איתור ומיפוי גורמי סיכון ארגונומיים של מחלות שריר שלד מצטברות בתעשייה בישראל

1. איתור ומיפוי גורמי סיכון ארגונומיים של מחלות שריר שלד מצטברות בתעשייה בישראל Dr. Yair Lifshitz, Rachel Epstein, Michal Shelef

2. “It’s not the strongest of the species that survives, nor is it the most intelligent;it is the one that ismost adaptable to change!” Charles Darwin Who Survives?

3. Outline • Introduction • Background • Objective • Methods • Results • Examples • Summary

4. Introduction • Musculoskeletal disorders (MSD) largest category work-related illnesses • Acute or cumulative • Muscles, tendons, ligaments, joints, peripheral nerves

5. Costs of MSD • The EU: Upper limb MSD - 2% of gross national product (GNP) • USA: Upper limb MSD - 3% of GNP • $3.4bn to $5.1bn per year in Israel BLS (2003)

6. Risk Factors - Occupational • Forceful exertions • Duration • Repetition • Insufficient recovery time • Awkward postures • Vibration • Temperature • High demand, dissatisfaction(Eastman Kodak Company, 1983; Armstrong, et al, 1986; Armstrong, et al, 1987; Cacha,1999).

7. Risk Factors - Occupational • Repetition – chicken factory example:

8. Risk Factors – Non-Occupational • Gender and age • Previous injuries • Level of physical activity RISK FACTORS INTERACT Difficult to determine Threshold Limit Values (TLV)What level of exposure is considered a risk?

9. MSD Prevention • Engineering controls • Elimination of risk factors • Reduction of exposure to risk factors

10. Significance of Project • No recommendations exist in Israel • To make a significant change in risk factor exposure: • Clear recommendations • Adjusted to Israeli population • User friendly

11. ACGIH Tool • Recommendations for upper limb risk factor exposure level • Normalized Peak hand Force (NPF) • Average Hand Activity Level (HAL) – frequency and duty cycle • ’Mono-task’ jobs: 4 hours or more/day

12. ACGIH Tool

13. Advances of the tool • Fast screening of different jobs • Good for assessing different types of changes • Useful for various populations: • Safety inspectors – evaluating alternative solutions for risky jobs • Managers – prioritizing jobs to be modified • Engineers – fast screening of jobs

14. Significance of ACGIH Tool • Quantitative assessment of force and hand activity level required for any job • Assist in: • Identifying the potential risks of different jobs • Identifying where improvements are needed • Prioritising the order of improvements • Guideline when designing new work stations and/or devices

15. Previous Project • Implemented an adjusted version of the ACGIH tool that allows for quantitative assessment of exposure to forceful exertions and hand activity level in various mono-task jobs in industries around Israel • Obtained a normalized distribution of peak grip and pinch force, for a sample of males and females in different age groups, working in various industries in Israel

16. Methods • Grip and pinch force data • 1014 subjects (514 females, 500 males) from various industries • Gender • Age (Average age 44.5) • Weight and height • Reported dominant hand

17. Apparatus Hand dynamometer Pinch gauge 0-20 kg Peak hold needle Grip span: 3.5 – 8.6 cm 0-90 kg

18. Results • Data specific to the reference population in Israel • Average forces • grip and pinch, gender, age and hand dominance • Normal distribution • grip and pinch, gender and hand dominance • Cumulative • grip and pinch, gender and hand dominance

19. Normal & Cumulative Distributions: few examples

20. 4 Guiding Examples For Using The NPF-HAL Evaluation Chart

21. 1a. Food Factory Assembly Line Job description Gripping food passing on the belt and packing into containers Cycle time: about 30 seconds Rapid hand movements with steady exertion No regular pauses Risk factors: Maximal peak force – 5 kg grip 10% percentile for women; NPF = 1 Hand activity level –8 (high)

