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Safety in the Workplace

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► Objectives

1. List the Joint Commission’s 2010 patient safety goals for ambulatory health centers.

2. List methods for reducing patient injury and illness.

3. Discuss what should be included in a patient safety plan.

4. Describe how to reduce the transmission of communicable diseases.

5. Discuss methods for reducing injuries in the workplace.

6. Discuss different types of hazards that are common in the medical workplace.

7. List components of a chemical hygiene program.

8. Describe steps to take in the event of a chemical spill.

9. Discuss the importance of fire safety and describe the various types of fire extinguishers.

10. Discuss the importance of ergonomics in maintaining employee safety.

Safety in the Workplace

Individuals often associate workplace injury and illness with the construction, coal mining and manufacturing industries; however, OSHA estimates that “5.6 million workers in the health care industry and related occupations are at risk of workplace illness due to occupational exposure to bloodborne pathogens, including human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and others” (Bloodborne Pathogens and Needlestick Prevention, ).

Musculoskeletal injuries are the most common type of injury reported by health care workers due to lifting responsibilities. In addition to personal safety, health care workers need to be concerned about the safety of patients—which is why it is important to create a culture of safety rather than simply following a set of safety rules.

The purpose of this handout is to provide learners with information to create and maintain an environment that is safe for both health care workers, including medical assistants, and their patients.

Patient Safety

The Joint Commission (JC) is an independent, not-for-profit organization that accredits and certifies more than 17,000 health care organizations and programs in the United States. Each year, the JC publishes a list of national patient safety goals to help improve patient safety. Table 1 contains the 2010 Patient Safety Goals, which are geared toward ambulatory health centers and should be implemented in order to maintain JC accreditation. There are several other goals for inpatient establishments. Read more about these goals at the Joint Commission’s web site, .

Table 1: The Joint Commission’s 2010 Patient Safety Goals

| |2010 Patient Safety Goals |Steps for Implementation |

|1. |Improve the accuracy of patient identification. |Using two patient identifiers before conducting any testing or |

| | |administering any medications can assist in accomplishing this |

| | |goal. |

|2. |Improve the effectiveness of communication among caregivers.|This particular goal doesn’t apply directly to ambulatory health |

| | |centers; however, all health care professionals should do |

| | |everything possible to promote effective communication from one |

| | |caregiver to the next. |

|3. |Improve the safety of using medications. |Make certain that drugs that look alike or sound alike are |

| | |separated or labeled in a manner that they cannot be confused with |

| | |one another. |

|4. |Reduce the risk of health care associated infections. |Implement the CDC hand hygiene guidelines and develop a sterile |

| | |conscience to help prevent the threat of surgical site infections. |

|5. |Accurately and completely reconcile medications across the |Compare current and newly ordered medications. |

| |continuum. |Communicate medications to the next provider |

| | |Provide a reconciled medication list to the patient. |

|6. |Reduce the risk of patient harm resulting from falls. |This can be accomplished by checking the stability of the patient |

| | |before asking the patient to stand or ambulate and providing |

| | |assistance to patients that may be unsteady. |

| | |Medical assistants should always check to make certain that halls |

| | |are free from clutter and that there are no rugs or cords that may |

| | |promote patient falls. |

Patient Safety Plan

According to a 2009 article from Thomson Reuters, 98,000 lives are lost each year due to medical errors; ten years prior, a 1999 report by the Institute of Medicine (IOM) found that medical errors cost the United States $17-$29 billion a year. These statistics are alarming and unacceptable which is why organizations like the JC and Institute for Safe Medication Practices (ISMP) strive to educate health care workers on ways to reduce errors. One of the most aggressive goals to help reduce medical errors is the nationwide adoption of electronic medical records. This goal will reduce mistakes made from illegible handwriting and organize each patient’s chart so that any practitioner can readily find pertinent information.

