ERGONOMIC EQUIPMENT AND TRAININIG REDUCES COMPUTER RELATED REPETITIVE STRAIN INJURIES

Prepared for Human Resources The Urban Systems, Inc. 2033 Campus Way South Largo, MD 20811

Prepared by J. Smith and S. Jones 2233 Park Drive Mytown, MD 20700 Computer Consultants

May 1, 2006

MARSHALL COMPUTER CONSULTANTS

2233 Park Drive Mytown, Maryland 20700 April 26, 2006 Urban Systems Inc. Human Resources Department Largo, Maryland 20811 Dear Jean Tate: The attached report requested by the Human Resources Department of Urban Systems Inc. describes the computer-related injuries, which are Carpal Tunnel Syndrome (CTS) and Repetitive Strain Injury (RSI) that has affected the productivity of your workforce. We believe you will find the results of this study useful in researching future workstations within your organization. This study was designed to examine economic impact in three areas: Working day losses Increase in worker insurance compensation Effects of companies www.marshallcc.com (301) 888-1111

Primary research consisted of interviews with company employees, managers, and experts in (CTI) and (RSI). Secondary research sources included online articles and research journals. Results of this research, discussed more fully in this report, indicate that computer-related diseases are treatable and can be prevented in the workplace. We would be pleased to discuss this report and its conclusions with you at your request. On behalf of our company we would like to thank you for your confidence in selecting our company to prepare this comprehensive report. Sincerely, S. Jones Computer Consultant J. Smith Computer Consultant

Scope and Costs of Computer-Related Diseases....................................................2 Various Types of Computer-Related Diseases.......................................................3 Ergonomic Equipment ...........................................................................................4 Effectiveness of Ergonomics Success Stories......................................................6 CONCLUSIONS AND RECOMENDATIONS.....................................................7 WORKS CITED..................................................................................................................8

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EXECUTIVE SUMMARY The Urban Systems, Inc. can benefit from implementing new procedures in establishing a comprehensive workplace ergonomic education and training program. In Both direct and indirect benefits result as reflected by a General Accounting Office report Townsend (1998, p.23). The Urban Systems, Inc. authorized the study when the company began experiencing computer-related health issues with their data entry personnel. The associated sought the Urban Systems, Inc.s approval for the proposed implementation of ergonomic research and equipment for the staff. The Urban Systems Inc. requested evidence demonstrating that an existing establishment could benefit the company. Our conclusion that the Urban Systems, Inc. benefits from the use of ergonomic equipment and research based on data supplied by the Bureau of Labor Statistics, Department of Labor, which details the amount of computer-related injuries sustained to employees over the course of two years. Analysis of the data revealed benefits in three areas: Revenue. The Urban Systems, Inc. An estimated one in eight US workers suffer from repetitive stress injuries with a total cost of 100 billion to employers. According to the Bureau of Labor Statistics computer-related diseases can be potentially costly for employers both in lost workdays and worker compensation. Ergonomic equipment and training. We believe that this is the best training. It is the preventive, not curative. It is essential idea of ergonomics (Townsend 1998, p 20). Improved morale. There will be extensive training for managers and employees on ergonomics. With additional training there will be increased productivity within the workplace.

On the basis of these findings it is recommended that implementing new procedures in establishing a comprehensive workplace ergonomic education and training program will encourage each individual to perform daily work responsibilities to the best of their ability.

