visibility, workers should use a cart with a vertical pole or add a vertical pole to a cart (similar to a bellhop’s cart) so they can push the cart from the side, near the front. If the load on the cart is heavy, ensure that there are two people pushing the cart, one on either sideof thecart(refertopage30,fig3.5).

HANDLES

If workers need to pull a cart, they should use a T-bar handle that is at least 91 cm (36 in.) above the ground.

Figure 4.5 T-bar handles are an appropriate choice for carts that need to be pulled.

Figure 4.6 Carts with vertical poles are useful when the load is high enough to obstruct visibility from the back.


SHELVES AND DRAWERS

Figure 4.10 Working heights for specific kinds of tasks

94-109 cm(37-43 in.)

86-94 cm(34-37 in.)

71-89 cm(28 -35 in.)

Precision work (for example, writing): 5–10 cm (2– 4 in.) above elbow height

Light work (for example, checking pieces): 5–10 cm (2– 4 in.) below elbow height

Heavy work (for example, transferring supplies on and off a cart): 10–25 cm (4–10 in.) below elbow height

What is elbow height?Elbow height is the distance between the ground and your elbow when you are standing with your arms relaxed by your sides.

SHELVES AND DRAWERS

The heights of shelves and drawers can affect worker posture. Work surfaces that are too high can lead to awkward shoulder postures while workers are loading and unloading, as well as awkward neck and back postures if the load impedes visibility while workers are pushing. Work surfaces that are too low can also lead to awkward neck and back postures.

Figure 4.9 High shelves can lead to awkward shoulder postures. Low shelves can lead to awkward neck and back postures.

Shelvesanddrawersthatareadjustabletosuitindividualworkersarepreferred.If thisisnotpracticaland there is a wide range in worker heights, provide two or more carts with different work surface heights to accommodate different workers. Consider each task associated with the cart to help determine the most appropriate work surface heights. Ask the following questions:

•Whatisthesizeof theitembeinghandled?•Howheavyistheitem?•Whatareworkersdoingwiththeitem(forexample,liftingit,readinglabels,orcheckingpieces)?

too low

too high


CASTERS

A caster is the hardware that mounts a wheel to a cart. Casters are either rigid or swivel. Rigid casters arefixedsotheydonotrotate.Swivelcastershavebearingsmountedinaswivelframesotheycanrotate 360 degrees. Swivel casters may include a directional lock so they can double as rigid casters as needed.

Figure 4.11 Rigid casters are fixed and do not rotate. Swivel casters have bearings that allow them to rotate.

Swivel casters are equipped with one of the following two types of bearings:• sealedballbearings,whichrolleasilyandrequirelittlemaintenance• rollerbearings,whicharecommonbutrequireregularlubrication

Carts that are frequently washed or used in wet areas (for example, in kitchens) should be equipped with waterproof casters that have sealed bearings.

Rigid caster Swivel caster

SHELVES AND DRAWERS

General guidelinesConsider the following guidelines for using shelves and drawers on carts:

•Workersshouldplaceheavieritemsonshelvesclosesttowaistheight.Lighteritemsshouldbeplaced on lower and higher shelves.

• Thebestheightforshelvesordrawersoncartsis60.5–122.5cm(24–48in.).• Itemsbeinghandledontheuppershelf shouldbenohigherthantheshoulderheightof the

shortest worker. • Thelowershelf ordrawershouldbenolowerthanthekneeheightof thetallestworker.•Workersshouldbeencouragedtouseonlythoseshelvesthatarebetweentheirkneeand

shoulder heights when using carts.• Cartsshouldnothavedeepshelvesorotherobstacles(forexample,smallclearancesbetweenshelves)thatmakeworkersadoptawkwardposturesoranextendedreachtoaccessobjectsonthe shelves.

kingpin

bird's eye view

swivel radius

Kingpin

bird’s eye view


A wheel is the rolling component within a caster that interacts with the axle. The type of wheel used affects the amount of force required to start moving a cart and keep it moving. This is referred to as rollability.Rollabilityisinfluencedbyseveralvariables,includingwheeldiameter,width,shape,andfirmness(describedinthissection),aswellasthetypeof bearingsandtheweightof theload.Whenselecting wheels, consider the most common conditions that the cart will be used in.

DiameterThe diameter of a wheel is one variable that determines ease of mobility and manoeuvrability. In general, the taller the wheel, the easier it is to roll the cart. Consider the following guidelines for wheel diameter:

• Largerdiameterwheelsallowforlessrollingresistance, which results in lower pushing forces for workers.

• Largerdiameterwheelsmakeiteasiertoovercomeobstacles.

•Heavierloadsrequirelargerdiameterwheels.• Longerdistancesrequirelargerdiameterwheels.

Be aware that overall cart height increases with larger diameter wheels.

Use of Cart Wheel Diameter

Short distances, pushing by hand 7.5–10 cm (3–4 in.)

Long distances, pushing by hand 12.5–20 cm (5–8 in.)

Table 4.1 Recommended specifications for wheel diameter

WHEELS

Load weightCasters with ball bearings are recommended for loads over 115 kg (250 lb.). When considering load weight,itisimportanttoincludeanyimpactsorshockloadsthatthecasterwillbesubjectedto.Shockload is produced by dropping a load on the cart or rolling the caster over an obstacle (for example, an elevator sill) or a surface that causes vibration. For more information on load weight, see page 57 & 98.

Swivel radiusSwivel radius is the measured horizontal distance from the vertical centre line of the kingpin to theoutsideedgeof thetiretread.Theswivelradiusspecifiestheminimumclearancerequiredforamounted caster to swivel 360 degrees. The larger the swivel radius, the easier the caster will rotate.

Figure 4.12 Swivel radius is measured horizontally, from the vertical centre line of the kingpin to the outside edge of the tire tread.

CASTERS

swivel radius


Firmness (material)Differentdegreesof firmnessmakedifferentwheelsbettersuitedforcertainapplications.Ingeneral,harderwheels(forexample,nylon)rolleasilyonhard,smoothsurfacesbuttheyaremoredifficulttorolloverfloorcracksorelevatorsills.Softerwheels(forexample,rubberorpolyurethane)rollmoreeasily on rough surfaces but they are harder to push on hard, smooth surfaces. Some common wheel materials and their characteristics and recommended uses are listed in Table 4.3.

Type of wheel Characteristics Recommended uses

Harder—Nylonorplastic(Duratron)

• lesselastic,withlessgive• low-friction• non-marking• non-waterabsorbing

• hardfloors•wetenvironments• heavyloads

Softer—Elastomerrubber or urethane

• conformstosurfaces,withmore give

• high-friction• long-lasting• quiet• non-marking

• carpets,hardfloors• indoorandoutdoor

surfaces

Table 4.3 Wheel materials, characteristics, and recommended uses

WHEELS

WidthNarrower wheels allow for greater manoeuvrability. Narrower wheels are recommended on hard floorsorflat,unpaddedcarpetswherehighmanoeuvrabilityisrequired.

