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1 9 (9 9 ) J Korean Soc Occup Environ Hyg 9;9():7~ Work Related Musculoskeletal Disorders and Ergonomic Work Posture Analysis of Operating Room Nurses Cheonok Lee Younsoon Ahn Wooseok Kwak Jong Uk Won Shinyoung Lee Chinyon Kim Jaehoon Roh National Cancer Center, ) Department of Occupational & Environmental Medicine, Dongguk University Hospital, Graduate School of Public Health, Yonsei University, Institute for Occupational Health, Yonsei University College of Medicine This study was carried out to evaluate a musculoskeletal symptom and the work posture of the nurses in an operating room who have worked in the present department for more than one year. The job analysis of operating room nurses for ergonomic work posture analysis is divided into tasks. On the basis of that, a survey research and ergonomic work posture analysis are also carried out. Among operating room nurses of a cancer center in Kyonggi province who responded to the selfadministered questionnaire, nurses were observed and videorecorded to apply Rapid Entire Body Assessment(REBA) to ergonomic work posture analysis from April, 7 to May, 7. The results of analysis are as follows. The prevalence rate of musculoskeletal symptoms was 7.% and its prevalence rates by part of the body are these followings; lower back and leg/foot.9%, shoulder.%, neck.%, hand/wrist/ finger.%, arm/elbow.%. In accordance with the results of ergonomic work posture analysis, tasks that have a REBA score of have high-risk levels and require an immediate management. It shows there is a significant correlation with overall musculoskeletal symptoms and objective workloads that are estimated by REBA. In conclusion, the work conditions of operating room nurses should be improved. It is also necessary that inappropriate work postures and ergonomic work conditions are improved to prevent musculoskeletal disorders of operating room nurses. Key Words : operating room nurse, musculoskeletal disorder, work posture, Rapid Entire Body Assessment(REBA) : 9, : 9 7 : (, Tel: --9, Fax: -9-, jhroh@yuhs.ac )

2 7 (work related musculoskeletal disorder) (,, ).,,,,,,, (, ), (National Institute for Occupational Safety and Health, 99).,,,, (, ). (Ando et al, )., (Bureau of Labor Statistics, 999),.,, (Sosnowitz & Hriceniak, 9; Allen, 99; Collins & Owen, 99; Brulin et al, 99).,, (Kant et al, 99; Trinkoff et al, ). (Kant et al, 99). (Gribbins & Marshall, 9)., (, 9). (). (, ;, ).. (, ).,.,,. 7, ( 7.%).. ) (, ;, ),. (),,,,,., (,,, ).,,,, (Table ). ) 7

3 7 Jobs Descriptions Risk factors Records the equipments used, counts of needles and gauze, types and counts of inserted materials, drainage devices, specimens, and the work postures position of the patients, focusing on the nursing interventions. Hands sterilization & putting on the gloves and gowns Performs the surgical scrub with repetitive actions to make sure the hands and arms be sterile using the brushes and antiseptics, and put on the gowns and gloves. During the patient's preparation for the operation, the scrub nurse arranges the instruments, equipments, gowns, gloves, and linens on the sterile table. Dress members of the surgical team in Gowns and gloves During an operation, scrub and cirulating nurses count precise numbers of every gauze, sponges, needles, equipments used in the operation according to the provided methods, before suturing the incision. work postures, repitition work postures, strength work postures, repitition work postures, repitition During an operation, Passes the materials needeed to the surgeons or the assistants appropriately, e.g., making gauze wet or suitable for dressing, work postures, repitition for hemostat, etc. During an operation, hands the instrumenets and equipments to the surgeons. work postures, repitition, strength Cleanness maintenance Maintains sterility thoughout the procedure by removing unsanitary materials frequently in order to prevent intraoperative infections. work postures, repitition Connects the instruments for operation, and separates appropriately after the operation. Exposes the surgical area appropriately for smooth progress of procedures and in order to minimize the patient's discomfort. Moves the patient into the operating room or moves out the patient to the recovery room after surgery. Checks the equipments and instruments used in the operation to make sure that they are available at the next operation. work postures, strength work postures, strength work postures, strength work postures Cleans and organizes the operating room with the sanitizers before the operation. work postures, repitition, strength