Health care facilities should design a patient safety plan that reduces medical mistakes and promotes patient wellness and safety. The plan may include the following:

• What the patient can do to promote their own safety

• What the facility can do to prevent the transfer of communicable diseases

• What the facility can do to prevent injury to patients

What Patients Can Do to Promote Personal Safety

At the beginning of care, all patients should receive a statement explaining how they can be active participants in promoting their own personal safety. The following points are some examples of what may be included in the statement:

• Provide us with thorough information regarding your medical history and your current condition.

• Ask questions when you don’t understand your diagnosis or treatment, or any other aspect of your care.

• Keep us informed of any changes in your condition—whether good or bad.

• Keep us posted on any medication changes.

• Take medications only as directed and report any adverse reactions to medications.

• Never take medication that was prescribed for someone else.

• Follow all homecare instructions.

Preventing the Transfer of Communicable Diseases

The term noscomial infection means an infection acquired while in a hospital or other medical establishment. The most common nosocomial infections are surgical wound infections, urinary and respiratory tract infections, and bacteremia (blood infections). Many of these infections are caused by antibiotic-resistant bacteria, known as superbugs—a strain of bacteria resistant to all forms of antibiotics. Superbugs often have serious consequences for affected individuals and the medical community at large.

The transmission of superbugs is not as common in an ambulatory setting, but may occur if health care workers are not careful. Of course, the best way to stop the spread of infection is through effective handwashing techniques. It is estimated that half of all infections could be prevented if health care workers would simply wash their hands.

►►Some hospitals are investing in wireless technology to detect whether employees have washed their hands. Employees begin by washing their hands with an alcohol antiseptic cleanser outside of the patient’s room. Upon entering the room, employees wave their hands near a sensor on their ID badge. A green light means that the sensor has picked up alcohol on the worker’s hands; a red light means that the employee must rewash their hands and be scanned again before proceeding with patient responsibilities. Hospitals that have invested in this technology state noscomial infections have declined as a result of the technology.

The following actions can assist in reducing infections:

• Wash hands before and after working with patients.

• Wear gloves when working with body fluids.

• Wash hands before applying and removing gloves.

• Disinfect equipment that is used between patients, such as blood pressure cuffs, stethoscopes, pulse oximeters, etc.

• Sterilize equipment or instruments that are inserted into a body cavity or through a break in the skin.

• Wear a mask when you may have a contagious respiratory ailment.

• Cover any open wounds before working with patients.

Reducing the Spread of Communicable Disease between Infected Patients

The most effective method for stopping the spread of microorganisms between patients is to design a policy listing specific steps that should be taken when patients have potentially infectious diseases, particularly airborne illnesses or staph infections. Policies only work when enforced, so it is imperative that all staff members follow the policy. The chart below lists steps to reduce the spread of communicable diseases from one patient to another.

|Communicable Diseases |

|Policy in Place |Display a sign stating the following: |

| |Patients displaying symptoms of a respiratory illness, rash, or fever should wear a mask, perform hand |

| |hygiene and alert the receptionist so that they can be taken to a separate area. |

| |Masks, waterless hand cleanser, and tissue should be in the entrance area for patients that need them. |

|Recognize |Patients displaying possible infectious disease should be screened as early as possible and separated from|

| |other patients. (This applies to patients that do not identify themselves as potentially infectious.) |

|Screen |Screen patients according to facility guidelines for possible respiratory illness or rash. |

|Separate |If patient does appear to have an infectious disease follow office protocol regarding the separation of |

| |the patient from other patients. |

It is also important to disinfect toys in the play area whenever possible to reduce the spread of microorganisms between children.

Preventing Patient Injuries

No one thinks about incurring an injury in a place that heals injuries, but injuries can occur anywhere—even in the medical office. There are several actions that medical assistants can take do to help prevent patient injuries.

Guidelines for Preventing Patient Injuries

• Rugs should not be used in patient areas because of the risk of tripping or falling.

• Wet floors should be marked and blocked accordingly.

• Electrical cords and wires should be inspected for any problems, such as fraying.

• All sharps containers in patient areas should be adhered to a wall and out of children’s reach.

