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Ergonomics in Histology

From manual tasks to automated processes, laboratorians are cutting out workplace strain

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"A man who works with his hands is a laborer; a man who works with his hands and his brain is an artist; but a man who works with his hands, his brain and his heart is a craftsman!"  -Louis Nizer

Ergonomics is a science, a science that deals with people and their working skills, environment and equipment. The healthcare field is no different than any other work force when it comes to skill and the ability to perform repetitious tasks. In the histology laboratory, there are many types of skills and continual work that produce physical stress, muscular tension and other strenuous health issues.

The Work
Many of the tasks and work in the histology lab have been mostly manual until recent years. The daily work was performed over and over again without thinking about the long term effects on the hands, wrists, arms, posture, standing and bending to name a few. The symptoms of any injury were not always felt immediately, but would occur in the months - even years - ahead. The type of work in the histology lab would be preparing cassettes by writing the surgical and autopsy numbers on the small writing surfaces, manual embedding, microtomy, coverslipping, changing the tissue processor, pipetting and even microscopy. These were repetitive tasks that had to be performed daily.

Other areas that have become targets of health-related issues in the histology lab are the computer keyboards. The health issues with computers and keyboards can affect the posture, back, shoulders and wrists. Some of the specific biomechanical risk factors include excessive exposure to force, repetitive motions, difficult posture arrangements and vibration. A few health issues that can come from these areas are carpal tunnel syndrome, tendonitis and tenosynovitis. Focus on the anatomy and how the task is performed, then study the need to maybe change the way that the work is done.

Today, the need for changing the manner in which the work is done and, particularly, working more with our upper extremities is critical. Take time and listen to what your body is signaling, and investigate the pain. Pain was put into our bodies for a reason or signal, not to endure until something drastic or damaging occurs. A few of the areas of high concern of the human body that can be affected are the wrists, shoulders, arms, neck and lower back. Be alert and pay careful attention to the signs and symptoms that your body tells you.  Get up from your work, take a break, take a short walk away from the work area and rotate tasks often.

The Job
The primary focus of an ergonomic program is to modify the task or job to fit the person performing the job. Examine the work environment, design, layout and even the process. Spend some time critically thinking "outside the box" for simple and workable solutions to a repetitive task. Explore the possible changes that could be evaluated and implemented to prevent serious health issues.

The Science
Basically, ergonomics is a science that deals with the connection between people, the instruments, equipment and the work surroundings. Work habits, posture, tools, countertops, "work stations," furniture, lighting, temperature and arrangement of the equipment and instruments all have an important role in proper ergonomic situations. There are effective ergonomic programs that should involve committed management/employee participation.

There are several components that should be included in this type of program: work station analysis, hazard and safety prevention, medical management and training education. One of the vital training components could be the use of videotaping certain situations to demonstrate both good and bad ergonomic conditions. Solving solutions to the ergonomic problems is still a significant issue in histology laboratories today.

Work Stations
The last few years brought about the use of "workstations." Initially, a work station was thought of as a computer and its components. In the histology laboratory, workstations have been put in place to process the work in a more uniform and specific workflow. Good workstation design will create a comfortable and task-efficient laboratory. 

With the use of both Six Sigma and Lean processing, workstations should follow the workflow and accommodate the equipment, instruments and supplies. How many employees will the cubicle/workspace accommodate comfortably? Other variables include the physical layout, whether the employees will sit or stand or both, the type of shelving/drawers/doors to allow the employees to see and reach the work to be done, the lighting and the temperature. 

The temperature is a great consideration because some of the equipment and instruments - such as ovens, embedding centers, paraffin block trimmers and cryostats to name a few - do generate heat. A small workspace with these types of equipment plus several people can make for a difficult work environment. Humidity controls should also be in place and monitored daily. The lighting, whether overhead or in a specific workstation light, should be investigated - especially for the height of the people working in the workspace.

Certainly the "draft" should also be addressed for areas of embedding and microtomy. Vent deflectors are available to aid in addressing these types of issues. Workstations should be versatile, flexible and modular in order to adjust to accommodate the tasks, work and people. The workstation can be adjusted for the changes in workflow design, workload and people in a short time frame and for a smaller expense. Restructuring and changing the workstations and workspace can help reduce the repetitive workplace "stressors" such as carpal tunnel syndrome, tendonitis and tenosynovitis.

The Laboratory Design
The laboratory design is another ergonomic aspect to creating a "comfortable" working laboratory. A great deal of thought, planning and designing must go into the design of a histology laboratory. There is a need for the laboratory's design to be "ergonomically friendly," to examine the task to be performed and explore what is the most comfortable method to perform the job. For countertops, the adjustable models may be the best investment for some of the workspaces in the histology laboratory to aid in the type of task being performed.

