bringing health to work

8/14/2019 Bringing Health to Work

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Bring ing hea lth to work

a wo rkshop b y Ca nad ian Centre for Oc c upa tional Hea lth a nd Safety In association with www .Tha ilandHotelier.c om

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Hea lthy Employe es + Hea lthy Orga niza tions = Hea lthy Workp lac es

There is a strong c onnec tion b etw ee n the hea lth and we ll b eing of peo p le a ndtheir work environments. When people feel valued, respected and satisfied intheir jobs and work in safe, healthy environments, they are more likely to bemore productive and committed to their work. When the workplace is unsafe,stressful or unhealthy, ultimately both the organization and the employees arehurt. Everyone c a n be nefit from a hea lthy workplac e.

The goa l of this workshop is to ma ke informa tion, to ols and resource s ea silyavailable that will help employees, employers and practitioners participate inma king their wo rkplac es hea lthy and sa fe.

Bringing Health to Work ...helping all to thrive and benefit - employees,em p loye rs, fam ilies, co mmunities and gove rnme nts.



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Cook

What does a c ook d o?

The m a in dut ies of c oo ks in resta urant s, hote ls, hea lthca re fa c ilities and sc ho ols includ e t hefollowing:

Plan and prepa re m enus, and de termine food po rtions and qua ntities need ed . Pa y atte ntion to spe c ia l dieta ry need s, if ap plic ab le. Mo nitor and orde r sup plies. Clea n up kitc hen or wo rk area . Sup ervise kitc hen sta ff.

Wha t are som e he alth and safety issues for coo ks?

Working with foo d presents its ow n unique set of p ote ntial haza rd s. Som e of t he ma in o nes a re:

Hand ling raw m ea t and po ultry. Exposure to c leaning prod uc ts, pe st c ontrol prod uc ts, or other c hem ica ls. Working in aw kwa rd po sitions or pe rforming rep et itive ma nua l ta sks. (Ap p end ix 1) Lifting or c a rrying he avy trays. (Ap p end ix 2) Risk of ac c id enta l ra d ia tion lea ks from mic row a ve ov ens. (App end ix 3) Working in extreme te mp eratures. (App end ix 4) Working with knives, mince rs, and othe r da nge rous too ls or eq uipme nt. Risk of b urns or fire from ovens, de ep -fat fryers, and ste am from pot s. Slip s, trips a nd fa lls. Ap p en d ix 5) Stre ss. (Ap p end ix 6) Working alone . (App end ix 7)

What a re som e p reventive m ea sures for coo ks?

Wash hand s freq uently. (App end ix 8) Lea rn sa fe lifting t ec hnique s. Know how to w ork with all eq uipme nt a nd t oo ls req uired for the job . Wear a p p rop riate pe rsona l protec tive eq uip me nt, inc luding sa fety shoe s with non-skid

soles, and eye p rote c tion. Know how to rep ort haza rd s. (Ap pe nd ix 9)

What are som e go od g eneral safe work prac tices?

Pra c tice sa fe lifting tec hniques. (App end ix 2) Exerc ise c aut ion w hen w orking with knives a nd othe r sha rp eq uip me nt. Use, maintain and store personal protective equipment according to manufacturers'

recommendations. Follow company safety rules. Follow g oo d housekee ping p roc ed ures. (App end ix 10) Rea d the ma terial sa fety d at a shee t (MSDS) for any ha za rdo us p rod uc t tha t you use a nd

follow rec omm end ed safety p rec autions.



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Food and Beve rage servers

What d oe s a server do?

The duties of servers, ta b le w a it sta ff, hoste sses, "bus-bo ys," and ot he r foo d and hosp italityp ersonne l va ry ac c ording to the w orkp lac e. The fo llow ing is a ge neral summ a ry of d utiesthese p eop le ha ve in c ommo n:

Greet customers. Ta ke orde rs an d relay the m to kitc hen a nd b ar sta ff. Pay at tention to c ustom ers' sp ec ia l menu an d d ieta ry nee d s or restric tions, when

applicable. Serve foo d or d rinks to c ustome rs. Clea n up ta b les or kitc hen.

What a re som e he alth a nd safe ty issues of servers?

Work environm ents suc h a s resta ura nts, hote ls and b a rs, whe re foo d an d be verag es a reserved , present a unique set o f ha za rds.

The m a in hea lth and sa fet y issues fo r serve rs inc lude:

Conta ct with raw mea t or poultry. Exposure to c leaning p rod uc ts and othe r c hem ic als. Musc uloskeleta l injuries from wo rking in from a wkw a rd p ositions, or pe rforming rep et itive

ma nua l ta sks. (Ap p end ix 1) Lifting or ca rrying hea vy trays or othe r objec ts. (App end ix 2) Noise expo sure. (Ap p end ix 11) Slip s, trips a nd fa lls. (Ap p en d ix 5) Stre ss. (Ap p end ix 6) Dea ling with d iffic ult or p ote ntially violent c ustom ers. Long hours of w ork or extend ed wo rk da ys. Working alone . (App end ix 7)

What a re som e p reven tive me asures for a server?

Lea rn sa fe lifting tec hnique s. (Ap pend ix 2) Wash your hand s be fore ea ting, drinking or smo king , or after go ing to the t oilet, a nd at

the be ginning a nd e nd of the d ay. If you c om e in c onta c t with raw food such a s mea t or

p oultry, wa sh your ha nd s b efo re to uc hing a nything e lse. (App end ix 8) Wea r ap prop riate pe rsona l protec tive eq uipm ent a nd a pp arel for the ta sk. Wea r sho es with no n-skid so les.

What are som e go od g eneral safe work prac tic es?

Pra c tice sa fe lifting tec hniq ues. Follow company safety rules. Know ho w to report a hazard. (App end ix 9) Follow g oo d housekee ping p roc ed ures. (App end ix 10) Work safely with c hemica ls ac c ording to rec omm end ed prac tic es. Selec t the p ersona l p rote c tive equ ipm ent. Use, ma inta in and store it ac c ording to

ma nufac turer's rec om mend ations.



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Housekeeping

What kind of work do peop le do in housekeep ing in a hotel?

Housekeep ing in a ho tel is a very physica lly d em a nd ing job tha t include s ma ny, varied ta sks.Typ ica lly, in this c a se stud y, houseke ep ers were resp onsible fo r c lea ning 16 rooms per shift. Theac tual amo unt of wo rk dep end s on the size o f the roo m a nd the numb er of bed s. Ahousekee p er nee ds be twe en fiftee n and thirty minutes to d o on e room . A housekee pe r c a rriesout the following ta sks:

ma king b ed s (Figures 1a, 1b, 1c), tidying rooms (Figure 2), c leaning a nd p olishing to ilet s, ta p s, sinks, b a thtubs and mirrors (Figures 3a, 3b ), washing floors, rem ov ing sta ins, and vac uuming .

Figure 1a Figure 1b Figure 1c Making Beds

Figure 2 Figure 3a

What are the risk fac tors of housekee ping ?

The m a in risk fac to rs for rep et itive m ot ion injuries (RMIs) in houseke ep ing a re:

hea vy ph ysic a l workload a nd exce ssive b od ily mo tions which a re a high risk for ba c kinjuries and

force ful upp er limb mo tions in a wkwa rd p ositions which a re a high risk for nec k orshoulde r and a rm injuries.



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Sp ac e limita tions require w orkers to u se m a ny unc om forta b le po stures. These a re:

sta nd ing or wa lking,

stooping, squatting, kneeling, stretching, reaching, bending, tw isting, a nd crouching.

A housekeep er cha nge s b od y po sition every three sec ond s while c lea ning a roo m. If we a ssumethat the ave rag e c lea ning time for eac h room is twe nty-five m inutes, we c an estima te tha t ahousekeep er a ssumes 8,000 different bod y p ostures eve ry shift.

In a d d ition, forceful m ove me nts while using a wkwa rd b od y p ositions inc lud e lifting ma ttresses,c lea ning tiles, and va c uuming e very shift. Housekee p ing is a physic a lly d em an ding an d verytiring job . It c an be c la ssified a s "mo d erate ly heavy" to "hea vy" wo rk bec a use th e e nergyrequired is approximately 4 kilocalories per minute (4 kcal/min.)

How c an w e red uc e the risk fac tors for RMI?

Hote l housekee p ers wo rk in a unique p la c e. Hote ls a re usually d esigne d for the c om fort of the irguests rathe r tha n the ir housekeep ing sta ff. This fa c t m a kes it ve ry d ifficult to imp rove w orkingc ond itions for housekee p ers b y me an s of b ette r eng inee ring . How eve r, som e imp rove me nts c anbe ma de by selec ting m ore a pp ropriate equipment.

Light er vac uum c lea ners (preferab ly the self-p rop elling type ), and light er servic e c a rts withwhe els de sig ned for ca rp ete d floo rs wo uld ea se the wo rkloa d for their op erato rs p roviding thiseq uip me nt is a lwa ys kept in go od rep a ir. When ne w va c uum c leane rs are p urc ha sed , low noiseem issions should b e o ne o f the c rite ria .

Imp roving the bod y p ostures tha t p ose a ma jor risk for musc uloskeleta l disord ers see ms a nuna c hieva b le ta sk. Ag a in, this fac t results from the p ec ulia rity of ho te ls a s a w orkplac e. Toattrac t g uests and rema in c om pe titive, hotel ma nag eme nt p ursues a po lic y that everythingshould be "so clean it sparkles". Floors, walls, windows, mirrors, and bathroom fixtures might bead eq uately clea ned w ith som e form of an extension too l to red uce be nding and over-stretc hing. How eve r, the de ma nd for sp otless c lea nliness an d hyg iene , ma na ge me nt ofte nreq uires their c lea ning sta ff to sp end extra time a nd effort c lea ning by knee ling, lea ning ,sq ua tting , c rouc hing, slouc hing a nd stretc hing. These p ostures will in time c on tribute t o ne wmusc uloskeleta l injuries a nd a gg ra vat e old one s.

New a pp roa c hes, othe r tha n stric tly ergo nom ic o nes, nee d to b e investigat ed . For exa mp le,ac tion c an be taken from the ad ministrative level. Options for imp rovem ent include:

job rota tion, job enric hment a nd job enlargeme nt, tea m wo rk, and ed uca tion a nd training o n wo rk prac tic es.



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How c an job rota tion reduc e the risk for RMI?

Job rota tion is one p ossib le a pp roa c h. It req uires wo rkers to mo ve b etw ee n d ifferent ta sks, at

fixed or irreg ula r period s. How eve r, it m ust b e a rota tion whe re wo rkers do som ething c om plete lyd ifferent . Different ta sks must use d ifferen t m usc le g roup s to a llow musc les a lrea dy stressed torecover.

How c an job enlargem ent and enric hme nt red uc e the risk for RMI?

Ano the r a pp roac h is job enla rgem ent . This increa ses the va riety of t a sks built into the job . Itbreaks the mo notony of the job a nd a voids overloa ding one p art of the bo dy. Job enric hmentinvolves mo re a utono my a nd c ontrol for the w orker.