Widerwheelsarerecommendedforcarpetsandlow-frictionsurfaces(forexample,wetflooring)wherehighmanoeuvrabilityisnotrequired;orforplushorpaddedcarpetingwherehighmanoeuvrability is required.

ShapeThetwogeneralshapesof wheelsarecrownandflat.

Crown-type wheel Flat-type wheel

Figure 4.13 Crown-type wheels have curved edges and flat-type wheels have flat edges.

Crown-type wheels Flat-type wheels

Contact Surface Area •lesscontactwithfloor •morecontactwithfloor

Friction •lessfriction •morefriction

Manoeuvrability •bettermanoeuvrability •poorermanoeuvrability

Recommended uses•non-carpetedfloors,especially

in areas requiring side-to-side manoeuvrability and sharp turns

•carpetsorlow-frictionsurfaces(forexample,wetflooring)wherehighmanoeuvrability is not required

Table 4.2 Characteristics of crown-type and flat-type wheels

WHEELS


Atireisthecushionthatfitsaroundawheelandformsitstread.Thethreemaintypesof tiresarepneumatic, solid, and semi-pneumatic.

Pneumatic Solid Semi-pneumaticFigure 4.14 Pneumatic and semi-pneumatic tires have air chambers.

Pneumatictireshaveanairchamber,whichmakesthemgoodfortraversingroughoruneventerrainor on carts used to transport fragile items. Solid tires are recommended for high load capacities and easy rollability on smooth surfaces. Semi-pneumatic tires combine an air chamber with some of the properties of a solid tire. Semi-pneumatic tires are ideal for low-speed carts.

TIRES

Table 4.4 summarizes the basic options when considering wheel diameter, width, shape, and firmness.Usethepre-purchasechecklistinAppendix4toassistyouwithwheelselection.

Diameter Width Shape FirmnessLarge Small Narrow Wide Crown Flat Hard Soft

• lowerpush force

• easytoroll over obstacles

• higherpush force

• difficultto roll over obstacles

• goodturning ability

• lowrollingfriction

• idealforfloors

• poorturningability

• highrollingfriction

• idealforcarpets and wet floors

• goodturning ability

• lowrollingfriction

• idealforfloors

• poorturning ability

• highrollingfriction

• idealforcarpets

• difficulttoroll over obstacles

• idealforcarpets

• easytoroll over obstacles

• idealforrough surfaces and outdoors

Table 4.4 Options when considering wheel characteristics

WHEELS


Four swivel castersLoad weight limit: •multiplytheloadcapacityof theweakestcasterby3

Manoeuvrability: • excellent,especiallyforwindingaislesorside-to-sidemovement

Steering: • difficultforlong-distancepushingandonunevensurfacesOther: • notrecommendedforinclines

Two swivel casters and two rigid castersLoad weight limit: •multiplytheloadcapacityof theweakestcasterby3

Manoeuvrability: • good

Steering: • accurateforlong-distancepushing•moderatelyeasyinbusyorsmallspaces

Other: • shouldnormallybepushedwiththerigidcastersleading

CASTER AND WHEEL POSITION AND CONFIGURATION

Frequent manoeuvring of carts may require workers to use repetitive, forceful wrist motions. Thepositionandconfigurationof castersandwheelsonacartinfluenceitsloadweightlimitandmanoeuvrability. This section provides information that will help you select a set-up for each cart that will provide the optimal manoeuvrability for the task at hand.

L

swivel caster

rigid caster

swivel caster with lock

Figure 4.15 The illustrations of carts in this section indicate different types of casters as shown here.

Four swivel casters, including two directional locking caster Themostversatilecasterandwheelconfigurationisfourswivelcasters,includingtwothathavedirectional locking at the front of the cart. Workers can lock the two front casters for straight long-distance pushing and unlock them in tighter areas where greater manoeuvrability is required.

L

Load weight limit: •multiplytheloadcapacityof theweakestcasterby3

Manoeuvrability: • excellent,especiallyforwindingaislesorside-to-sidemovement

Steering: • accurateforlong-distancepushing• easyinbusyorsmallspaces



Load weight limit: •multiplytheloadcapacityof theweakestcasterby1.5• entireloadmayrestonthetwocentralcasters

Manoeuvrability: • poor

Steering: • idealforlongdistanceswithinfrequentchangesof direction

Other: • economical• unsteadybalance• pivotingonthecentralwheelsallowsforeasiermovementacrossobstaclessuchasfloortransitionsordoorfooters

• thecastersaresubjectedtoshockloadsif thecartistipped,the load is unevenly distributed, or when crossing obstacles

Four rigid casters (two raised central casters, allowing central pivoting)The central rigid casters can be replaced by wheels mounted on a central axle.


One swivel caster and two rigid casters

Load weight limit: •multiplytheloadcapacityof theweakestcasterby2.25• distributetheloadevenlytoensurestability

Manoeuvrability: • goodforlightloadedcarts

Steering: •moderatelyeasy

Other: • loadmustbeevenlydistributedtoensurestability


Load weight limit: •multiplytheloadcapacityof theweakestcasterby2.25• idealforsmallloads

Manoeuvrability: • excellent

Steering: • difficultinstraightlinesoronunevensurfaces• unsteadybalance

Other: • idealforbarreldolliesandsmallportablemachines

Three swivel casters


Turning radius Differentcasterandwheelpositionsandconfigurationsprovidedifferentturningradiuses.Figure4.16contraststheturningradiusesof twodifferentconfigurations:fourswivelcastersversustwoswiveland two rigid casters. Swivel casters are recommended for navigating cluttered hallways or tight turns.

Four swivel casters Two swivel casters and two rigid casters under the handle

Figure 4.16 A configuration of four swivel casters provides the manoeuvrability necessary to navigate cluttered hallways or tight turns.


Four swivel casters and two rigid casters (allowing central pivoting)

Load weight limit: •multiplytheloadcapacityof theweakestcasterby1.5

Manoeuvrability: • good

Steering: • easytohandle

Other: • bestusedforverylongcarts• designedtocarryheavyloads• verystable• baseof thecartmustbestronglyconstructed• theswivelcastersaresubjectedtoshockloadsif thecartis

tipped or the load is unevenly distributed

The central rigid casters can be replaced by wheels mounted on a central axle

Two swivel casters and two rigid casters (allowing central pivoting)

Load weight limit: •multiplytheloadcapacityof theweakestcasterby1.5• entireloadrestsonthetwocentralcasters

Manoeuvrability: • excellent

Steering: • excellent

Other: • greatfortightspaces• thefixedcastersaresubjectedtoshockloadsif thecartis

heavily tipped or the load is unevenly distributed


The central rigid casters can be replaced by wheels mounted on a central axle


Two-wheeled hand cart Three-wheeled hand cart

Figure 4.17 Selecting the appropriate hand cart or truck for a specific task can help reduce the risk of MSI.

