This program outlines the requirements necessary to prevent or lessen the potential for work-related repetitive injuries at the University of New Mexico. It is designed to provide information to the University faculty, staff and students, about the preventative measures necessary to avoid musculoskeletal injuries and the risk factors that can cause or aggravate those disorders.

The purpose of this program is to improve employee well being through the reduction of workplace discomfort by the identification and correction of ergonomic hazards. This program applies to all University employees.

This program is applicable to all University employees in their day-to-day work duties. This program provides a systematic method to evaluate workplace hazards, and create controls for those hazards. The program provides educational material for managers and employees, and outlines specific procedures necessary to avoid repetitive injuries.

It is also designed to comply with current safety practices and laws, and anticipated changes in state and federal occupational safety laws.

B. DEFINITIONS

Administrative Controls - These are procedural risk-control measures that include, but are not limited to, redesign of work duties, adjustment of work pace, use of rest periods and breaks, training, or altering work duties to interrupt activities that pose a risk to the employee.

Engineering Controls - Engineered risk-control measures include, but are not limited to, devices such as adjustable workstations, tables, chairs, equipment, and tools. Engineering controls also may include modifications to workstations, equipment, tools, production processes, or any other aspect of the work environment.

Ergonomics – The field of applied science and engineering that is concerned with the interaction among systems and the people who operate and maintain them (sometimes known as Human Factors Engineering). Ergonomics seeks to fit the job to the person rather than the person to the job. The aim of this discipline is to prevent ergonomic disorders.

Ergonomic Complaints – Almost everyone becomes fatigued at some time or another while working at a computer. Workers who must lift and move material may complain of back soreness, fatigue, or pains. Some employees may also experience occasional aching, cramping or soreness. While this does not necessarily indicate the presence of a repetitive motion injury, these early warning symptoms may indicate that an underlying problem needs correction.

Employee discomfort that lasts more than two weeks or that affects job performance should be reported to a supervisor. The employee should consult with the supervisor or medical professional if there is severe or chronic pain. This includes pain, soreness, or burning sensations numbness or tingling fatigue, weakness, or stiffness, frequent headaches, eye discomfort, and discomfort in the neck, shoulders, upper back, wrists, hands, lower back, hips, or legs.

The information contained in this program is not a substitute for medical advice or treatment. SHEA recommends that employees consult with a health care professional at the Employee Occupational Health Services.

Ergonomic Hazards – Conditions that lead to biomechanical stresses have been identified over 100 years ago. Recent changes in the way work is done have led to an increased interest in biomechanics (ergonomics). Such hazards include, but are not limited to, faulty workstation layout, incorrect work methods and postures, improper lifting, and overuse of poorly designed tools. It may also include job design problems that include aspects of repetitive workflow, excessive speed demands, poor postures, force requirements, and the lack of work or rest cycles. These hazards also exist in the home environment, and with many sports activities.

Ergonomic Risk Factors – There are four primary risk factors that should be controlled: awkward postures, forceful exertions, repetitive motions, and outside conditions. The more risk factors that are present, the more the potential for a repetitive motion injury.

Repetitive Motion - The performance of the same physical motion continuously.

Repetitive Motion Injuries – These are injury types that are chronic as opposed to acute, and are caused by repetitive exposure to recognized hazards. These injuries are caused or aggravated by repeated exertions and movements and occur frequently in the hands, wrists, and upper extremities. These injuries affect bones, joints, and soft tissues, and are generally preventable. A person’s disposition to such an injury is dependent on previous injuries, age, health, gender, work and recreation history.

Video Display Terminal (VDT) - This includes any device not designed for hand-held use that involves a cathode-ray tube or other electronic device for display of data or text and a keyboard for entry. These include personal computers, computer terminals and data input stations.

Worksite Analysis - This is the division of the complete working environment into components including personnel, workstation, workplace layout, equipment, supplies, resources and procedures for the purpose of identifying possible hazards, providing education and developing solutions for eliminating or controlling these hazards.