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ERGONOMIC EQUIPMENT AND TRAINING REDUCES COMPUTER RELATED REPETITIVE STRAIN INJURIES PROBLEM This study was designed to analyze the impact of computer-related diseases that have affected the data-entry personnel. Specifically, the study seeks to answer these questions: What are the causes of computer-related diseases? How can they be prevented? How many and what kind of jobs are directly attributed to computer-related diseases? What will happen in the future for data-entry positions? What indirect effect has computer-related diseases had in the computer industry, worker compensation, and loss of work? BACKGROUND The Urban Systems, Inc. commissioned this study of Carpal Tunnel Syndrome (CTS) and Repetitive Strain Injury (RSI) at the request of Jean Tate. Before authorizing the research in computer-related diseases, Director, Jean Tate requested a study examining the impact computer-related has on data-entry personnel. In addition, she wanted to determine if a significant increase in un-official leave being taken by data-entry personnel was attributed to computer-related diseases, and what can be done to resolve the problem. Carpal Tunnel Syndrome (CTS) and Repetitive Strain Injury (RSI) are computer related disease that affects a vast majority of Americans. They cause stress in the hands and wrists. Repetitive Stress Injury also leads to more lost workdays than any other workplace injury. Carpal Tunnel Syndrome is caused by a malfunction in the hand and wrist, which is caused by repetitive movement. Forceful pinching or gripping and frequent hand motion can also cause CTS. The median nerve transmits body temperature, pain, and controls the sweating of the hand. Pressure on the median nerve can result in serious injury leading to (CTS). Repetitive Strain Injury is caused by various body functions, which include bad ergonomics, poor posture, and repetitive motion. In addition, there are several symptoms that can ultimately lead to (RSI) which are pain, stiffness, swelling, numbness, or tingling in hands, wrists, elbows, shoulders, back, and neck. The discomfort generally spreads from one area to another area. In addition to carpal tunnel syndrome (CTS) and repetitive strain injury (RSI) another form of a computer related disease is Video Display Terminal disease. It causes

additional stress to the eyes, which is caused by long periods of reading or staring at computer screens. Some of the symptoms include watery eyes, aching, and headaches. Information for this report came from a 2003 and 2004 report on various injuries resulting in days lost from work (Bureau of Labor Statistics, US Department of Labor). The potential costs to employers for lost workdays and worker compensation has increased substantially as a result of computer-related diseases (Townsend 20). DISCUSSION OF FINDINGS The results of this research indicate that major direct and indirect benefits have increase quality and productivity, lower compensation costs to the Urban System, Inc as a result of implement ergonomics equipment and training program. The research findings presented here fall into four categories: (a) scope and costs of computer-related diseases, (b) various types of computer-related diseases, (c) ergonomic equipment, (d) ergonomic training, (e) effectiveness of ergonomics-success stories. Scope and Costs of Computer-Related Diseases As computers become cheap and affordable to most American families and small businesses, the computer-related diseases rise sharply at the national level. As any regular computer user knows, long periods of sitting in front of and operating a computer may lead to injuries to the hand, wrists, arms, neck, back, eyes, or even death, as reported in Asia of teenagers playing video games for several days with few breaks and collapsed. Swartz (1998, p. 28) noted that an estimated one in eight US workers suffers from repetitive stress injuries, with a total cost of $100 billion; 25 percent of all computer operators reportedly are inflicted with CTS in 1998. Kao (2003, p. 534) states that, according to the US Bureau of Labor statistics, the incidence rate of repetitive trauma increases from 6.4 cases per 10,000 full-time workers in 1986 to 36.8 cases in 1992. Repetitive stress injuries lead to more lost workdays than any other workplace injury. While not all repetitive stress injuries are caused by computer use, it is no doubt that the heavy use of computers is a significant source of the injuries. At our company level, there are two data entry personnel reporting symptoms of carpal tunnel syndrome (CTS) and Video Display Terminal (VDT), two of most common computer-related injuries. The two employees have been sent home for rest and treatment of the diseases. The 66% incidence rate of computer-related diseases (2 out of 3 employees) necessitates the analysis of causes and effects of computer-related injuries. Given the small size and potential growth of our company, we are expecting to add more data entry personnel in the future to the current three-person data entry team. It is important to conduct the research now and avoid big problems in the future. Computer-related diseases can be potentially costly for employers both in lost workdays and worker compensation. For 1996, the Bureau of Labor Statistics reports that in industry group, Finance, Insurance, and Real Estate, known for heavy computer and

