This document summarizes an ergonomic evaluation of a sterile processing department. It includes an agenda, background on work-related musculoskeletal disorders and injury rates in healthcare, an overview of ergonomic assessment tools like RULA, REBA, and NIOSH Lifting Equation. The document then describes job tasks analyzed like storage, processing, and cart washing. Assessment results for specific tasks show risk levels from medium to very high. Recommendations include changes to workstations, adjustable cart heights, and proper lifting techniques to reduce ergonomic risks.

1. Ergonomic Evaluation -
Sterile Process Department
Instructor: Dr. Sang Choi, Ph.D., CSP, CPE
Presented By: Eric Brown
Philip Porter
Nick Bradley
Omari Taylor
Sam Stauber
Gary Young

2. Agenda
 Introduction & Background
 Work-Related Musculoskeletal Disorders
 Ergonomic Assessment Techniques/Tools
 Methods – Job Task Analysis
 Recommendations

3. Introduction & Background
Injury and Illness Rates – (DOL, 2010)
- Healthcare industry had higher rates of injury and illness than
manufacturing.
- Healthcare industry had the highest rates of work-related
musculoskeletal disorders of all occupations.
- Work-related musculoskeletal disorders (MSDs) account for
over 600,000 injuries and illness in the U.S (OSHA, 2013).

4. Work-Related Musculoskeletal Disorders
 Bursitis (joints/ shoulder)
 Carpal Tunnel Syndrome
 Cubital Tunnel Syndrome
 DeQuervain’s Disease
 Dry Eye Syndrome
 Lumbosacral (strain/sprain)
 Sciatica (lower back/ legs)
 Tendonitis (joints, elbow, wrist)
 Tension Neck Syndrome

5. Risk Factors for Work-Related MSDs
 AWKWARD POSTURES
 FREQUENT REPETITIVE MOTIONS
 HEAVY AND AWKWARD LIFTING
 FORCE AND PRESSURE
 CONTACT STRESS

6. Why Does Ergonomics Matter?
 1/3 of all workers’ comp. costs are associated with MSDs
 Employer’s spend over $20 billion annually on direct
costs and five times that amount on indirect costs
(hiring & training replacement workers).
 Cost to an organization:
 Workers’ compensation
 Medical Bills
 Lost revenue
 Employee morale

7. Essential Job Functions:
 Reprocesses all instruments
and equipment for the
organization
 Picks case carts and supports
the daily operations of the
surgery department.
 Maintains and orders inventory
to adequate par levels.
Work Tasks
Sterile Reprocessing Technician

8. Ergonomic Assessment Techniques
OBJECTIVE:
 RULA- Rapid Upper Limb Assessment
 REBA – Rapid Entire Body Assessment
 JSI - Job Strain Index
 NIOSH Lifting Equation
SUBJECTIVE:
 Body Mapping
 Informal Interviews

9. Rapid Upper Limb Assessment (RULA)
 Developed by Dr. Corlett and Dr. McAtamney in 1993
 Survey method developed focusing on ergonomic
investigation of the workplace.
 RULA is a screening tool that measures biomechanical and
postural loading on the whole body with specific
consideration to the neck, trunk and upper limbs.
 RULA is an ergonomic technique that evaluates an
individuals’ exposure to postures, forces and muscle activities
that can contribute to WMSDs.

10. Scoring Classifications
Action Level 1 (1 or 2)
Posture is acceptable if it is not maintained or repeated for long
periods of time
Action Level 2 (3 or 4)
Further investigation is needed and changes may be required
Action Level 3 (5 or 6)
Further investigation and changes may be required soon
Action Level 4 (7)
Indicates that investigation and changes are required immediately
Rapid Upper Limb Assessment (RULA)

11. RULA Assessment Worksheet

12.  Developed by Dr. Hignett and McAtamney in 2000.
 Useful in assessing unpredictable working postures found in
the health care and service industries.
 Data is collected to assess:
 Body Posture
 Forces used
 Types of movements or action
 Repetition
 Coupling
Rapid Upper Body Assessment (REBA)