How c an tea m work reduc e the risk for RMI?

Tea m w ork c a n p rovide grea ter variety a nd mo re e venly distrib uted musc ula r wo rk. The w holetea m is involved in the p la nning o f the wo rk. Ea c h tea m m em be r c a rries out a set o f op erationsto c om plete the w hole prod uc t, allow ing the wo rker to a lternate b etw ee n ta sks. This red uc es therisk of RMI.

How c an im proved work p rac tices red uc e the risk for RMI?

A we ll-d esigned job , sup p orted b y a w ell-design ed wo rkplac e a nd p rop er tools, allow s thewo rker to a void un nec essa ry mo tion of t he ne c k, shoulde rs a nd up pe r limb s. How eve r, thea c tua l p erforma nc e o f the ta sks d ep end s on individ uals.

Training should b e p rovided fo r wo rkers who a re invo lved w ith housekee p ing a c tivities. It isimp ortant tha t housekeep ing sta ff be informed a b out ha za rds in the w orkplac e, inc lud ing t he riskof injuries to the mu sc uloskeleta l system. The refo re, id en tific a tion o f the ha za rds for suc h injury ata ny given hotel is fund am enta l.

Ind ividua l wo rk p rac tice s, includ ing lifting ha b its, are sha p ed b y prop er tra ining . Tra ining shouldenc ourag e e mp loyers and wo rkers to a do pt metho ds that red uce fatigue. For examp le, it isa dv isa ble to p la n one 's wo rkloa d a nd d o the hea vier ta sks at t he b eg inning o f the wo rkshift,rathe r tha n a t the end , when fa tigue is a t its ma ximum. When a p erson is tired , the risk of injuringa musc le is highe r.

Tra ining should a lso e xplain the he a lth ha za rd s of imp rop er lifting a nd give rec om me nd a tions onwha t a wo rker ca n d o t o imp rove lifting p ositions. Tra ining should a lso e mp ha size t he imp ortanc eof rest p eriod s for the wo rkers' hea lth a nd explain how a c tive rest c a n do mo re fo r keep ingwo rkers hea lthy than p a ssive rest. The e ffec t of suc h tra ining c an rea c h far be yond oc c up a tionalsituat ions bec a use the w orkers c an a pp ly this know ledge a lso in the ir off-job live s.



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Hotel laund ry

What kind of work do p eop le do in the hotel laundry?

Work in this c a se stud y of a hote l laund ry is d ivided into two op erations d one by tw o sep a ra tegroup s of w orkers. Sorting, w a shing a nd d rying tow els is c om p lete d b y one group of tw o w orkers.Drying (exce pt for tow els) and folding is c om plete d b y ano ther group of six workers.

Wha t are the ta sks invo lved in "Sorting a nd Washing"?

In this hote l, housekee pe rs use a laund ry c hute to ge t the dirty linen from the upsta irs do wn tothe la und ry a rea . The sorting a nd wa shing op eration involves the follow ing:

sorting laund ry loa ding b ins whic h we igh 60 pound s of d ry la und ry, a nd 120 p ound s whe n we t transporting (pushing/pulling) bins to washer loa ding w asher unloa ding wa sher transp orting (p ushing/ pulling) b ins to d ryer (tow els on ly) loa d ing d ryer with towe ls unloa ding to we ls from t he d ryer

In one eight-hour shift, 20 bins of laundry are processed by twoworkers (Figure 1.). The dry laundry is handled four times (60 lbs x 4handlings x 20 bins = 4,800 lbs); the wet laundry is handled twice (120lbs x 2 handlings x 20 bins = 4,800 lbs). The workload is distributedevenly, so each worker handles approximately 4,800 lbs or 2,200 kg of laundry every day.

Figure 1 - Sorting laundry



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The ha nd ling of t he laund ry req uires the use of c onsid erab le fo rc e:

p ulling la und ry from the p ile u nde r the c hute (Figure 2, 3) loa d ing laund ry into the wa sher (Figure 4) pulling wet laundry from the washer (Figure 5)

Figure 2 - Sorting laundry Figure 3 - Sorting laundry Figure 4 - Loading the washer

The se m ovemen ts a re pa rticu larly stressful on the ha nd s, wrists a nd shoulders.

Handling the laundry requires whole body motions beyondacceptable ranges. Reaching above the shoulder, bending to

the floor (Figure 5) and twisting are examples. In addition, the job is carried out while standing on a concrete floor which addsstress to the feet and legs as well as to the rest of the body.

Figure 5 - Pulling wet laundry from thewasher

What a re the risk fac tors of "Sorting a nd Washing"?

The RMI sec tion o f OSH Answe rs ha s mo re informa tion o n g ene ral ergo nomic RMI riskfactors . Ca rrying o ut the sorting a nd w a shing ta sks c a n be ha za rdo us to the workers. The re a rethree ma jor risk fa c to rs:

The he av y wo rk loa d (hand ling o ver 2 tonne s of laund ry pe r shift) c om b ined with bo d ilymo tions beyo nd sa fe ranges c rea te risk for b a c k injuries.

Freq uent a nd fo rc eful move me nts (while p ulling/ p ushing the la und ry) and force ful grip sc reat e a high risk for wrist a nd ot her up per limb injuries.

Working while sta nd ing/ wa lking on a ha rd floo r creat es the risk for low er leg d isc om fort,and ac ce lerates the d evelopm ent of fatigue.

These fa ct ors have a c om po unding effec t. In othe r words, eac h of the m inc rea ses the e ffect ofthe ot hers

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What are the ta sks involve d in "Drying a nd Fold ing"?

In this op eration the re a re three w orksta tions a t w hic h five d ifferent ta sks a re pe rformed :

fee d ing the rolling d ryer with sma ll p iec es of laund ry (Figure 6) feed ing the rolling dryer with la rge piec es of laund ry (Figure 7) ret rieving sma ll p iec es of laund ry from the rolling d ryer (Figure 8) ret rieving large p iec es of laund ry from the rolling d ryer (Figure 9) fold ing t ow els (Figure 10)

Figures 6 and 7 - Feeding the rolling dryer

Figures 8 and 9 - Retrieving laundry from the rolling dryer

As a n examp le, to fe ed the roller dryer with sma ll laund ry suc h a s p illow c a ses (Figure 6), a w orkerp erforms the following ta sks:

rea c hing for the laun d ry in the b in (Figu re 11) unfolding an d stretc hing the laund ry sp read ing t he laund ry on rollers (Figure 6)

Figure 10 - Folding towels Figure 11 - Reaching for the laundry

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To feed the dryer with laundry such as bed sheets, two workers form ateam (Figure 7). This task involves the following:

reaching for bedsheets in the bin (Figure 11) unfolding the bedsheets spreading the bedsheets (Figure 12) spreading the bedsheets on rollers

Figure 12 - Spreading the laundry

What are the risk fa c tors of "Drying a nd Fold ing"?

Seve ra l aspe c ts of fe ed ing the d ryer with bo th sma ll a nd large p iec es of laund ry p ose t he risks forrepet itive m ot ion injuries. Workers a re at a high risk for upp er arm, ne c k and shoulde r injuriesb ec a use o f limited c ontrol over the p a c e o f wo rk, high ly rep etitious mo vem ents (one t a sk la stsa p proxima tely 3 to 8 sec ond s), wo rking with arms a t or ab ove shoulde r level, a nd ha ndma nipulation while hand ling the laund ry. Bend ing and twisting, reac hing forwa rd and upw ard,and stand ing in a lea ning-forwa rd p osition c ontribute to low ba c k pa in. Prolonged stand ing on ahard floor contribute s to lowe r leg disc om fort a nd spe ed s up the d evelopm ent o f musc ularfatigue. All of these fac tors have a c omp ound ing effec t. In othe r words, eac h of the m increasesthe effec t of the others.

What are the tasks involved in retrieving pieces of laundry?

To retrieve small laundry such as pillow cases from the regular dryer (Figure

8) a worker performs the following tasks:

reaching forward to pick up the laundry folding laundry

To retrieve big pieces of laundry such as bedsheets, which come out of thedryer partially folded (Figure 13), a worker performs the followingmovements:

bending and reaching for the bedsheet folding the bedsheet piling the bedsheet

Figure 13 - Retrieving bedsheets

What are the risk fac tors of retrieving p iec es of laund ry?

Workers involved in ret rieving sma ll p iec es of laund ry are a t risk for rep et itive mo tion injuries. Theha za rd ous cond itions are:

no c ontrol over pa ce of work rep etitive mo veme nts c onstrained wo rk p osture lea ning forwa rd sta nd ing po sition

reac hing forwa rd b eyond rec omm ended range working w ith extended arms stand ing o n a hard floor



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The lac k of co ntrol ove r the p a c e o f wo rk, highly rep etitious mo vem ents, co nstrained wo rkposture, and extended arms while working create a high risk for RMIs. Neck, shoulders and upperarms are at the highest risk for injuries. Leaning forward, over-reaching and prolonged standing ina restric ted p osition p ut w orkers a t high risk for low b a c k injury. Prolonged sta nd ing on a ha rdfloo r c ontribut es to lowe r leg d isc om fort and sp ee ds up the d eve lopm ent o f musc ula r fat igue . Allof these fa ct ors have a c om po unding effec t. In other words, eac h of them inc rea ses the effec tof t he o thers.

Workers involved in ret rieving b ig p iec es of laund ry are a t risk for rep et itive mo tion injuries,inc luding low b a c k pa in. The ha za rd ous c ond itions a re:

prolong ed stoop ed stand ing po sition d ue to a low work surfac e rep etitive mo veme nts stand ing o n a hard floor no c ontrol over the pa ce of work

Co ntribut ing fa c tors a re p rolong ed , restric ted , a nd stoo p ed wo rking p ositions a nd b end ing.The re is a lso a risk for injuries of the nec k and shoulde rs. Prolonged sta nd ing o n a ha rd floo rc ontrib utes to lowe r leg d isc om fort and sp ee d s up t he d eve lop me nt of musc ular fatigue . All ofthese fa ct ors have a c om po unding effec t. In other wo rds, eac h of them inc rea ses the e ffect o fthe others.

How c an w e red uc e the risk fac tors for RMI?

General

Continual twisting and rea c hing while wo rking with extend ed arms c an c ontribute to thed eve lopme nt o f repet itive mo tion injuries. How eve r, the risk for suc h injuries wh ile fo lding t ow els issom ew hat low er when d rying a nd fo ld ing o f be d shee ts a nd p illow c a ses. Som e c ontrol over thepace of work and some flexibility in the working postures are responsible for the reduced risk.

Let's see how we c a n improve the op erations in this hote l lau nd ry fac ility:

Sorting and Washing

In the la und ry p roc essing plant , the sorting and wa shing op erations a re typ ic a lly ma nua l mate ria lha nd ling ta sks. These ta sks p ose the risk for low ba c k p a in.