• All cabinet and closets in patient areas should have safety locks.

• Employees should inspect and learn how to properly use all patient exam tables and beds before using with patients.

• Safety belts should be used on patients who are not stable.

• Patients should always roll toward the medical assistant when changing positions on the exam table.

• Non-ambulatory patients or patients with mobility concerns should be placed in a wheelchair when transferred from one area of the clinic to another.

• Coffeemakers should not be placed in patient areas due to the threat of injury.

• Toys that may cause choking or other potential injuries should be removed from children’s play areas.

• Halls and other patient access areas should be free of obstacles.

• Parking lots and sidewalks should be cleared of ice and snow.

• Elevators should be serviced regularly and display instructions on what to do in an emergency.

Promoting Employee Safety in the Workplace

Workplace injury and illness is a real problem. Businesses are required to promote a safe working environment and take steps to prevent or reduce health risks to employees. Some states, such as California, require businesses to have an Injury and Illness Prevention Program (IIPP). The purpose of the program is to help identify injuries and illnesses that are common in the workplace and to develop a plan to prevent or reduce such events. Information that should be included in the program will vary according to each state’s standards, but generally include:

• A statement regarding management’s commitment to the program;

• Staff assignments and responsibilities for carrying out the plan;

• A method for effectively communicating with employees regarding safety practices;

• A system for assuring employee compliance with safe work practices;

• Accident and exposure evaluations;

• Scheduled inspections/evaluation system;

• Procedures for correcting unsafe/unhealthy conditions;

• Safety and health training and instruction;

• Recordkeeping and documentation.

Controls for Workplace Safety

There are three types of controls which are used to promote workplace safety: administrative controls, engineering controls, and workplace controls. Administrative controls include workplace policy, procedures, and practices that minimize the exposure of workers to risk conditions. Engineering controls are devices used to separate employees from workplace hazards and include items such as retractable needles, lab hoods, and sharps containers. Workplace controls are the means used to minimize or eliminate employee exposure and may be considered a type of administrative control. An example of a workplace control would be a procedure for handling hazardous chemicals.

Personal Protective Equipment (PPE)

OSHA requires the use of personal protective equipment (PPE) (shown in Figure 1) to reduce employee exposure to hazards when engineering and administrative controls are not effective in reducing these exposures. OSHA requires health care facilities to supply PPE to any worker that comes into contact with hazardous chemicals, blood, or other potentially infectious material (OPIM). Common PPE in a health care facility includes:

• Gloves

• Masks

• Goggles

• Gowns

• Foot Covers

• Plastic Shields

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Figure 1: Examples of PPE.

Safety Signs, Symbols and Labels

There are a variety of warning signs, symbols, and labels that are used to warn health care workers of potential hazards. Refer to Chapter 10, page 212, to learn about the biohazard label and pages 214-215 to learn about special labeling for chemicals.

Eyewash Stations and Emergency Showers

Eyewash stations are areas which allow quick flushing of eyes that become contaminated by harmful chemicals. These stations are required in any workplace in which there is a threat of chemical splashes. The American National Standards Institute (ANSI) recommends that flushing occur for a minimum of 15 minutes or more depending on the type and amount of chemical exposure; check the MSDS sheet for specific information. Eyewash stations can be connected to standard plumbing or come as a portable unit. Recommended temperatures for flushing eyes range between 16-38°C (60-100°F). Temperatures higher than 38°C (100°F) can be harmful to the eyes and may enhance chemical interaction with the skin and eyes. Long flushing times with cold water (less than 15.5°C (60°F) can cause hypothermia; additionally, it may result in not rinsing or showering for the full recommended time.

Emergency showers are also recommended in any establishment in which there is the threat of chemical exposure to other parts of the body. For more information about emergency showers, contact the American National Standards Institute.