keyboard use, 19.3 percent of injuries and illness involves days away from work resulted from stains and sprains, tendonitis or carpal tunnel syndrome; 30.7 percent affected wrists, hands, and fingers; and finally, as a source of injury, 19.9 percent of injuries in this industry group involved worker motion or position.(Townsend, 1998, p. 20). Table 1 illustrates the median number of days lost in 2003 and 2004 for various injuries where computer use can be one of the causes. The number of workday lost can range from seven days for back pain to thirty days fro fractures. There is little variation in median days lost in 2003 and 2004. Working day losses imply decreases in revenue and increases in worker insurance and compensation, directly affecting the bottom line of the companies, especially for small businesses like ours. In our case, two out of three staffs in the data entry team have to take days off for computer-related diseases. Their absence leaves heavy work duties on other staffs, stretches our resources, dampens the morale and productivity of other employees, and adversely affects the servicing of our clients. Therefore, the research of computer-related diseases and their solutions is critical to the survival of our company. Table 1: Median Days Lost in All US Industries NATURE OF INJURIES Fractures Sprains, strains, tears Back pain, hurt back Tendonitis Overexertion Repetitive motion Musculoskeletal disorders YEAR 2003 30 8 7 11 10 22 10 YEAR 2004 28 8 7 13 9 20 10

Source: Bureau of Labor Statistics, US Department of Labor

Various Types of Computer-Related Diseases Computer-related disease is one example of repetitive strain injuries (RSI). Repetitive strain injury is a description of manual injuries associated with any repetitive activity such as piano playing, truck driving, and computer use. Unfortunately, there is no consensus on what consists of RSI. Indeed, RSI has many other names in academic journals and papers. However, two of the most common computer-related cases of RSI are Carpal Tunnel Syndrome (CTS) and Video Display Terminal (VDT) diseases. Carpal Tunnel Syndrome is a mechanical malfunction of the hand and wrist, stemming from repetitive movement that shortens the size of the thenar muscles in the hand and wrist. This shortening of the thenar muscles puts adverse stress on the median nerve and causes CTS (Swartz, 1998, p. 28). It is well known that repetitive movements at the wrists, as occurs usually with prolonged use of computers, can lead to CTS. It causes a tingling, numbness in the fingers (McDowell, 2000, p. 3). Wrist or finger motion is not the only activity that may cause CTS. Forceful pinching or gripping and frequent hand vibration can also lead to CTS.

Another type of RSI is Video Display Terminal disease, which can cause eye discomfort and fatigue, generally due to long period of staring at computer screens. Visual stress in VDT users is thought to be associated with effort required when computer monitor distance and a users visual resting states are incompatible (Sommerich, Joines, and Psihogios, 2001, p. 39). VDT can have symptoms of red watery or dry eyes, aching or heaviness of the eyelids or foreheads, headaches, etc (McDowell, 2000, p.3). To explore the sources of these computer-related diseases, a physical therapist with expertise in CTS and VDT was brought in to observe employees at workstations for all 20 people in our company. The expert identified the following problems that can cause CTS, VDT and other computer-related diseases: Posture: leaning forward or slumping in the chair Feet: do not touch the floor Arms: raised above the keyboard or mouse with too high or two low keyboard set Neck and back: view monitors with the neck flexed upward and downward Wrists: incorrect typing style with writs up and down Force: hard typing, stapling, gripping objects, etc. Eye strain: long hours staring at a computer screen Ergonomic Equipment We believe that ergonomic equipment and training are the best solution to the computerrelated diseases at work place. Ergonomics is the science that deals with the interaction of people and the workplace. It is preventive, not curative; it is loss control, not clinical treatment. The essential idea of ergonomics is to fit the particular job and the workstation to the individual (Townsend, 1998, p. 20). As our expert suggests, the first step to reduce injuries is to buy ergonomic workstations, furniture, and equipment for all our staffs. Best room lighting: A mixture of fluorescent and incandescent light is most pleasing to reduce eye strain. The most important aspect of lighting is to reduce glare and bright reflections from your screen, nearby glass, or shiny surfaces. Best position for monitor: The monitor screen should be at a level such that the user can easily see the screen with the head held at a comfortable position. It should be 18-30 inches from your eyes, or about an arms length. The optimal height of the monitor is such that the top of the monitor is at eve level because the eyes are at their most comfortable position straight ahead but slightly downward. Optimal height for mouse: Mouse position should be on the same level as the keyboard so that mouse use does not create a twisted or reaching posture. Best position for chairs: that can be adjusted in multiple ways to help prevent back strain. It should have firm support for the inward curve of the lower spine (lumbar) and outward curve of the upper spine (thoracic). The seat of the chair should be large enough to accommodate frequent changes in position and firm enough to allow the weight to be supported through the buttocks not the thighs.