Deans, Directors, and Department Chairs are responsible for ensuring this program is followed within their area of authority. He or she could select a person to act as safety coordinator or appoint a safety committee with appropriate authority, to oversee the guidelines of this program.

Supervisors and Managers are responsible for implementing this ergonomic program in their area of authority. Supervisors and managers must:

• be familiar with the concepts of ergonomics and identify workplace conditions and practices that may be of concern,
• make employees aware of this program and the information contained in this program,
• train employees how to best arrange workstations to avoid injury,
• investigate accidents or reports of injury or illness,
• report injuries according to the "Worker's Compensation" Policy 3630, UBP, and
• ensure that recommendations for reducing ergonomic hazards are implemented in a timely manner.

Employees should be involved in all phases of this program implementation including exposure identification, risk assessment and control of work practices risk factors. They must perform work duties according to the training provided. The SHEA website has a specific ergonomic site (http://www.unm.edu/~sheaweb/) and employees are encouraged to apply the instructional modules. Employees must:

• optimize their own work areas and tasks and notify their supervisor of their reasonable needs to improve their workstations,
• correctly use the equipment provided by their supervisor,
• identify ergonomically related concerns to their supervisor for corrective action, and
• participate in ergonomics training when provided, and
• follow UNM Policy regarding the reporting of any injury or illness. An employee should not "self-prescribe" medical devices, braces, or splints. These items should be used under a doctor’s supervision.

Safety, Health and Environmental Affairs (SHEA) will conduct workplace evaluations that are designed to educate employees about safe work practices, to remove hazards, and to prevent accidents. SHEA will:

• assist in training exposure evaluation and determination, perform exposure monitoring, interpret standards, and provide technical advice,
• revise and monitor this program periodically, and
• review injury and incident trends, and review specific cases to identify areas of concern.

The Facilities Planning Departments shall be responsible for integrating ergonomics considerations into workspace planning, workstation design, and building modifications. Additionally, the Facilities Planning Departments shall design for optimal environmental factors such as temperature, noise, vibration, and lighting during facility planning.

The Purchasing Department shall be responsible for purchasing chairs and equipment which is of such quality and design as to reduce the potential for ergonomic injuries. SHEA would willingly assist in any type of evaluation prior to a purchase. Many ergonomic problems are created by the use of low cost, low value equipment.

Employee Occupational Health Services (EOHS) is responsible for medical evaluation of work-related injuries and illnesses to ensure early identification, evaluation, and treatment of signs and symptoms.

Signs of repetitive motion stresses include pain of the upper extremities, numbness, or tingling of the fingers, wrists, elbows, or shoulders. Chronic back and neck problems may result in pain, numbness, or tingling that radiates to the arms or legs, and limit back motion.

It is critical to recognize the repetitive effects of stresses and the need to balance tasks and activities. Without appropriate recovery periods, ergonomic stresses incurred during one activity become cumulative with those from another similar activity. For instance, hand movement stresses incurred in a lab can be cumulative with those incurred playing the piano. Balancing these activities allows an adequate recovery period.

The earlier ergonomic needs are dealt with, the better. Ergonomic needs should be considered during the design phase for new processes, and at the point that new equipment purchases are first contemplated. Never assume that because equipment and processes are new and up-to-date, they will be ergonomically correct. To assist with evaluation of ergonomic issues SHEA has included a resource on its web page to assist in identification of ergonomic concerns and evaluation of workstations. The SHEA web page is: http://www.unm.edu/~sheaweb.

• Avoid mechanical stresses to the arms. (For example, avoid resting hands or forearms on the sharp table edge).
• Rest between tasks that require hand grasping or pinch gripping. (Such as grasping large files, or stapling).
• Rest and stretch after repetitively performing the same motion or motion pattern (every few seconds for more than 2 hours continuously or four hours daily).
• Avoid working in a position that requires maintaining an unsupported fixed or awkward posture (for more than 1 hour continuously, or four hours daily). These postures include raised elbows and arms, bent wrists or hands.
• Avoid using vibrating or impact tools or equipment for more than 1 hour continuously or 2 hours daily.
• Avoid using forceful hand exertions for more than two hours daily (greater than 7 lb. of hand force).
• Unassisted frequent or heavy lifting should be avoided also. A person may be able to lift heavy loads, but the potential for back injury increases with each lift.

