Assessment of Musculoskeletal Disorder Risk with Hand and Syringe use in Chemotherapy Nurses and Pharmacy Assistants

Occupational Applications

Occupational Applications Healthcare workers who use syringes and use their hands frequently have increased risk for work-related musculoskeletal disorders. Syringe use, handling, writing, and other pinch grip tasks occur in chemotherapy, pharmaceuticals, laboratories, and dietetics. Many hospitals have similar tasks where medications are administered to patients via syringes or IV bags. With limited research available, this study sought to gain further insight by exploring hand and syringe tasks in the healthcare field. Evidence of muscular overload for nurses and pharmacy assistants performing syringe (intravenous push treatments) and hand tasks was indicated by a high number of hand efforts combined with prolonged durations, thumb forces, and high muscle activity with a lack of muscular rest. Pharmacy assistants also presented a higher risk for work-related musculoskeletal disorders. The results of this study can assist workers in the chemotherapy department, and may impact professions with similar hand and syringe efforts, by creating an awareness of the tasks performed, the extent of hand use, and associated work-related musculoskeletal disorders risk while providing risk reduction strategies.

Technical Abstract

Rationale: There is a need to evaluate and redesign manual “pushing” and mixing chemotherapy drugs to prevent musculoskeletal disorders to hospital staff, improve patient care quality, and reduce healthcare costs. Purpose: The purpose of this study was to examine hand and syringe actions required of workers in chemotherapy preparation and administration over a work shift, and to propose risk control strategies. Methods: Thumb forces and muscle activity from the forearm flexor and extensor muscles were measured from five lab nurses, five floor nurses and five pharmacy assistants; each had their actions recorded throughout their shift. Results: Pharmacy assistants and nurses spent the majority of the work shift performing hand tasks (87% and 72%, respectively). Lab nurses performed a mean (SD) of 1.85 (0.48) hand efforts per min, floor nurses performed 1.62 (0.09) per min, while pharmacy assistants performed significantly more at 5.29 (1.27) per min. Syringe use accounted for 17% of the pharmacy assistants’ shift and 12% for floor and lab nurses. Drawing fluid and manually pushing treatment represented 10% of the work day. Thumb forces reached up to 57% of maximum, and muscle activity reached 58% of maximum for the twist task (connecting syringe-IV tubing). The left forearm flexors exhibited the highest activity over the workday and across tasks while only resting for 6% of the workday. Conclusions: The high number of hand efforts, combined with prolonged durations, muscle activity, thumb force, and lack of muscular rest, provide evidence of muscular overload over the course of the shift suggesting that pharmacy assistants have higher risk for work-related musculoskeletal disorders. These results may also help explain injury statistics and complaints associated with the arm, hand, and thumb in chemotherapy departments. Findings and suggested risk reduction strategies can act as a guide for future evaluation of workplaces with similar syringe and hand demands.

Keywords:

• Musculoskeletal disorders
• syringe
• nurses
• pharmacy assistants

Conflicts of Interest

No potential conflicts of interest were disclosed.

Acknowledgments

Thank you to the Health, Safety and Wellness, Chemotherapy, and Systemic Therapy department leadership at Hamilton Health Sciences for in-kind contributions of time, resources, and facilities, and to Michael Rizzuto for assistance in software and analysis.

Supplemental Material

Supplemental data for this article can be accessed here.

Additional information

Funding

This study was supported by a seed grant from the Centre of Research Expertise for the Prevention of Musculoskeletal Disorders (CRE-MSD).