Four-wheeled hand cart Powered-hand pallet truck

LOAD WEIGHT AND LOAD CAPACITY

Load weightThe load weight of a cart is the sum of the weight of the material being transported and the weight of thecartitself.Loadweightinfluencestheamountof forcethatworkersmustexertwhenhandlingcarts.

Load weight limits By selecting the appropriate cart for a task, workers can minimize the amount of force they will needtoexertforthattask.Knowingacart’sloadweightlimitandusingthecartwithinthatlimitwillfurtherreducetheoverallriskof injury.Table4.5specifiesrecommendedmaximumloadweightlimitsfor hand carts and trucks. Figure 4.17 shows examples of each type of cart or truck.

Type of Cart or TruckLoad Weight Limit*

kg lbtwo-wheeled hand cart 114 250three-wheeled hand cart 227 500four-wheeled hand cart 227 500hand pallet truck 682 1500

Table 4.5 Recommended maximum load weight limits for hand carts and hand trucks * Load weight limit = cart weight + material weight



Consider the following when deciding if a cart should have a braking system:•Wheelbrakesshouldbelockedandunlockedbyfootratherthanbyhand.Thismakesaccess

to the brakes easier and will encourage workers to use them, and will help minimize awkward postures.

• Cartswithacapacityof morethan500kg(1100lb.)shouldhavehand-activatedbrakingsystems.

•Whentransportingcartsoninclines,workerscanusehandbrakestokeepthespeeddown.Hand brakes reduce the force needed to slow down the cart and provide workers with greater control of the cart.

Figure 4.18 Hand brakes provide workers with greater control over the speed of a cart.

BRAKES

Load capacityTheloadcapacityistheamountof weightthatacastercansafelysupport.Knowingtheloadcapacityof casters allows you to:

• chooseacartforaspecificload• determinetheloadweightlimitof anexistingcartsoitcanbeusedsafely

See Appendix 5 for sample calculations using load weight and load capacity.



5Environmental

ConditionsConditions in the work environment may influenceergonomicriskfactorsdirectlyor indirectly, which can increase the risk of injury.Thissectionoutlinesthreeenvironmentalfactorsthatmayinfluencetheriskof MSIforworkerswhoarehandling carts:

•Floorsandgroundcovering•Hallwaysanddoors•Inclines

MOTORIZED PUSH PULLERS

Workers can use mechanical devices such as motorized push-pullers to pull carts that exceed the load weight limit, or several carts together instead of pulling them manually one at a time. This helps reducetheamountof forceneededtocompletetheMMHtaskandreducestheriskassociatedwithhighly repetitive tasks.

Motorizedpush-pullerscanresolvevisibilityproblemsassociatedwithtallcartsbecausetheyallowworkerstostandinfrontof thecartsandusethemachinetopullthem.Motorizedpush-pullersarealsoanoptioninsituationswhereheavycartscannotbemodified.

Motorizedpush-pullersarenotsuitableforallfacilities.Theyrequireextrahallwayspaceandsteeringroom, and purchase costs may be prohibitive.

Figure 4.19 Workers can use motorized push-pullers to move several carts at once

UsingCartsinHealthcare:AResourceGuideforReducingMusculoskeletalInjury(MSI)64 PartFive:EnvironmentalConditions 65

HALLWAYS AND DOORWAYS

Movingcartssafelythroughhallwaysanddoorsdependsonadequateclearance,goodmanoeuvrability, and clear visibility. Consider the following guidelines for hallways and doors to reducetheriskof injury:

• Ensurethathallwaysorpassagesinwhichcartswillbeusedmeettherecommendedminimum width of 122 cm (48 in.).

•Allow“swingdoors”atcartdestinationstoremainopen.• Installautomaticdoorsthatareactivatedbymotiondetectorsorpushbuttons.Thiswill

eliminate the awkward postures and forceful exertion that occur when workers hold doors open to move carts through doorways.

• Removeraiseddoorsillsorprovideaninclineovertop.

FLOORS AND GROUND COVERING

Consider what types of surfaces workers will be handling carts on. Wheels on carts must be large enoughtonegotiatefloorconditionssuchascracksinthefloor,tracks,mouldings,gapsatelevatordoors,transitionsbetweenflooringsurfaces,andanyotherunforeseenobstacles.

Also consider if carts will be handled outdoors and if weather conditions will affect handling. Careful selectionof wheelsize,shape,andfirmness,aswellastheconfigurationof wheelsandcasterswillgive the best results where unusual conditions exist (for example, moisture, extreme heat or cold, and exposure to substances such as chemicals, blood, fats, oils, or salt).

Considertheseguidelinesforminimizingtheimpactof floorsandgroundcoveringontheriskof MSI:

•Keepfloorscleanandfreeof debristhatmayinterferewithwheels.Forexample,inshippingand receiving, packing materials and tape can stick to wheels, making them harder to roll.

• Fillincracksinthefloorsowheelswillrollsmoothly.•Designtransitionsbetweendifferentfloortypes(forexample,betweencarpetandtile)sothey

are smooth, with minimal gaps or changes in height.

1

1

1

12

16

20

UsingCartsinHealthcare:AResourceGuideforReducingMusculoskeletalInjury(MSI)66 PartFive:EnvironmentalConditions 67

INCLINES

Cross slopeIf a worker is required to move across a ramp, the cross slope of the ramp should be no greater than 1:50.

Figure 5.2 When moving across a ramp, a cross slope ratio of no more than 1:50 is acceptable.

cross slope ratio of 1:50

cross slope ratio of 1:12xINCLINES

Slope, rise, and run Slopeisdefinedastheratioof verticaldistance(rise)tohorizontaldistance(run)soagreaternumbermeans a greater incline. Ideally, the incline should have a slope less than 1:20 (for example, 1:25, 1:30, etc.). The maximum rise and minimum run of a ramp depends on the slope (see Table 5.1).

RampA ramp is any inclined plane that has a slope greater than 1:20 (for example 1:15, 1:10, etc.). Avoid transportingcartsupanddownrampsif possible.Minimizingoreliminatingtheuseof rampswillreduce the forces required to move carts. If workers must use a ramp, it should have the most gradual slope possible. Table 5.1 describes guidelines for designing ramps. These comply with the BC Building CodeandADAAG(2002)guidelines.

Figure 5.1 Inclines with slope ratios of 1:12, 1:16, and 1:20.

Slope Maximum Rise Minimum Run1:12 to < 1:16 76 cm (30 in.) 9 m (30 ft.)1:16 to < 1:20 76 cm (30 in.) 12 m (40 ft.)