Ma nua l mat eria l hand ling c a nnot b e fully eliminate d but it is p ossib le to red uc e it b y reo rga nizingthe flow of w ork. For exam ple, instea d of sorting tow els a nd linen b efore loa d ing them into theb ins, it wo uld b e p refe ra b le to loa d t he laund ry in the b ins d irec tly from the p ile und er the c hute.This wo uld e liminate ha nd ling the sa me laund ry twic e.

Further imp rove me nts of w orking c ond itions c a n b e a c hieve d by red uc ing stressful bo d ymo vem ents while ha nd ling the laund ry. Shortening the laund ry chut e (p ip e) through w hic hlaund ry is dropp ed would c rea te m ore spa c e so tha t the laund ry wo uld not c om press ag ainstthe p ip e itself. As a c onseq uenc e, the sorting of t he la und ry wo uld req uire less pulling force .



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To reduce bending while reaching for the laundry at the bottom of the bins, it would beadvisable to use different types of bins. For example, a bin with one side that opensmounted on a moveable tilt/lift table (Figure 14).

To reduce pulling and pushing while manoeuvering the bins full of laundry, it would beadvisable to use lighter bins with wheels designed for hard floors. In addition, the binsshould be maintained regularly with particular attention to the wheels.

Figure 14 - Tilt-lift table

Working in the sorting a nd wa shing a rea s req uires sta nd ing on a c onc rete floo r. Sinc e thea pp lic a tion of ant i-fatigue m a tting is not p ra c tica l, wo rkers should w ea r shoe s tha t p rovide go od

c ushioning o r they should use p rop er inserts to lessen t he stress on the fee t a nd on the lowe rback .

Drying and Folding

The ove rall workloa d , po or la yout of the wo rk sta tion, imp rop er de sign of the laund ry b ins a ndthe repet itivene ss of t he w ork are the ma jor risk fac to rs for rep et itive m ot ion injuries in the d ryingand folding job .

Providing bins with one side that op ens on e leva ting de vic es would reduc e be nding a nd othera wkwa rd b od y po sitions while reac hing fo r tow els at t he b otto m o f the b ins.

To red uc e a wkwa rd b od y po sitions suc h a s rea c hing a b ove shoulde r leve l while fe ed ing thed ryer, it wo uld b e a dv isab le to use a p lat form. Narrow ing the c ounte r tha t sep a rat es the w orkerfrom the d ryer wo uld red uc e reac hing forward.

Retrieving piec es of laundry and fold ing towe ls

To reduce awkward body positions such as reaching aboveshoulder level while retrieving pillow cases from the dryer, it wouldbe advisable to use a platform (Figure15). Narrowing the counterthat separates the worker from the dryer would reduce reachingforward. Workers should have a sit/stand stool available to restbetween tasks. Also, a foot bar to allow the worker to switch theweight of the body from one foot to the other should be made

available.

Figure 15 - Standing on a platform while retrievinglaundry



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Partially folded bedsheets coming out of the dryer should be collected in abasket (Figure 16) so that when completing the folding operation, aworker can use a counter of appropriate height and reduce excessivebending.

To reduce discomfort due to prolonged standing while folding towels,anti-fatigue matting should be used. Also, a saddle chair and a foot barshould be provided.

Figure 16 - Collecting bedsheet in a basket

To further reduce the stress on the body due to prolongedstanding, it would be advisable to use sit/stand devices(Figure 17).

If it is not practical to sit while performing the task, workersshould use these devices between tasks.

Figure 17 - A sit-stand saddle chair

General Rec omm enda tions

One of t he m a in risk fac to rs for rep et itive m ot ion injuries in the laund ry is the repet itiveness of thewo rk. To c ha ng e the rep etitive p a tterns of w ork, we nee d t o d o d ifferent ta sks. Job rota tion a ndtea m wo rk are tw o o p tions tha t a llow wo rkers to va ry ta sks.

Job rota tion requires wo rkers to mo ve b etw ee n d ifferent ta sks a t fixed or irreg ula r pe riod s of t ime .Workers in the laund ry c a nno t fully bene fit from job rota tion b ec a use a ll the ta sks a re simila r innature. Still, the feeling of c hang e reduc es mono tony a nd slows down the d evelopm ent o ffatigue.

In tea m w ork, workers form a t ea m a nd ea c h me mb er of the te a m sha res seve ra l d ifferent tasks.The w ho le tea m is involved in the p lanning of the w ork. The te am c on trols a ll a sp ec ts of w ork. Thisimp rove s at titude a nd job sa tisfac tion, whic h are imp ortant fa c tors in the p reve ntion o foc c up at iona l d isea ses.



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Office g eneral

Offic e sta ff ma y type o r file d oc ume nts, c orresp ond enc e, rep orts, sta tem ents a nd o ther

ma teria l. Their wo rksta tion usually has a c om put er/VDT a nd telep hone , am ong othe r eq uip me nt.

The m a in d uties of a n office wo rker inc lude:

Answe r telep hone or p ersona l enq uiries Photoc opy and c ollate d oc uments Ma inta in and up d a te filing , inventory, ma iling a nd d a ta b ase system s Op en, sort and route inco ming ma il and c ourier pa c kage s Process reports, applications, receipts, expenditures and other documents, using a

computer

Wha t are some hea lth and safe ty issues for office workers?

Although office environm ents d on't usua lly p resent the sam e p hysic a l haza rd s a s som e of t hemo re sa fety-critica l ind ustries, there a re othe r hazards to b e a wa re of:

Perfumes and other scents (potential allergens) In som e c a ses, expo sure t o c leaning p rod uc ts Ind oo r air qua lity Sitting for long period s of time Working in from aw kwa rd po sitions, or p erforming rep etitive ma nua l tasks Lifting aw kward o r heavy ob jec ts Eye stra in Working in unc om fortab le temp eratures Annoying or distrac ting noise a nd vibration from elec tronic e q uip me nt Slips, trips and fa lls Risk of vio lenc e Working alone Stress

Wha t are som e p reventive m ea sures for office wo rkers?

Lea rn a bo ut ho w t o a void m usc uloskeleta l pa in o r injury from rep etitive or physic a llyaw kward t asks. Ta ke brea ks a s nee de d . (App end ix 1)

Lea rn sa fe lifting tec hnique s. (Ap pend ix 2) Kee p all wo rk area s c lea r of clutter.


Follow company safety rules. Lea rn a b out c hem ic a l safe ty, WHMIS an d MSDSs Know ho w to report a hazard (App end ix 9) Pra c tice sa fe lifting (App end ix 2) Follow go od housekee ping p roc ed ures. (Ap p end ix 10)

http://www.ccohs.ca/oshanswers/legisl/msdss.htmlhttp://www.ccohs.ca/oshanswers/legisl/msdss.html


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Landscaper

What doe s a landscap er do?

Und er the lab el "la nd sc ap er" we a re referring to ga rd ene rs, greenkee p ers, la wn c a re sp ec ialistsa nd ho rticultura l wo rkers. These p eo p le w ork in businesses or hom es, ind oo rs or o utd oo rs.

Som e o f the ma in d uties of a land sc ap er are to:

Plan , c rea te a nd m a inta in la nd sc ap ed environm ents, whic h ma y inc lud e flowe rs, p la nts,trees, lawns, fenc es, de c ks, pa tios or wa te r feat ures.

Prep a re a nd sp ra y c hem ic a l mixtures using va rious type s of e quipm ent. Ope rate p owered eq uipm ent and hand to ols.

Wha t are som e he alth and safety issues for land sc ap ers?

Dep end ing o n exac t oc c up at ion or geo grap hic loc at ion, the follow ing a re p ossib le risks:

Expo sure to infec tious huma n a nd an ima l waste. Irrita tion o r allergic reac tion from p lant s, or from insec t b ites or stings. Histoplasmosis from bird droppings. Hantavirus from mouse droppings. Exposure to p esticides and othe r toxic c hem ic als. Pain or injury from working in awkward positions, lifting and carrying heavy objects. Noise. (Appendix (11) Exposure to e xtrem e tem pe ra tures. (App end ix 4) Work with hea vy ma c hinery, ma nua l a nd p ow er tools, a nd lad d ers. Working nea r elec tric a l line s. (Ap p end ix 12) Working alone . (App end ix 7)

What a re som e preventive m ea sures for landsc ap ers?

Wash your hand s freq uently. (App end ix 8) Rem ove c onta minated c lothing a nd foo twe ar to a void transferring c hemica ls to your

hom e o r othe r "c lea n" spa c es. Wash co nta minate d items b efore re-we a ring or d isc arding. Kee p your limb s c ove red to a void insec t b ites. Prote c t yourself from the sun a nd from extrem e he a t or co ld . Lea rn sa fe lifting tec hnique s. (Ap pend ix 2) Wea r ap prop riate pe rsona l protec tive eq uipm ent. Know how to sa fely use e quipm ent a nd t oo ls.


Pra c tice sa fe lifting tec hniq ues. Work sa fely with eq uip me nt, too ls, and lad d ers. Follow rec om me nd at ions whe n wo rking with c hem ic a ls. Use, maintain and store personal protective equipment according to manufacturers'

recommendations. Sta y hyd rat ed to av oid h ea t stress.

Follow company safety rules. Know ho w to report a hazard. (App end ix 9) Follow go od housekee ping p roc ed ures. (Ap p end ix 10)



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Electrician

What do es an elec trician d o?

Elec tric ians wo rk in com merc ial, industria l or residential set tings. Som e o f the ir ma in dut ies a re to :

Insta ll, rep a ir and ma intain elec tric a l systems Conform to building c od es and other reg ulations Rea d , prep a re o r inte rpret b luep rints an d d ra wings Prepare cost estimates and documentation for clients Use, clea n and ma inta in various eq uip me nt Sup ervise a p p rentices or other wo rkers

Wha t are som e he alth and safety issues for elec tric ians?

Elect ric ians wo rk in a va riety of sett ings and ma y b e e xp osed to seve ra l haza rd s, inc lud ing :

Lea d , solven ts, sold er, and ot he r ma te ria ls Risk of fa ta l elec tric a l shoc k (App end ix 12) Risk o f e lec tric a l burns Working in c onfined spa c es (App end ix 13) Welding hazards, including UV radiation Extreme tem p eratures (App end ix 4) Risk of p a in or injury from awkw a rd p ositions, rep et itive ma nua l tasks, or lifting heavy

ob ject s (App end ix 1,2) Moulds, fungi and bacteria Risk of infec tion from b ird or rod ent d rop p ings Working a t height s Risk of eye injury from flying particles Slip s, trips a nd fa lls (Ap pend ix 5) Working with va rious ha nd too ls, po we r too ls a nd eq uip me nt Shift wo rk or extend ed wo rk da ys Possible exposure to asbestos

What are som e preventive m ea sures for electricians?

Keep tools and eq uipm ent in goo d working o rde r. Use a p p rop ria te p ersona l p rote c tive equipm ent for the task, including foo twe a r. Keep wo rk area s c lea r of c lutter and eq uipm ent. Avoid a wkwa rd p ositions, and rep etitive ta sks, Lea rn sa fe lifting t ec hnique s. Follow a rec om me nd ed shift wo rk pa ttern, a nd know the a ssoc iated ha za rd s.