• Evaluate the workplace to identify ergonomic risk factors and potential sources of accidents. Avoid awkward motions and postures.
• Encourage employee awareness and provide education.
• Use ergonomically appropriate work habits and require the same of employees.
• Take frequent breaks, stretch, and move around to keep muscles flexible. Workplace exercises relieve physical discomfort.
• Use ergonomically designed hand tools and furniture. The preferred furniture provides flexibility for adjustments and allows for preferred individual posture. Furniture and the workplace should be adjusted to the user.
• Perform five minutes of alternative work activity, or resting for every 30 minutes of continuous, high intensity, repetitive work. For example, after two hours of continuous keyboarding, devote 15 minutes to non-repetitive motion activities like returning phone calls or filing.
• Expand the tasks a person performs to minimize the constant repetition of any one particular task.
• Evaluate and intervene when the employee complains of repetitive motion injury symptoms or when the employee complains of back pain. Prompt corrective action is required to allow for the body to recover from overexertion.

• Use a chair that is stable, mobile, swivels, and allows for operator movement.
• Use a chair that provides substantial lower back support. The back support should be easy to adjust backward, forward, up, and down. A properly adjusted chair is important to help reduce or prevent discomfort on the back and should support the inward curve of the back.
• Use a chair that has an adjustable seat height. Raise or lower the chair to a comfortable height such that the thighs are parallel to the floor and the knees are at a 90-degree angle. Rest the feet flat on the floor or use a footrest.
• Use the armrests if they allow maintaining elbows at a 90-degree angle. If the armrests obstruct sitting posture, then adjust the armrests, use a chair that allows an erect posture, or use a chair without armrests.

• Adjust the work surface (table) so that the keyboard is at the correct height to maintain the best posture (elbows at keyboard height with the forearms parallel to the floor). If possible, use a split-level design table that has an adjustable top height: the lower level for the keyboard and mouse or trackball, and the upper level for the VDT monitor. The height of each level should adjust separately.
• Use a table large enough to hold the keyboard, monitor, wrist rest, mouse or trackball, and a document holder or all necessary documents.
• Keep adequate clearance under the table for leg length, knee height, and thighs.

• Position the VDT monitor directly in front and in line with the keyboard.
• Position the VDT at a comfortable viewing distance (18-24 inches from the eyes), viewing height (top of the display screen at or slightly below eye level), and viewing angle (10-15 degrees below the horizontal line of sight).
• Use a VDT monitor that tilts and rotates.
• Use a VDT monitor that has adjustable contrast and brightness. Adjust the contrast to a high level and the brightness to a low level to minimize or prevent eyestrain.
• Keep the display screen or glare shield clean because dust reduces character clarity and reflects light.

• Use a keyboard that is detached from the VDT monitor.
• Position the keyboard directly in front of your torso.
• Position the keyboard approximately at elbow height.
• Adjust the keyboard angle to a comfortable position; keep the wrists straight and in line with the forearm. The control to adjust the angle is located at the rear of the keyboard.

• When using a mouse, trackball, or special keypads, place the wrist in a neutral position. Rest the arm and hand close to the body and at the natural elevation. Do not reach forward, outward or raise the shoulders.
• Use the whole arm to move the input device instead of just the wrist.
• If the arm is resting on the table edge (hard work surface) when using the mouse or trackball, then use a mousepad rest to provide cushion.

• Use a wrist rest for support to help maintain a neutral wrist position.
• Use a wrist rest for cushioning to protect the wrist from resting on a hard or sharp work surface. Note that wrist rests are designed to be used during pauses in typing.

• Use a document holder that has an adjustable height.
• Use a document holder that is large enough to support the documents.
• Position the document holder beside and parallel to the display screen.
• Position the document holder at the same height and distance as the display screen. This positioning minimizes the amount the operator has to turn his or her head to look from the document to the display screen, and reduces eye muscle fatigue by maintaining the same focal distance.