13. Rapid Upper Body Assessment (REBA)
Focuses on the wrists, forearms, elbows, neck, trunk, back, legs and knees.

14. Rapid Upper Body Assessment (REBA)
Scoring Classification
Final Score:
1: the risk level is ‘negligible’ and no action is considered necessary
(Action Level =0 )
2-3: ‘low’ and further action may be needed if it is indicated by other information
(Action Level = 1)
4-7: ‘medium’ and further action is considered to be ‘necessary’
(Action Level =2)
8-10: ‘high’ and further action is considered to be necessary soon
(Action Level = 3)
11-15: ‘very high’ and further action is considered to be necessary now
(Action Level = 4)

15. NIOSH Lifting Equation
 Improper lifting techniques can lead to MSDs with special
regard to low back pain.
 The NIOSH lifting equation was revised in 1993 – it is
used to evaluate the physical demands of Manual
Materials Handling (MMH)
 The equation breaks down several variables of a task into
an quantitative equation and by using a formula we can
determine the risk of the task

16. Data Collection and Analysis
 The two final variables are the RWL and LI which is used
to determine the level of risk associated with the task
 The formula for the NIOSH lifting equation is:
 LC x HM x VM x DM x AM x FM x CM = RWL
 After this we determine the Lifting Index (LI) by Dividing
the RWL by the Weight of the object being lifted:
Weight/RWL = LI

17. Data Collection
 LC – is always 51 pounds
 HM – Horizontal Location
 VM – Vertical distance
 DM – The vertical travel
 AM – Asymmetric Angle
 CM – Coupling (handles)
 FM – Frequency measure

18. Job Strain Index
 Moore & Garg (1995) published in American Industrial
Hygiene Association Journal
 Job Strain Index (JSI) is a means to assess jobs for risk
factors for work-related musculoskeletal disorders (MSDs)
of upper extremities:
 Hands
 Wrists
 Elbow
 Forearm
 Divide the job into tasks –
For each task and for each hand, you must assess the six job
risk factors by assigning it to a category.

19. Job Strain Index Elements
 Intensity of exertions (force)
 Duration of Exertion (% cycle)
 Efforts per minute
 Hand/wrist posture
 Speed of work
 Duration of task per day (hours)

20. BodyMap Assessment
What is a Body Map Assessment?
 An aid in assessing potential ergonomic concerns or “leading indicators”
for musculoskeletal disorder risk.
 By comparing the different symptoms of members working in the same
department or performing the same task you can identify trends.
 Cluster of common problems and their causes (area of causes).
 Gives employees an understanding of shared risk factors.
 Provides anonymity and gives the workforce a voice/involvement.
 Can be used to identify and help to develop practical solutions.

21. BodyMap Assessment Form
25 points of interest with a subjective score

22. BodyMap Score Sheet
DLFQ 0 1 2 3
0
1
2
3
4
5
6
7
8
9
10
”Green” zone: not likely to seek treatment
“Yellow” zone: somewhat likely to seek treatment
“Red” zone: very likely to seek treatment
Infeasible zone (no recording)

23. RULA:
STORAGE
PROCESSING

24. Right Side = 7
Very High Risk Change Now
RULA

25. 5
1
2
1
5
0
0
5
4
1
1
5
0
0
56
Storage #1

26. RULA SCORE = 5
Medium Risk Further
Investigation, Change Soon
RAPID UPPER BODY ASSESSMNENT

27. 5
1
1
1
5
0
1
6
2
3
4
0
1
1
56
Task #2

28. RULA SCORE = 4
RAPID UPPER BODY ASSESSMENT

29. 4
3
1
1
4
0
0
4
2
3
4
1
0
44
0
Task #3

30. Cart Wash and Drying
REBA ASSESSMENT #1

32. REBA Assessment #2

34. Genesis Tool Set: Storage
 Manual handling of Genesis tool set
 Weighs roughly 25 lbs.
 Removed from shelving units of various heights
 Placed onto cart for transportation

