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Applied Ergonomics for LTC. University of Oregon, Labor Education and Research Center (LERC) and Oregon Occupational Safety and Health Administration (OR-OSHA)

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Applied Ergonomics for LTC

University of Oregon, Labor Education and Research Center (LERC) and Oregon Occupational Safety and Health Administration (OR-OSHA)

This material has been made possible by a grant from the Oregon Occupational Safety and Health Division, Department of Consumer and Business Services


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Acknowledgements

Materials for this presentation material made possible

by

Oregon OSHA

Veterans Health Affairs

SAIF Corporation

HumanFit

Bay Area Hospital, Coos Bay, OR

Oregon Nurses Association (ONA)

University of Oregon, Labor Education and Research Center

Back Injury Resource Nurses (BIRN)

National Institute of Occupational Safety and Health (NIOSH)


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Introduction

  • Ergonomic concepts

  • Risk factors for musculoskeletal injury

  • Elements of an ergonomics program

  • SRH Case studies

Today’s workshop will cover


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Learning Objectives

By the completion of this class you should be able to:

  • List 4 risk factors for musculoskeletal injury

  • Describe 4 action steps that can reduce your risk of injury during resident handling activities

  • Identify effective solutions to prevent injuries in for number of common resident handling activities


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What is Ergonomics?

Worker

Environment

Task/job

The goal of ergonomics is to design the

job to fit the worker

NOT make the worker fit the job


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What kinds of Injuries are Musculoskeletal Disorders (MSDs)?

Acute injuries

  • Happen immediately due to overload

  • Can become chronic

  • Re-injury possible

  • Strains, sprains, disc herniations

  • Chronicinjuries

    • Pain or symptoms lasting more

    • than a month

  • Cumulativetrauma

    • Happenover time

    • Difficult to cure


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Cumulative Trauma/Injury

Activity

microtrauma (small tears)

irritation to tissue

produces scar tissue

Keeps repeating

as long as

activity continues

  • results in:

    •  flexibility

    •  strength

    • Function

      *INJURY*

adhesions form

tears combine


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The Cumulative Effect

Fatigue

Continued exposure to risk factors

Discomfort

Nurses/CNAs report here

Pain

Injury

Disability

Time


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Terms for Disorders

  • Work-related Musculoskeletal Disorder (WRMSD)

  • Cumulative Trauma Disorder

  • Repetitive Strain Injury

  • Overexertion or Overuse Injury

  • Types of disorders

    • Strains and sprains

    • Rotator cuff injuries

    • Disc herniations

    • Carpal Tunnel Syndrome

    • Bursitis, tendonitis

    • Sciatica


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Why is Manual Resident Handling so Hazardous?

  • Physical demands of the work

    • Job exceeds physical demands of individuals

  • Poor equipment and facility design

  • Poor work practices

  • Individual characteristics

    • Age, past injuries, physical condition, leisurely activities


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What are the Risk Factors for Musculoskeletal Disorders?

  • Excessive force

  • Awkward postures

  • Prolonged postures

  • Repetition


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Excessive Forces

Common activities contributing to excessive force:

  • Lifting and carrying

  • Pushing and pulling

  • Reaching to pick up loads

  • Prolonged holding

  • Pinching or squeezing


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Awkward Postures

Common risky postures:

  • Working overhead

  • Kneeling all day

  • Reaching to pick up loads

  • Twisting while lifting

  • Bending over to floor/ground

  • Working with wrist bent


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Prolonged Postures

  • Standing or sitting for long

  • periods of time

  • Holding arms in fixed

  • positions for extended

  • periods


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Repetitive Motions

Common problem to look for:

  • Same posture or motions again and again

    • can be very frequent over short period of time

    • can be less frequent but repeated over time

injury

time

injury

time


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Common Problems Leading to MSDS

:

  • Poorly Designed Equipment

    • Does not have a good grip

    • Too heavy

    • Hard to use

    • Uncomfortable

    • Bad condition

    • Wrong tool/equipment for the job


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Common Problems Leading to MSDs

  • Poor work organization

    • In adequate scheduling

    • Lack of planning

    • Poor communication among staff and other

    • resident stakeholders

    • Poor work practices


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When is an Activity Likely to Become an Injury?

  • Activity performed frequently

  • You do the activity a long time

  • Work intensity is high

  • There are a combination of risk factors


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How do you find solutions?