Workplace Hazard Checklist

Medical offices are continually being assessed by the Joint Commission (JC), insurance companies, and a host of other governmental agencies. Inspectors from these organizations will conduct safety inspections during visits. Medical office personnel should be proactive by conducting their own hazard inspections to identify potential hazards before problems develop. Table 2 includes several categories of hazards that should be assessed on a continuous basis. For a complete listing of items that should be checked, review the checklist on OSHA’s Small Business Handbook, at Publications/smallbusiness/small-business.html.

Table 2: Types of Workplace Hazards

|Safety Hazards |Check for unsafe workplace conditions, unsafe work practices, inadequate safety devices, machine |

| |guards, needles with protective devices, etc. |

|Biological Hazards |Check to make certain that disinfection practices are adequately removing organisms such as viruses,|

| |bacteria, fungi and parasites. |

|Chemical Hazards |Check to determine the way that chemicals are being stored and used, ventilation requirements, |

| |whether there an up-to-date MSDS book on site; how chemicals are discarded (according to OSHA and |

| |EPA standards). |

|Ergonomic Hazards |Check to make certain that employees are performing procedures in a manner that would not cause |

| |anatomical or physiological damage due to poor lifting techniques or improperly-designed |

| |workstations. |

|Physical Hazards |Check to make certain that there are no physical hazards caused by loud noises, weather or |

| |electricity. |

|Radiation Hazards |Check to make certain that radiography equipment is working properly and that the equipment is being|

| |inspected on a regular basis. |

Protection Against Hazardous Chemicals

OSHA defines a hazardous chemical as, “one in which there is statistically significant evidence based on at least one study conducted in accordance with established scientific principles that acute or chronic health effects may occur. The term health hazard includes chemicals which are carcinogens, toxic or highly toxic agents, reproductive toxins, irritants, corrosives, sensitizers, hepatotoxins, nephrotoxins, neurotoxins, agents which act on the hematopoietic systems and agents which damage the lungs, skin, eyes, or mucous membranes.”

Health care workers must be diligent about protecting themselves from dangerous chemicals in the workplace. Chemicals must be stored and used in the proper manner in order to prevent exposure incidents. Exposure can occur through inhalation, injection or direct contact to the skin. Hazardous chemicals include acetone, formaldehyde, bleach, ethyl alcohol, lab reagents, bloodstains and fixatives.

Businesses that utilize hazardous chemicals should incorporate a chemical hygiene plan which identifies chemicals that are hazardous and initiate a standard operating plan for working with such chemicals. The plan should also list what to do when a chemical exposure occurs. Standards for a chemical hygiene plan should include:

• A listing of all hazards to employees.

• Compliance rules for exposure prevention. (This would include standard operating procedures for handling hazardous chemicals.)

• A material safety data sheet (MSDS) manual that includes MSDS forms for each chemical listed on the inventory form of hazardous chemicals.

• Standard operating procedure explaining what to do when an exposure occurs.

• Standard operating procedure for the proper disposal of chemical wastes.

• Proper labeling of any products that are potentially hazardous.

• Employee training within 30 days of the start of employment.

Each business should also have a chemical hygiene officer who oversees the chemical hygiene plan.

Material Safety Data Sheets

A MSDS Manual should be available to all employees that have the potential of coming into contact with hazardous chemicals. The MSDS form includes information about the chemical including the product’s ingredients, physical data, fire and explosive information, reactivity information, health hazards associated with the chemical, emergency and first aid procedures, spill or leak procedures, and protective measures that should be taken when working with the chemical. Refer to Figure 10-18 in the text for a sample of an MSDS form.

MSDS forms are usually shipped with hazardous chemicals; if not, the forms are usually available online. Each new form should be placed in the MSDS manual upon arrival of the shipment or after retrieving online.

Rules to Follow When Handling Hazardous Chemicals

To avoid injury or illness from a hazardous chemical, follow these rules when working with hazardous chemicals.

Rules to Follow when Working with Hazardous Chemicals:

• Read the MSDS form before working or handling any chemical.

• Use appropriate PPE when handling hazardous chemicals.