Table 5.1 Recommended maximum rises and minimum runs for slopes (from BC Building Code, Article 3.8.3.3)

12 units

16 units

20 units

unit

unit

unit

1

1

1


6Education and

TrainingThis part provides information on worker educationandtrainingonMSIpreventionrelatedtoMMHandusingcarts.Itincludesthe following sections:

•SampleeducationmoduleforMSIprevention for workers using carts•Guidelinesforoccupationalhealth

and safety training

INCLINES

Outdoor rampsOutdoor ramps such as those on loading docks should be coated or covered with slip-resistant material to improve stability when moving carts in wet conditions. Ideally, the ramp should be under a roof to prevent exposure to moisture.

LandingsRamps should have level landings at the top and bottom. Landings should have the following specifications:

• Thelandingshouldbeatleastaswideastheramprunleadingtoit.• Thelandingshouldbeatleast152.5cm(60in.)long.• If therampchangesdirectionatthelanding,thelandingshouldbeatleast152.5x152.5cm

(60 x 60 in.).

level landing

level landing

rise surface of ramp

run

Figure 5.3 A ramp with level landings at the top and bottom.

UsingCartsinHealthcare:AResourceGuideforReducingMusculoskeletalInjury(MSI)70 PartSix:EducationandTraining 71

SAMPLE EDUCATION MODULE FOR MSI PREVENTION FOR WORKERS USING CARTS

6. Body mechanics• safeposture• lifting,lowering,andcarrying• pushingandpulling• stretchingandrelaxation• personalfactors• practicesessions

7. Techniques and procedures• selectingappropriatecartsforspecifictasks• demonstrationsonhowtousespecificcarts• safepushingandpullingmethods• procedureforout-of-servicecarts•maintenanceplan

Suggested handouts•MSIpreventionprogramforthefacility•MSIpreventionpoliciesandproceduresforthefacility(forexample,safeworkprocedures)• stretchingexercises

This sample education module is for anyone who will be affected by the implementation of carts in a facility. It is recommended that the following seven components be delivered in several sessions to allow participants enough time to absorb the information. For more information on effective health andsafetytraining,see“Guidelinesforoccupationalhealthandsafetytraining,”on page 72.

1. Introduction and goals• reasonsfortraining• whatparticipantsshouldknowbytheendof thecourseorsession•WorkSafeBCrequirements• facility-specificMSIpreventionpoliciesandprocedures

2. What is musculoskeletal injury (MSI)?• commontypesof MSI• signsandsymptomsof MSI• healtheffectsof MSI• progressionof atypicalMSI

3. Risk factors for MSI• generalriskfactors• cart-specificriskfactors• identifyingriskfactors

4. Risk assessment• assessingworkareas,equipment,loads,andtasks

5. Control measures• hierarchyof controlmeasures(engineeringcontrols,administrativecontrols,andpersonal

protective equipment)• generalcontrolmeasures(forexample,workspacelayout,workorganization,andrestbreaks)• cart-specificcontrolmeasures

SAMPLE EDUCATION MODULE FOR MSI PREVENTION FOR WORKERS USING CARTS


7Implementation and Evaluation

This part provides information on the risk management process as well as implementing and evaluating a control measure, in this case, the use of carts for MMH.Itincludesthefollowingsections:

•Pre-implementationriskidentificationand assessment •Implementationof thecontrol

measures•Post-implementationevaluation

GUIDELINES FOR OCCUPATIONAL HEALTH AND SAFETY TRAINING

Follow these basic guidelines for effective occupational health and safety training:

1. Assess learning needs.2.Developatrainingprogramwithoccupationalhealthandsafetyspecialistsandfront-line

workers. Ensure that the training is:• specifictothetasksencounteredbytheworkers• specifictotheworkhistoryof theworkers• highlyinteractiveandbasedonadultlearningprinciples• tailoredtotheneedsof eachaudienceof workers

3.Provideresourcesandencourageahighlevelof workerparticipation.4. Train workers, supervisors, and support staff. 5. Ensure that the person delivering the training program is familiar with the occupational risk factorsforMSIandthespecifictasksrequiredbythejob.

6. Ensure that supervisors and other staff reinforce safe practices regularly.7. Update workers, supervisors, and support staff on a regular basis.

Note: OHSAHergonomistsmaybeavailableforconsultationandassistancewithsettingupa“train-the-trainer”programinwhichpeersteachpeers.

UsingCartsinHealthcare:AResourceGuideforReducingMusculoskeletalInjury(MSI)74 PartSeven:ImplementationandEvaluation 75

Tool 3: Interviews and focus groupsInterviews allow for open discussion and can provide more information than surveys. Informal or formalinterviewswithworkerscanbeausefulwaytogatherinformationaboutjobsandspecifictasksthatmayrequireassessment.Youmayconductinterviewswithindividualworkersorsmallgroups.

•WhatdoworkersfeelareprioritieswithrespecttoMMHtasks?•Whichtasksdoworkersfeelcouldbemadeeasierwiththeuseof acart?•Howwillacartchangetheirwork?

Let workers know that you are evaluating the work site and work equipment, not their performance. Maintainingalevelof confidentialitymayimprovethelevelof discussion(forexample,donotrecordnames with concerns or suggestions).

Tool 4: Incident reportsAnalyze incident report forms, going back one to three years. How often have incidents related to MMHoccurredinthepast?Whatbodypartswereaffected?Whatwasthenatureof theinjury?Usethis tool in combination with one of the other two tools. Workers may have signs or symptoms even though few incidents are, or have been, reported.

Tool 5: Risk identification checklistsObserveworkersperformingtheMMHtasks,notingdetailssuchasbodyposture,repetitivemotion,andforcefulexertion.Useariskidentificationchecklist(seeAppendix2)toidentifypotentialriskfactorsforMSIassociatedwithusingcarts.

Step 3. Investigate and assess the current risk of MSITherearefourelementstoconsiderwhenassessingsignificantrisks:

•magnitudeof eachriskfactor(howmuch?)• frequencyof exposuretoeachriskfactor(howoften?)• durationof exposuretoeachriskfactor(howlong?)• presenceof multipleriskfactors

PRE-IMPLEMENTATION RISK IDENTIFICATION AND ASSESSMENTPRE-IMPLEMENTATION RISK IDENTIFICATION AND ASSESSMENT

Thepurposeof riskidentificationistoidentifythelocationsandtasksinthefacilitythatposeariskof MSItoworkers.Onceriskshavebeenidentifiedforaspecifictask,theyneedtobeassessedtodetermine the degree of risk present and what types of control measures should be implemented.Evaluating the success of a control measure is important and can be a simple process. Evaluations allowyoutoseewhatworksandwhatdoesnot.Conductingapre-implementationriskidentificationand assessment helps clarify what you are trying to accomplish and establishes current risk levels. Knowingcurrentrisklevelswillmakeiteasierforyoutoevaluatetheeffectivenessof usingcartsasacontrol measure.

