降低手術室人員肌肉骨骼傷害風險程度

Reducing the Risk from Ergonomic Hazards of Operating Room Staffs

醫療機構工作人員常會有肌肉骨骼傷害（Musculoskeletal disorders, MSDs）情形，而手術室人員常因搬運器械包盤、包布次數頻繁且重量過重等因素，而導致罹患相關肌肉骨骼傷害的比例高達92.72%。快速上肢評估法（Rapid Upper Limb Assessment, RULA）是常被用來調查肌肉骨骼傷害(MSDs)的風險評估工具，在實施專案之前本單位手術室RULA得分超過7分，表示有高度罹患MSDs的風險須立即改善工作環境或執行過程。探究其導因包含未曾接受過物品正確搬運課程，人員不知正確施力方式、器械包盤或包布太重、搬動次數多及存放位置不符合人因工程設計、未適時使用輔具（腳踏墊）等。改善措施為定期檢視各科器械包盤內容、設定包盤及包布重量上限、規劃符合人因工程設計之儲存櫃，訂定符合人因工程之儲放物品規範、採包布車交換制度、加強輔具使用及相關教育訓練。經實施上述改善措施後本單位RULA得分從7分降低至4分，此外人員不符合人因工程動作之白班平均次數由484次降為32次，降幅為92.3%，追蹤一年人員未再發生新的肌肉骨骼傷害情形。透過工作場所的改善及適當的工作姿勢與方法可降低護理人員執業性肌肉骨骼傷害。

Musculoskeletal disorders (MSDs) are commonly reported injuries and/or illnesses among healthcare workers, and are a significant work-related complaint amongst operating room staffs. The prevalence of musculoskeletal complaints among operating room staffs in a particular medical center reached 92.72%.When the ＂Rapid Upper Limb Assessment (RULA)＂ method was used to investigate the risk of MSDs amongst those workers, a score of 7 resulted, indicating a high risk of MSDs and called for an improvement of the working environment and process immediately. The possible causes of MSDs were identified as poor ergonomic design of the storage of surgical instruments and the delivery and storage process, an unsafe amount of supplies within each packaging, inadequate and frequent transfers of surgical instruments to be sterilized after operations, a lack of knowledge and skill related to maintaining proper posture, and moving packages and other equipment without use of auxiliary equipment. After analyzing the working process in person, various strategies for improving the ergonomics of the workplace were applied, including checking the contents of the instrument packages periodically, restricting the weight of the packages, reforming the storage area, defining the principles of storing materials, encouraging the use of auxiliary equipment, and continuous provision of an education program regarding ergonomics. After the implementation of the strategies to improve the working process and environment, the RULA score decreased from 7 to 4, and the posture of the daytime staff improved significantly, from 484 incidences of nonconforming ergonomic postures to 32 incidences. No new work-related MSD cases were reported during a one year follow-up. The results of our study show that building a safer work environment and improving the working process can reduce the risk of MSD for operating room staff effectively.