4 7... Rapid Entire Body Assessment(REBA), REBA. ),,, (, ).,,,,, ( - ), ( - ), ( ), ( ), ( ). ) 7,.,.,,,,.,,,,,,,,,.,,,,,,. (, ), NIOSH.,, /, / /,, /,,,,. NIOSH,,,, (,,, ), (NIOSH, 99; Hales, 99)..,. (, ),,,,. Likert. REBA,. SPSS..,, Chi-square. REBA SAS.,. ) -9 (.%), - 7 (7.%), - (.%), (.%). (7.%), (.%), cm (.%), cm (.9%) cm. (.%).. (.%),.. (,.%)

5 7 Variables N(%) Necks Shoulders Arms /Elbows Hands /wrists /fingers Waists Legs /Foots - 7(7.) (.9)* (.9) (.) (7.) (.) Age(years) -9 - (.) (.7)* (.)* 7(.) (.7) (.) (.) (7.) (.7) (.) (.) (7.) (.7) (.) (.)* (.) (.) (.) (.) (.) Marital state unmarried married (7.) (.) 9(.) (.) (.) (.) (.7)* (.)* 7(.) (.) (.7) (.) (.) (.) Height(cm) Average time for hosekeeping (hours per a day) < almost none - (.) (.9) 9(.) (.7) 9(.) 9(9.) (7.) (.) (.) (.) (.) (7.) (.) (.) (.) (7.) (.) (.) (.) (.) (7.) (7.) (.) ( 7.7) (.) 9(9.) 9(.) (.) 7(.) (.) (.) (.) 9(7.) 7(.) (.) Drinking No Yes 7(.) (.) (.) (.) (9.) (.7) (7.) (.) (.) (.) (7.) (.7) 7(.) (.) Career as the operating nurse (years) - - > (9.) (.) 9(.) (.)* (.)* (.7)* (.)* (.7) (.) (.7) (.) (.) (.7) (.) (.7) ( 7.) (.) (.) (.) (.9) (.) (.) (.) (.7) (.) (.) (.) ( 9.)* (.) (.) (.) (.) Total career - (.) (.7)* (.7) (.) (.7) 7(.7) (.) (years) - (.7)* (.7) (.7) (.) (.) (.) > 9(.) (.)* (.) (.) (.) (.) (.) Standing time on the job - (.) (9.) (.) 7(.) (7.) (7.) (hours) > (.) (.7) Working time on the (.) (.) (.) (.7) 7(.) (.) (.) platform (hours) - (7.) (.) (7.) ( 9.) (.) (.) (.) Sum (.) (.) (.) (.) (.) (.) (.), (7.%).,. /, (p<.).,. / /,

6 7 Parts of the body N % Waist Leg/Foot Shoulder Neck Hand/Wrist/Finger Arm/Elbow Ratio of musculoskeletal symptoms* Variables Necks Shoulders Arms /Elbows Hands /wrists /fingers Waists Leg /Foot Ranking ( 9.) (.) (9.) (.) Preparing equipments & sterilizing materials (.7) 7(.) (.9) 7 Hands sterilization & putting on the gloves and gowns ( 7.) (.7) 9(.) (.) (7.) ( 7.) (.) 9(.) 9(.) (.) 7(7.) 9 ( 9.) (.) (.) 7(7.) (.9) 9(.) ( 7.) (.) 9(.) (.) (.) 9(.) 9(.) (.) (.) (.) (.) 9(.) (.7) (.) (.) 9(.) Cleanness maintenance (.) (9.) (.) (9.) (.) (.) 9(.) (.) (.) (.9) (.) 7(7.) 9(.) (.) 7(.) (.7) 7(.9) 7(7.) (.) (.7) (.) (.) (.) (.) 9(.) (.) 9(.) (.) 9(.) (.7) 9(.) (.9) (.) (9.) (p<.) (Table ). ) 7.%( ), / (.9%), (.%), (.%), / / 9 (.%), / (.%) (Table ). ),.,,,,,,,,,,,. /,, / /,,,,,.,,,. /,