Step 1. Determine what you are trying to identify and assessWhataretheareasof concern?WhichMMHtasksdoworkershavedifficultywith?

Step 2. Identify potential risk factors for MSIDoesitappearthatriskfactorsarepresent?Useoneormoreof thefollowingfivetoolstoevaluatethecurrentriskof MSI.

Tool 1: Task descriptionsCompileadescriptivelistof allthetasksthatarerequiredtoperformajob,includingtheMMHtasks.Whatdoestheworkerdointhisjob?AtasklistwillhelptoensurethatalltasksareconsideredandthatriskidentificationforindividualMMHtasksisviewedwithinthecontextof theentirejob.Ataskdescriptionshouldinclude,atminimum,alistof tasksperformedinthejobandthetypicalfrequencyand duration of the tasks.

Tool 2: Signs and symptoms surveyA signs and symptoms survey (see Appendix 1) helps determine if workers are currently experiencing signsandsymptomsof MSI.Makecopiesandsurveyworkersduringtheriskidentificationstage,before the use of carts is implemented. Allowing workers to complete the survey anonymously will likely increase the return rate.

UsingCartsinHealthcare:AResourceGuideforReducingMusculoskeletalInjury(MSI)76 PartSeven:ImplementationandEvaluation 77

POST-IMPLEMENTATION EVALUATION

Conducting evaluations after control measures are implemented helps determine the effectiveness and efficiencyof thecontrolmeasures.

Step 1. Identify potential risk factors for MSIDoesitappearthattheriskfactorsyouintendedtoaddresshavebeeneliminatedorminimized?Observe workers using carts, noting details such as cart selection, body posture, and repetitive motion.

Step 2. Evaluate whether the risk of MSI has decreased Hastheriskof MSIdecreasedasaresultof usingcarts?Yourevaluationshould:

• re-evaluatetheriskfactorsthatyouintendedtoeliminateorminimize• determinewhetherthecontrolmeasurehascreatednewriskfactors

Useoneormoreof thefollowingthreetoolstoevaluatewhethertheriskof MSIhasdecreased.

Tool 1: Signs and symptoms surveySurvey workers three to six months after the carts have been put into use. Signs and symptoms should decrease with the new control measure.

Tool 2: Interviews and focus groupsSchedule meetings with workers or small groups of workers. Let workers know that you are evaluating the control measure, not their performance. Get their perceptions as to whether the control measure has been an improvement and whether any new issues have arisen.

Tool 3: Incident reportsAnalyze incident report forms, comparing reports from one to three years before any carts were implementedwithreportsfromonetothreeyearsafterwards.Didreportedincidentsdecreaseafterchangesweremade?Usethisanalysisincombinationwithoneof theothertwotools.

IMPLEMENTATION OF THE CONTROL MEASURE

Afteryouhaveidentifiedthepotentialriskfactors,thenextstepistoimplementthecontrolmeasure(using carts). As part of the implementation process, you should create a working group and develop an implementation guideline.

Create a working groupCreate a working group to oversee the implementation process. Include the following individuals:

•managers• departmentworkers•maintenanceworkers• ahealthandsafetyprofessional(forexample,anergonomist,occupationalhealthandsafetyconsultant,MSIpreventionadvisor,occupationaltherapist,physiotherapist,orunionsafetysteward)

Develop an implementation guideline Discusspotentialcontrolmeasuresandcometoaconsensusaboutwhichmeasuresshouldbeimplemented. In this case, discussion will focus on the types of carts that should be used and which tasks they should be used for. Write down all the control measures that the working group wants to implement (see the implementation guideline in Appendix 7). Include reasons for decisions, actual dates for implementation, and names of individuals who will oversee the implementation process.

Onceyourimplementationguidelineisfinalized,giveeachworkinggroupparticipantacopy.Postacopy in a common area of the department that will be affected by the implementation and check off control measures as they are implemented. By doing this you will ensure that those affected will be informed and the working group will be held accountable for implementation.


Step 3. Compile the resultsDocumentandcirculateyourevaluationresultsforfuturereference.

Step 4. Understand the resultsDeterminewhetherthecartswerehelpful,andwhetherthenewproceduresandnewequipmentarebeing used. If the new carts were not effective, review the risk factors and develop new solutions. Gather the working group together without delay and try another control measure or modify the carts currently in place.

POST-IMPLEMENTATION EVALUATION

Appendices

These appendices provide additional information and resources that will help you improve health and safety for workers using carts.

•Appendix1:Signsandsymptomssurvey•Appendix2:Riskfactoridentification

checklist •Appendix3:WorkSafeBC

ergonomics requirements •Appendix4:Pre-purchasechecklistsandflowcharts•Appendix5:Samplecalculations

using load weight and load capacity •Appendix6:Cartidentificationform(existingcarts)•Appendix7:Implementation

guideline •Appendix8:Stretchingroutine•Appendix9:References

UsingCartsinHealthcare:AResourceGuideforReducingMusculoskeletalInjury(MSI)80 Appendices 81

1.Circletheword(s)thatbestdescribeyourproblem.

Aching Numbness(asleep) Tingling

Burning Pain Weakness

Cramping Swelling Other

Lossof Colour Stiffness

2.Whendidyoufirstnoticetheproblem?_______________(month)___________________(year)

3.Howlongdoeseachepisodelast?(MarkanXalongtheline)

1hour 1day 1week 1month 6months

4.Howmanyseparateepisodeshaveyouhadinthelastyear?

5.Whatdoyouthinkcausedtheproblem?

6.Haveyouhadthisprobleminthelast7days?_____Yes_____No

7.Howwouldyouratethisproblem?(MarkandXontheline)

a.NOW

None Unbearable

b.WhenitistheWORST

None Unbearable

APPENDIX 1 signs and symptoms surveyAPPENDIX 1 signs and symptoms survey

Date_____/_____/_____/ Name:_______________________________

Facility:_________________ Department#:_____ Jobname:____________________________

Shifthoursworked/week:_____________________TimeonTHISjob:______years______months

Your responses will remain confidential

Body Maps

Facility:__________________________

Department#:____________________

JobName:________________________

TimeonTHISjob:___years___months(If morethan2jobs,includethoseyouworkedonthemost)

Otherjobsyouhavedoneinthelastyear(formorethan2weeks)Facility:__________________________

Department#:____________________

JobName:________________________

TimeonTHISjob:___years___months

Haveyouhadanypainordiscomfortduringthelastyear?YesNo

(If NO,stophere)

If YES,carefullyshadeinareaof thedrawingwhichbothersyouthe

MOST.(Completeaseparatepageforeachareathatbothersyou)

CircleArea:

Neck Shoulder Elbow/Forearm Hand/Wrist

Fingers UpperBack LowBack Thigh/Knee

LowLeg Ankle/Foot


APPENDIX 2 risk factor identification checklist

UsethischecklisttoidentifypotentialriskfactorsforMSIassociatedwithusingcarts.Beforefillingoutthechecklist,familiarizeyourself withthetasksbeingperformed.Checking“Yes”foritemsindicatesthatpotentialriskfactorsmaybepresentandfurtheranalysisisrequired.Forhelpdeterminingcontrolmeasuresfortheidentifiedriskfactors,refertoParts3and4.