Job

Tasks

Solution

Hazards

Solution

  • Form SRH team

  • Ergonomic Risk Analysis

  • Needs Assessment

  • Formulate solutions

Solution

Solution


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Work practice

controls

Engineering controls/

Equipment improvement

Proper

body

mechanics

Fitness &

wellness

Risk of

musculoskeletal injury

Administrative

controls

Personal

protective

equipment


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Choose Effective Solutions

Most

Effective

  • Engineering

    • Tools/equipment

    • Workplace design

  • Administrative

    • Job rotation

    • Number of workers

  • Work practices

    • Changing bed height

  • Behavioral

    • Body mechanics

    • Stretching/Fitness

    • PPE

Least

Effective


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Preventing MSDS

  • First Choice: Engineering Controls

  • Eliminate or reduce primary risk factors

  • Use resident handling equipment, such as,

  • ceiling and portable floor lifts, air assist transfer devices, and mechanical sit to stand lifts

  • Must match equipment use with

    • Resident dependency (physical and cognitive abilities)

    • Type of lift, transfer or movement

    • Number of staff available


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Preventing MSDS

Second Choice: Administrative Controls

  • Reduce employee exposure to primary risk factors

    • Ergonomics training

    • Policy & procedures that define good work practices

    • Staffing and overtime practices

    • Job rotation


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Preventing MSDS

Second Choice: Work Practice Controls

  • Reduce employee exposure to primary risk factors by using best work methods:

    • Plan work organization

    • Use good housekeeping practices

    • Use adjustments on equipment

    • Get help when needed

    • Eliminate unnecessary movements

    • Don’t use broken equipment

Remember – it’s the employee’s responsibility to use good work practices and follow the organizations’ safe resident handling policy and procedures


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Preventing MSDs

Second Choice: Work Practice Controls

  • Neutral spine posture - 3 Curves make your spine strong and minimize physical stress

  • It is important to KEEP THESE CURVES when moving, bending and lifting

  • Neutral spine is the reason body builders can lift so much weight without injury

Cervical

Thoracic

Lumbar

Using good body mechanics is important, even when using equipment, but alone body mechanics will NOT prevent MSDs


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Conduct Ergonomic Risk Assessment

  • Recognizing hazards is the first step toward injury prevention

  • Job analysis performed by people with ergonomics training

    • Ergonomics team

    • Safety committee members

    • Line personnel


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What Can You Do to

Reduce Your Risk of MSDs?

The following materials from the Safe Resident Handling in Health Care Guide, and made possible by a grant from Oregon OSHA, Department of Consumer and Business Services, 2004.

Used with permission from Oregon Nurses Association, UO LERC and Bay Area Hospital, Coos Bay, OR


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Risk Assessment steps

  • Assess the resident

  • Assess & prepare the environment

  • Get necessary equipment & help

  • Perform the Resident care task, lift or movement safely

Plan and Prepare – It only takes a minute but can save a career


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Assess the Resident

Goal:

To assess if resident status (physical and cognitive abilities) has changed and to determine the safest method to transfer or move the resident.

Compare assessment with resident handling orders or instructions in the Resident's Care Plan and ensure that staff are alerted to changes in resident status.


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Assess the Resident

This brief observation includes assessment of the resident’s:

  • Ability to provide assistance

  • Physical status – ability to bear weight, upper extremity strength, coordination and balance

  • Ability to cooperate and follow instructions

  • Medical status – changes in diagnosis or symptoms, pain, fatigue, medications

When in doubt, assume the resident cannot assist with the transfer/ repositioning


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Assess & Prepare the Environment

  • Ensure that the path for transfer or movement is clear and remove obstacles and clutter that constrain use of good posture and access to the Resident, e.g.,

    • bed tables, and chairs

    • trip hazards, e.g., cords from medical equipment

    • slip hazards , e.g., spilled beverages or other fluids on the floor


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Assess & Prepare the Environment

  • Consider safe handling of medical devices, such as catheters, intravenous tubing, oxygen tubing, and monitoring devices

  • Ensure good lighting.

  • Adjust equipment, such as beds to correct working height to promote good postures

  • Keep supplies close to body to avoid long reaches


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Get Necessary Equipment & Help

  • Get the correct equipment and supplies for the task as determined in the Resident Care Plan and after the Resident Assessment in Step 1

  • Get additional help as required

  • Ensure that

    • Equipment is in good working order

    • Devices such as gait belts and slings are in good condition and the correct size

    • The resident is wearing non-slip footwear if they are to be weight bearing


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Perform Resident Care Task, Lift or Movement Safely

  • Explain the task to the resident – agree on how much help he or she can give during the task

  • Position equipment correctly, e.g., height between a stretcher and bed is equal

  • Apply brakes on equipment and furniture used

  • Lower bed rails when necessary

You should receive training on correct use of equipment, resident assessment and safe work practices before handling Residents


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Perform Resident Care Task, Lift or Movement Safely

  • Coordinate the task as a team (nurses and Resident)

  • Have the Resident assist as much as possible

  • Use good body posture – keep work close to the body and at optimal height

  • Know your physical limits and do not exceed them

Follow your organizations safe Resident handling policy and procedures


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What else can you do?