• A footrest may be necessary if the operator cannot place his or her feet comfortably on the floor.
• Use a footrest that has an adjustable height and heel stop.
• Use a footrest that is large enough to allow for operator movement.

• Use a printer with a low noise level. Otherwise, enclosing the printer in a noise-absorbing box can reduce discomfort from high noise exposure.
• Locate the paper supply where the operator can easily reach it.

• For the eyes, look away from the work to a distant point at least every hour.
• For the body, stretch the neck, shoulders, back, legs, arms, and fingers at least twice a day. Stand up and walk around often to increase blood flow circulation. Warm up exercises are recommended in the morning, prior to commencing work, and after lunch, to recondition for data entry work.

• Reflective glare is created by a mirror-like surface, such as the monitor screen, which may reflect overhead lights or an operator’s bright clothing. (Detect by turning the monitor off and looking for reflections on the screen).
• Direct glare results when a light source is shined directly to the eyes. The viewing surface, for example, may be obscured by brightness from uncovered windows or other bright sources directly behind the terminal. This type of glare masks the display image.

• Do not place the monitor so the window is behind the screen, or directly facing windows. Ideally, the screen should be orientated so that it is perpendicular to the line of windows and rows of lighting fixtures.
• Cover windows with drapes or blinds to limit the penetration of direct sunlight.
• Consider attaching a glare screen.
• Install recessed overhead lighting and special fixtures, where feasible.
• Paint nearby walls in a dark or pastel color with a matte finish (less than 50% reflective), or add wall coverings on the wall directly behind the monitor screen.
• Choose screen colors carefully. In general, use green and yellow and avoid red and blue.
• Lower illumination levels for VDT tasks to approximately half the intensity of normal office lighting to reduce glare and eye strain. Ambient illumination in the room should be approximately 50 foot-candles (200 lux).
• Contact the Physical Plant Area in charge of your facility to assist in lowering the light level (by removing every other bulb or by reducing the intensity of the bulb illumination).
• Adjust the VDT brightness and contrast controls to increase character resolution.
• Use additional task lighting for reading copy while the light intensity is lowered.

• Poor physical condition,
• Poor posture,
• Improper body mechanics,
• Incorrect lifting, and
• Jobs and work tasks that require high energy.

• Use upright, neutral working postures and preferred body mechanics:

• Try to keep the load close to the body. Try to keep the majority of the weight between your waist and shoulders.
• Move the person towards you, not away from you.
• Use slides and lateral transfers instead of manual lifting when possible.
• Use transfer belts to move patients.
• Use a wide, balanced stance with one foot slightly ahead of the other.
• Lower the patient slowly by bending your legs, not your back. Return to an erect position as soon as possible.
• Use smooth movements and do not jerk the load. When lifting with other persons, coordinate the lift by counting down and synchronizing the lift.

• Position surfaces (for example, bed and gurney, bed and cardiac chair) as close as possible to each other. Surfaces should be at approximately waist height, with the receiving surface slightly lower to take advantage of gravity.
• Lower the rails.
• Use draw sheets or incontinence pads in combination with friction-reducing devices (such as slide boards, slippery sheets, plastic bags, and low-friction mattress covers).
• Get a firm handhold by rolling up draw sheets and incontinence pads or use other assist equipment such as slippery sheets with handles.
• Kneel on the bed or gurney to avoid extended reaches and back bending.
• Have team members on both sides of the bed or other surfaces. Count down and synchronize the lift. Use a smooth, coordinated push-pull motion. Do not reach across the person you are moving.

• Keep the individual as close as possible.
• Avoid bending, reaching or twisting your back when attaching or removing belts (for example: raising or lowering beds bend at the knees), lowering the individual, or assisting with ambulation.
• Pivot with your feet to turn.
• Use a gentle rocking motion to take advantage of momentum.