Break reminder software: Install break reminder software in every workstation to remind employees that short breaks should be taken frequently ever 30 minutes while longer breaks should be taken after every two hours of intensive computer use. Ergonomic Training

Besides buying the ergonomic furniture, to fully utilize these ergonomic equipments, we also need to implement the ergonomic education and training in work place. Following the expert suggestions by Bailin (n.d), Computer-related (n.d), McDermott, Lopez, and Weiss (2004), McDowell (2000), Swartz (1998) and Townsend (1998), the following general rules are recommended to be implemented companywide: Frequent exercises and breaks: Taking frequent breaks and exercises can avoid many computer-related diseases such as eye strain, neck and back programs and CTS. Generally, look away from your screen at least every 30 minutes and focus on something over 20 feet away. Extending and stretching of wrists and making and relaxing fists can relax the tendons inside the carpal tunnel and reduce the number of occurrences of CTS. Proper posture: One should keep the shoulders and arms relaxed while typing, change the sitting position at least every 15 minutes, alternate non-computer jobs with computer jobs to keep your work routine varied, and keep the whole body as relaxed as possible. Most healthy posture for wrists: the best position is neutral. That is, the knuckles, wrist, and top of the forearm should form a straight line. Best elbow and shoulder position: The elbows should form a 90-degree angle while hanging at your sides from the shoulders. The shoulders remain relaxed in a lowered position during keyboarding. Make sure to lift objects with the entire hand, or both hands. Doing this can keep stress off the writes and prevent CTS. These general rules will be implemented as part of the employee workplace standards policy. All employees are required to follow these rules. Furthermore, a general employee ergonomic training program will be implemented to train our employees to understand these ergonomic principles: New employees are required to attend the training course on these rules in their first week of employment. Like fire drills, all employees are required to attend the training course once every quarter to promote the awareness of and reinforce the implementation of correct work habits Existing employees experiencing discomfort are required to re-take the training course and report any current habit inconsistent with these general ergonomic rules. The information is confidential and used for the sole purpose of improving our training program, not of punishing staffs. Existing employees facing more keyboard- or mouse-intensive projects are required to take the training course before taking the new jobs. Employees are encouraged to report even minor discomfort to their supervisors and managers so that appropriate actions can be taken to avoid injuries. Employees are 5