  • Report ergonomic problems to your supervisor

  • Apply back injury prevention principles to your off -the-job activities

  • Report any physical problems early – leads to a quicker recovery


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Case Studies

Safe Resident Handling Program:Applied Ergonomics for Nurses and

Health Care Workers


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Case Studies

  • Case study 1: Repositioning resident in bed

  • Case study 2: Transfer from chair to bed

  • Case study 3: Transfer from bed to stretcher

  • Case study 4: Transfer from wheelchair to bed

  • Case study 5: Making a bed & repositioning

    resident in bed

  • Case study 6: Resident ambulation and fall

    recovery



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Case Studies

  • Remember – what you are about to practice is not a substitute for specific training on safe use of resident handling equipment

  • Not all resident handling equipment available is shown in the video

  • Always follow the Resident handling policy at your facility


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Case Study 1Repositioning Resident in Bed

What Did You See?

  • Identify primary risk factors for MSDs

  • Identify hazards that may cause slips, trips, falls or other acute or traumatic injuries

  • Determine the cause or the primary risk factors and hazards observed

  • Determine a safer way to perform the task


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Case Study 1Repositioning Resident in Bed


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Case Study 1Repositioning Resident in Bed


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Case Study 1Repositioning Resident in Bed:

The Safer Way

  • Assess the Resident

    • Has upper extremity strength, can sit unaided, is non-weight bearing, cooperative (consider medical status etc.)

  • Assess the Environment

    • Move bed table and phone, raise bed, lower rail when administering injection

    • Raise bed and lower bed rails before moving resident


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Case Study 1Repositioning Resident in Bed:

The Safer Way

  • Get Necessary Equipment & Help

    • Friction reducing device (slippery sheet) & two nurses or CNAs

  • Perform the Task Safely

    • Coordinate the move

    • Use good posture

    • Have resident assist


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Case Study 2 Transfer from Chair to Bed

What Did You See?

  • Identify primary risk factors for MSDs

  • Identify hazards that may cause slips, trips, falls or other acute or traumatic injuries

  • Determine the cause or the primary risk factors and hazards observed

  • Determine a safer way to perform the task


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Case Study 2Transfer from Chair to Bed


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Case Study 2Transfer from Chair to Bed


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Case Study 2Transfer from Chair to Bed: The Safer Way

  • Assess the Resident

    • Partial weight bearing, cooperative, has upper extremity strength and can sit unaided

  • Assess the Environment

    • Move bed table, lower head of bed; lower bed rail using good posture


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Case Study 2Transfer from Chair to Bed:The Safer Way

  • Get Necessary Equipment & Help

    • Powered Sit-to-Stand device

    • Only one caregiver needed

  • Perform the Task Safely

    • Apply equipment brakes when raising or lowering resident

    • Raise bed before lifting resident’s legs

    • Use good posture

    • Have Resident assist


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Case Study 3Transfer from Bed to Stretcher

What Did You See?

  • Identify primary risk factors for MSDs

  • Identify hazards that may cause slips, trips, falls or other acute or traumatic injuries

  • Determine the cause or the primary risk factors and hazards observed

  • Determine a safer way to perform the task


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Case Study 3Transfer from Bed to Stretcher


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Case Study 3Transfer from Bed to Stretcher


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Case Study 3Transfer from Bed to Stretcher


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Case Study 3Transfer from Bed to Stretcher: The Safer Way

  • Assess the Resident

    • This is a Bariatric resident who cannot assist with the transfer

  • Assess the Environment

    • Move furniture from of work area before bringing stretcher into room


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Case Study 3Transfer from Bed to Stretcher: The Safer Way

  • Get Necessary Equipment & Help

    • Air assisted friction-reducing device & three caregivers

    • Pass IV bag around resident

    • Stretcher has holder for IV and Oxygen tank

    • Larger wheels and steering assist mechanism


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Case Study 3Transfer from Bed to Stretcher: The Safer Way

  • Perform the Task Safely

    • Coordinate the preparation and transfer

    • Work heights equal and equipment/bed brakes applied

    • Use good posture

    • Adjust stretcher height for movement to allow good posture

    • 2nd person required to guide front of stretcher only


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Case Study 4Transfer from Wheel Chair to Bed

What Did You See?

