Ergonomics has been an issue in healthcare facilities for many years. In fact, the American Hospital Association (AHA) estimates that work-related musculoskeletal disorders (MSDs) account for the largest portion of workers'' compensation costs in hospitals and long-term nursing home facilities nationwide.
When many people think of ergonomics in healthcare, they think of nurses and nurses'' aides who experience MSDs from improperly lifting patients. However, the issue of ergonomics in healthcare also extends to the environmental services (ES) department. Many repetitive motions and procedures used to clean healthcare facilities result in heavy lifting, injury and strain on ES staff.
While not commonly known, frontline cleaning personnel are more vulnerable to ergonomic injury than most other occupations. The Occupational Safety and Health Administration (OSHA) rates janitors and ES workers fifth on its list of top occupations at risk for MSDs, only behind nurses'' aides, truck drivers, non-construction laborers and assemblers. While there are many potential ergonomic pitfalls in an ES department, hard floor care is an area of particular concern. Many floor care systems require staff to lift heavy pails of floor finish and transfer into secondary mopping buckets while also using tools or equipment that are not fitted to workers'' motions.
The problem with poor ergonomics permeates throughout all areas of an ES department. ES directors who do not consider ergonomic programs and tools will lose money due to workers'' compensation claims, lost productivity and absenteeism. In addition, workers suffering from ergonomic injury are more likely to have poor morale which can infuse negativity into an operation. With waning budgets and the need to enhance productivity, these are costs many ES directors cannot afford.
The Problem with Poor Ergonomics
Simply defined, ergonomics is "the study of work." It involves looking at the science associated with occupations and designing the job to fit the worker as opposed to forcing workers'' bodies to fit the job. Tools fit to the worker help reduce physical stress on the worker''s body and the likelihood of MSDs.
MSDs can result in a number of injuries to ES workers, including pain, numbness, tingling, stiff joints, difficulty moving, muscle loss and occasional paralysis. Each of these injuries can limit productivity and/or result in absenteeism. In a study by the Bureau of Labor Statistics, 42,000 occupational injuries required time away from work in the janitorial industry. Of these, 15,200 were MSDs requiring a median of seven days away from work.
Parts of the body most likely to be affected by an MSD include arms, hands, fingers, neck, back, wrists and shoulders. ES workers responsible for cleaning, stripping and finishing hard floors are at high risk for MSDs.
Southeast Missouri Hospital (SMH) in Cape Girardeau, Mo., has multiple off-campus buildings, requiring cleaning staff to carry tools used to maintain hard floors from the utility closet to the building where floors are being finished.
"We previously used a mop-and-bucket method to apply floor finish," said Debbie Goodhart, ES director for SMH. "It requires multiple components, including buckets, trash bags, bucket liners, mop sticks, mop heads and floor finish. Buckets of finish can be heavy for workers to lift which results in unnecessary strain. In addition, pushing heavy string mops back and forth across the floor requires twisting and turning. This can cause strain on workers'' backs and shoulders."
OSHA details several catalysts for work-related MSDs, including:
- Awkward postures or unsupported positions that stretch physical limits
- Motion, such as increased speed or acceleration when bending and twisting
- Compression. Grasping sharp edges like tool handles reduces blood flow and nerve transmission and causes damage to tendons
Another MSD that accounts for a significant loss of productivity and large compensation costs is back injury. According to the OSHA publication "Ergonomics: the Study of Work," workers cite back disorders most often, after the common cold and flu, as reasons for missing work.
The Cost of Poor Ergonomics
Labor accounts for the largest portion of an environmental service department''s total budget. Just as ES directors would protect a substantial investment in an auto-scrubber by ensuring regular maintenance, they must also protect their investment in staff and labor.
Each year, MSDs account for more than $15 billion to $20 billion in workers'' compensation costs and 34 percent of all lost workday injuries and illnesses. According to OSHA, total direct costs add up to as much as $50 billion annually. This means $1 of every $3 spent on workers'' compensation can be attributed to MSD-related issues.