• Be sure that each chemical has an appropriate label that identifies the container’s contents and required safety labeling.

• Dispose of chemicals in the right manner. Never pour any chemical down the drain or in the trash without checking instructions for proper disposal.

• Keep lids closed on chemicals when not in use.

• Make sure chemicals are stored and transported according to manufacturer’s instructions.

• Use ventilation devices when working with chemicals that can cause damage to the respiratory tract.

• Always know exactly where eyewash stations are and fire extinguishers in the event a chemical splashes or sparks a fire.

Hazardous Material Disposal

Pouring hazardous chemicals down the drain or toilet or into lakes, rivers or streams is against the law and may cause great harm to the environment. The Environmental Protection Agency (EPA) states that a waste is hazardous if it has one or more of the following characteristics in Table 3.

Table 3: Hazardous Waste

|Waste is considered hazardous, if it: |

|Contains any of several hundred chemicals specifically | |

|listed by EPA as toxic or acutely toxic. | |

|Contains any of several hundred chemicals specifically |For example, EPA lists a number of spent solvents as hazardous waste. |

|listed by EPA as toxic or acutely toxic. | |

|Results from a process listed by EPA as generating | |

|hazardous waste. | |

|Is corrosive. |Can burn the eyes or skin or body tissue on contact. Corrosives may also |

| |wear away standard containers. |

|Is ignitable. |Can catch fire or explode easily when exposed to heat or a spark. |

|Is reactive. |Can catch fire, explode, or give off dangerous vapors if it comes in contact|

| |with air, water, or certain other substances. |

|Is toxic (poisonous). |Can cause illness. Some substances are toxic if inhaled, some if they get on|

| |the skin, and some if they're swallowed. Some substances may be toxic on the|

| |first exposure; others cause health problems as a result of repeated |

| |exposures. Sometimes the effects show up immediately—for instance, nausea or|

| |rash; other health problems may not show up for years. Often these long-term|

| |effects are very serious—for example, organ damage, cancer or even death. |

There are a variety of ways to safely dispose of hazardous waste, including:

• Incineration: Burning with a special incinerator. This incinerator gets much hotter than incinerators used for regular trash.

• Special Landfills for Hazardous Substances: These landfills have special linings that keep hazardous substances from leaking out into the soil.

• Recycling: Not always possible, but you can check to see if the chemical is recyclable prior to disposal.

• Hazardous Waste Removal: The waste can be removed by a waste management company certified in the removal of hazardous wastes.

Biological waste is another type of waste that needs to be properly disposed. Biological waste is any material that contains or has been contaminated by a biohazardous agent. Biological waste includes (but is not limited to) needles, syringes, specimen containers, blood vials, pipettes, petri dishes, absorbent materials such as gauze containing blood or other OPIM, and contaminated PPE. Refer to Chapter 10 in your text regarding the Bloodborne Pathogen Standard and exposure and determination plans for biological wastes.

What to Do When There is a Chemical or Biological Spill

The best defense for a chemical or biological spill is prevention; however, if a spill does occur, follow the instructions on the MSDS form for handling chemical spills. Follow office protocol for handling biological spills. Each health care facility should include spill kits and absorbents to clean up such spills. In most cases, chemical and biological exposures to the eyes will require several minutes of flushing at the eyewash station. Treat chemical skin exposures according to the directions on the MSDS forms. Biological exposures to any skin surface (open or closed) should be thoroughly washed with soap and water. Counseling should take place following any exposure in regards to the need for prophylactic or medical treatment. Affected employees will also need to complete the appropriate OSHA forms. Both the affected employee and supervisor will need to determine why the incident occurred and discuss ways to prevent the incident from occurring in the future.

Developing Your Commitment to Safety

Employers go through a great deal to keep employees safe; however, employees need to do their part as well. A safety device only works when used and gloves only protect when they are applied. It is easy to fall into a complacent mindset upon entering the industry—taking shortcuts and acquiring other people’s poor work habits. Commit now to take safety seriously by following all safety precautions and regularly practicing what to do in an exposure event. The following points are a list of guidelines that can assist with environmental safety.