36. NIOSH Lifting Equation
56”
22”
32”

37. NIOSH Lifting Equation
LC x HM x VM x DM x AM x FM x CM = RWL

38. Results
 Based upon the results:
 The weight at the origin is acceptable
 The weight at the destination creates the potential for
WMSDs
 One of the major issues with the destination RWL is that
the horizontal multiplier (H) is low
 The cause of this is the extension of the arms necessary to
load the Genesis unit onto the cart (when the cart is to the
worker’s side).
 By directly facing the cart while loading the worker can
avoid this extension.
 The result will be less distance between the load and the
body and a higher H value.

39. REBA: Loading onto Cart
 REBA was conducted for both the removal of the carts
from storage and for placement onto carts

40. 9 = High risk, investigate and implement change

41. REBA:
SHELF LIFT

42. 5: Medium risk, further investigation, change soon

43. Recommendations
REBA SHELF LIFT
 Hazard may increase when units are taken from
higher shelves
 Carts with adjustable heights may solve the problem
 Employee could slide the unit onto the cart, eliminating the lift
almost entirely
 Adjustable carts may not meet the requirement of equipment
in the sterile processing operation; could also result in
increased washing times

44. Basin Wrapping Task

45. RULA Basin Wrapping Task
Final Score of 6: Further investigation, changes may be needed.

46. Peel Packing

47. RULA Peel Packing
Final Score of 6: Further investigation, changes may be needed.

48.  Basin Wrapping Task
 Improve workstation by bringing peel packing device
closer to the worker to reduce reach and wrist strain.
 Peel Packing
 Raise workstation tables to reduce reaching strain for
basin wrapping.
Recommendations from RULA

49. Lifting a Genesis Box

50. Lifting a Genesis Box
 The task in question is the lifting of a surgical basin onto
the top shelf of a cart
 This task can by performed up to 24 times in a shift
 The table is 36 inches high and the top of the cart is 52
inches off the ground

51. Multipliers
Multiplier
Load Constant LC
Horizontal Multiplier HM (10/H)
Vertical Multiplier VM 1-(.0075|V-30|)
Distance Multiplier DM .82 + (1.8/D)
Asymmetric Multiplier AM 1-(.0032A)
Frequency Multiplier FM From Table
Coupling Multiplier CM From Table

52. Frequency Table
<_ 1 hour > 1 < 2 hours > 2 < 8 hours
Frequency lifts/min (F) V < 30+ V > 30 V < 30 V > 30 V < 30 V > 30
<_ 0.2 1 1 0.95 0.95 0.85 0.85
0.5 0.97 0.97 0.92 0.92 0.81 0.81
1 0.94 0.94 0.88 0.88 0.75 0.75
2 0.91 0.91 0.84 0.84 0.65 0.65
3 0.88 0.88 0.79 0.79 0.55 0.55
4 0.84 0.84 0.72 0.72 0.45 0.45
5 0.8 0.8 0.6 0.6 0.35 0.35
6 0.75 0.75 0.5 0.5 0.27 0.27
7 0.7 0.7 0.42 0.42 0.22 0.22
8 0.6 0.6 0.35 0.35 0.18 0.18
9 0.52 0.52 0.3 0.3 0 0.15
10 0.45 0.45 0.26 0.26 0 0.13
11 0.41 0.41 0 0.23 0 0
12 0.37 0.37 0 0.23 0 0
13 0 0.34 0 0 0 0
14 0 0.31 0 0 0 0
15 0 0.28 0 0 0 0
>15 0 0 0 0 0 0

