Integrating ergonomic tools to reduce injury and strain in packaging and assembly

Improve productivity, reduce staff injuries, and enhance patient safety with a few simple tools

Medical devices or instruments go through numerous reprocessing steps before they’re deemed sterilized. The packaging and assembly area of the sterile processing department (SPD) is critical in assuring “the sterility of an item” while protecting “the contents until use.” To assure sterility, personnel must follow standards and guidelines to make sure the packaged instrument will not pose risks to patients.

 

The rigorous requirements for preparation for sterilization in ANSI/AAMI ST79:2017 requires that “devices should be cleaned; dried; inspected for cleanliness, flaws, and damage; assembled; and packaged according to the manufacturer’s written IFU.”1  To do so, ANSI/AAMI ST79 states that “there should be sufficient space for clean textile storage (both before and after assembly into packs), an illuminated inspection table, and patching equipment. …the clean work area should include space for magnifying lights; processing tables, which should be made of nonporous materials (e.g., stainless steel), ergonomic, and, preferably, height-adjustable.”

 

The effects of packaging and assembly on the musculoskeletal system

The packaging and assembly process during medical device reprocessing is often very labor-intensive and can lead to musculoskeletal disorders (MSDs). Many times, departments have the best intentions when designing and establishing a packaging and assembly area, only to realize a few more options would have helped improve ergonomics and overall employee satisfaction.

 

back painMeet ergonomic compliance

ANSI/AAMI ST79 and OSHA ergonomic guidelines2 require height-adjustable workstations. Sterile processing trays are often extremely heavy. Bending and lifting trays onto workstations that are not at comfortable working levels can lead to musculoskeletal disorders. According to OSHA, MSDs “affect the muscles, nerves, blood vessels, ligaments and tendons. Workers in many different industries and occupations can be exposed to risk factors at work, such as lifting heavy items, bending, reaching overhead, pushing and pulling heavy loads, working in awkward body postures and performing the same or similar tasks repetitively. Exposure to these known risk factors for MSDs increases a worker’s risk of injury.”

 

The repetitive motion tasks that are also associated with packaging and assembly can lead to injury and strain. Did you know that ergonomic options go beyond making workstations height-adjustable?

 

Reduce injuries from repetitive tasks

ergonomic accessoriesKeeping items easily within reach is key to reducing musculoskeletal disorders from repeated reaching. By employing an integrated pegboard wall, shelving, bins, peel pouch rolls and trays, tape dispensers and more can be designed with the user in mind. Pegboards allow items to be easily moved and adjusted to meet the end users physiological and workflow needs.

 

When it comes to workflow, “providing adequate space for supplies and equipment and designing the layout to facilitate the flow of work through the various steps of preparation contributes to the efficiency and accuracy of the sterile processing staff.”3

 

Meet lighting compliance

magnification light with instrumentIn 2013, researchers found that by integrating a few simple ergonomic changes into a department’s design can help improve staff safety. In one department, “a lack of space in the packing area,” led to “…undesirable twists when moving around equipment.”4 By leaving “enough space to establish safe and sound work processes,” the department’s workflow improved.

 

Another area in which prep and pack table design can benefit the end user is integrated lighting. ANSI/AAMI ST79: 2017, 3.3.5.6 states that “adequate lighting of work surfaces should be provided in accordance with the recommendations of the Illuminating Engineering Society of America (IES) for minimum levels of illumination…” The rationale is based on the “importance of speed or accuracy of the work done in the area (the greater the importance of speed or accuracy, the more illuminance needed).”

 

Upon completion of the cleaning process, staff must perform cleaning verification. “Cleaning verification by users should include (a) visual inspection combined with other verification methods that allow the assessment of both external surfaces and the inner housing and channels of medical devices…”

 

magnification light for inspectionMany instruments have very small pieces and tips that look quite similar to the naked eye. It is even more difficult to notice these subtle differences under inadequate lighting. A 2019 study regarding errors in packaging surgical instruments found that “personnel error is the primary reason for packaging errors. Central sterile supply department (CSSD) staff members are not familiar with the clinical utilization of surgical instruments, and therefore it was hard for them to distinguish between instruments with minor differences.”5

 

To avoid errors in packaging surgical instruments, departments can meet compliance with magnifying task lighting. Magnifying task lights improve patient safety by enhancing visual inspection with direct light, as well as allowing technicians to verify cleaning processes and assess any damage to instruments prior to sterilization. Of equal importance, magnification and lighting improve staff safety by reducing eye and neck strain.