What are some goo d g eneral safe wo rk p ractice s? Follow c orrec t p roc ed ures for:

o Elec tric a l sa fetyo Co nfined spa c es entryo Working a t heightso Working with ha nd too ls, and

power tools

Use, maintain and store personalprotective eq uipme nt ac co rding tomanufacturer's recommendations.

Lea rn a bo ut c hemica l hazards,WHMIS and MSDSs.

Know how to repo rt a hazard Follow go od housekee p ing

procedures. Follow company safety rules.



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Carpenter

What doe s a c arpe nter do ?

A c a rpente r b uild s or rep a irs va rious struc tures, working p rima rily with w oo d . Som e o f ac a rpe nter's ma in d uties are to :

Me a sure, c ut, sha pe , assem b le an d join m at eria ls. Rea d , prep a re a nd interpret b luep rints and d ra wings. Prep a re c ost estimate s a nd d oc ume nta tion for clients. Conform to building c od es and other reg ulations. Use, clea n and ma inta in various eq uip me nt a nd to ols. Sup ervise ap p rentices or o the r wo rkers.

Wha t are som e he alth and safety issues for c arpente rs?

Ca rp ente rs fac e the ir ow n unique set o f oc c up at iona l hazards. These include the fo llow ing :

Use o f va rious ma c hinery and to ols. Moulds, fungi and ba c teria. Che mic a ls, solven ts a nd othe r ma te ria ls - de rma titis, allergic rea c tions or resp ira to ry

problems. Ca nc er risk from wo od d ust. Flamm a b le o r c om b ustible ma teria ls, inc lud ing wo od d ust. Risk of p a in or injury from wo rking in a wkw a rd p ositions, pe rforming repet itive ta sks, or

lifting. (Appendix 1,2) Extreme te mp eratures whe n wo rking o utd oo rs. (App end ix 4) Risk of e ye injury from flying p a rticles. Working a t he ights. Shift work or extend ed wo rk d a ys.

What a re som e preventive m ea sures for c arpe nters?

Insta ll and ma inta in go od ventila tion. Keep tools and eq uipm ent in goo d working o rde r. Clea n up wo od dust regularly. Wea r ap prop riate e ye protec tion, foo twea r, and other protec tive eq uipm ent for the

task. Keep wo rk area s c lea r of c lutter and eq uipm ent. Lea rn sa fe lifting t ec hnique s. Avoid a wkwa rd p ostures or repe titive ta sks, or ta ke freque nt b rea ks. Follow a rec om me nd ed shift wo rk pa ttern, a nd know the a ssoc iated ha za rd s.

What are some goo d g eneral safe wo rk p ractice s? Work sa fely with all equ ip me nt:

o Wood working ma c hineso Hand toolso Pow ered hand too ls

Use, maintain and store personalprotective eq uipm ent asrec omm ended by the manufac turer.

Follow sa fe lifting te c hnique s. Follow company safety rules. Lea rn a bo ut c hemica l hazards,

WHMIS and MSDSs. Know how to rep ort a ha zard. Follow go od housekee p ing

procedures.



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App endix 1

What are work- related m usc uloskeletal d isorders (WMSDs)?

Work-rela te d musc uloskeleta l disord ers (WMSDs) a re a g roup of p a inful disorders of musc les,tend ons, and nerves. Ca rp a l tunnel syndrom e, te nd onitis, thorac ic out let syndrom e, a nd tensionnec k syndrom e a re exam ples. Work ac tivities which a re freq uent a nd rep etitive, or a c tivities witha wkwa rd p ostures c a use th ese disorde rs which ma y b e pa inful during wo rk or at rest.Almo st a ll wo rk req uires the use o f the a rms a nd ha nd s. Therefo re, most WMSD a ffec t the ha nd s,wrists, elbo ws, nec k, and shoulde rs. Work using t he legs c a n lea d to WMSD of the leg s, hips,a nkles, and fee t. Som e b ac k prob lems a lso result from rep et itive a c tivities.

How c om mo n a re WMSDs?

WMSDs a re rec og nized a s lea d ing c a uses of signific ant huma n suffe ring, loss of p rod uc tivity, and

ec onom ic burdens on soc iety. How ever, we do not ha ve reliab le e stima tes of the numb er ofWMSDs in Ca na da . The d at a a va ilab le a re limited a nd do es not rep resent the ma gnitude of thep rob lem b ec au se th ere is a g rea t d ea l of und er-rep orting of the se t ype s of injuries. For exam p le,over 20,000 Ont a rio wo rkers rec eived c om p ensa tion in 1987 for new c a ses of WMSDs,a c c ounting fo r ab ou t 600,000 da ys of lost w ork. In British Co lumb ia, ove r ha lf the industria ld isea se c laims a re d ue to WMSDs. A survey o f c a shiers throug hout B.C., p erforme d b y SimonFraser University and the United Foo d a nd Co mm erc ial Workers in 1982, indic a ted tha t o ver 30%of t he w ork force surveyed suffered a form o f WMSD.

Wha t a re the risk fac tors for WMSDs?

WMSDs a rise from ordinary arm an d ha nd mo vem ents suc h a s b end ing, straightening, g rip p ing,holding, twisting , c lenc hing a nd rea c hing. These c om mo n mo vem ents a re not pa rticularlyha rmfu l in the ord inary ac tivities of d a ily life. Wha t m a kes the m ha za rdous in wo rk situat ions is thec ontinual rep etition, often in a forc eful manner, and mo st o f all, the spe ed of the move me ntsa nd t he lac k of time for rec ove ry be twe en the m. WMSDs are a ssoc iat ed with wo rk p at terns tha tinclude:

Fixed or c onstrained b od y p ositions Continual rep etition o f move me nts Force c onc entrate d on sma ll p a rts of the b od y, suc h a s the ha nd or wrist A pa c e of wo rk that d oes not a llow suffic ient recove ry betw een m ovem ents

Ge ne rally, none o f these fa c to rs a c ts sep a rate ly to c a use WMSD. WMSDs c om monly oc c ur a s aresult of a c om bination and interaction am ong them.

Hea t, co ld and vibration also c ontribute to the d evelopm ent o f WMSD.

Bod y Position

The re a re two a sp ec ts of b od y po sition (p osture) tha t c ont rib ute t o injuries in job s involvingrepetitive tasks.The first relates to the po sition o f the p a rt o f the bo d y tha t p erforms the a c tua l task, usua lly theup pe r limb . For exam p le, ta sks tha t require rep etitive m ove me nts to t he e xtreme rang es of the

joint in the wrist, elbow or shoulde r cont rib ute t o the oc c urrenc e o f a p a inful c ond ition in tho se

a rea s. Ta b le 1 g ives exam ples of suc h m ove me nts. Poo r la yout o f the wo rksta tion a nd imp rop erselection of eq uipm ent a nd too ls ca n lea d to these ha zardous bo dy m ovem ents.



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Table 1

Body Movement Areas of Pain

repetitive, horizontal or vertical movements of the wrist to the extreme ranges (Fig. 1A) moving fingers while the wrist is in an extreme position (Fig. 1B,1C)

wrist and palm

repetitive bending or straightening of the elbow from its neutral position (at a right angle)

twisting the wrist and forearm (Fig. 2) elbow

reaching above shoulder level (Fig. 3B)

reaching behind the trunk (Fig. 3C)

reaching far out in front of the body (Fig. 3A)

twisting the arm (Fig. 3C)

neck and shoulder

The othe r postural asp ec t tha t c ontrib utes to WMSD is a fixed p osition o f the nec k and theshoulde rs. To p erform an y c ont rolled mo vem ent of a n up pe r limb , the w orker must sta bilize theshoulde r-nec k reg ion. Musc les in the shoulde r and the ne c k c ontrac t and sta y co ntrac ted toho ld the p osition sta b le for as long a s the ta sk req uires. The c ont ra c ted musc les squee ze theb lood vessels. This restric ts the flow o f bloo d a ll the wa y dow n to t he w orking musc les of the ha ndwhe re t he b loo d , be c a use of the intense m usc ula r effort, is nee d ed the mo st. The result istwo fold. The ne c k-shoulde r musc les b ec om e fa tigued , even tho ugh there is no m ove me nt. Thisc ontribute s to p ain in the nec k area . At the sam e time, the red uce d b lood supp ly to therem a ining pa rts of the up p er limb ac c elerates fatigue in the m oving m usc les, ma king the m m oresusc ep tible to injury.

Figures 1A, 1B & 1C -Hazardous movements of the

hand

Figure 2 - Exerting force whileextending forearm



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Repetition

Workers performing high ly rep et itive ta sks a re a t the highest risk for WMSD. This sho ws tha t

repe tition o f mo veme nts, althou gh it neve r a c ts sep a rate ly, is mo st likely the strong est risk fac to r.Ta sks req uiring rep et itive movemen ts a lwa ys involve o the r risk fac to rs for WMSD suc h a s fixedb od y po sition and force : the wo rker, in orde r to p erform the ta sk, ha s to m ainta in the shoulde rand nec k in a fixed po sition a nd to exert som e force .

Figure 3A - Hazardous reaching movements - reachingforward Figure 3B - Hazardous reaching movements - reaching

above shoulder level

Figure 3C - Hazardous reachingmovements - reaching behind the trunk

Work involving mo vem ent rep ea ted ove r and ove r ag a in is very tiring. This is be c a use t he wo rkerc a nnot fully rec ove r in the short pe riod s of time tha t a re g iven b etw ee n ta sks. With time , theeffort to m a inta in the rep etitive m ove me nts, even if they involve m inima l force s, stea d ilyinc rea ses. When the wo rk ac tivity is c ontinued in spite of t he de velop ing fat igue , injuries oc c ur.

Forc e

The force req uired to d o t he t a sk also p la ys a n imp ortant role in the o nset of WMSD. More forceeq uals mo re m usc ular effort, and c onseq uently, a longe r time is need ed to rec over be twee n

ta sks. Since in rep et itive w ork, a s a rule, the re is no t sufficient time for rec overy, the m ore fo rc efulmo vem ents d eve lop fatigue muc h fa ster. Exerting fo rc e in c ertain ha nd p ositions is p a rticularly



22/64

ha za rd ous (Fig. 1A-4F). The a mo unt of fo rc e ne ed ed d ep end s on the we ight of the too ls a ndob jec ts that the w orker is req uired to o pe rate or move, a nd their plac eme nt in relation to thewo rker's bo d y. Mo re streng th ha s to b e used , the fa rther aw ay from the b od y the force ha s to b ea pp lied . The sha pe of the too l p la ys a n impo rta nt role, also. Too ls tha t d o no t a llow the b estp osition o f the wrist, elbo w a nd shoulde r sub sta ntially increa se the force req uired . Worn a ndp oo rly ma intained t oo ls a re ve ry imp ortant as we ll, yet o ften o verloo ked. For exam ple, a w ornsc rewd river, p liers with w orn jaw s, or dull sc issors c a n increa se t he op erat ing fo rce a s muc h a stenfold.