ES workers who suffer from an MSD can take up to 28 days to recover from an injury like carpal tunnel syndrome. More serious injuries can take even longer, possibly presenting workers with permanent disabilities that may prevent them from returning to their jobs.
When ES workers are absent for short or extended periods of time, new employees must be trained to complete their tasks, which results in additional labor cost. If someone is unable to return to work because of the injury or leaves to find a less strenuous vocation, a new employee must be hired. According to the American Management Association, it costs up to $4,800 to replace an $8/hour employee.
In addition to the cost of hiring a new employee, ES directors and other cleaning professionals note that finding new staff has become increasingly difficult. A Cleaning Management Institute (CMI) 2008 survey reveals that 52 percent of respondents had difficulty hiring new employees. As a result, ES directors must spend extra time finding someone to fill a position, adding to lost productivity. In addition, an open position increases the stress placed on the rest of the staff.
There are numerous unexpected costs that a department can incur by not having the proper ergonomic systems in place. More ES directors are realizing that tools that protect workers will also protect their bottom line.
Improving Floor Finish Applicator Ergonomics
Generally, floor finish is applied using one of three traditional methods: mop-and-bucket, flat mopping and backpack applicator systems.
With a traditional mop and bucket method, floor finish is poured into a bucket. ES floor care staff must then carry or roll the bucket to the area where floors will be finished. Gripping a straight mop handle, the worker pushes the mop back and forth across the floor to apply the finish. Upon completion of the task, the worker returns tools to a utility area where they are cleaned and stored for later use.
Flat mop and backpack applicator systems also require heavy lifting. With most flat mop systems, users lift a heavy bucket of finish and pour it into a container that is affixed to the unit handle, increasing the weight of the handle. Finish is dispensed to the flat mop through a line connecting the container to the flat mop. Similarly, with a backpack system, finish is poured into a container located inside a backpack that is worn by the user. Finish is filtered from the backpack to a flat mop through a dispensing line.
While current flat mop and backpack applicator systems give the user improvements in application appearance and reduction of chemical waste, the units are often unreliable and can increase water consumption because extensive cleaning is required between uses.
Many healthcare facilities in the U.S. are beginning to transition from these first generation methods to new innovations in applicator technology that improve ergonomics while also reducing water and floor finish waste. Similar to flat mop and backpack applicators, these new tools eliminate the need for lifting a heavy bucket filled with finish.
However, unlike other older applicator technology, new innovations are lightweight and built for workers of any height. Workers simply link a connector tube to the pouch holding the finish and insert the connected pouch on the applicator handle. They are then ready to finish a floor. After the floor finish is applied, workers easily disassemble and discard the tube and applicator pad. Any leftover finish is stored for later use.
Looking to improve productivity and ergonomics, SMH recently began using newer floor finish innovations with ergonomic designs.
"We have two full-time floor finishers and approximately 19 part-time finishers," Goodhart said. "While some employees are reluctant to test anything new, users immediately saw the benefit of the new system once they used it. Its ergonomic design makes it easy to move across the floor and suitable for cleaners of varying heights and levels of experience. In addition, the new system has eliminated complaints of back and wrist pains."
A Closer Look at Muscle Strain
Regardless of what floor finish applicator method is used, numerous muscle groups are used to apply floor finish. To identify which of these systems has the largest physiological impact, an independent study conducted by a leading researcher at the University of Wisconsin analyzed several users of varying height, weight and experience as they finished floors using a mop-and-bucket method and new applicator innovations. The study was conducted to determine overall muscle effort and heart rate when using each system.
Using Electromyography (EMG), the muscular exertion of each participant was assessed in real time. The electrical impulses that initiate muscle contraction were measured by placing surface electrodes on the skin above the muscle groups studied. The higher the voltage indicated by the electrode, the stronger the muscle contraction. Muscle groups studied included the trapezius, the neck and upper back; deltoid, cap of the shoulder; flexor capri radialis, flexor of the fingers and hand; and erector spinae, postural muscle of the lower back.
