As I mentioned above, we had not ignored any type of injuries that our employees had experienced. Prior to TOSHA's visit we had recognized the potential of repetitive motion injuries in our upholstery operations, not only carpal tunnel syndrome, but lower back injuries as well. We had reorganized this department. But more important, we custom-designed and fabricated an upholstery table which could be raised and lowered with a hydraulic foot pump similar to the way a barber's chair is adjusted. This allowed each upholsterer to adjust the height of their table to their own stature, preference, as well as the size of the particular chair they were working on at the time.
In addition, we had pre-employment physical examinations, and used physical therapy and work hardening programs for injured employees. Any workers' compensation case involving repetitive motion or a joint injury was handled on a case by case basis. The very day of the inspection, we took action to comply with the requests and suggestions of TOSHA.
Seek expert adviceWe formed a response team made up of our industrial engineer, our personnel director, an executive vice president and myself. Shelby Williams also sought the advice of outside experts. Because there were no federal or state regulations on the matter, we had to find a guideline to follow. The only government document we found was the "Ergonomics Program Management Guidelines For Meatpacking Plants." Through the American Furniture Manufacturer's Association, I got the name of Ms. Karen Piegorsch, owner-operator of ErgoWorks, an ergonomics consulting and seminars firm in Columbia, SC. In May 1993, she had published "Ergonomics In The Furniture Industry," a technical report completed under the sponsorship of the Furniture Manufacturing and Management Center at North Carolina State University. Ms. Piegorsch advised us that we couldn't go wrong by designing our program after the meatpacking guidelines.
Conduct a physical evaluationWe also contacted Mr. Tim Humann, operater of Morristown Physical Therapy and Rehabilitation Center (MPTRC). Mr. Humann had worked with us on therapy for injured employees, work hardening, and performance testing. First, Mr. Humann inspected our work areas. Then, he and a member of his staff met with our response team. It was decided that Mr. Humann's organization would conduct an in-depth study of our workstations and alert us to actions or equipment that could increase the potential for repetitive motion injuries. He would next interview and evaluate every employee in the upholstery, sewing and assembly departments to determine a baseline of their current physical status. Out of this, Mr. Humann would determine whether an employee exhibited any potential for carpal tunnel syndrome or any other cumulative trauma injury.
Plan for training & therapyThe next phase involved training. First, all supervisors were trained on how to identify potential carpal tunnel situations in their departments and how to work with people to minimize the likelihood of injury. All employees in the affected departments went through work training with additional information on what to do to lessen the dangers at home or during recreational activity.
Shelby Williams also agreed to send all employees suspected of a musculoskeletal injury to Mr. Humann for evaluation by a physical therapist. If any employee needed therapy beyond the initial evaluation, MPTRC would provide the therapy. Also, MPTRC would continue to provide two injury prevention education programs to employees each year and screen prospective new employees. This would include a background check, medical history, previous injuries, flexibility testing for cervical, thoracic, low back, upper extremity and cumulative trauma disorders.
MPTRC's worksite analysis began with an examination of the OSHA 200 logs and medical records. Employees were videotaped during their normal workday. Then the tapes were played back in slow motion in order to better view the demands on the worker and the methods that some individuals used. A symptom survey of the workers was completed. This involved sitting down with them on a one-to-one basis within the high risk departments. The employee completed a questionnaire which was made up of a medical history, a description of their job, length of service, other jobs done both in the past and recently, physical complaints using a body diagram to show problem areas, types of pain (if any), and home activities.
The next stage of the worksite analysis was screening tests to determine overall joint flexibility and symptoms of cumulative trauma disorders. These tests were also on a one-to-one basis and included the sit and reach, hip flexion, low back rotation and extension, cervical and thoracic flexibility, grip and pinch strength for wrist and fingers, Phalen's test for wrist, and Tinel's test for the wrist.
Study & test resultsAfter all the studies and tests were completed, it was found that 17 percent of all reported injuries in 1992 and 25 percent of all reported injuries in 1993 were related to cumulative trauma. This was found in the OSHA 200. Given the opportunity to express physical complaints, a number did, but relatively few had valid complaints that were verifiable by physical testing. A total of 220 people were screened with 79 people complaining of some type of upper extremity pain. Out of those 79, 55 were in the upholstery department. Of those 79, 22 tested positive for CTDs, with 18 of the 22 being in the upholstery department. The rest of the people complaining of symptoms associated with cumulative trauma tested negative at this time. Also noted was that, of the 79 who complained, 61 percent were women.
Upholstery employees have to perform pulling, gripping, and pinching. The fabric must be pulled and stretched and held down with one hand while the other hand staples the fabric to the frame. For employees outside the upholstery departments, these problems were not a factor. These employees did not complain about the tools being used, and had virtually no complaints of cumulative trauma. Two employees in these departments had carpal tunnel surgery performed within a year of the screenings, but their physical job activities could not be related to any type of repetitive pinching, gripping or pulling. It appeared that their CTD problems could be attributed to outside activities.
While we used the Meatpacking Guidelines as our outline, we did not follow it to the letter. With the help of MPTC we had achieved several requirements of its AProgram Elements. The worksite analysis had been done. But the second requirement of AHazard Prevention and Control would prove more elusive. As stated earlier in this article, we had designed and were using hydraulic lift tables for our upholsterers prior to the TOSHA visit. This met the criterion of workstation design and also touched upon the criterion of design of work methods as it did eliminate extreme and awkward postures. But there was little anyone could do about the hand pressure or force necessary for upholstery work. The fact is that the use of the hand in gripping, pulling and holding cannot be engineered out or lessened by improved tools.
Administrative controls have also been difficult to use, such as limiting overtime, decreasing production, or increasing headcount. Upholstery is a learned skill. At Shelby Williams, each upholsterer upholsters the entire chair. Unlike chairs which are made for commercial retail outlets, we do not make large runs of an individual type of chair. Factories which do this can have one person who upholsters backs, and another who upholsters arms, etc. But we do not. And it takes years for a person to get proficient at doing the entire chair. I really do not know if job rotation would work for any type of upholsterer even if they did different parts of the chair. It all involves the same motions.
It has been four years since we developed our written ergonomics program. OSHA plans to release its proposal this summer. If you need to develop a program which can be upgraded to meet the coming standards, you can begin with the four recommended program elements listed in the "Ergonomics Program Management Guidelines for Meatpacking Plants." These are:
hazard prevention and control,
medical management, and finally,
training and education.
Once you begin, you will find that you already have some or all of these elements within your health and safety program. You need to pull them together under one program, expand certain areas, and document your work. It might be some time before we hear anything solid from OSHA, but your workplace can't wait.