• This transfer is used for moving a person from bed to chair, or to help an individual stand up from a sitting position.
• Use transfer discs or other assists when available. If one is using a gait or transfer belt with handles, follow the guidelines in d).
• Keep the feet at least at shoulder width apart.
• If the patient is on a bed, lower the bed so that they can place their feet on the floor to stand.
• Place the receiving surface (such as a wheelchair) on the patient’s strong side (e.g., for stroke or hemi-paralysis conditions) so they can help in the transfer.
• Get the patient closer to the edge of bed or chair and ask them to lean forward as they stand (if medically appropriate).
• Block the individual's weak leg with your legs or knees (this may place your leg in an awkward, unstable position; an alternative is to use a transfer belt with handles and straddle your legs around the weak leg of the patient or resident).
• Bend your legs, not your back.
• Pivot with your feet to turn.
• Use a gentle, rocking motion to take advantage of momentum.

• Some common methods involve repositioning individuals using draw sheets and incontinence pads in combination with a "log roll" or other techniques.
• Adjust beds, gurneys or other surfaces to waist height and as position it as close to you as possible.
• Lower the rails on the bed or gurney and work on the side where the individual is the closest. Move equipment close to you at waist height.
• Obtain help and use the teamwork approach, described in b).

• It is often necessary to transport patients in gurneys, wheelchairs, or beds, or handle various types of carts, monitors, instrument sets, and other medical equipment.
• Decrease the load or weight of carts, instrument trays as much as possible by removing items.
• Shelve items and equipment between waist and shoulder height to reduce lifting from low or high positions.
• Use sliding motions or lateral transfers instead of lifting as much as possible.
• Pushing is preferred to pulling motions. Keep loads close to your body. Use an upright, neutral posture and push with your whole body, not just your arms.
• Move down the center of corridors to prevent collisions.
• Watch for door handles that may protrude into the walking area and for and high thresholds that can cause abrupt stops.
• Promptly take out of service any rolling equipment that is defective or in need of maintenance and tag it with a description of the problem. Report it to the appropriate department.

• Cramped showers, bathrooms or other facilities in combination with poor work practices may cause employees to assume awkward positions or postures or use forceful exertions when performing ADLs.
• Use upright, neutral working postures and preferred body mechanics. Bend your legs, not your back.
• Eliminate bending, twisting and long reaches by using long-handled extension tools (such as hand-held showerheads, wash and scrub brushes). Wheel people out of showers or bathrooms and turn them around to wash hard-to-reach places.
• Use shower-toilet chairs that are high enough to fit over toilets. This eliminates additional transfers to and from wheelchairs.
• Use shower carts or gurneys, bath boards, pelvic lift devices, bathtub and shower lifts, and other transfer equipment.

• When it is medically appropriate, use a mechanical assist device to lift patients from the floor. If assist devices are not readily available or appropriate, a manual lift may be necessary. When placing slings, blankets, draw sheets or cots under the patient:
• Position at least two providers on each side of the person. Obtain additional help for large patients or residents.
• Bend at your knees, not your back. Do not twist.
• Roll the person onto their side without reaching across them.
• When using hoists, lower the hoist enough to attach slings without straining the back.
• If a manual lift is being done, kneel on one knee, grasp the blanket, draw sheet, or cot. Count down ("3-2-1-Lift") and synchronize the lift. Perform a smooth lift with your legs as you stand. Do not bend your back.

• Use retractor rings instead of holding retractors for prolonged periods.
• Position operating tables or other work surfaces at waist height.
• Stand on lifts or stools to reduce reaching.
• Frequently shift position or stretch during long operations.
• Avoid prolonged or repeated bending of the neck and the waist. Stand with one foot on a lift and frequently alternate feet to reduce pressure on the back.
• Reduce the number of instrument sets (trays) on a case cart.
• Store instrument sets (trays) in racks that are between the waist and shoulder height.
• Use stands or fixtures to hold extremities.
• Get help from co-workers as needed to position legs or extremities in stirrups, and to move heavy carts, microscopes, monitors, alternate operating tables, equipment, or fixtures.