Environmental Safety Guidelines:

• Learn the hazards of each job you perform and follow safety protocol including the use of administrative, engineering, and workplace controls when working with hazards.

• Maintain a safe work environment. Never compromise on safety by taking shortcuts!

• Identify workplace hazards by periodically conducting your own walkthrough of the areas in which you work. Look for physical and chemical hazards such as obstructed walkways, frayed electrical cords, chemicals not stored correctly, and overfilled sharp’s containers.

• Report potential hazards to your supervisor right away unless the hazard can be easily remedied by you.

• Participate as needed in exposure hazards measurement programs.

Fire Safety

Fires can strike any facility at anytime, including medical establishments. Medical assistants must familiarize themselves with ways to prevent fire. The following tips will assist you with fire prevention and safety.

Fire Prevention and Safety Guidelines:

• Properly store any items that are combustible (such as solvents, cleaning agents, and fuels) by following the instructions on the label.

• Smoking should be prohibited throughout the workplace.

• Frequently check cords on electrical equipment and report any that are frayed or plugs that are bent.

• Only use power strips with surge protectors.

• Report any chemical odors that are abnormal.

• Attend a fire prevention safety course within your organization.

• Know where fire extinguishers are located and learn how to use them.

• Be familiar with all emergency egress plans in your working area.

• Keep emergency equipment and exit paths clear and free of obstructions at all times.

• Report fires immediately, sound the alarm, evacuate the buildings, and use fire extinguishers only if appropriate.

Fire Extinguishers

There are four basic kinds of fire extinguishers, each designed to handle specific types of fire. On the label of each fire extinguisher, there is also a numerical rating which determines the extinguishing potential for each size and type of extinguisher. The number is an indication of the extinguisher's size, or firefighting, effectiveness; see Table 4.

Table 4: Classes of Fire Extinguishers

|Type of Extinguisher |What it Extinguishes |Label Information |Numerical Listing |

|Class A |Ordinary combustibles such as paper|Older labels have a green triangle |The numerical listing refers to the |

| |and wood. |with the letter A in the center of the|amount of water the extinguisher |

| | |triangle. |holds and the size of fire it will |

| | |Newer labels have a picture of a trash|extinguish. |

| | |can on fire. | |

|Class B |Flammable liquids such as grease, |Older labels have a red square with a |The numerical listing refers to the |

| |oil and gas. |B on the label. |approximate number of square feet of|

| | |Newer labels should a gas can with a |a flammable liquid that can be |

| | |flame around it. |extinguished by a non-expert. |

|Class C |Should only be used on electrical |Older labels have a blue circle with a|Does not have a numerical rating. |

| |energized fires. |C in the center of the label. | |

| | |Newer labels illustrate a plug and | |

| | |electrical outlet on fire. | |

|Class D |Used on flammable metals specified |Older labels have a yellow star with |Does not have a numerical rating. |

| |on the label. |the letter D in the center. | |

| | |There is no picture on the new labels.| |

|Multiple Class Ratings|Depending on the class on the |Older labels will have the |Does not have a numerical rating. |

| |label. |combinations of the triangle, square, | |

| |Different types; the letter on the |or circle with the single letters ABC | |

| |label illustrate which type of fire|on each shape depending on the type of| |

| |it will extinguish. |extinguisher. | |

| |A-B; B-C or A-B-C. |Newer labels will have pictures of | |

| |Not suitable for class D fires. |what it extinguishers in a horizontal | |

| | |line. | |

Types of Extinguishers

Each fire extinguisher will be filled with a particular chemical:

• Dry chemicals (usually rated for multiple purpose use);

• Halon gas (used on electrical equipment);

• Water (only used on class A fires);

• Carbon Dioxide (only used on class B and C fires).

Inspection of the Fire Extinguisher

Fire extinguishers should be checked at least once a month. The following items should be checked when performing monthly inspections:

• The path to the extinguisher is completely clear; there are no obstacles interfering with access.