Figure 4A - Pulp pinch Figure 4B - Lateral pinch

Figure 4A and 4B - Exerting force in various hand positions

Figure 4C - Palm

Pinch

Figure 4D - Finger

Press

Figures 4C and 4D - Exerting force in various hand positions

Figure 4E - Pulp

grasp

Figure 4F - Finger press

Figures 4E and 4F - Exerting force in various hand positions



23/64

Pac e o f Work

Pac e o f work de termines the a mo unt of time a vailab le for rest a nd rec overy of the b od y

b etw ee n c yc les of a p a rticular task. The fa ster the p a c e, the less time is av ailab le a nd the highe rthe risk fo r WMSD.

When the w orker has no c ontrol over timing a nd sp ee d o f wo rk be c ause o f externa l fac to rs likea ssem b ly line spee d or q uo ta syste ms the n stress leve l inc rea ses. With h igher stress leve l co mesmusc le te nsion c a using fatigue a nd a ga in inc rea sed risk for WMSD. Controlling the p a c e o f wo rkexternally denies the worker the flexibility to determine their own work speed. It is a humanc ha ra c teristic to wo rk at va rying rat es a t d ifferent time s of the d a y.

Tem pe rature and Vibration

Tem pe rat ure a nd humidity affec t the w orker pe rforming rep etitive w ork. When it is too hot a nd

too humid, the w orkers tire m ore q uic kly and thereb y be c om e m ore susc ep tible to injury. On theothe r hand , c old tem p eratures de c rea se the flexibility o f m usc les a nd joints, inc rea sing thelikelihood of injury of a ny kind .

Vib ration a ffec ts tend ons, musc les, joints, an d ne rves. Workers using v ibrating to ols ma yexpe rienc e n umb ness of th e finge rs, loss of to uc h a nd grip , and pa in. For mo re informa tion onthis subject, refer to OSH Answers document Ra ynaud 's Pheno me non .

How do WMSDs occur?

WMSDs d o not ha p p en a s a result o f a single a c c id ent or injury. Ra ther, they d eve lop grad ua llya s a result of rep ea ted trauma . Exc essive stretc hing of m usc les an d tend ons c a n c a use injuriestha t o nly la st a short time. But rep ea ted ep isod es of stretc hing c a using tissue infla mm at ion c a nlea d to long -la sting injury or WMSDs.

WMSDs inc lude t hree typ es of injuries:

musc le injury tend on injury nerve injury

Muscle Injury

When musc les c ontrac t, they use c hem ic a l ene rgy from sug a rs a nd p rod uc e b y-produc ts suc has lac tic ac id which a re removed by the b loo d. A musc le c ontract ion that lasts a long t imered uc es the b loo d flow . Co nseq uently, the sub sta nc es prod uc ed b y the musc les a re no trem ove d fa st eno ugh , a nd t hey ac c umulate . The a c c umulation of these sub sta nc es irrita tesmusc les an d c a uses pa in. The seve rity of the p a in d ep end s on t he d urat ion o f the m usc lec ontrac tions a nd the a mo unt of time be twe en a c tivities for the m usc les to g et rid o f thoseirritating substances.

http://www.ccohs.ca/oshanswers/diseases/raynaud.htmlhttp://www.ccohs.ca/oshanswers/diseases/raynaud.html


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Tend on Injury

Tendons consist of numerous bundles of fibres that attachmuscles to bones. Tendon disorders related to repetitive orfrequent work activities and awkward postures occur in twomajor categories --tendons with sheaths (Fig. 5), foundmainly in the hand and wrist; and tendons without sheaths(Fig. 6), generally found around the shoulder, elbow, andforearm.

The tendons of the hand are encased in sheaths throughwhich the tendon slides.

Figure 5 - Finger tendons and their sheaths

The inner walls of the sheaths contain cells that produce a slippery fluid to lubricatethe tendon. With repetitive or excessive movement of the hand, the lubricationsystem may malfunction. It may not produce enough fluid, or it may produce afluid with poor lubricating qualities. Failure of the lubricating system creates frictionbetween the tendon and its sheath, causing inflammation and swelling of thetendon area. Repeated episodes of inflammation cause fibrous tissue to form. Thefibrous tissue thickens the tendon sheath, and hinders tendon movement.Inflammation of the tendon sheath is known as tenosynovitis.

Figure 6 - Tendon, muscle,bone unit

When inflam ed , a tend on shea th ma y swe ll up with lubric ating fluid and c ause a bum p unde rthe skin. This is refe rred to a s a ga ng lion c yst.

Tend ons without shea ths are vulnerab le t o rep etitive m otions a nd aw kward p ostures. In fa c t,when a tend on is rep ea ted ly tensed , som e of its fibres c an tea r ap art. The te ndo n b ec om esthickened an d b ump y, c a using inflam ma tion. Tend onitis is the g ene ra l term indica tinginfla mm at ion of t he tend on. In som e c a ses, suc h a s in the shoulde r, tend ons pa ss throug h ana rrow sp a c e b etw ee n b one s. A sa c c alled the bu rsa filled with lubric at ing fluid is insertedbe twee n the tend ons and the b ones as an a nti-fric tion d evic e. As the tend ons be c omeincreasingly thic kened and bum py, the b ursa is subject to a lot of fric tion a nd be c ome sinfla me d . Inflam ma tion o f the b ursa is know n a s b ursitis.

Nerve Injury

Nerves c a rry signa ls from the b rain to c on trol ac tivities of m usc les. They a lso c a rry info rma tionab out temp erature, pain and to uch from the b od y to the brain, and c ontrol bo dily functionssuch as sweating and salivation. Nerves are surrounded by muscles, tendons, and ligaments.With rep et itive m ot ions a nd a wkw a rd p ostures, the tissues surround ing ne rves b ec om e swo llen ,and squeeze or compress nerves (Fig. 7A,7B).



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Figure 7A - Wrist in natural conditionFigure 7B - Wrist showing symptoms of Carpal

Tunnel Syndrome

Co mpression o f a ne rve c a uses musc le we a kness, sensa tions of "pins a nd need les" a ndnum b ness. Dryness of skin, and p oo r c irc ulation t o t he e xtrem ities, ma y also o c c ur.

Wha t are the sym ptom s of WMSDs?

Pa in is the mo st c om mo n symp to m a ssoc iate d with WMSDs. In som e c a ses the re ma y be jointstiffness, musc le tigh tne ss, red ness a nd swe lling o f the a ffec ted a rea . Som e wo rkers ma y a lsoexperience sensations of "pins and needles," numbness, skin colour changes, and decreasedswe at ing o f the han d s.

WMSDs ma y p rog ress in sta ges from mild to severe.

Early stage: Ac hing and tired ness of the affec ted limb oc c ur during the w ork shift but disap pe arat night a nd during d ays off work. No reduc tion o f work performanc e.

Intermed iate stag e : Ac hing a nd tired ness oc c ur early in the w ork shift a nd p ersist a t night.Red uce d c ap ac ity for rep etitive w ork.

Late stag e: Ac hing, fatigue , and we akness p ersist a t rest. Ina b ility to slee p an d to p erform lightduties.

Not eve ryone go es throug h these sta ge s in the sam e w a y. In fac t, it m ay b e d iffic ult to sa yexac tly when o ne sta ge end s and the next b eg ins. The first p ain is a sig na l that t he m usc les a ndtend ons should rest a nd rec ove r. Otherwise, an injury c a n be c om e long sta nd ing , andsom et imes, irreve rsible. The e a rlier p eo p le rec og nize symp toms, the q uicke r the y shou ld resp ondto them.

Ta b le 2 o utlines oc c up a tional risk fac tors a nd symp tom s of th e m ost c om mo n d isorde rs of theup pe r bo d y a ssoc iat ed with WMSDs.



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Table 2 Identified disorders, occupational risk factors and symptoms

Disorders Occupational risk factors Symptoms

Tendonitis/tenosynovitis Repetitive wrist motionsRepetitive shoulder motionsSustained hyper extension of armsProlonged load on shoulders

Pain, weakness, swelling, burningsensation or dull ache over affected area

Epicondylitis (elbow tendonitis) Repeated or forceful rotation of theforearm and bending of the wrist at thesame time

Same symptoms as tendonitis

Carpal tunnel syndrome Repetitive wrist motions Pain, numbness, tingling, burningsensations, wasting of muscles at base of thumb, dry palm

DeQuervain's disease Repetitive hand twisting and forcefulgripping

Pain at the base of thumb

Thoracic outlet syndrome Prolonged shoulder flexionExtending arms above shoulder heightCarrying loads on the shoulder

Pain, numbness, swelling of the hands

Tension neck syndrome Prolonged restricted posture Pain

How are WMSDs recognized?

The eva luation of WMSDs includ es id ent ifying wo rkp lac e risks. Eva luation b eg ins w ith a d isc ussionof the pe rson's em p loym ent a nd req uires a d eta iled d esc ript ion o f a ll the p roc esses involved in atypic a l workda y. Consid eration is given t o the freq uenc y, intensity, duration, and reg ula rity of

ea c h task performed at w ork.

Dia gn osis of WMSDs is c onfirme d b y p erforming la bo rat ory a nd elec tronic tests tha t d ete rminenerve or musc le d a ma ge . One suc h test, elec troneuromyo grap hy (ENMG), enc om pa sses twoareas: elec trom yograp hy (EMG) a nd nerve c ond uct ion veloc ity (NCV). Mag netic resona nceima g ing (MRI), a n a lternative to x-rays, p rovide s ima ges of te nd ons, ligament s, and musc les andimp rove s the q ua lity of the d iag nostic informa tion.

How are WMSDs trea ted ?

The t rea tm ent o f WMSDs involves seve ral ap p roac hes includ ing the following :

Restric tion o f m ove me nt App lic ation of heat o r co ld Exerc ise Med ic ation a nd surge ry

Restriction of Movem ent

The first a pp roac h to trea tm ent of WMSDs is to a vo id the a c tivities c ausing the injury. This oft enrequires work restric tions. In som e c a ses, transfer to a d ifferen t job should b e c onside red . A sp lintc a n a lso be used to restric t m ove me nts or to imm ob ilize t he injured joint. How eve r, the use o fsp lints in oc c up a tiona l situat ions requires extreme c a ution. If used inap p rop ria te ly, sp lints c a nc a use m ore d a ma ge tha n go od . Sp lints a re usually used for two rea sons: to me c ha nic a llysup p ort a joint where a n exce ssive loa d on the joint is a nticipa ted , or to restric t the m ove me nt ofthe injured joint.



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In the o c c up at iona l c onte xt, sp lints should no t b e used a s a me c ha nica l sup p ort for the joint.Instea d , the job should b e red esign ed to a void th e e xtrem e loa d on t he w orker's joint in the firstp la c e. To b e effec tive, the use o f sp lints to imm ob ilize a n a ffec ted joint a lso req uires tha t thewo rk ac tivity tha t c a used the injury be stop p ed or c ha nge d . If injurious wo rk co ntinues, then thewo rker is expo sed to risk of injury to othe r joints tha t ha ve t o c om pe nsat e fo r the o ne t ha t issplinted.