7 77,, (Table ). ) REBA (,,,,, ), ( ),, REBA (Table ). REBA,,,,,,,..,,,,.,,. REBA,,,,,,,,.. ),,.,,,,,.,,,, (Table ). Jobs Preparing equipments & sterilizing materials Hands sterilization & putting on the gloves and gowns Cleanness maintenance Total score Average Torso Neck Leg.. Parts of the body. Upper arm. Fore arm. Wrist. manag Load Beahavial REBA Handle ement /Strength Score Score level* 7 7. Risk level Low High Low High High High Low Ignored

8 7 a c b d ),,,,,,.,. REBA,,,,,,, REBA,.,, REBA,,. REBA (Table 7). REBA.7. Jobs Workload (A) Work frequency (B) Total score (A*B) Ranking.7.. Preparing equipments & sterilizing materials.. 7. Hands sterilization & putting on the gloves and gowns Cleanness maintenance

9 Work evaluation Ranking REBA* Ranking Workload 79 Ranking Musculoskeletal symptoms Preparing equipments & sterilizing Preparing equipments & sterilizing materials materials Cleanliness maintenance 7 Preparing equipments & sterilizing materials Hands sterilization & putting on the Cleanliness maintenance gloves and gowns 9 Cleanliness maintenance Hands sterilization & putting on the gloves and gowns Hands sterilization & putting on the gloves and gowns,. REBA,,,,,,,.,,,,,.,,

10 REBA,,. / REBA. REBA. (, ) REBA., REBA. /. 7.%, /.9%,.%,.%, / /.%, /.%.,, /. / /,... REBA..,,,,. (response bias).,.,.,, REBA.,,. 7.%, /.9%,.%,.%, / /.%, /.%., REBA,,,,,,, REBA.,, REBA,,. REBA.. REFERENCES..,..,,. ;():-.. -7,. :.

11 , 9..,..,.. KOSHA Code H--,.. KOSHA code H-9-, Allen A. On-the-job injury: A costly problem. J Post Anesth Nurs 99;():7- Ando S, Ono Y, Shimaoka M, Hiruta S, Hattori Y, Hori F. Associations of self estimated workloads with musculoskeletal symptoms among hospital nurses. Occupational and Environmental Medicine ;7:- Brulin C, Gerdle B, Granlund B, Hoog J, Ksutson A, Sundelin G. Physical and psychosocial work-related risk factors associated with musculoskeletal symptoms among home care perconnel. Scand J Caring Sci 99;():- Bureau of Labor Statistics. Workplace Injuries and Illness in Collins JW, Owen BD. NIOSH research initiatives to prevent back injuries to nursing assistants, aides, and orderlies in nursing homes. Am J Ind Med 99;9():- Gribbins RE, Marshall RE. Stress and coping in the NICU staff nurse: Practical implications for change. Crit Care Med 9;():-7 Hales TR, Sauter SL, Peterson MR, Fine LJ, Anderson VP, Schlhifer LR, Oshs TT, Bernard BP. Musculoskeletal disorders among visual display terminal users in a telecommunication company. Ergonomics 99;7:- Kant IJ, de Jong LC, van Rijssen-Moll M, Borm PJ. A survey of static and dynamic work postures of operating room staff. Int Arch Occup Environ Health 99;():- National Institute for Occupational Safety and Health(NIOSH). NIOSH health hazard evaluation report. NIOSH report. NO. HETA 9--, 99 Sosnowitz BG, Hriceniak JP. Neonatal intensive care units can be hazardous to nurses' health. J Perinatol 99;():-7 Trinkoff AM, Storr CL, Lipscomb JA. Physically demanding work and inadequate sleep, pain medication use, and absenteeism in registered nurses. J Occup Environ Med ;():-

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