Mitigating need for broad organizational involvement to mitigate

Mitigating Musculoskeletal Disorder (MSD) risks

Although two decades of research have demonstrated the work-relatedness
of MSD, use of single-approach intervention methods to reduce MSD exposures
(e.g., engineering controls, administrative changes, or worker training only) has
shown inconsistent outcomes, likely due to the combination of factors related
to MSD and the need for broad organizational involvement to mitigate MSD
problems. Despite these concerns, important evidence-based successes have
been demonstrated in reducing MSD, especially during patient lifting and
transfer. Interventions incorporating participatory ergonomics have been
found to improve upon previous approaches by allowing for extensive worker
input into the design and adoption of preventive practices. In a
participatory ergonomics approach, employees participate in the identification
of ergonomic risk factors, brainstorm alternatives and solutions, handle
implementation of controls, and assess control effectiveness along with symptom
identification, ultimately becoming champions for ergonomics
change. Participatory ergonomics also has the potential for changing the
culture of health care organizations, as employees begin to use ergonomic
principles to improve jobs and the workplace. Because participatory
interventions incorporate both management commitments to reducing injuries,
along with workers who are involved in developing solutions, positive and
effective workplace changes can occur.

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Interventions for Musculoskeletal Disorder (MSD)

Three common interventions used to prevent work-related musculoskeletal
injuries associated with patient handling are (1) classes in body mechanics,
(2) training in safe lifting techniques, and (3) back belts. Despite their wide
spread use, these strategies are based on tradition rather than scientific
evidence; there is in fact strong evidence these strategies are not effective. Recently
there has been a major paradigm shift away from these approaches toward the
following evidence-based practices: (1) patient handling equipment/devices, (2)
no-lift policies, (3) training on proper use of patient handling equipment/devices,
and (4) patient lift teams.

Chemical Occupational Exposures

There are thousands of chemicals and other toxic substances to which
nurses are exposed in practice. Hazardous chemical exposures can occur in a
variety of forms—including aerosols, gases, and skin contaminants—from
medications used in practice. Exposures can occur on an acute basis, up to
chronic long-term exposures, depending upon practice sites and compounds
administered; primary exposure routes are pulmonary and dermal. Substances
commonly used in the health care setting can cause asthma or trigger asthma
attacks, according to a recent report. The report explores the scientific
evidence linking 11 substances to asthma, including cleaners and disinfectants,
sterilants, latex, pesticides, volatile organic compounds (including
formaldehyde), and pharmaceuticals. An important criterion for the selection of
the substances in the report was the presence of safer alternative products or
processes. The evidence is derived from an array of peer-reviewed sources of
scientific information, such as the National Academy of Science Institute of