App lication of Hea t or Cold

App lying heat or co ld seem s to relieve pa in a nd ma y ac c elerate the repa ir proc ess. Hea t isrecommended for pain relief of minor injuries. It is not recommended for injuries with significantinfla mm a tion and swe lling.

Hea t increa ses the flow of b loo d a nd inc rea ses swe lling. Ice red uc es p a in a nd swe lling.

Exe rc ise

Stretching is b ene fic ial b ec a use it p rom ote s c irc ulat ion a nd red uc es musc le t ension. Howe ver,p eo p le suffering from WMSDs shou ld c onsult a p hysica l therap ist b efo re exerc ising. Stretc hing o rexercise p rog ra ms c a n ag grava te the existing c ond ition if not p rop erly de sign ed .

Med ica tion and Surgery

Anti-inflam ma tory drugs c an red uce pa in a nd inflam ma tion. The d oc tor ma y try mo re e lab oratetreatm ents or eve n surge ry if a ll other a pp roa c hes fail.

How c an we prev ent WMSDs?

Ha za rd s a re b est eliminate d at the source ; this is a fund am enta l princ ip le o f oc c up a tional hea ltha nd sa fety. In the c a se o f WMSDs, the p rime sou rc e o f ha za rd is the repet itiveness of w ork. Ot herc om po nents of wo rk such as the a pp lied forc e, fixed bo dy p ositions, and the p ac e o f workreq uiring rep etition o f the sa me mo vem ents ove r a nd o ver ag ain, a re a lso c ont ributing fac tors toWMSDs. The refore t he ma in effort to p rot ec t w orkers from WMSDs should fo c us on avo idingrep etitive p at terns of wo rk through job d esign w hic h ma y inc lud e me c ha niza tion, job rota tion,

job enlargem ent a nd e nric hme nt or tea mw ork. Where elimination of the rep etitive p at terns ofwo rk is not p ra c tica l, p reve ntion strateg ies involving w orkplac e layout , too l a nd e q uip me ntd esign, and wo rk pra c tice s should b e c onsid ered .

Job Design

Mechanization

One wa y to eliminate rep etitive t asks is to me c ha nize th e job . Where m ec ha nizat ion is notfea sible or a pp rop riate, othe r alternatives a re a va ilab le.

Job Rotation

Job rota tion is one p ossib le a pp roa c h. It req uires wo rkers to mo ve b etw ee n d ifferent ta sks, atfixed or irregular pe riod s of time. But it must b e a rot a tion w he re wo rkers do som ethingc om plete ly d ifferent. Different ta sks must e nga ge different musc le g roup s in o rd er to a llow

rec ove ry for those a lrea dy strained.



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How eve r, job rota tion alone will not b e e ffec tive in red uc ing WNSDs if not c om bined with thep rop er de sign of w orksta tions. And it w ill not b e e ffec tive while th e high p a c e of w ork persists.

Job Enlargement and Enrichment

Ano the r a pp roac h is job enla rgem ent . This increa ses the va riety of t a sks built into the job . Itbreaks the mo notony of the job a nd a voids overloa ding one p art of the bo dy. Job enric hmentinvolves mo re a utono my a nd c ontrol for the w orker.

Team Work

Tea m w ork c a n p rovide grea ter variety a nd mo re e venly distrib uted musc ula r wo rk. The w holetea m is involved in the planning a nd a lloca tion of the wo rk. Eac h tea m m em b er ca rries out a setof op erations to c om plete the whole p rod uct , allow ing the wo rker to a lternate be twee n ta sks,hen c e, red uc ing t he risk of WMSDs.

Workplac e Design

The guiding p rinc ip le in w orkplac e d esign is to fit the wo rkplac e t o t he w orker. Eva luat ion of thewo rkp lac e c a n id ent ify the sou rc e o r sou rce s of WMSD. Prop er de sign of the w orksta tiond ec rea ses the e ffort req uired of the wo rker to ma inta in a wo rking p osition. Id ea lly, thewo rksta tion should b e fully a d justa ble, p roviding a wo rker with the op tions to wo rk in sta nd ing ,sitting or sitting -sta nd ing p ositions, as well as fitting the wo rker's b od y size a nd sha p e. Det a iledinforma tion a bo ut prope r workplac e d esign c an b e found in the OSH Answers documents"Working in a Sta nd ing Position " and " Working in a Sitting Position ".

Too ls and Equ ipm ent Design

Prop er design of to ols and eq uipm ent signific antly dec rea ses the force need ed to c omp lete thetask.

Providing the wo rker with the p roper jig s or fixtures for ta sks tha t req uire hold ing e leme nts sa ves alot of muscular effort in awkward positions.

Goo d too ls, maintained c arefully and where nec essary freq uently c hang ed , ca n a lso save a lotof m usc le strain. Mo re informat ion a b out hand too ls a nd p reve nting WMSD resulting from theiruse c a n b e fo und in the OSH Answe rs d oc ume nt " Ha nd Too l Ergonomic s ".

Work Prac tice s

A we ll-d esigned job , sup p orted b y a w ell-design ed wo rkplac e a nd p rop er tools, allow s thewo rker to a void un nec essa ry mo tion of t he ne c k, shoulde rs a nd up pe r limb s. How eve r, thea c tua l p erforma nc e o f the ta sks d ep end s on individ uals.

Training should b e p rovided fo r wo rkers wh o a re invo lved in job s tha t includ e rep et itive ta sks.Workers nee d to know how to a d just w orksta tions to fit the ta sks an d their ind ivid ua l need s.Tra ining should also e mp ha size the imp ortanc e o f rest p eriod s a nd tea c h how to t a kea dv an ta ge of short pe riod s of time b etw ee n ta sks to relax the musc les, and how to c onsc iouslyc ontrol musc le t ension t hroug hout the who le w ork shift.

http://www.ccohs.ca/oshanswers/ergonomics/standing/standing.htmhttp://www.ccohs.ca/oshanswers/ergonomics/sitting/sitting.htmhttp://www.ccohs.ca/oshanswers/ergonomics/handtools/tooldesign.htmlhttp://www.ccohs.ca/oshanswers/ergonomics/handtools/tooldesign.htmlhttp://www.ccohs.ca/oshanswers/ergonomics/sitting/sitting.htmhttp://www.ccohs.ca/oshanswers/ergonomics/standing/standing.htm


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Conclusion

WMSDs of m usc les, tend on s a nd ne rves a re a m a jor ca use o f lost w ork in ma ny lab ou r-intensive

ind ustries. Oc c upa tional risk fac tors inc lud e c ontinual rep etition of m ove me nts, fixed b od yp ositions, force s c onc entrate d on sma ll p a rts of the b od y, a nd la c k of suffic ient rest b etw ee nta sks.

Preve ntion m ust a im at eliminat ing the rep etitivene ss of the wo rk by prop er job d esig n. Wherethis is not p ossib le, p reve ntive strateg ies suc h a s go od wo rkplac e layo ut, too l and eq uipme ntd esign, a nd prop er wo rk prac tice s should b e c onsid ered . Ea rly rec og nition o f these d isorde rs isvery imp ortant b ec ause m ed ic a l treatm ents a re unlikely to be e ffec tive on c e these injuriesbec ome longstanding.

Preve ntive a nd c ontrol me a sures, in o rd er to b e truly effec tive, require signific a nt involveme nt o nthe p art of the wo rkers, their rep resenta tives, and ma nag eme nt to imp rove oc cup ational hea lth

and safety.

How do es rep etitiveness and pa c e o f work influence WMSDs?

Rep etitive m ove me nts a re e spe c ia lly haza rdo us whe n the y involve the sa me joints and musc legroups over and o ver and w hen we do the sam e mo tion too often, too q uic kly and fo r too long.

To a na lyze how repet itive a ta sk is, we need to desc rib e it in terms of ste p s or c yc les. Forexam p le, the b ottle p a c king op eration (Figure 6) req uires wo rkers to p a c k boxes with twe nty-fourbottles.

Figure 6 - Packing bottles

One c ycle c an be de sc ribe d as follows:

rea c h for bo ttles grasp bo ttles move b ottles to b ox plac e b ottles in bo x



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If a w orker grasp s four bo ttles ea c h time, the sa me c yc le w ould ha ve to b e rep ea ted six times tofill a b ox. Assuming tha t one c ycle lasts two sec ond s, it w ould ta ke twe lve sec ond s to p a c k a b oxwith tw enty-four bo ttles.

The re a re no rules to judg e m ove me nts a s eithe r high o r low in rep et ition. Som e resea rc he rsc lassify a job a s "high rep et itive" if the t ime to c om plete suc h a job wa s less tha n 30 sec ond s or"low repe titive" if the time to c om plete t he job w a s mo re tha n 30 sec ond s. Althoug h no on erea lly know s a t w ha t p oint WMSDs ma y develop , workers p erforming rep et itive ta sks a re at risk forWMSDs Work involving m ove me nt rep ea ted ove r a nd ove r is very tiring b ec au se the wo rker c annot fully reco ver in the short p eriod s of time b etw ee n m ove me nts. Eventua lly, it t akes more e ffortto p erform the sam e rep etitive m ove me nts. When the wo rk ac tivity c ontinues in spite o f thefat igue , injuries c a n o c c ur.

What should I know ab out forc e of mo vem ents?

Force is the a mo unt o f effort o ur bod ies must d o t o lift o b jec ts, to use t oo ls, or to m ove .The a mo unt of forc e w e use to do a job de pe nds on m any fac tors such as the w eight of theob jec ts and their plac em ent in relation to the b od y. It requires mo re fo rc e to lift and c arry a bo xwith arms outstretc hed a nd held a wa y from the b od y (Figure 7) or to lift the sam e o b jec ts in a"p inch" po sition (Figure 7a ) tha n in a "hook" po sition (Figure 8, 8a).

Figure 7 - Lifting in a "pinch" Figure 7a - Pinch position

A fo rce of mo re t ha n four kilog ram s, or nine p ound s, is c onside red signific a nt. This is the forc eused to ham me r a na il, for exam ple. Although no o ne rea lly knows whe n WMSDs will deve lop,wo rkers performing forc eful mo veme nts a re a t risk. Work invo lving forc efu l move me nts is ve rytiring a ga in b ec au se the re is not t ime for a full rec ove ry be twe en m ove me nts. Eventua lly it ta keseffort to p erform t he sam e t ask. When the wo rk ac tivity c ontinues in sp ite o f the d eve lop ingfatigue, injuries occur.

Figure 8 - Lifting in a "hook"

Figure 8a -Hook position



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App endix 2

Lifting general prac tice

What typ es of protec tive clothing should b e wo rn?

DO WEAR

light we ight , flexible, te a r and p unc ture-resista nt c lothing, sa fety b oo ts with t oe c a p s a nd slip -resista nt soles, and protec tive gloves, ap propriate for the ma terials be ing hand led .

DO NOT WEAR

ap rons, co a ts, c lothing w ith e xpo sed b utto ns, zipp ers or loo se flap s, or hea vy dut y mitts.

What should you do be fore lifting?

