Ergonomics for SonographersAn owner’s manual

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Ergonomic Guidelines for SonographersCHECKLIST

Managing Work Injury Prevention in Sonography

The Importance of Ergonomics in Diagnostic Ultrasound

Setting up the Ergonomic Work Station

Sonographer Work Related Injuries

The Economics of Ergonomics for Sonography

The Importance of Exercise and Fitness In the Prevention of WRMSDs

Reducing Muscle Fatigue & Load Through Postural Changes

Making it Ergonomically Right with What You Have

Taking Responsibility for How you Practice

Reducing Your Risk of Occupational Injury

Happy, happy, joy, joy!!

ErgonomicsYou’re doing it wrong.

Fuzzy wrong.

The injury risk factors impacted by chair selection are…› Increased spinal pressure› Unsupported feet› Decreased circulation of lower extremities

The study of ergonomics involves adapting the work environment to the worker, NOT adapting the worker to the work environment.

Data collected from around the world shows that over 80% of sonographers have some degree of pain or injury related to their work as a sonographer. Of these individuals, 20 percent have sustained a career-ending injury.

Sonographers at the highest risk for developing MSD (musculoskeletal Disease) are those who perform the same type of exams during the work day.

Engineering controls:› The name for ergonomic controls that

remove or reduce the presence of risk factors in the work place.

Once your patient is lying on the exam table, ask her to move toward you and close to the edge of the table. Adjust the height of the table and chair so that your forearm is PARALLE to the floor when your elbow is bent at a 90-degree angle.

Cardiac sonographers…beware!!

Symptoms of MSD can occur after months or years of overuse and have been staged according to the reversibility and outcome of the symptoms.

There are Three stages of pain: Stage 1, Stage 2, and Stage 3.

Aching, fatigue and weakness, as well as pain, describes Stage 1.

Specific disorders of MSD common among sonographers are:› Tendonitis› Thoracic outlet syndrome› De Quervain’s Syndrome

Tendonitis of the sheath that surrounds the two tendons that control movement of the thumb.

The cost to the employer of WRMSD (work-related musculoskeletal disorder) is significant. Of all the costs associated with WRMSD, Worker’s Compensation is the most costly.

Other costs-Replacement staff…

It takes more than one… Employers, Sonographers, and

Equipment Manufactures can contribute to a reduction in WRMSD in Sonography.

Treatment for WRMSD has a poor outcome because sonographers return to the same injury-producing environment*.

*without modification.

In addition, many leisure activities can cause MSD:› Gardening› Knitting› Playing the violin› Texting?HINT: What to be published in the JDMS?Run a study on texting and how it

relates/does not relate to MSD. GET A GRANT TO FUND THIS STUDY!!

Add-on patients are best accommodated during lunch breaks so that the workday does not exceed 8 hours.

NOT!!! Give yourself a chance to rest.

The term “ergonomics” was created by W. Jastrezebowski in the 1800’s.

The International Ergonomics Association defines ergonomics as follows:

“Ergonomics is the scientific discipline concerned with the understanding of interactions among humans and other elements of a system, and the profession that applies theory, principles, data and methods to design in order to optimize human well-being and overall system performance.”

The SDMS (Society of Diagnostic Medical Sonography) has sponsored several activities that addresses ergonomics:

› Sonographer Benchmark Survey› The 1997 sonographer survey by the

Healthcare Benefit Trust of British Columbia

› The consensus conference in May of 2003

The phases of ergonomic intervention in the workplace include:

› Analysis of the worker’s job tasks› Proposing possible solutions to mitigate

worker injury› Regular evaluation of the effectiveness of

solutions

The OSHA (Occupational Safety and Health Administration) regulation that addresses Sonography work environments is the General Duty Clause.

› “Each employer shall furnish to each of his employees employment and a place of employment which are free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees.”

Changing a Sonographer’s work schedule is an example of an Administrative control measure.

Ergonomic training is an example of a control measure called SONOGRAPHER SOLUTIONS.

Best practices for sonographers:

› Adjusting chairs & exam tables› Positioning patient close to worker› Supporting scanning arm› Performing regular stretching exercises

› STUDENTS!!! SEE NEXT SLIDE

A key factor that contributes to a worker’s risk for MSDs is STRESS.

Factors that may reduce a worker’s risk for MSDs are:› Stretching› Employer support› Relaxation

Excessive trunk bending and twisting can be prevented by

› Moving the patient close to the worker

› Adjusting the exam table height

The ideal maximum angle of arm abduction for the majority of work tasks is 30 degrees.

Prolonged sitting results in Muscle shortening.

Extreme and prolonged arm abduction is injury producing because:

It decreases circulation to the shoulder joint.

When sitting for prolonged periods of time, movement is important for› Maintaining hip flexibility› Strengthening back muscles› Strengthening abdominal muscles

Studies measuring force exerted by sonographers during an exam show that force can be as high as 40 lbs.

One way to reduced risk for injury resulting from bedside exams is to perform exams portably only when absolutely necessary.

A more comfortable position for the Sonographer's scanning arm during endovaginal exams is with forearm below shoulder level

Resting your non-scanning arm on the ultrasound system:

Results in pressure on the carpal tunnel

Exam gloves can contribute to injury risk unless:› They fit properly› They have textured finger

The most injury producing method of gripping the transducer is the Pinch grip.

An example of the indirect costs associated with worker injury is the cost of hiring replacement staff.

Examples of the direct costs associated with worker injury are:› Cost for rotator cuff surgery› Worker’s Compensation insurance

The main goal of ergonomics is to increase productivity.

The ergonomic benefit of retractable side rails on the exam table is to:

› Reduce the distance between the sonographer & the patient.

An important dietary component for maintaining muscle tone is Vitamin B

Upper body stability can be achieved by good foot support.

Collectively, MSDs (or MSIs: Musculoskeletal Injuries) are defined as Injuries caused by work activities.

The economic impact of worker injury is› Loss of experienced workers› Loss of productivity› Personal financial hardship

Exercise helps mitigate injury by developing the muscles that support neutral postures

Tendon injuries have an impact on the surrounding muscles.

The Muscle must compensate by providing increased support for the joint, which can lead to further injury.

Musculoskeletal pain can be caused by damage to:› Bones and joints, › Muscles, and tendons, › Ligaments, nerves and bursae

Keep on the lookout…

Early symptoms of WRMSK may occur at night causing disruption of sleep

The components of the ultrasound work station are:› Ancillary equipment› Personal adaptive equipment › Ultrasound system

Get this table…not!! Too Expensive…

Cushions for forearm support, cable brace are considered to be adaptive equipment.

The following features are essential for an ergonomic multipurpose ultrasound table:› Electrically height adjustment› retractable side rails› stirrups› brakes

The major four sites of injury for the Sonographer are:› Shoulder,› neck› wrist› Upper back

The most ergonomic work station would have the following:

Table height adjustable from 22-38 inches,

Chair height adjustable from 17-38 inches.

Ultrasound system with monitor separately adjustable from the control panel.

Muscle activity be reduced by supporting the forearm on cushions or towels by as much as 78%.

Question: “How many scans is it ‘safe’ to do per day?”

Answer: “It is not how many exams you can do, but how you scan that reduces your risk.”