 

Find sterile wrap perforations without eye strain

packaging and assembly tabletop lightAdditionally, when wrapping trays with woven and nonwoven sterile wraps, ANSI/AAMI ST79:2017, 9.5 states that departments must “inspect the wrap to ensure that it is free of defects that could have an adverse effect on the performance of the material.”

 

The International Association of Healthcare Central Service Materiel Management (IAHCSMM) recommends that visual “inspection is performed using a light table that has a light source built into the tabletop to help spot small holes and punctures. As the wrap is passed over the lighted table top, light shines through the small holes and punctures making them easier to identify.”6 By doing so, imperfections and perforations in sterile wrap materials can easily be identified and staff do not have to strain to find small holes.

 

Reduce medical costs while increasing productivity and patient and staff safety

In 2008, researchers sought to connect the costs of injuries and strains on a sterile processing department and in turn, design an intervention to alleviate the number of injuries and straining. The study found that in this particular department, “between 2001 and mid-year 2005, employees in the sterile processing center (SPC) experienced 32 injuries, costing $187,266.00 in direct medical costs (i.e., loss expenses), with strain injuries accounting for 94% of the total expenses and 50% of the total injuries.”7 Many departments are already backlogged with cases and need capacity boosting solutions. Adding injuries and strain to staff only creates further backlogs. By integrating ergonomic solutions in the packaging and assembly area, costs are reduced and throughput is increased. Not to mention, staff productivity and employee satisfaction are boosted as well.

 

Learn more about Pure Processing height-adjustable workstations and inspection tables to meet your workflow and workplace environment goals.

Want to earn 1 free CE? Watch Under Wraps: Packaging Materials, Their History, Efficacy and Creating Packaging Material Inspection Protocols

 

References

 

  1. Association For The Advancement Of Medical Instrumentation. Sterilization Standards Committee, Association For The Advancement Of Medical Instrumentation, & American National Standards Institute. (2017). Comprehensive guide to steam sterilization and sterility assurance in health care facilities. Arlington, Va: Association For The Advancement Of Medical Instrumentation.
  2. Ergonomics – Overview | Occupational Safety and Health Administration. (n.d.). Retrieved February 3, 2021, from www.osha.gov website: https://www.osha.gov/ergonomics
  3. Association For The Advancement Of Medical Instrumentation. Sterilization Standards Committee, Association For The Advancement Of Medical Instrumentation, & American National Standards Institute. (2017). Comprehensive guide to steam sterilization and sterility assurance in health care facilities. Arlington, Va: Association For The Advancement Of Medical Instrumentation.
  4. Hall-Andersen, L. B., & Broberg, O. (2014). Integrating ergonomics into engineering design: The role of objects. Applied Ergonomics, 45(3), 647–654. https://doi.org/10.1016/j.apergo.2013.09.002
  5. Zhu, X., Yuan, L., Li, T., & Cheng, P. (2019). Errors in packaging surgical instruments based on a surgical instrument tracking system: an observational study. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4007-3
  6. International Association Of Healthcare Central Service Material Management. (2016). Central Service Technical Manual. (p. ). : IAHCSMM.
  7. Boynton, T., & Darragh, A. R. (2008). Participatory ergonomics intervention in a sterile processing center: a case study. Work (Reading, Mass.), 31(1), 95–99. Retrieved from https://pubmed.ncbi.nlm.nih.gov/18820424/

 

 

 

 

 

 

 

 

 

 

 

 

 

3 Ways Height Adjustable Sinks & Tables Improve Sterile Processing Workflow

According to the Occupational Safety and Health Administration (OSHA), “Ergonomics is the practice of designing equipment and work tasks to conform to the capability of the worker.” The ultimate purpose of this practice is to prevent injuries to staff while they are performing their tasks.

Preventable injuries create a host of negative consequences to workers and their employers, including:

  • Pain and an inability to perform tasks
  • Healthcare and worker’s compensation costs
  • Temporary staffing costs
  • Possible turnover and retraining costs
  • Lost productivity and morale
  • Lost revenue

OSHA’s Occupational Safety and Health Act of 1970 mandates that employers provide workplaces that are “free from recognized hazards that are causing or are likely to cause death or serious physical harm” to employees.