22. 1b. Food Factory Assembly Line Job description Gripping food passing on the belt and packing into containers Cycle time: about 30 seconds Rapid hand movements with steady exertion No regular pauses Same job with heavier content, changed from safe to dangerous!!! Risk factors: Maximal peak force – 25 kg grip 20% percentile for woman; NPF = 2 Hand activity level –8 (high)

23. 2a. Dental Hygienist Job description Cleaning patient’s teeth with sharp instrument Cycle time: 3 minutes Continuous hand movement at changing speeds No regular pauses Risk factors: Maximal peak force – 4 kg pinch 40% percentile for women; NPF = 4 Hand activity level –7 (moderate - high)

24. 2b. Dental Hygienist Job description Cleaning patient’s teeth with sharp instrument Cycle time: 3 minutes Continuous hand movement at changing speeds With regular pauses Adding regular pauses lowered job’s risk Risk factors: Maximal peak force – 4 kg pinch 40% percentile for woman; NPF = 4 Hand activity level –5 (moderate)

25. 3a. Pharmaceutics Assembly Line Job description Packing medicine tablets in zipper-type bags Closing each bag requires 10 seconds Slow, steady hand movements Possible to take prolonged breaks Risk factors: Maximal peak force – 2.5 kg pinch Percentile 0 for men; NPF = 1 Hand activity level – 4 (moderate)

26. 3b. Pharmaceutics Assembly Line Job description Packing medicine tablets in zipper-type bags Closing each bag requires 10 seconds fasthand movements No regularbreaks Faster hand movements and no breaks did not change job risk Risk factors: Maximal peak force – 2.5 kg pinch Percentile 0 for man; NPF = 1 Hand activity level –8 (high)

27. 4a. Metal Industry Job description Gripping and lifting a pole Slow, steady hand movements Possible to take prolonged breaks Risk factors: Maximal peak force – 60 kg grip 50% percentile for men; NPF = 5 Hand activity level – 2 (low)

28. 4b. Metal Industry Job description Gripping and lifting a pole Slow, steady hand movements Possible to take prolonged breaks Same job performed by a women- changed from safe to dangerous!!! Risk factors: Maximal peak force – 40 kg grip 90% percentile for woman; NPF = 9 Hand activity level – 2 (low)

29. 4c. Metal Industry Job description Gripping and lifting a pole Slow, steady hand movements Possible to take prolonged breaks Same job with lower force, changed from dangerous to safe!!! Risk factors: Maximal peak force – 30 kg grip 30% percentile for woman; NPF =3 Hand activity level – 2 (low)

30. סיכום חשיבות וייחודיות הפרויקט מאפשר הערכות ארגונומיות אובייקטיביות של עמדות עבודה. מאפשר בקרה, פיקוח ומניעה של מחלות שריר שלד. מאפשר סקר סיכונים ארגונומיים בכל רמה נדרשת (מפעלית, מחלקתית, קווי יצור, עמדות עבודה). מאפשר ניתוח ותיעדוף של הפתרונות הארגונומיים המוצעים.

31. סיכום-חשיבות וייחודיות הפרויקט • מאפשר שימוש יעיל בקביעת סדר עדיפות בישום תוכניות ארגונומיות שונות. • מאפשר ניתוח ותיעדוף של הפתרונות הארגונומיים המוצעים. • מאפשר שימוש על ידי אוכלוסיות מגוונות ורחבות כגון, מנהלים, מהנדסים, תפעול, יצור, רופאים תעסוקתיים, וכמובן אנשי פיקוח, בטיחות וגהות

32. תודה רבה!

33. Summary Importance And Uniqueness Of The Project: • Enables objective ergonomic evaluation of work stations. • Enables monitoring, control and prevention of Musculoskeletal disorders (MSD). • Enables to identify ergonomic risks on various levels (factory, department, production line, work station). • Enables setting of effective priorities for implementation of ergonomic intervention plans. • Enables analysis of the suggested ergonomic solutions. • Can be used by different populations such as managers, engineers, safety inspectors, occupational doctors and so on.