For the most comfort, the work to be performed should be placed directly in front of you. Adapt the work supplies to be within reach and not to impose strain. For precision or exact tasks, a higher workstation may be best, and for those tasks that require weight constraints, it should be placed lower. 

The laboratory chairs and other seating furniture should be a high consideration. If the countertops are not movable or adjustable, then adjustable chairs may be an option. There are ergonomic programs that work with both employees and administration to properly "size up" the employee to the proper chair for the most comfort for the task that they need to perform. Laboratory chairs and stools might be available for trial before purchase. Someone can also evaluate you in the position(s) that you take on while performing your work. 

Another task that requires the correct posture and height is pipetting, such as in the special stain or immunohistochemistry (IHC) area of the histology laboratory. Micro-pipetting is a repetitive task that requires movement of the wrist and several fingers continually. Examine the methodology of the person performing the pipetting - there is a correct way to properly hold and operate the pipetor.

Another area of increased ergonomic issues is the proper posture while sitting at a microscope. When purchasing a microscope, explore the spacers to allow for the height of a tall person while properly sitting at the microscope. Request an adjustable/tilting microscope head and arm and wrist pads to help prevent leaning on elbows that compresses and creates numbness in some fingers.  The embedding center needs to be placed on a counter that is designed for proper height for the wrists. Maintain good sitting posture, keep as many tools as possible in a close range, keep joints in neutral position and rotate the motion used for opening the tissue cassettes. 

The design for a microtomy workstation may include a counter with a cut out area to allow the histotech to actually position themselves into the workspace with the microtome directly in front of them.  The water bath, barcode scanner (if available), slide rack and any other tools need to be within reach and placed on either side of the cut out work area. If a monitor is used for reviewing any logs or reports at the time of microtomy, then the monitor needs to be mounted at least at eye level, preferably off the counter top to avoid the histotech tilting their head and straining to read the information.

The Automation
Automation has worked its way into the Histology world and has proven to every effective in many aspects of the daily work that used to be entirely manual.  Even some of the most manual processes in Histology have now become automation to some degree.  The histotech has to accept the challenge to use automation, learn how automation can aid in reducing ergonomic issues and health issues and at the same time improving workflow and turnaround time (TAT). Automation can reduce the physical stresses that employees can face. Automation should be explored to replace manual tasks that require standardization and can also contribute to musculoskeletal disorders. Automation does not necessarily replace the person, but rather the repetitious task, and provides more consistency in the work. It then allows the histotech to do more important tasks in a less strenuous way.

The Equipment
Manufacturers and vendors have engaged into producing equipment, tools and instruments to help with most ergonomic situations. In the gross room, the grossing stations have had the capability to raise and lower to adjust to the height of PAs, histotechs or pathologists while performing the gross dissection. Gloves may have to be sized up properly - a tight glove can also give rise to carpal tunnel syndrome. Cassette engravers and printers have been available for some time to produce readable numbers on the cassettes for tissue processing, taking away the burdensome task of printing surgical numbers/accessioning numbers. The numbers do not smear, but are neat and easily read.

Embedding centers now have padding in certain places to aid in cushioning the wrists while embedding. Also, there is a variety of ergonomic forceps available that require very little pressure to use to pick up tissues in both the grossing and embedding processes. There is even an automatic embedding instrument available that will efficiently and precisely embed 120 tissues per hour. This instrument is designed to be a Lean/Six Sigma random access workflow instrument.

Microtomes now have been designed to be manual and semi-automated - and there are a few available that are "fully" automated. Automated H and E stainers, special stainers and IHC stainers have been available for quite a while, but are continuously being updated and re-designed to meet the ergonomic and workflow needs of the histology laboratory. Automated coverslipping instruments provide a complete finished, coverslipped slide in minutes, avoiding the tiring task of manually applying a cover glass. Many IHC antibodies are now available in ready-to-use formats, eliminating the manual task of using manual pipetors to prepare dilutions for staining, which eliminates the need for the constant wrist and finger motion. Even the buttons on instruments should be about 18 inches away, within reach without using incorrect posture.

Conclusion
The manner in which we perform our daily work in the histology laboratory truly makes a difference in how we feel at the end of the day. Not only do we need to address our physical needs, but our emotions and attitude will also contribute to our health. Stress, both physically and mentally, greatly affects our health. Proper exercise, good nutrition and proper posture will all help us to feel better about ourselves.

M. Lamar Jones, BS, HT(ASCP), is the education coordinator of the School of Clinical Laboratory Science at  Carolinas College of Health Sciences, Charlotte, and Davidson County Community College, Lexington, NC.

References:

1.  Theory and Practice of Histological Techniques, Bancroft, JD, Layton, C,
Suvarna, SK, 7th edition, El Sevier, Baltimore, 2013.

2. Pathology Partners, Leica Microsystems, September, 2006, Volume No. 2.




     

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