discouraged to take the wait and see approach to work through discomfort, since this process usually makes a minor problem into a serious injury. No initiative can be successfully implemented without the firm support of senior management. Hence, to effectively reduce computer-related injuries, all managers are required to attend an additional manager ergonomic training course besides the general employee-training course. Specifically, the manager-training course should emphasize the following: Managers should try to take ergonomics into consideration when assigning jobs. Manager should design tasks to minimize job-related stresses for their staffs. Managers should try to consider workflow, design ways to break up repetitive tasks, and build variety into the jobs. Managers should not penalize employees taking frequent work breaks. Managers performance is judged not just on the revenue of their departments. But workers compensation costs and lost workdays due to computer-related diseases are also part of the performance evaluation criteria. Mangers are required to take rapid ergonomic intervention to resolve discomfort reported by employees. Managers to gauge the progress of the employees must conduct consistent follow-ups. If discomfort increases, healthcare professionals will be brought in for further evaluation and possible medical treatment. Effectiveness of Ergonomics Success Stories There are several documented cases of applying ergonomics in the work place. McDermott, Lopez and Weiss (2004, p. 36) noted an anonymous multinational petroleum firm that implemented a companywide ergonomic program. All employees using a computer at work are required to complete a risk assessment survey. Then supervisors held one-on-one meeting with each moderate- or high-risk worker to determine the appropriate preventive measures for that employee. The agreed-upon action steps were part of employ annual review. After one-year of preventive follow-up steps, employees in high- and moderate-risk categories dropped from 50 percent to 21 percent. At the same time worker compensation 60 percent or more also lowers costs. Ninety percent of employees felt that the ergonomics program helped them to work more comfortably at their computers. Townsend (1998, p. 23) documented that the General Accounting Office report to Congress on private-sector ergonomics programs details positive results from a number of large corporations: Texas Instruments, American Express, AMP Inc., Navistar International and Sisters of Charity Health System. These organizations implemented comprehensive ergonomics program. One example is American Express. An ergonomics specialist teaches a weekly 90-minute course targeting at the many computerrelated jobs at the facility. Employees are required to attend the course before workstations are adjusted. The company realized an 80 percent reduction in musculoskeletal disorders over a four-year period.

Although all the documented success stories are about large corporation, ergonomics programs should have similar results in our small company. It is not only reducing computer-related workplace injuries, but minimizing the costs of operation as well. It is in the best interests of both employees and employers to implement the ergonomics program. CONCLUSIONS AND RECOMENDATIONS Based on these principles, with the help from our on-site expert and our extensive research on RSI, we believe a combination of ergonomic workstations and education training on ergonomic principles is the best solution to reduce computer-related diseases. Our recommended solutions rest on the fundamental principles: To improve employee comfort levels at the desktops by providing ergonomic furniture and equipments. To target preventive resources, instead of curative resources, to reduce the occurrences of computer-related diseases. To engage employees and managers in ergonomics awareness to practice proper workplace ergonomic standards To rapidly respond to employee discomfort and prevent development of RSI in workplace. To train employees to understand ergonomic principles and avoid potential computerrelated injuries. To train managers to understand and promote ergonomic principles to fit the job to employee. We recommend a comprehensive workplace ergonomic education and training program, including: Establish an ergonomic workplace by purchasing all ergonomic-friendly furniture and software. Enforce the ergonomic workplace standards for all employees. Standardize the ergonomics training for all new employees and employees with new job duties and once a quarter for existing employees. Train senior management to ergonomically design tasks and rapidly intervene any early signs of employee discomfort. Ergonomic treatments of the computer-related diseases fit the long-term goal of our company. Implementing the training programs with ergonomic equipments, our entire organization will benefit from increased quality and productivity, lower compensation costs, and improved morale.

WORKS CITED Bureau of Labor Statistics (BLS), US Department of Labor, http://www.bls.gov/iif/home.htm Bailin, J. (n.d), Ergonomics & Computer Injury: FAQs, from http://www.netsci.org/Science/Speical/feature01.html Computer-related health problems (n.d.) from http://www.co.broward.fl.us/medical/mei0274.htm Kao, S. Y. (2003), Carpal tunnel syndrome as an occupational disease, Journal of American Board Family Practice 16(6), 533-542. McDermott, H., Lopez, K., & Weiss, B. (2004), Computer Ergonomics Programs, Professional Safety, 49, 34-39. McDowell, J. (2000), Computer-related injuries: how information technology managers help ease the pain, http://faculty.ed.umuc.edu/~meinkej/inss690/mcdowell/mcdowell.htm Sommerich, C.M., Joines, S. M.B., & Psihogios, J. P. (2001), Effects of computer monitor viewing angle and related factors on strain, performance, and preference outcomes, Human Factors, 43(1), 39-55 Swartz, M. A., (1998), Carpal Tunnel Syndrome: an investigation into the pain, Professional Safety, 43, 28-30. Townsend, J. J. (1998), Ergonomics at the PC: raising employee comfort levels through training, Professional Safety, 43, 20-23.