Ergonomics and obesity

Ergonomics is a relatively new science in comparison to other sciences which have been in existence for centuries. The Ergonomic Society was set up in the UK and is about to celebrate 60 years of practice. If you were to ask staff in the health service ‘what is ergonomics?’ most would not know as not everyone understands what ergonomics is, what it does, or how it affects people. Staff would, however, recognise the term ‘manual handling’ as they are taught to move and handle inanimate and animate loads as part of their training; however manual handling is a small section of what an ergonomics service provides.
    
This article will explain ergonomics and what benefits it has within the health service for both patients and staff. It will give examples of changes in ‘best practice’ as a result of ergonomics and working in partnership with other agencies. These examples include work to improve the transportation of bariatric patients in a dignified manner.
    
For the purposes of this paper a Bariatric person is defined as someone whose weight is over 19 stone – 120 Kg or has a Body Mass Index of greater than 30.

What is Ergonomics?
Ergonomics derives from two Greek words; ergon, meaning work, and nomoi, meaning natural laws, to create a word that means the science of work and a person’s relationship to that work. Pheasant (1991) defines ergonomics as “the application of scientific information concerning human beings to the design of objects, systems and environments for human use. The role of ergonomics, as it pertains to health and safety at work, overlaps with that of a number of other professional disciplines: occupational medicine, occupational hygiene, occupational psychology, production of engineering, production management and so on.”    
    
An Ergonomist in the health service will assess the fit between the person and their work and give consideration not only to the physical aspects but also the psychological aspects. The physical aspects include body size, and shape, fitness and strength, posture, senses and the stresses and strains on muscles, joints and nerves. The psychological aspects include mental abilities, personality, knowledge and experience. This information allows the ergonomist to assess the aspects of the staff and patients, the working environment as well as the interaction between them to design safe, effective and productive systems of work. Within the health service this includes dealing with issues that affect the patient as well as staff.

Obesity
In the UK, the National Audit Office reported (2001) the prevalence of obesity in England had tripled over the last 20 years and continues to rise. Most adults in England are overweight, and one in five is obese. It was estimated that obesity accounted for 18 million days of sickness absence and 30,000 premature deaths in 1998. Treating obesity costs the NHS at least half a billion pounds per year.
    
Managing bariatric patients safely is a growing problem and is well documented by researchers; Rush (2005) said that the number of obese patients had more than doubled in the last decade, and Palmer (2004) suggests that handling patients can be more complex when the person is obese.
    
It is a known fact that the population is getting heavier and this has caused a number of difficulties for many hospitals and the staff managing the situation. One area of difficulty is managing a very obese deceased patient. This can not only be problematic in a hospital but causes all kinds of problems to other agencies. Transporting a very obese patient (occasionally deceased) into hospital with dignity has been difficult when there were no reinforced vehicles or appropriate equipment to deal with them.

Example of benefits to staff
The mortuary is thought of as a place of sadness, grief or repulsion and no-one really wants to have to visit it if at all possible. The families that have lost a loved one may have to visit and this can be a traumatic experience. Mortuary staff attempt to make the experience as pleasant, calm and dignified as possible. In some hospitals the mortuary may have existed for as long as the hospital, which for some can be over a century and can be very small. The refrigerated mortuary shelving system used in most hospitals are of a floor to ceiling design. This requires mortuary staff to use equipment to assist them when handling the deceased person to reduce injuries to staff and maintain dignity for the deceased.
    
There is evidence that handling bariatric patients is high risk and this was confirmed in a study by Randall et al (2009). This research showed that when bariatric patients with a body mass index (BMI>35kg/m2) were <10 per cent of the workload, handling accidents had accounted for almost 30 per cent of the recorded staff injuries.
    
An article in an Australian newspaper (Pepper 2010) informed the public that The director of Forensic Science SA, Dr Ross Vining, had said that racks used to store bodies need to be widened and reinforced, and heavy duty lifting gear needs to be installed to cope with bodies heavier than 300kg. The report went on to say that in 2007 a post mortem had to be performed on the floor of a mortuary in Adelaide because the deceased weighed 315 kilogram’s and was too heavy to lift. Dr Vining said an upgrade of the morgue would take place in the coming years, although no date has been set and costs have not been determined.
    
In the UK there have been a number of articles in the press about obesity contributing to an early demise. In reality obesity has created real problems for many hospital workers whose role is to look after this group of people. The most sensitive area is the mortuary and the staff working in this area has the task of looking after the deceased until the body is released for burial. In some instances a post mortem is necessary and staff are required to move a body from the fridges to a mortuary table and return to the fridge on completion. Some Trusts have carried out extensive changes to the mortuary and invested where possible in lifting equipment that is fixed to the ceiling which reduces the risks of injuries to staff involved in performing these tasks.
    
The type and quantity of equipment in a mortuary varies, in some cases this can be due to the age of the building. In an old building there are limitations to the installation of some equipment as the building is just too small to accommodate it. Ceiling tracking is not an option in some old buildings because the ceiling will not support the extra weight. Free standing gantry hoisting is available but once erected reduces the space the technician has to work in because of the area the equipment requires.
    
Some of the more recent ergonomic changes that have taken place at the hospital as a result of working with a manufacturer have been to help a hoist company develop lifting equipment which is suitable for the small mortuary as well as those fortunate enough to have been purpose built for the obese person. The work has taken approximately two years to complete but the finished product has received interest from mortuaries all over the UK.
    
The hoist was originally manufactured for moving a patient in a seated position. The hoist moves with a motorised base which allows the operator to manoeuvrer it with a remote control and it can be taken very close to an object. Unlike the conventional hoists that require the operator to push and pull the machine to operate it and usually requires staff to manoeuvre the hoist legs under furniture. The hoist can be manoeuvred in a very small space, which is also advantageous.
    
The manufacturing company originally did not manufacture slings. After discussion recommendations were made to the manufacturer to consider using the hoist in the mortuary, which would result in a number of alterations being made. The alterations would be to the spreader bar and type of sling to allow a person to lifted in a supine position. The picture displaying the supine position is showing it being used with a very large sling and a slim person and does not show the benefits when hoisting a bariatric load.
    
The project resulted in a number of meetings, discussions and trialling of various spreader bars and slings before the team were fully happy with the results. Various methods of putting the sling in position were tried and tested to ensure it was quick and easy to use as staff needs to be confident it works well and is not perceived as time consuming. The latest model is now being put through its paces to confirm it works efficiently and effectively. The finished product will benefit not only mortuaries in the health service but also the private sector because it can be used in more confined spaces than most conventional mobile hoists currently on the market.

Example of benefits to patients
Based on current trends 50-60 per cent of adults and 25 per cent of children will be obese by 2012 (DOH Healthy Weight, Healthy Lives A cross-government strategy for England). As the population gets heavier, there is a need for hospitals and emergency services to establish plans to work together to cope with obese patients, while maintaining their dignity and privacy. There was a need to establish a safe solution to the difficulties arising from the moving and handling of bariatric individuals from community to acute care in the event of a hospital appointment or emergency admission, and back to community care on discharge.
    
Within the Acute care setting systems were in place for looking after these patients, however, as a member of the local National Back Exchange Essex group discussions identified the difficulties were transporting these people. Some patients had been brought into the hospital in the past on the floor of an ambulance because they were over the safe working load for the equipment the ambulance service had on board. This was very distressing for the patient who was already in crisis and was now being subjected to an undignified transfer. Discharging patients was also problematic when attempting to send them home with dignity and ensuring they had an adequate package of care.

Part two of this feature, discussing how to address the problem, will appear in the next issue of Health Business.