  • Identify primary risk factors for MSDs

  • Identify hazards that may cause slips, trips, falls or other acute or traumatic injuries

  • Determine the cause or the primary risk factors and hazards observed

  • Determine a safer way to perform the task


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Case Study 4Transfer from Wheel Chair to Bed


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Case Study 4Transfer from Wheel Chair to Bed


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Case Study 4Transfer from Wheel Chair to Bed


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Case Study 4Transfer from Wheel Chair to Bed: The Safer Way

  • Assess the Resident

    • Partial weight bearing, cooperative, has upper extremity strength and can sit unaided

  • Assess the Environment

    • Move bed table, raise bed, raise head of bed, lower bed rail using good posture


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Case Study 4Transfer from Wheel Chair to Bed: The Safer Way

  • Get Necessary Equipment & Help

    • Gait belt; crutches and trapeze bar

    • Only one caregiver needed


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Case Study 4Transfer from Wheel Chair to Be The Safer Way

  • Perform the Task Safely

    • Use good posture to apply gait belt and to adjust wheel chair foot supports

    • Have resident assist to hold leg while adjusting foot support

    • Do NOT lift but guide resident to a standing

    • Have resident transfer self to bed with stand-by assist

    • Have resident reposition self on bed


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Case Study 5 Making Bed & Repositioning Resident in Bed

What Did You See?

  • Identify primary risk factors for MSDs

  • Identify hazards that may cause slips, trips, falls or other acute or traumatic injuries

  • Determine the cause or the primary risk factors and hazards observed

  • Determine a safer way to perform the task


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Case Study 5Making a Bed and Repositioning Resident in Bed


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Case Study 5Making a Bed and Repositioning Resident in Bed


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Case Study 5Making a Bed and Repositioning Resident in Bed:

The Safer Way

  • Assess the Resident

    • This is a semi-conscious resident who is unable to assist

  • Assess the Environment

    • Clean up spill, have bed linens ready, raise bed and lower rails


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Case Study 5Making a Bed and Repositioning Resident in Bed:

The Safer Way

  • Get Necessary Equipment & Help

    • Ceiling hoist and 2 nurses or caregivers

  • Perform the Task Safely

    • Coordinate lift and movement

    • Each nurse makes a side of the bed

    • Move bed and/or use ceiling lift to reposition resident safely


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Case Study 6Resident Ambulation & Fall Recovery

What Did You See?

  • Identify primary risk factors for MSDs

  • Identify hazards that may cause slips, trips, falls or other acute or traumatic injuries

  • Determine the cause or the primary risk factors and hazards observed

  • Determine a safer way to perform the task


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Case Study 6Resident Ambulation and Fall Recovery


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Case Study 6Resident Ambulation and Fall Recovery


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Case Study 6Resident Ambulation and Fall Recovery


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  • Case Study 6Resident Ambulation and Fall Recovery:

    • The Safer Way

  • Assess the Resident

    • Can weight bear with standby assist and is cooperative

    • The resident cannot stand without assistance after fall

  • Assess the Environment

    • Move IV pole and wheelchair in walkway


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Case Study 6Resident Ambulation and Fall Recovery:

The Safer Way

  • Get Necessary Equipment & Help

    • Use gait belt for ambulation

    • Only one nurse or caregiver needed

    • Portable powered floor lift and two nurses or caregivers to safely lift resident from floor using equipment


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Case Study 6Resident Ambulation and Fall Recovery:

The Safer Way

  • Perform the Task Safely

    • Improve coupling or handhold by using gait belt with handles (less grip force required)

    • Control fall correctly using gait belt as aid (but not to ‘lift’ Resident)

    • Maintain good posture while controlling the fall and supporting resident in floor lift sling

    • Use of portable powered floor lift reduces injury risk for caregiver and resident



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Resources

  • National Center for Resident Safety

    • http://www.va.gov/ncps/

  • Resident Safety Center of Inquiry

    • http://www.visn8.med.va.gov/Residentsafetycenter/

  • National Institute of Occupational Safety and Health

    • http://www.cdc.gov/niosh/topics/healthcare/

  • OSHA (federal)

    • www.osha.gov

    • http://www.osha.gov/SLTC/etools/nursinghome/index.html

  • Oregon OSHA: www.cbs.state.or.us/osha/

  • SAIF Corporation: www.saif.com/



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