Step 3: Solutions to Computer-Related Health Problems

There are five areas in which actions need to be taken to make computer work safe and comfortable.

• EQUIPMENT: Replacing or modifying equipment and furniture, and creating a comfortable environment (engineering controls).
• JOB TASKS: Changing the way work is organized (administrative controls).
• MEDICAL CARE: Ensuring that injured workers get proper care and that symptoms are reported at an early stage (medical management).
• TRAINING: Training workers and supervisors about proper ergonomics.
• PROGRAM EVALUATION: Assessing the effectiveness of the ergonomics program.

GETTING THE RIGHT FIT:

EQUIPMENT, FURNITURE AND ENVIRONMENT

A key to healthy and comfortable computer work is a workstation that fits the worker who uses it. Since people are not all the same shape or size, the workstation needs to be adjustable. See Figure 11.

Ergonomics should be considered BEFORE new computers or furniture are purchased or older equipment is replaced. There are also many computer accessories available that allow workers to make existing workstations more comfortable. Whether buying new or fixing old equipment, the ergonomics committee along with other employees should evaluate the products. The following recommendations should make computer work safer and more comfortable for the vast majority of computer operators.

Monitor

• viewing distance 18–30 inches
• eyes level with top of monitor — able to see top
• monitor tilt is adjustable
• contrast/brightness controls
• document holder
• should be placed directly in front of user to eliminate twisting the neck to view

Keyboard

• adjustable surface to hold the keyboard
• keyboard slope 0°–25°
• keyboard surface adjustable 23–28 inches above floor
• mouse or tracking ball at same height as the keyboard
• padded wrist rests

Chair

• seat height adjustment 16–20.5 inches
• seat depth between 15 and 17 inches
• seat width a minimum of 18 inches
• contoured, cushioned seat pan
• space between the back of the knees and the front edge of the seat
• angle between seat pan and seat back 90°–105°
• backrest contoured in shape and supports lumbar region
• foot rests
• armrests at least as wide as seat width
• armrests adjustable for height and width
• a five-point base

Accessories

Having a properly designed workstation does not mean your employer has to buy all new equipment. There are many accessories on the market that will allow workers to adjust their existing workstations. See Figure 12.

The Office Environment

Many offices that were originally designed for tasks such as reading printed document and typing need to be modified to address the special lighting requirements of computer work, excess noise and proper indoor air quality.

Lighting
Inappropriate office lighting is probably the most widespread environmental problem for computer workers. The light comes primarily from sunlight or bright, unshielded overhead light. There are a number of ways to correct lighting problems.

• Lower lighting levels where computers are used to a range of 200 to 500 lux. Illumination is measured in units called lux or footcandles.
• Eliminate glare and bright sunlight from windows by using curtains or shades and positioning the screen at a 90 degree angle to windows. Screens should never be placed with a window directly in front or behind the terminal.
• Reduce glare from overhead lighting by using indirect lighting or by shielding overhead tubes with shields or parabolic louvers.
• Try glare screens, if needed, after attempting to eliminate bright light and glare.
• Use a desk lamp (task lighting) when more light is needed for working with printed material.
• Furnish offices with colors and materials that absorb rather than reflect light.

Indoor air quality
A comfortable temperature, somewhere around 70 degrees, should be maintained, with humidity around 50 percent. The ventilation should be properly maintained, filters regularly changed, and enough air exchanges provided to prevent the buildup of air contaminants.

JOB TASKS — WORK ORGANIZATION

Work organization refers to breaks, periods of non-computer work, job enlargement, light-duty for injured workers and other working conditions. Administrative controls means adjusting these factors to make work safer.

Although there is no OSHA standard, research into this area supports a number of common sense recommendations. At a minimum, computer operators should have a 15-minute break for every two hours of computer work, and a break from the computer every hour if they perform intensive keyboard work. In addition to rest breaks, employees should be allowed and encouraged to regularly take brief periods to stretch and do non-computer work tasks.

It is important that workers are not making problems worse when they are performing noncomputer tasks. For example, typing, writing or book handling pose some of the same risk factors for MSDs as computer work.

Piece work or other types of incentive programs can be harmful. Workers need to give their bodies time to rest during their shift or when they are feeling pain.

MEDICAL MANAGEMENT

An effective medical management program will prevent and treat musculoskeletal disorders. The proper medical management of MSDs requires:

• Ensuring the early identification and evaluation of signs and symptoms of MSDs.
• Making a correct diagnosis. The medical assessment includes an occupational and medical history, physical exam and may involve laboratory tests.
• Providing appropriate medical treatment. The treatment depends on the type and severity of the illness. Treatment of upper extremity MSDs may involve rest, immobilizing the affected area, drugs, exercise, heat and cold, and local injections of anti-inflammatory agents. More aggressive treatment, such as surgery, may be necessary in cases of carpal tunnel syndrome or other disorders involving nerve entrapment.
• Changing the workstation and work process to eliminate or reduce exposure to risk factors as much as possible. Without such changes, the worker will again be subjected to the same conditions that caused the problem in the first place. It is likely that the injury will occur again.

A qualified occupational health professional with training in the prevention and treatment of MSDs should be selected to supervise the program. The union should participate in the choice of this person. The health care provider should be part of the ergonomics team which, consists of union and management representatives and others with knowledge about ergonomics.

A medical management program includes the following elements:

1) Trained and Available Health Care Providers 
Employees need access to health care providers with knowledge in the prevention, early recognition, evaluation, treatment and rehabilitation of MSDs.

2) Periodic Workplace Walkthrough 
The purpose is to spot risk factors, identify light-duty jobs and ensure that hazards have been corrected.

3) Symptoms Survey 
A symptoms survey of employees should be conducted at least annually.

4) A List of Light-Duty Jobs
Light-duty means jobs with the least exposure to the risk factors that cause MSDs.

5) Health Surveillance
Health surveillance can establish a base against which changes in a person’s health can be compared. Exams should not be used to deny people a job. A baseline evaluation should include a medical and job history, and physical exam. Additional evaluations should be conducted every couple of years.

6) Training and Education 
Training should include employees and supervisors. The subjects should include different types of injuries, their causes, prevention, and early signs and symptoms.

7) Early Reporting of Symptoms 
It is crucial that employees are encouraged to report symptoms and signs of problems. Early identification and treatment saves suffering, days off work or restricted duty, and recovery time.

8) Standardized Procedures for Health Care Providers 
Different health care providers should use similar methods to diagnose and treat MSDs. These written standardized procedures are called protocols.

9) Evaluation, Treatment and Follow-up of MSDs
The medical management program should provide follow-up to the initial evaluation and treatment. Employees returning to work after time off may need a period of adjustment and re-conditioning.

10) Keeping Accurate and Complete Records 
Records are important to monitor progress as well as problems.

TRAINING

All computer operators and their supervisors should receive training about MSDs and how to prevent them. Workers should be trained to:

• Recognize the signs and symptoms of MSDs.
• Adjust equipment and furniture.
• Take breaks from computer work.
• Do stretching and other exercises at their desks.
• Report symptoms to the appropriate person.

PROGRAM EVALUATION

How can you tell if the ergonomics program is working? The measure of the ergonomics program is whether there is a reduction of MSDs, symptoms and lost time or restricted duty. This requires accurate and complete records.

If management will not cooperate in implementing an effective ergonomics program, the local union should collect information on the extent of MSDs and symptoms, identify risk factors in the workplace and make recommendations to implement an ergonomics program.