• Rotate pipetting tasks among several people.
• Take short pauses for a few seconds if a longer break is not feasible.
• Use only the force necessary to operate the pipetter.
• Choose pipetters requiring the least pressure.
• Work with arms close to the body to reduce strain on shoulders.
• Keep head and shoulders in a neutral position (bent forward no more than 30 degrees).
• Use adjustable chairs or stools with built-in solid footstools. Don't use a foot ring, which could compress blood vessels in feet, and don't use high stool, which can force you to work with a bent neck.
• Don't elevate your arms for lengthy periods without some type of support.
• Use short pipettes to decrease hand elevation and consequent awkward postures.
• Use low profile waste receptacles for used tips. They should be no higher than the top of the tubes being filled.

• Avoid using a microscope for more than five hours per day. Spread use over the entire workday to avoid long uninterrupted periods in static postures.
• Keep microscopes cleaned and use illuminators and shadow boxes properly to avoid visual and musculoskeletal strain.
• Adjust chair height so thighs are horizontal and feet flat on the floor. Chairs should be adjustable from 15-21 inches.
• Make sure the backrest provides firm lumbar support and be sure to readjust when you change positions.
• Padded armrests to rest your arms and increase stability without compressing the ulnar nerve in your arm.
• Position work surfaces high enough to allow close inspection without inclining your head beyond 17-29 degrees.
• Use a cutout worktable. This puts you close to the scope yet gives and area for supporting forearms.

E. TRAINING

Workers who have jobs that require manual material handling or repetitive motions should be trained and educated about the procedures to prevent injuries. The training should be done at the time of hire and whenever the job changes. Refresher training should be done as needed. Training may include:

• presentations which discuss body mechanics, discomfort reduction, and exercises,
• informal worksite observations and evaluations, and
• instructional videos, handouts, and literature.

SHEA provides training sessions including interactive lecture, worksite evaluations and computer based workstation evaluations. Supervisors may request training for groups of employees, or EOHS may recommend training for individuals. These training sessions include:

• Back Injury Prevention training,
• Office Ergonomics instruction, and
• Computer based worksite evaluations.

Problems result from making "one size fit all", so it is best to purchase adjustable chairs and furniture. Anticipate changes in work tasks, in the office layout, and in employee needs. Contact SHEA for information about ergonomic features of the products that are being considered, and the Purchasing Department for price information and vendor referrals.

Involve potential users in the selection process by having employees test the products before purchases are made. Check the refund policy before purchases are made. It is also best to have a product representative provide instruction on the features and correct use of the product. Look for these preferred features when shopping for chairs and furniture:

• a height adjustment for the pneumatic seat (pan),
• a height adjustment for the back rest,
• an adjustable back rest angle,
• an adjustable seat tilt,
• a swivel mechanism, and
• a height adjustable or removable arm rest

• an adjustable work surface (table) height,
• an adequate size work area (dimension),
• work surface edges and corners that are smooth, without sharp edges,
• adequate leg clearance and space, and
• a non-glare finish

• a height adjustment,
• a work area large enough to accommodate the mouse,
• a built-in soft wrist rest (not the metal lip); or enough room for an add-on wrist rest,
• adequate leg room once the keyboard drawer is installed, and
• an easily adjustable and moveable suspension device

Work tasks and working positions that need an evaluation can be identified by the worker, the supervisor, EOHS staff or SHEA staff. If additional assistance is needed, SHEA should be contacted to coordinate an evaluation. Worksites should also be evaluated if an employee has been diagnosed with a repetitive motion injury at the workstation and will be returning to the same activity.

Ergonomic evaluations seek to identify workplace conditions that may cause or aggravate work-related musculoskeletal injuries. If workplace conditions are observed which should be corrected, recommendations are provided to the employee and to the supervisor. Recommendations typically consist of both engineering and administrative controls. Supervisors are responsible for the implementation of the recommended controls.

The Computer Workstation Self-evaluation (see Attachment A) can be used to help evaluate the arrangement of a workstation. This evaluation is easiest if conducted by two people: one person should use the workstation and the another person should act as an observer using the checklist.