Alwa ys c hec k be fore lifting t o see if mec ha nica l aid s suc h a s ho ists, lift trucks d ollies orwheelbarrows are available.

Get he lp with heavy or awkwa rd loa ds. Assess the we ight o f the loa d . Ide ntify the weight of the load . Be sure tha t you c a n lift the loa d without o ver-exertion.

Be sure tha t the loa d is "free " to m ove . Chec k that the p lanned loc ation of the loa d is free of o bstac les and de bris. Be sure tha t the p a th to th e p lanned loc at ion o f the loa d is c lea r. Grea se, oil, wate r, litter

and d eb ris c a n c a use slip s a nd fa lls. Partic ular hand ling a nd lifting tec hniq ues a re ne ed ed for different kind s of loa d s or

ma terials be ing hand led (for examp le, compa ct loads , sma ll b a gs , large sacks, drums,ba rre ls, cylind ers, shee t ma te ria ls like meta l or g lass).

Do not lift if you are not sure tha t you c a n hand le the loa d sa fely.

Wha t are som e g ene ral tips for lifting?

Prep a re fo r the lift b y wa rming u p the musc les. Stand close to the loa d and fac e the w ay you intend to move. Use a wide stanc e to g ain ba lanc e. Be sure you ha ve a go od grip on the loa d. Kee p a rms straight . Tigh ten ab d om inal musc les. Tuc k chin into t he c hest. Initiate th e lift with bo d y we ight . Lift the loa d a s c lose to the b od y a s po ssib le. Lift smo ot hly without jerking . Avoid twisting a nd side b end ing while lifting.

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App endix 3

Mic rowave ovens and their risks

Why do peo ple worry ab out microwave radiation?

Mic rowa ve o ven s a re used d a ily in resta urants, ca fet eria s, loung es, kitchens, sna c k ba rs, andhome s. Mic row ave oven users are o ften c onc erned a bo ut p otential health hazards from theexposure to microwave rad iation leakag e. With the late st tec hnological a dva nce s in d oor sea lde sign a nd w ith prope r ma intenanc e, mic row ave oven leakag e ha s be en g rea tly minimized oreliminated.

How d o m icrowave ove ns work?

In a m ic row a ve ove n, foo d is c oo ked b y exp osing it to microw ave ra d ia tion. Mo st househo ldmicrow av e o vens op erate on a freq uenc y of 2450 me ga hertz (MHz or million c ycles p er sec ond )in a c ontinuous wa ve (c w) m od e. La rge r ovens used for ind ustria l ap p lic a tions som etimesop erate a t 915 MHz.

The m ic row a ve e nergy from the m a gne tron is transferred to the ove n c a vity throug h awa veg uid e sec tion. A mo d e stirrer sp rea d s the mic row a ve e nergy m ore o r less eve nlythroug hout the oven.

The m ic rowa ve rad iation p rod uce s hea t inside the foo d in the oven. Hea t is prod uce d when thewa ter mo lec ules in the fo od vibrate (a t a ra te o f 2,450,000,000 time s pe r sec ond ) whe n the foo da b sorbs the mic row a ve ra d ia tion. The mo vem ent of the mo lec ules prod uc e fric tion whic hc a uses hea t. This hea t c oo ks or wa rms up the foo d .

Can m icrowaves leak rad iation?

Old o r faulty doo r sea ls are the mo st c om mo n c auses of m ic row ave rad iation leakag e.Mec hanica l ab use, a b uild-up o f dirt, or simp le w ea r and tea r of c ontinued use c an c ause d oo rsea ls to b e less effe c tive. Theoret ica lly, there w ill b e sma ll a mo unts of lea kag e th rough theviewing glass but measurements have shown this to be insignificant.



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What a re the health effec ts of mic rowave radiation?

A large am ount o f literature has be en p ublished on the biologica l effects of m ic row averad iation. Gene ra lly sp ea king, e xposure t o very high levels of m ic row a ve rad ia tion c a n result insignific a nt a mo unts of e nergy b eing a bsorbe d b y the b od y. Just a s with food , this ene rgy istransforme d into hea t in the b od y. Sensitive b od y pa rts, suc h a s the eye s, teste s a nd b ra in, a renot a ble to g et rid o f the extra he a t tha t ma y build up . How eve r, the situa tions whe re effe c ts oftherma l (hea t) da ma ge has ac tually oc c urred to the eye o r brain req uired long term e xpo sureto ve ry high p ow er de nsities well in exc ess of those m ea sured around microwave ovens.

Som e b iologica l effec ts c anno t b e e xplained b y a tem pe rature rise in the b od y or in a ny onep a rt. Persons wo rking in m ic row ave fields ha ve rep orted hea d a c hes, eyestrain, ove r-all fatiguea nd d isturba nc e o f slee p . These e ffec ts ha ve b ee n assoc ia ted with the intera c tion of themicrow a ve field s with the c entral nervous system of the b od y. Suc h effec ts ha ve b ee n lab eled

a s "non-therma l" interac tions. These m ay be resp onsible for som e o f the long -term e ffec ts fromp rolong ed expo sure to low leve ls of elec trom a gne tic fields. There is no c onfirme d sc ientificevide nc e to p rove a link b etw ee n suc h effec ts a nd m ic row av e rad iat us expo sure. How eve r, itmust b e e mp ha sized tha t the se e ffec ts usua lly oc c ur with p ulsed or pulse-mo d ula ted fields a ndnot w ith the c ontinuous wa ve fields assoc iated with microwa ve o vens.

What a re som e g eneral safety p reca utions for mic rowave ove ns?

Safe ty tips for op eration o f microw ave ove ns:

Do not operate oven when emp ty. Exercise e xtrem e c aution if you ha ve a pa ce ma ker imp lant. Microw ave rad iation m ay

c a use p ac em a ker interferenc e. Persons with pa c em a ker imp la nts should no t b e nea r amicrow ave ove n unless they a re sure tha t it is in g oo d op erating c ond ition a nd there is nolea kage o f microwa ve rad iation.

Chec k to see that do or sea l and inside surfac es of d oor and oven c avity are c lea n a fterea c h use.

Keep out of the reac h of c hildren. Do not p ermit young c hildren to op erate the o ven. Do not put fa c e c lose to d oor windo w w hen oven is op erating.

Safe ty tips for insta llation and ma intena nc e o f microw ave ove ns inc lud e:

Take spe c ial ca re to ensure tha t no d am ag e o c c urs to the pa rt of the o ven ma kingc onta c t with the d oor or doo r sea ls.

Ensure that the m ic rowa ve is unplugge d or disc onnec ted from electric al p ow er be forerea c hing into a ny ac c essib le o p enings or atte mp ting a ny rep a irs.

Ensure tha t the a djustment of a pp lied voltag es, rep lac eme nt of the microwave po werge nerating c om po nent, disma ntling o f the oven c om po nents, and refitting o fwa veguides are unde rtaken only b y pe rsons who ha ve b ee n spe c ia lly tra ined for suc hta sks. The servic es of a q ua lified rep a irma n should b e soug ht w hen a ny m a lfunc tion issuspected.

Do no t b y p a ss the d oo r interloc ks. Do not test a microwa ve po wer generating c omp onent without an a pp rop riate load

c onnec ted to its outp ut. The p owe r ge nerate d must never be a llowe d t o radiate freelyinto oc c upied a rea s.



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App endix 4

Extrem e Hot o r Cold Tem pe rature Cond itions

Is there a temp erature at whic h work bec om es da nge rous and should be stoppe d?

The short a nswe r is yes. Both very co ld a nd very hot te mp eratures c ould b e d a nge rous to yourhealth.

Exce ssive e xpo sure to hea t is referred to a s hea t stress and exc essive e xposure to c old is referredto a s c old stress.

In a very hot e nvironm ent, the mo st serious c onc ern is hea t stroke. In a b senc e o f imm ed iat eme d ic al atte ntion, hea t stroke co uld be fat al. Hea t stroke fata lities d o o c c ur eve ry summ er. Hea texha ustion, a nd fa inting (sync op e) a re less serious typ es illnesses wh ich a re no t fa ta l but interferewith a p erson 's a b ility to wo rk.

At ve ry c old t em p eratures, the m ost serious c onc ern is the risk of hyp ot hermia or da ng erousove rc oo ling of t he b od y. Anothe r serious effec t o f c old expo sure is frostb ite or free zing of theexposed extremities such as fingers, toes, nose and ear lobes. Hypothermia could be fatal inab sence of imme diate me dical attention.

What a re the warning signs of hea t stroke and hypo thermia?

The victims of hea t stroke a nd hyp othe rmia a re una b le to notic e the symp tom s, a nd t herefore,

their surviva l dep end s on c o-wo rkers' ab ility to id entify symp tom s an d to see k me dic a l help .

While symp tom s c a n va ry from p erson t o p erson, the wa rning signs of he a t stroke c a n includec om p laints of sud de n a nd seve re fat igue , nau sea , dizziness, light hea d ed ness, a nd p rofuse a ndp rolong ed swe a ting. If a c o-wo rker a p pe ars to b e d isorienta ted or co nfused (inc ludingeuphoria), or has unaccountable irritability, malaise or flu-like symptoms, the worker should bemoved to a co ol loc ation and seek medica l ad vice .

Warning signs of hyp othermia c an includ e c om p laints of na usea , fatigue, d izziness, irritab ility o reup horia . Workers c a n also e xpe rienc e p a in in the ir extremities (ha nd s, fee t, ea rs, et c ), andseve re shivering. Workers should b e m ove d to a hea ted shelter and see k med ic al ad vice w henappropriate.

Dehydration (hypo hyd ration )

is the rem ova l of wa ter from a n ob ject . Med ic a lly, dehyd ra tion is a serious a nd p ote ntially life-threa tening c ond ition in which the bo dy c onta ins an insuffic ient vo lume of w ate r for norma lfunctioning.

In huma ns, dehyd ration c an be c aused by a wide rang e o f disea ses and state s that imp airwa te r home osta sis in the bod y. These inc lude :

Externa l or stress-rela te d c a useso Prolong ed p hysic a l a c tivity without co nsuming a de q uat e wa ter, esp ec ially in a

hot environme nto Prolonged exposure to dry air, e.g., in high-flying airplanes (5-15% r.h.)



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o Diarrheao Shoc ko Vomiting

Infectious diseaseso Cholerao Gastroenteritiso Shigellosiso Yellow fever

Malnutritiono Excessive c onsump tion o f a lc oho lo Fa stingo Rec ent ra p id we ight loss ma y reflec t p rog ressive d ep letion o f fluid volume .o Pa tient refusa l of nut rition a nd hydrat ion

Symp tom s ma y inc lude he a d a c hes simila r to w ha t is expe rienc ed d uring a ha ngo ver, a sud d enep isod e o f visua l snow, d ec rea sed b lood p ressure (hypot ension ), and d izziness or fainting w hensta nd ing up d ue t o orthosta tic hyp ote nsion. Untreate d de hydration g ene ra lly results in delirium ,unc onsc iousness, an d in e xtreme c ases dea th.