 

Sterile processing worker and workflow hazards

OSHA says hospitals are among the most hazardous places to work. During the 12 months of 2014, the Bureau of Labor Statistics recorded 294,000 nonfatal work-related illnesses and injuries in U.S. hospitals.

Ergonomic hazards in sterile processing departments (SPDs) are typically musculoskeletal disorders (MSD) associated with bending, reaching and repetitive motion tasks. Specifically, when working in sinks, technicians must sort, take apart, and manually pre-clean each device or instrument, and then prepare it for disinfection or sterilization processes.

These tasks are performed hundreds of times a week, and have typically been done while standing at static, deep sinks designed for the restaurant industry. Workers spend hours on their feet each day inspecting instruments and trays and wrapping each tray for sterilization. These tasks are often performed at a non-adjustable workstation that is not designed with staff safety in mind.

 

Focus on sterile processing ergonomics

Whether they are performed in the GI department or the sterile processing department, reprocessing tasks are rife with potentially uncomfortable activities. These range from prolonged standing in one place, to awkward postures and repeated extreme bending, or performing repetitive wrist and arm movements that can cause pain and numbness. Some ergonomic solutions were designed to be added to existing department equipment. However, when a department is ready to remodel, or a new facility is being built, an opportunity is created to identify ergonomic hazards and address them more thoroughly through better designed pre-cleaning workflows and permanently installed injury-prevention solutions.

OSHA has provided specific “possible solutions” to help address ergonomic injuries in the SPD (also known as Central Supply). They are intended to be applied to other similar work areas in the hospital. Among other suggestions, they include:

  • Redesign workstations so packaging and equipment can be reached while maintaining elbows close to the body
  • Use height-adjustable work surfaces
  • Minimize prolonged overhead activity (to avoid reaching over shoulder height)

In addition, the American National Standards Institute (ANSI) and the Association for the Advancement of Medical Instrumentation (AAMI) issued a joint document, the ANSI/AAMI ST79: 2017, 3.3.6.1.3,  which offers more detailed recommendations for setting up a decontamination area:  “Ergonomic factors affecting worker safety and comfort should be considered when designing work spaces in the decontamination area, including: a) adjustable counters, sinks, and work surfaces positioned at heights that take into account the average height of the employees and the tasks to be performed at each location.”

The standard also states:

“Designing the area to facilitate efficient work flow and to provide adequate space for necessary equipment can reduce the potential for cross-contamination and enhance efficiency. Considering ergonomic factors during the design phase can help prevent worker injury.”

 

All utility sinks are not healthcare reprocessing sinks!

Every effort should be made to make the sink area station as ergonomic as possible since it is the primary pre-cleaning work site. In the past, healthcare facilities had few options for sinks that could be used to reprocess devices. Their stainless steel sinks, not designed for healthcare functions, were unnecessarily deep. When used for healthcare instrument reprocessing activities, they have been a source of MSD of the hip, back, shoulder, and arm.

 

All prep and pack tables are not equal

Workstations in the assembly area of sterile processing are one of the most critical pieces of equipment required to properly inspect and package instruments prior to sterilization. Workstations without ergonomic considerations are a culprit in back, hip, shoulder, arm, and eye strain.

Incorporating a height-adjustable countertop as well as an attached pegboard allows users to raise or lower the workstation to meet their height while also allowing supplies and tools to be within easy reach. Attached task lights also move with the height-adjustability of the workstation, aiding in reducing eye and neck strain during inspection tasks.

Healthcare manufacturers identified the need to supply more ergonomic equipment and are developing better tools for these critical functions.

 

Workflow is essential to productivity

It is important to understand the flow of tasks and activities, the challenges and bottlenecks, the specific items being processed, and which specific processes are being used. In addition, the workflow requirements of all reprocessing stakeholders must be considered: Technicians, facility management, and the infection control department. Everyone should express their objectives and challenges in order to design the best solution for all. Planning for inventory growth and turnover is also a consideration for this area.

 

Three ways height-adjustable sinks and workstations improve workflow

1.  Height-adjustable sinks and workstation allow for less strain and minimize overhead activity

A height-adjustable sink or workstation allows fully customizable placement of the tools for individual technicians and brings items closer to the user. A height-adjustable pegboard and other movable hanging storage systems bring tools to users’ fingertips. Height adjustment on sinks and workstations enable the optimal ergonomic working height setting and head tilt for virtually any user, to help avoid strain and injury.