53. Coupling Table
Coupling Multiplier
Coupling type V < 30 inches V > 30 inches
Good 1 1
Fair 0.95 1
Poor 0.9 0.9

54. Results
Origin Destination
Measurement Multiplier Measurement Multiplier
Load (L) pounds 23 lbs 23 lbs
Load Constant (pounds) 51 lbs 51 51 lbs 51
Horizontal Location (HM) inches 12 inches 0.83 16 inches 0.625
Vertical Location (VM) (inches) 38 inches 0.94 56 inches 0.805
Vertical Distance Travel (Vo - Vd) 18 inches 0.92 18 inches 0.92
Asymmetry Angle (A) (degrees) 90 degrees 0.712 90 degrees 0.712
Lifting Duration (hours) 8 hours 8 hours
Lifting Frequency (F) (lifts/minute) 0.05 0.85 0.05 0.85
Coupling (CM) Fair .95 Fair .95
RWL 21.04 13.57
LI 1.09 1.69

55. Results
 According to this study the task of lifting a genesis box
onto the top of cart.
 The origin of the lift is 1.09 which is very close to be
acceptable
 The destination of the lift is 1.69 which makes it an
increased risk for MSDs.
Recommendations
 The genesis box should not be placed on the top shelf.
Only the bottom and second highest shelf.
 The handles should be replaced to ones that are a little
sturdier.

56. Peel Packing

57. JSI - Peel Packing

59. Somewhat
Hard
2
3
37%
3
1.5
>4
1
0.5
Fair
3
1.5
Fast
1.5
4
<1
.25
1
JSI = 3 X 1.5 X 0.5 X 1.5 X 1.5 X .25
JSI =1.27

60. Job Strain Index
 Strain Index (SI) =
(Intensity of Exertion) x (Duration of Exertion) x (Exertions
per Minute) x (Posture) x (Speed of Work) x (Duration per Day
Multiplier).
 Decision Threshold:
 SI <3 = Safe
 SI between 3 and 5 = Uncertain
 SI between 5 and 7 = Some Risk
 SI >7 = Hazardous

61. BodyMap Assessment Form
25 points of interest with a subjective score

62. Subject #1
DLFQ 0 1 2 3
0
1
2
3 LW, RW
4
N, LF, RS, RF,
MLB
5 LH, RH
6 LF/A, RF/A
7
8
9
10

63. Subject #2
DLFQ 0 1 2 3
0
1
2
3 MLB UB
4
RF, RW, RH,
RLL
5 RS,RUA, RK
6 RF/A
7 RE
8
9
10

64. Subject #3
DLFQ 0 1 2 3
0
1
2 N
3 E, LW, RW
4 RH, RF/A
5 LH
6 LF/A, UB
7 MLB
8
9
10

65. Subject #4
DLFQ 0 1 2 3
0
1
2
3 LK
4 LS
5 LT MLB, RF/A
6
7
8
9
10

66. Subject #5
DLFQ 0 1 2 3
0
1
2
3 LS, LF/A, RLL
4
LW, UB, RW,
MLB LH, RH, RF/A
5 LK
6
7
8
9
10

67. Subject #6
DLFQ 0 1 2 3
0
1
2
3
4
5 MLB, RK RT
6
7
8
9
10

68. Group BodyMap Results

69. Recommendations:
Short term
• ERGO STEP STOOL
• Weight capacity of 500 lbs.
• Anti-skid feet will keep if
firmly planted
• Interlocking feature creates a
safe work platform
• Distinctive in it bright orange
color and easily recognizable
• Price: Around $50-$150

70. Recommendations:
Long term
• High density storage
• Ease of findingpicking
location of equipment
• Less injuries due to improved
ergonomics
• Elimination of manual counting
results in improved inventory
accuracy
• Increased staff efficiency

71. Recommendations
 Elevate work station
 Using a table
 Different nozzle for hose
 One handed nozzle
 Different kind of cart
 One that has doors instead
of folded
 Lean cart against the wall
$85
$30
$2,282

72. Long Term Solution
 Cart wash
About $250,000

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