Dehydration sympt oms generally b ec om e notic ea ble a fter 2% of o ne's normal wa ter volume hasb ee n lost. Initia lly, one exp erienc es thirst a nd d isc om fort, possibly along with loss of appetite andd ry skin. Athlete s ma y suffer a loss of p erforma nc e o f up to 50%, and experienc e flushing, lowend uranc e, rap id hea rt rate s, elevate d bo dy tem pe ratures, and rap id onset o f fatigue.

Symp tom s of m ild d ehyd rat ion inc lude thirst, de c rea sed urine volume , urine tha t is d a rker than

usua l, unexplained tired ness, lac k of te a rs whe n c rying, he a d a c he, d ry mo uth, an d dizzinesswhen standing due to orthostatic hypotension.

In mo de rat e to seve re d ehyd rat ion, there ma y be no urine out p ut at a ll. Other symp tom s inthese states include lethargy or extreme sleepiness, seizures, sunken fontanel (soft spot) in infants,fainting, and sunken eyes.

The symp to ms b ec om e inc rea singly seve re with grea te r wa te r loss. One's hea rt a nd resp ira tionrat es b eg in to inc rea se to c om pe nsa te for de c rea sed p la sma volume a nd b loo d p ressure, whileb od y tem p erature ma y rise b ec a use o f de c rea sed swe a ting . Around 5% to 6% wa ter loss, onema y bec om e g rog gy o r sleep y, experienc e hea da c hes or nausea , and m ay fee l tingling in one'slimb s (pa resthesia ). With 10% to 15% fluid loss, musc les ma y b ec om e sp a stic , skin m a y shrive l andwrinkle, vision m a y dim, urina tion will b e g rea tly red uc ed a nd m ay b ec om e p a inful, and d eliriumma y b eg in. Losses g rea te r than 15% a re usua lly fa ta l.

The b est trea tm en t for minor de hyd ration is d rinking wa te r a nd sto pp ing fluid loss. Wa te r isp refe rab le to spo rt d rinks a nd othe r c om me rc ia lly-sold rehyd ra tion fluids, as the b a la nc e o felec trolytes they p rovide ma y not ma tc h the replac em ent req uirem ents of the individ ua l. To stopfluid loss from vomiting and diarrhea, avoid solid foods and drink only clear liquids.

Dehydrat ion is be st a voide d by d rinking p lenty o f wa ter. The g rea ter the a mo unt o f wa ter lostthrough pe rspiration, the more w ate r must b e c onsumed to replac e it and avo id de hydration.Sinc e the bo dy c a nnot to lerate la rge de fic its or exc esses in tota l b od y wa ter, c onsump tion ofwa te r must b e roug hly co nc urren t w ith the loss (in ot her wo rd s, if one is p ersp iring, one shoulda lso b e d rinking wa ter freq uently). Drinking wa ter slight ly be yond the ne ed s of the b od y enta ilsno risk, since the kid neys will effic iently rem ove any exc ess wa te r throug h the u rine with a large

http://en.wikipedia.org/wiki/Deliriumhttp://en.wikipedia.org/wiki/Appetitehttp://en.wikipedia.org/wiki/Appetitehttp://en.wikipedia.org/wiki/Delirium


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ma rgin of safety. A p erson's bo dy, during an ave rag e d ay in a tem pe rate c lima te such as theUnited Kingd om , loses a p p roxima te ly 2.5 lite rs of w a te r. This c a n b e th roug h the lungs a s wa te rva p or, through t he skin a s sweat , or throug h the kidneys a s urine . Som e wa te r (a less signific anta mo unt, in the a b senc e o f diarrhea ) is also lost through the b ow els. In wa rm o r humid w ea ther ord uring he avy e xertion, how eve r, the w a ter loss c a n inc rea se b y an o rd er of ma g nitud e o r mo rethrough p ersp irat ionall of wh ic h m ust b e p rom p tly rep lac ed . In e xtrem e c a ses, the losses ma ybe great enoug h to excee d the b od y's ab ility to ab sorb w ate r from the g astrointestinal trac t; inthese c a ses, it is not po ssible to d rink enoug h w at er to sta y hydrate d , and the only wa y to av oidd ehyd ra tion is to red uc e p ersp irat ion (through rest, a mo ve to a c oo ler environm ent, etc .). Auseful rule of thum b for avo id ing d ehyd rat ion in ho t o r humid environm ents or during strenuo usa c tivity involves mo nitoring the freq uenc y and c ha ra c ter of urina tion. If one d eve lop s a fullbladder at least every 3-5 hours and the urine is only lightly colored or colorless, chances are thatd ehyd rat ion is not oc c urring ; if urine is de ep ly c olored , or urina tion oc c urs only afte r man y hoursor not a t all, wa ter intake ma y not be a de qua te to m aintain prope r hydration.

When large a mo unts of w ate r are b eing lost through pe rspiration a nd co ncurrently rep lac ed byd rinking, m a inta ining prop er elec trolyte ba la nc e b ec om es a n issue. Drinking fluid s tha t a rehypertonic or hypo tonic w ith respe c t to pe rspiration ma y have grave c onseq uenc es(hypo na tremia o r hype rnat rem ia , princ ip ally) as the t ota l volume o f wa ter turnove r inc rea ses.

If wa ter is be ing lost throug h a n a bn orma l mec ha nisms suc h a s vom iting o r diarrhea , that c a rryaw ay e lec trolytes in large qua ntities, an imba lanc e c an de velop very quickly into a me dica lem erge nc y. In fa c t, the m a in me c ha nisms through w hic h d isea ses suc h a s infant ile d iarrhea a ndc ho lera kill the ir vict ims a re de hyd ration a nd loss of e lec trolytes.

http://en.wikipedia.org/wiki/Sweathttp://en.wikipedia.org/wiki/Sweat


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App endix 5

Slips, trips and falls

Why is prevention of slips, trips and falls imp ortant?

In C an ad a som e sixty tho usa nd wo rkers ge t injured a nnua lly due to fall ac c ide nts. This numb errep resents a b out fiftee n p erce nt o f the "time-loss injuries" that w ere a c c ep ted b y w orkers'c om pe nsat ion b oa rd s or co mm issions ac ross Ca nad a . Not m entioning a g rea t ec ono mica l loss,it a mo unts for a lot o f pa in an d suffering a nd som etime s (muc h too ofte n) even d ea th. All these,in mo st of c ases, d o no t ha ve to ha pp en. Wha t is nee d ed is:

understand ing how fall ac c ide nts hap pe n, ide ntifying the t roub le a rea s, and elimina ting o r minimizing ha za rds of fa lling.

How d o falls hap pe n?

Sta tistics show tha t the ma jority (60 perc en t) of fa lls ha p p en o n the same leve l resulting from slip sa nd trip s. The rema ining 40 pe rce nt a re fa lls from a he ight. This d oc umen t w ill summa rizeinformation on "falls on the same level" (slips and trips). Falls from an elevation, such as falls fromlad d ers, roo fs, do wn sta irs or from jump ing to a lowe r level, etc ., will d isc ussed in ano the rd oc ume nt sinc e e ac h type of fall req uires d ifferent fea tures in a fa ll p reve ntion program .

Slips

Slip s ha pp en w here there is too little fric tion or trac tion be twe en the foot we a r a nd t he w a lkingsurfac e. Co mm on c a uses of slip s a re:

we t o r oily surfac es, occasional spills, we at her hazards, loo se, una nc hored rug s or ma ts, and floo ring o r othe r wa lking surfac es tha t d o no t ha ve sa me de gree o f tra c tion in all a rea s.

Trip s

Trip s ha p pe n w hen your foot c ollid es (strikes, hits) a n o b jec t c a using you t o lose the ba lanc ea nd , eve ntua lly fall. Co mm on c a uses of trip p ing a re:

ob structe d view , po or light ing, c lutter in your wa y, wrinkled carpeting, uncovered cables, bo ttom draw ers not b eing c losed , and uneven (ste ps, thresho lds) w a lking surfac es.



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How to p reven t falls due to slips and trips?

Both slips and trip s result from som e a kind o f unintend ed or unexpec ted c ha nge in the c onta c tb etw ee n the fee t a nd the ground or wa lking surfac e. This show s tha t go od housekee p ing,quality of walking surfaces (flooring), selection of proper footwear, and appropriate pace ofwa lking a re c ritica l for preventing fa ll ac c idents.

Housekeeping

Go od housekee p ing is the first a nd the m ost imp ortant (fund a me nta l) leve l of preventing fa llsd ue to slip s a nd trip s. It inc lude s:

c leaning a ll sp ills imme d ia te ly, ma rking sp ills a nd we t a rea s, mo p p ing or swe ep ing de b ris from floo rs, rem oving ob sta c les from wa lkwa ys an d a lways keep ing the m free of c lutter, sec uring (tac king , ta p ing, etc .) ma ts, rug s a nd c a rpe ts tha t d o no t lay flat, alwa ys c losing file c a b inet or storag e d ra we rs, c ove ring c ab les tha t c ross wa lkwa ys, keep ing wo rking a rea s a nd wa lkwa ys we ll lit, rep lac ing used light bu lbs and faulty switc hes.

Without go od housekee p ing p rac tice s, any o ther p reve ntive me a sures suc h a s insta llat ion ofsop histica ted floo ring , sp ec ialty foo twe ar or training o n te c hniques of w a lking a nd safe falling willneve r be fully effec tive.

Flooring

Cha nging or mo d ifying wa lking surfac es is the next level of p reve nting slip and trips. Rec oa ting o rreplacing floors, installing mats, pressure-sensitive abrasive strips or abrasive-filled paint-onc oa ting and me ta l or synthetic d ec king c a n further imp rove sa fety an d red uc e risk of falling.How eve r, it is c ritica l to remem b er that high-te c h floo ring req uires go od housekeep ing a s muc ha s a ny othe r flooring . In ad d ition , resilient, non-slipp ery floo ring p reven ts or red uc es foo t fa tiguea nd c ontribut es to slip p reve ntion m ea sures.

Footwear

In w orkp la c es whe re floo rs ma y b e o ily or we t o r where w orkers sp end c onsid erab le t imeoutd oo rs, prevention o f fall a c c id ents should fo c us on selec ting p rop er footw ea r. Sinc e the re isno foo twe a r with a nti-slip prop erties for eve ry c ond ition, c onsulta tion w ith m a nufac turers' is high lyrecommended.

Prop erly fitting fo otw ea r inc rea ses c om fort a nd preven ts fat igue which, in turn, imp rove s sa fetyfor the em p loye e. For more informa tion o n foo twe a r visit our web -pa ge Foo t sa fety .

What c an yo u do to avoid falling a t work?

It is importa nt rem em bering tha t sa fet y is eve ryb od y b usiness. How ever, it is em p loyers'resp onsib ility to provide sa fe wo rk environm ent for all emp loyees. Emp loyees ca n imp rove their

ow n safety too .

http://www.ccohs.ca/oshanswers/prevention/ppe/footwear.htmlhttp://www.ccohs.ca/oshanswers/prevention/ppe/footwear.html

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