Potential risk factor Yes NoForceDoesthecartrequirealotof efforttogetmoving?Doesthecartrequirealotof efforttokeepmoving?Doesthecartrequirealotof efforttosteerormanoeuvre?Areworkersloadingorunloadingmaterialsheavierthan23kg(50lbs.)?Istheloadunstableorpronetoshiftingwhilethecartismoving?Arethereraiseddoorsills,floortransitions,cracks,orotherobstaclesonthegroundalongthepathof thecart?Doesthecarthavewheelslessthan7.5cm(3in.)indiameter?Doworkerspushthecartoverdeeppile,paddedcarpet,orothersoftsurfaces?Doworkerspushthecartupordowninclines?Arethereinclinesthathaveagradesteeperthan1:20?Aretherelateralslopesthatworkersmustpushthecartalong?Isthecartmorethan1.3m(51in.)longor1m(39in.)wide?

RepetitionDoworkersspendmostof theirworkdayspushingorpullingcarts?

8.Haveyouhadmedicaltreatmentforthisproblem?YesNo

8a.If NO,whynot?___________________________________________

____________________________________________________________

____________________________________________________________

8b.If YES,wheredidyoureceivetreatment?

1.Facilitymedical Timesinpastyear____________________

2.Personaldoctor Timesinpastyear____________________

3.Other Timesinpastyear____________________

8c.Didtreatmenthelp?YesNo

9.Howmuchtimehaveyoulostinthelastyearbecauseof thisproblem?

10.Howmanydaysinthelastyearwereyouonrestrictedorlightdutybecauseof this

problem?__________days

11.Pleasecommentonwhatyouthinkwouldimproveyoursymptoms.

APPENDIX 1 signs and symptoms survey


Undertheauthorityof theWorkersCompensationAct,WorkSafeBChasadoptedandimplementedergonomicsrequirements,detailedintheOccupationalHealthandSafetyRegulation,Sections4.46to4.53(reprintedinthisappendix).TheserequirementsrepresenttheminimumstandardsthatmustbecompliedwithatworkplacesthatfallunderWorkSafeBCjurisdictionandwithinthescopeof theAct.

Ergonomics (MSI) requirementsThepurposeof sections4.46to4.53istoeliminateor,if thatisnotpracticable,minimizetheriskof musculoskeletalinjurytoworkers.

Note:WorkSafeBCprovidespublicationstoassistwithimplementingtheErgonomics(MSI)Requirements.PreventingMusculoskeletalInjury(MSI):AGuideforEmployersandJointCommitteesprovidesaseven-stepprocesstoassistwiththeapplicationof theergonomicsrequirementsalongwithprocedurestoinvestigateincidentsof MSIandatableof commoncontrolmeasures.UnderstandingtheRisksof MusculoskeletalInjury(MSI)isintendedtohelpemployerswiththerequirementsof section4.51(1)toeducateworkersinriskidentification,signsandsymptomsof MSI,andtheirpotentialhealtheffects.[NoteaddedSeptember25,2001]

4.46 DefinitionInsections4.47to4.53(theErgonomics(MSI)Requirements)“musculoskeletalinjury”or“MSI”meansaninjuryordisorderof themuscles,tendons,ligaments,joints,nerves,bloodvesselsorrelatedsofttissueincludingasprain,strainandinflammation,thatmaybecausedoraggravatedbywork.

4.47 Risk identificationTheemployermustidentifyfactorsintheworkplacethatmayexposeworkerstoariskof musculoskeletalinjury(MSI).

4.48 Risk assessmentWhenfactorsthatmayexposeworkerstoariskof MSIhavebeenidentified,theemployermustensure that the risk to workers is assessed.

APPENDIX 3 WorkSafeBC ergonomics requirementsAPPENDIX 2 risk factor identification checklist

Potential risk factor Yes NoAwkward postureDoesthecarthaveshelvesbelowkneeheight?Doesthecarthaveshelvesaboveshoulderheight?Is it difficult to seeovertheloadedcartwhenpushingfrombehind?Doworkerspullcartsratherthanpushthem?Arethematerialscarriedonthecartoftenlargeorbulky?Doesthecartlackhandles?Arethecarthandlesbelowwaistheightoraboveshoulderheight?

Static postureDoworkerspushcartsoverdistancesgreaterthan60m(197ft.)?

Contact stressDothecarthandleslackpadding?Dothecarthandleshavesharporsquarededges?Arethecarthandleswiderthanthecart?


4.51 Education and training(1)Theemployermustensurethataworkerwhomaybeexposedtoariskof MSIiseducatedinriskidentificationrelatedtothework,includingtherecognitionof earlysignsandsymptomsof MSIsand their potential health effects.

(2)Theemployermustensurethataworkertobeassignedtoworkwhichrequiresspecificmeasurestocontroltheriskof MSIistrainedintheuseof thosemeasures,including,whereapplicable,workprocedures,mechanicalaidsandpersonalprotectiveequipment.

4.52 Evaluation(1)Theemployermustmonitortheeffectivenessof themeasurestakentocomplywiththeErgonomics(MSI)Requirementsandensuretheyarereviewedatleastannually.

(2)Whenthemonitoringrequiredbysubsection(1)identifiesdeficiencies,theymustbecorrectedwithout undue delay.

4.53 Consultation(1)Theemployermustconsultwiththejointcommitteeortheworkerhealthandsafetyrepresentative,asapplicable,withrespecttothefollowingwhentheyarerequiredbytheErgonomics(MSI)Requirements:(a)riskidentification,assessmentandcontrol;(b)thecontentandprovisionof workereducationandtraining;(c)theevaluationof thecompliancemeasurestaken.

(2)Theemployermust,whenperformingariskassessment,consultwith(a)workerswithsignsorsymptomsof MSI,and(b)arepresentativesampleof theworkerswhoarerequiredtocarryouttheworkbeing

assessed.

APPENDIX 3 WorkSafeBC ergonomics requirements

4.49 Risk factorsThefollowingfactorsmustbeconsidered,whereapplicable,intheidentificationandassessmentof theriskof MSI:

(a)thephysicaldemandsof workactivities,includingi. forcerequired,ii. repetition,iii. duration,iv. workpostures,andv. localcontactstresses;

(b)aspectsof thelayoutandconditionof theworkplaceorworkstation,includingi. workingreaches,ii. workingheights,iii. seating,andiv. floorsurfaces;

(c)thecharacteristicsof objectshandled,includingi. sizeandshape,ii. loadconditionandweightdistribution,andiii. container,toolandequipmenthandles;

(d)theenvironmentalconditions,includingcoldtemperature;(e)thefollowingcharacteristicsof theorganizationof work:

i. work-recoverycycles;ii. taskvariability;iii. work rate.