Researchers analyzed the average normalized effort of each muscle group throughout all stages of floor finish application including setup, application and cleanup. The results showed that each muscle group consistently exerted more energy and effort when using the mop-and-bucket method compared to new applicators tested. Specifically using newer ergonomically designed innovations that reduce setup and cleaning requirements, users showed 36 percent less forearm flexor effort, 35 percent less deltoid effort, 23 percent less trapezius effort and 36 percent less erector spinae effort. This data revealed that new innovations resulted in less stress to the user.
The heart rate of each user was also monitored throughout each activity. The heart rate indicated each user''s whole body effort when applying floor finish across a 2,500 square-foot area. To calculate the total impact, researchers multiplied the user''s heart rate by the duration of the effort to reveal the total heart beat or cumulative body effort. Participants using the mop-and-bucket method had a sustained heart rate of 264 beats. Participants using new applicator innovations had a sustained heart rate of 126 beats—less than half of those using the mop-and-bucket method. This data shows that users of the new applicator method exerted less overall effort compared to users of the mop-and-bucket system.
A Program that Pays Without Pains
To develop a comprehensive floor care program that enhances productivity and reduces labor, ES directors should look for floor finish application methods that reduce heavy lifting and worker strain. In addition, the number of tools required to finish floors should be limited so labor is not wasted if tools are left behind.
When deciding upon the proper applicator system, directors should select an application method that can be used by operators of varying heights and levels of experience.
Prior to using the system, staff should be properly trained on floor finishing techniques to reduce stress on the body. For example, if the chosen floor finish application method involves a mop and bucket, workers should be educated on the dangers of lifting with the back as opposed to using their legs. Workers who acknowledge extended soreness or injury should be immediately treated to reduce the opportunity of permanent injury.
More ES directors who want to improve cleanliness and reduce costs are turning to ergonomic tools and equipment. With the largest percentage of a department''s budget dedicated to labor expenses, the value of enhanced worker safety programs is paramount. Using ergonomic tools not only helps reduce costs associated with absenteeism, training and on-the-job-injuries, it also helps boost worker productivity and morale. Ergonomics is an investment with an immediate return.
Additional Ergonomic Resources:
- Occupational Safety and Health Administration
- Cornell Human Factors & Research Group
- The National Institute for Occupational Safety and Health
Lance Brown is an innovation leader of floor care for JohnsonDiversey. For more information, visit http://www.johnsondiversey.com/prospeed or call (262) 631-4001.
Continuing Education Unit Test Questions
1. According to the Bureau of Labor Statistics, MSDs account for a median of ___ days away from work?
2. Which of the following is not a cost associated with poor ergonomics?
a. Missed work
b. Increased product cost
c. Lost productivity
3. Ergonomics can be defined as:
a. Facilitating the work process
b. Ensuring a safe and clean working environment
c. The study of work
4. Which is not a traditional method for applying floor finish?
b. Rag topper
c. Flat mop
5. What is the method used to study muscular exertion?
6. In the study conducted in this article, researchers measured muscle exertion and ____
b. Heart rate
7. Which of the following is not an effective tactic for reducing costs associated with ergonomic injuries?
a. Invest in ergonomic equipment
b. Properly train staff on the correct way to perform their jobs
c. Use low-odor floor finishes
8. What was the difference in total heart beats of mop-and-bucket users compared to new floor finish applicator users?
9. Which muscle groups were not included in the study?
10. On average, it costs how much to replace an $8/hour employee?
A Quick Look at Potential Cost-Savings through Improved Ergonomic Programs:
- Reduced turnover
- Reduction in training-related costs
- Fewer workers'' compensation claims
- Reduced absenteeism
- Improved productivity