2.  Ability to rotate workers through repetitive tasks

The ability to instantly customize the height and reach of a sink or workstation electronically with the push of a button, makes it fast and easy to rotate staff members with different ergonomic needs and capabilities at the sink and workstation.

3.  Reducing the Clutter Factor

There is a strong indirect correlation between clutter and productivity in any workplace. Cluttered workstations add to workers’ time and effort, add to personal stress and morale, and can eventually affect the quality of work. In healthcare reprocessing areas, poor job quality can have a much more serious consequence: It can affect worker and patient health and safety.

Reprocessing areas are typically complex environments, with numerous cleaning tools, instructions, jugs of chemistries, device parts, packaging and assembly supplies in and around the work areas. Clutter and disorganization are very common conditions in these work areas because of the inherent nature of the work. A messy workspace requires more reaching, untangling and other musculoskeletal activity, which adds to the ergonomic stressors already in play. Additionally, heavily cluttered areas also carry the risk of becoming a breeding ground for organisms that can contaminate surfaces, tools and devices.

 

Improve your sterile processing workflow with the right tools

Before selecting a sink or workstation intended to be used as a medical device reprocessing tool, hospital decision-makers must consider this: Are they using a local fabricator or supplier with general sink design experience, or consulting a healthcare specialty manufacturer with extensive research and observation-based knowledge of the reprocessing function and its related requirements?

OSHA has made it clear that attention to proper ergonomics helps reduce injuries and discomfort that can affect a worker’s ability to function, and that identifying and addressing ergonomic issues should be a mandatory practice for all industries. Providing an ergonomic workplace can also help employers reduce healthcare and other costs related to avoidable injuries, so it is in their best interest to do so.

By installing and using a powered, auto-height adjustable healthcare reprocessing sink or prep and pack workstation, and providing ergonomic storage to organize the immediate workspace, sterile processing management can eliminate unnecessary pain and costs while developing a safe, efficient and highly productive workflow to better support clinical areas of their hospital. These industry-specific tools provide a simple and valuable solution for healthcare providers.

 

Learn more about Pure Processing height-adjustable tables and sinks, which feature moveable pegboard and shelving accessories to meet your workflow and workplace environment goals.

Looking for more sterile processing articles? Read Central Sterile Processing Education and Training Are Key to Reducing HAIs

 

References

  1. U.S. Bureau of Labor Statistics (2016). Hospital workers suffered 294,000 nonfatal workplace injuries and illnesses in 2014. TED: The Economics Daily. Accessed online 10/27/20. https://www.bls.gov/opub/ted/2016/hospital-workers-suffered-294000-nonfatal-workplace-injuries-and-illnesses-in-2014.htm
  2. United States Department of Labor. Healthcare wide hazards. Occupational Health and Safety Administration. Accessed online 10/26/20. https://www.osha.gov/SLTC/etools/hospital/hazards/ergo/ergo.html
  3. The Joint Commission (2014). OSHA worker safety in hospitals program launched online. Environment of Care News, April 2014, Volume 17, Issue 4. Accessed online 10/27/20. http://www.jcrinc.com/assets/1/7/EC-News-Apr-2014-1.pdf
  4. Centers for Disease Control and Prevention. Healthcare workers. The National Institute for Occupational Safety and Health (NIOSH). Accessed online 10/26/20. http://www.cdc.gov/niosh/topics/healthcare/default.html
  5. United States Department of Labor. Central supply. Occupational Safety and Health Administration. Accessed online 10/26/20. https://www.osha.gov/SLTC/etools/hospital/central/central.html
  6. United States Department of Labor. Occupational Safety and Health Administration. Accessed online 10/26/20. https://www.oshatrain.org/courses/pdf/OSHAErgonomics.pdf
  7. Dawson, Lawrence (2008). 6 reasons to clean out the clutter. Industrial Safety and Hygiene News. Accessed online 10/26/20. http://www.ishn.com/articles/87360-6-reasons-to-clean-out-the-clutter
  8. Association for the Advancement of Medical Instrumentation (2017). ANSI/AAMI ST79:2017, Comprehensive guide to steam sterilization and sterility assurance in healthcare facilities. Accessed online 10/26/20.