4.50 Risk control(1)Theemployermusteliminateor,if thatisnotpracticable,minimizetheriskof MSItoworkers.

(2)Personalprotectiveequipmentmayonlybeusedasasubstituteforengineeringoradministrativecontrolsif itisusedincircumstancesinwhichthosecontrolsarenotpracticable.

(3)Theemployermust,withoutdelay,implementinterimcontrolmeasureswhentheintroductionof permanentcontrolmeasureswillbedelayed.

APPENDIX 3 WorkSafeBC ergonomics requirements


3. Whatwillthemaximumloadsizebe?width_______length_______height_______

B. Wheels and casters

1. Whatkindof surfacewillthecarttravelon?(Check all that apply.) carpet

concrete

linoleum

tile

polyurethane

metal

wetfloor other __________________________

2. Whatobstacles,hazards,orfloorconditionsmaybeencountered?(Check all that apply.) none

gapbetweenelevatorandfloor raised door frames or moulding

puddles

wetfloor inclines→If inclinesareencountered,considerbrakes.

cracks

APPENDIX 4 pre-purchase checklists and flow charts

Usethissetof checklistsandflowchartsforeachtaskthatrequiresacart,tohelpidentifyyourneedssoyoucanmakeamoreinformeddecisionwhenpurchasingacart.Itissuggestedthatcompletedchecklistsbebroughttoyourfacilitybuyerandthemanufacturersotheycanassistyouinselectingthe ideal cart.

Task:__________________________________________________________________________

Materialstransported:_____________________________________________________________

Completedby:___________________________________________________________________

Date:__________________________________________________________________________

Step 1: ChecklistsCompletethefollowingchecklists.ForthequestionsinsectionsB–E,considerwhatisrequiredmost of the time.

A. Load weight, load capacity, and size

1. Whatwillthemaximumloadweightbe?(Loadweightisthecombinedweightof thecartandthematerialsbeingtransported.) Materialweight_______+Cartweight_______=Loadweight_______(kglb.circle one)

2. Whatwillthemaximumloadcapacitybe?(Loadcapacityof eachcaster=Loadweight÷Numberof casters)

Loadcapacity_______(kglb.circle one)=(loadweight_______x1.25)÷numberof casters_______

Istheloadcapacitygreaterthan113kg(250lb.)?

□yes→If yes,bearingsarerecommended.

□ no



D. Handles1. Howwillworkershandlethecart?

mostly push

mostly pull

equal amounts push and pull

2. Howtallarecartoperators?(Check all that apply.)<152cm(5ft.)

152–168cm(5ft.–5ft.6in.)

168–183cm(5ft.6in.–6ft.)

>183cm(6ft.)

Handlesshouldnotrequireorencourageworkerstohavehands,fingers,orarmsprotrudingto the side of the equipment.

E. Washing1. Howwillworkerswashthecart?

water cleaning

no water cleaning

2. Howoftenwillworkerswashthecart?

daily

weekly

every two weeks

monthly


floorstrips

confinedspaces

busypedestriantraffic

oil,grease,orchemicals

floordebrisorgrillsonthefloor

3. Howoftenisturningrequired?

rarely(<10%of travel) occasionally(10to30%of travel)

frequently(31to60%of travel) constantly(>60%of travel)

4. Doesthecartpathincludethefollowing?

long straight runs

confinedareas

5. Howfarwillthecarttravel?

Approximatedistance_______(mft.circle one)per(loadhourdaycircle one)

C. Storage on cart1. Arespecialshelvesorhooksrequired?

no

yes

If yes,describe.______________________________________________________________________________________________________________________________________________



A. Firmness of Wheel

No obstaclesObstacles (e.g.floor cracks,elevator gaps)


Soft Hard

*Hard: If more time is spent carpet than overcoming obstacor if carpet is thick.Soft: If more time is spentovercoming obstacles than oncarpet.

Soft Soft

Choose:

Smooth surface(hard or soft)

Rough surface


Hard or Soft* Hard

Carpet


Cart checklist

Criteria Yes No

1.Doesthesupplierincluderoutinemaintenanceinstructions?If “Yes,”aretheyeasytofollow?

2.Doesthesupplierincludepreventivemaintenanceprograminstructions?

3.Doesthesupplieroffertrainingandin-servicesregardingmaintenance?If “Yes,”aretheyeasytofollow?

4.Doesthesupplieridentifyacontactpersonforconcerns?5.Canservicingbecompletedin-house?6.Aresparepartsreadilyavailablefromthesupplier?7.Istheequipmenteasytoserviceandmaintain?8.Istheequipmentsafeandstable?9.Doesthesupplierofferanyafter-saleservices?

Step 2: Flow charts Usethefollowingflowchartstohelpdeterminetheappropriatecharacteristicsforyourcart.Startatthetopof eachflowchartandselectthemostappropriateitem.Movedownthrougheachlevelof theflowchartuntilyouhaveselectedoneitemfromthebottomlevel.



Longer travelShorter travel

Choose:

Turning rarely or

occasionally

Lighter loadHeavier load Lighter loadHeavier load

Largerdiameter

Largerdiameter

Largerdiameter

Largerdiameter

Larger = 12.5 to 20 cm (5 to 8 in.)Smaller = 7.5 to 10 cm (3 to 4 in.)

B. Diameter of Wheel


B. Diameter of Wheel



D. Wheel and Caster Configuration


4 swivel castors or2 swivel castors and2 fixed castors centrallypivoting or3 swivel castors*

4 swivel casterswith one directionallock

Choose:

Straight runs

Good loadcapacity

Excellent loadcapacity

Good loadcapacity



Excellentmaneuverability

Good loadcapacity


Good loadcapacity


4 fixed castorscentrally pivoting or2 swivel castors and2 fixed castors

4 fixed castors centrallypivoting or 4 swivelcastors and 2 fixedcastors centrally pivoting

4 fixed castors centrallypivoting or 2 swivel castorsand 2 fixed castors or4 swivel castors +

4 fixed castors centrallypivoting or 4 swivelcastors and 2 fixedcastors centrally pivoting

*3 swivel castors: ideal for barreldollies and small portablemachines only

+4 swivel castors: ideal if twocastors have directional locks

4 swivel casters

4 swivel casterswith one directionallock


C. Width of Wheels



APPENDIX 5sample calculations using load weight and load capacity

Thebasicrelationshipbetweenacart’sloadweightandtheloadcapacityof eachof itscastersisasfollows:Loadweight÷Numberof casters=Loadcapacityof eachcaster

Determining the required capacity of casters for a new cart

1.Considertheloadthatwillbetransportedandestablishtheloadweight.Materialweight+Cartweight=Loadweight

2.Calculatetheloadcapacityof therequiredcasters.Loadweight÷Numberof casters=Loadcapacityof eachcaster

Recommendation: Asanextraprecaution,selectcasterswithaloadcapacitygreaterthanthecalculatedloadweight.Formostsituations,buildinasafetyfactorof atleast25%(multiplytheloadweightby1.25).Thiswillaccountforanyenvironmentalchangesthatmayalterthecapacityof thecasters.Forexample,whentravellingonunevengroundonlythreeoutof thefourwheelsmaybebearingmostof theweight.