• The needle on extinguishers with gauges should be in the green zone.

• The nozzle or other parts of the extinguisher has not been tampered with.

• The tamper seal and pin are intact (if applicable).

• The extinguisher is free of dents, rust, chemical deposits, or other corrosives.

Some manufacturers recommend shaking any extinguishers that have a dry chemical. This will help prevent the chemical from settling in the bottom of the canister. Extinguishers should be pressure tested (a process called hydrostatic testing) after a number of years to ensure that the cylinder is safe to use. Consult the owner's manual, extinguisher label or the manufacturer to determine how often this type of maintenance needs to be performed. Maintenance testing may be performed by the fire department or by members of the safety team. If an extinguisher is damaged in any way or needs charged it should be removed and replaced until it is back in service.

Extinguishing the Fire

A procedure for responding to a fire is included in the emergency preparedness handout. The following is a reminder of how to use a fire extinguisher.

1. Only extinguish the fire if it is contained and manageable.

2. Use the PASS mnemonic when operating a fire extinguisher:

• Pull the pin (with the nozzle pointing away from you);

• Aim low (at the base of the fire);

• Squeeze the trigger (with a slow, even motion);

• Sweep the nozzle side-to-side across the area.

Never turn your back on a fire. If fire becomes unmanageable, back out of the area and exit the building immediately.

Ergonomics & Body Mechanics

Musculoskeletal disorders are the most common type of injuries that occur in the workplace. This is often the result of poor posturing and improper lifting. Ergonomics is a field that studies the body in different work environments and designs solutions to reduce injury and make the work environment healthier and safer. An ergonomist studies human capabilities in relationship to work demands. Ergonomists may look at the way individuals operate at home and in the car as well as the workplace.

Instituting proper body mechanics is essential to maintaining a healthy work environment. Body mechanics is the way that individuals use their bodies when sitting, standing, lifting, bending and working. An ergonomist will study the way workers sit at their computers, operate the mouse, hold the phone and write. Lifting techniques will be observed as well as the posture used when performing particular procedures.

The following are some tips that will assist you in preventing injury while at work, home or in the car.

Guidelines for Preventing Injury:

• Engage in regular exercise that helps to maintain muscle flexibility and strength.

• Change postures or positions throughout the day. When repetitive movements are necessary, take a five minute break each hour to rest the joints and muscles that are continuously being worked.

• When sitting at your desk, sit straight up. Your back should be straight and your head should be well above your shoulders. Feet should be flat on the ground. When legs are too short a foot rest should be used. There should be no slouching while sitting. Chairs should have built in lumbar support to promote the natural alignment of the lower back. The top of your monitor's screen should be about even or slightly lower than eye level. The key board should be positioned so that it tilts backward to prevent wrists from reaching upward. Hands should be kept in alignment with forearms.

• Keep work items such as keyboards, telephones and files close to your body to avoid excessive reaching.

• Use larger muscle groups when greater force is necessary such as lifting, pulling and pushing.

• A primary key to a healthy back is maintaining the spine in normal balance. The lower back should be slightly arched when sitting or standing. This is commonly referred to as the “power position.”

• Use a three point stance when lifting heavy items (similar to the stance that a football player uses at the line of scrimmage). This can be accomplished by bending your knees and hips instead of your waist; your buttocks should be pointed outward and your head and chest should face upward. This position is commonly referred to as the “power lift.” Always get as close as possible to the item being lifted to avoid reaching injuries.

• Use gait belts when lifting patients and get assistance when the patient is too large to handle.

Medical assistants should make ergonomics part of the standard checklist when looking for hazards in the workplace. Some offices invest in equipment that assist in good body mechanics such as ergonomically correct keyboards, desk chairs and head sets. It is far easier and less expensive to prevent injuries than to treat an injury caused by poor body mechanics.

© 2010 Delmar Cengage Learning. All rights reserved.

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