Example: Calculating the required load capacity of casters for a new cartMaterialweight=120kgCartweight=40kgNumberof casters=4Use:UnevengroundSafetyfactor:Assumethattheloadweightis1.25timesgreaterthanitactuallyis(25%safetyfactor).


Choose:

Straight runs

Good loadcapacity


Good loadcapacity


4 fixed castorscentrally pivoting or

2 swivel castors and

2 fixed castors

4 fixed castors centrallypivoting or 4 swivel

castors and 2 fixedcastors centrally pivoting

4 fixed castors centrallpivoting or 2 swivel cas

and 2 fixed castors or

4 swivel castors+

4 fixed castors centrallypivoting or 4 swivel

castors and 2 fixedcastors centrally pivoting

+4 swivel castors: ideal if twocastors have directional locks

D. Wheel and Caster Configuration



Determining the load weight limit of an existing cart Todeterminetheloadweightlimitof anexistingcart,multiplythemanufacturer’slistedloadcapacityfortheweakestcasterbythenumberof castersonthecart.Whenconsideringthenumberof castersonthecart,includeonlythecastersthattheloadrestson.Forexample,donotincludecentrallypivotingcastersorcentralaxlecasters.

Example: Calculating the load weight and material weight limits of an existing cartNumberof casters=2rigidand1swivelCasterloadcapacity(providedbymanufacturer)=75kgperrigidcasterand50kgperswivelcasterCartweight=40kgUse:Smoothsurface



1.Determinetheloadweight.Materialweight+Cartweight=Loadweight120kg+40kg=160kg

2.Determinetheloadcapacityof eachcaster.(LoadweightxSafetyfactor)÷Numberof casters=Loadcapacityof eachcaster(160kgx1.25)÷4=50kg

Eachof thecastersselectedforthisnewcartmusthavealoadcapacityof atleast50kg.


APPENDIX 6 cart identification form (existing carts)

Date:____________________

Completedby(name):___________________________Department:_______________________

Storagelocationof cart:___________________________________________________________

Equipment Make:_________________________________________________________________________

Model:_________________________________________________________________________

Serialnumber:___________________________________________________________________

Supplier:_______________________________________________________________________

Purchasecost:$__________________________________________________________________

Cart checklist

Criteria Yes No

1.Doesthesupplierincluderoutinemaintenanceinstructions?If “Yes,”aretheyeasytofollow?

2.Doesthesupplierincludepreventivemaintenanceprograminstructions?

3.Doesthesupplieroffertrainingandin-servicesregardingmaintenance?If “Yes,”aretheyeasytofollow?

4.Doesthesupplieridentifyacontactpersonforconcerns?5.Canservicingbecompletedin-house?6.Aresparepartsreadilyavailablefromthesupplier?7.Istheequipmenteasytoserviceandmaintain?8.Istheequipmentsafeandstable?9.Doesthesupplierofferanyafter-saleservices?

Comments:____________________________________________________________________________________________________________________________________________________

1.Determinetheloadweightlimit.Loadcapacityof weakestcasterxNumberof casters=Loadweightlimit50kgx3casters=150kg

2.Subtractthecartweighttodeterminemaximummaterialweight(withoutsafetyfactor).Loadweightlimit–Cartweight=Materialweight150kg–40kg=110kgTheloadplacedonthiscartshouldweighnomorethan110kg.

3.Buildina25%safetyfactor(recommended).LoadcapacityxNumberof casters÷Safetyfactor=Loadweightlimitwithsafetyfactor(50kgx3casters)÷1.25=120kgLoadweightlimitwith25%safetyfactor–Cartweight=Materialweightwith25%safetyfactor120kg–40kg=80kg

The load weight limit of each cart should be labelled so workers can choose the appropriate cart for each task.



APPENDIX 8 stretching routineAPPENDIX 7 implementation guideline

Date:_____________________

Workinggroup:________________________________________________________________

_____________________________________________________________________________

Control measure Person(s) responsible

In place by (date)

In place on time? (Y/N)

Potential barriers?


OxfordCaster.2000.Casters,wheels,andmaterialhandling.<www.oxfordcaster.com>(April28,2005).

PlasticWheels.com.2002.Technicalinformation.<www.plasticwheels.com/technical.htm>(April28,2005).

USArchitecturalandTransportationBarriersComplianceBoard.2002.AmericanswithDisabilitiesAct(ADA)AccessibilityGuidelinesforBuildingsandFacilities(ADAAG).Washington,DC.

APPENDIX 9 references

AlgoodCastersLimited.2004.HowtoselectthecorrectAlgoodcasterandwheel.<www.algood-casters.com/caster-selection.html>(April28,2005).

CanadianCentreforOccupationalHealthandSafety.1997.Manualmaterialshandling—Healthhazards.<www.ccohs.ca/oshanswers/ergonomics/mmh/hlth_haz.html>(April28,2005).

CanadianCentreforOccupationalHealthandSafety.1997.Pushing&pulling—Handcarts.<www.ccohs.ca/oshanswers/ergonomics/push2.html>(April28,2005).

DarcorLtd.andErgowebInc.2001.The ergonomics of manual material handling: Pushing and pulling tasks. Toronto:Darcor.<www.darcor.com/whatsnew.htm>(April28,2005).

Doyle,E.2002.Casterselectionguide.<www.stanleysmithco.com/Pages/cstrselection.html>(April28,2005).

EastmanKodakCompany.1986.Kodak’s ergonomic design for people at work.2nded.Toronto:JohnWileyandSons.

HealthandSafetyExecutive.2004.Getting to grips with manual handling: A short guide.Suffolk:HSEBooks.

Hoozemans,M.J.,A.J.vanderBeek,etal.1998.Pushingandpullinginrelationtomusculoskeletaldisorders:Areviewof riskfactors.Ergonomics 41(6):757–81.

IndustrialAccidentPreventionAssociation.2005.Manualmaterialshandling.<www.iapa.on.ca/pdf/manmat.pdf>(April28,2005).

JilsonGroup,The.2000.Castertechnicalguide.<www.jilson.com/selectguide.htm>(April28,2005).

APPENDIX 9 references

using carts in healthcare - provincial health services ... · • dr. dan robinson ... motorized...

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