|As I write
this, my right hand is in a brace. It is only a
cautionary measure at this point. But last year the
searing pain that shot from my fingers to my elbow was
both frightening and serious. I had ignored some early
warning signs and was awakened in the middle of the night
by the complete numbness of my right arm. I had not been
sleeping on my arm, the numbness was a result of carpal
tunnel syndrome, brought on by the incorrect over-usage
of my right hand at both the keyboard and the mouse. When
I awoke that night my fingers were in a tightly clinched
fist that I could not open. I had to use my left hand to
pry my fingers loose and I had no feeling whatsoever in
my entire arm for several minutes.
This unpleasant incident finally got my attention and made me realize that what I had jokingly referred to as "mouse arm," similar to "tennis elbow," was not the least bit amusing. I was suffering from a repetitive stress injury (RSI), and since I am self-employed, I had no one to blame but myself. I had to give my right arm complete rest for several weeks, undergo bouts of heat and cold therapy, and wear a wrist brace for about six weeks. I couldn't use my right arm to brush my teeth, open a door, or even pick up a book. I was miserable, but I considered myself lucky. At least I didn't have to undergo surgery to the relieve the pain of the damage done to the nerves and tendons in my wrist. This type of surgery is now the second most frequently performed operation in the United States.
Soft tissue injuries like nerve and tendon conditions are sometimes called occupational overuse syndrome or cumulative trauma disorders (CTD). These are not a recent phenomenon. They were first identified in 1717 by Italian physician Bernardino Ramazinni, the founder of occupational medicine. As he described it, workers "are injured by certain violent and irregular motions and unnatural postures of the body [that impair] the natural structure of the vital machine." Unfortunately we haven't learned enough since 1717, because about half of all work-related illnesses today are CTDs, and injuries like these have tripled in the past decade.
The National Institute for Occupational Safety and Health (NIOSH) has found that between a third and a half of all employees of meat-packing and poultry processing plants have had symptoms of these potentially crippling disorders. With the advent of computers CTDs have also become a major concern in the white-collar workplace.
A NIOSH survey determined that over 1,500 members of the Newspaper Guild, almost 5 percent, reported being affected by repetitive stress injures, as did 40 percent of the employees of Newsday, a daily newspaper in the New York City area. Three Newsday reporters and editor even went so far as to file a $40 million lawsuit against Atex Publishing Systems, makers of a powerful editing and composition computer system used at Newsday.
Eight other journalists have filed a $240 million product liability suit against Atex, claiming that it "knew or should have known that repetitive use of their computer systems would expose plaintiffs to a risk of developing cumulative trauma disorders and other injuries associated with the occupational use of video display terminals." Carpal tunnel syndrome, tendinitis, musculoskeletal and nerve disorders, along with upper extremity pain syndrome are among the injuries named in the suit. CTDs like these, if not caught and treated early, can result in serious lifelong disabilities and loss of the ability to work.
Taking a corporation to court is one way to get their attention. Legislating safety standards is another. Despite the fact that I live just north of San Francisco and work primarily in the field of desktop publishing I was only marginally aware of the debate that was going on regarding computers and health in the Bay area. In the Fall of 1990 an ordinance was introduced in San Francisco that would require all businesses to make the health and safety of employees that work with computers a top priority.
The Video Display Terminal Worker Safety Ordinance became law on January 28, 1991. It was about that time I learned that if I had been following the guidelines specified in the ordinance I probably could have avoided the painful symptoms I experienced. Ergonomics, the best placement of objects for safe and effective use by humans, plays a big factor in preventing such injuries and in determining the mandates set forth in the ordinance.
The nation's strongest VDT safety measure requires companies to provide glare shields, detachable keyboards, proper lighting, and adjustable furniture for employees who spend more than 4 hours a day at a computer. Businesses have four years to comply with all of the new regulations which are mandatory for companies with 15 or more employees.
Some estimates place the cost of meeting these requirements at $76 million but no one really knows what the exact cost will be. We do know that the Occupational Safety and Health Administration says 44 percent of all office workers experience injuries on the job and about one-third of all workers' compensation payments are a result of health problems related to ergonomic disorders. OHSA predicts that repetitive motion disorders will be the No. 1 health care cost in the U.S. this year. Obviously neither ignoring the problem nor taking steps to fix it are without a cost.
The ordinance had many Bay area businesses threatening to move out of the district. Well, they can run, but they can't hide. OSHA set standards last year for the meat-packing industry to regulate workplace analysis, employee education, and regular medical surveillance to help prevent RSI. This year they're formulating general ergonomic standards for all industries, so before long it won't matter where your business is located, you will have to deal with these issues. The question of the substantial health risk posed by working with computers is no longer debatable. The question now is what to do about it. Employers play the vital role in maintaining job safety and are strongly being encouraged to implement safety programs on their own.
What can you do?
Technological advances have led to narrower jobs and more intensified work. Solving the problems created by the computer age will not be an easy job but it is a necessary one. There are many steps you can take to prevent health problems brought on by using computers. The SF ordinance offers suggestions that will produce a system that is suited to the ability and creativity of the worker instead of one that requires them to assume unnatural positions and bend themselves to the dictates of an arbitrary mechanical workplace.
Providing wrist pads, paper holders, task lighting, and foot and back rests are a good beginning but they barely scratch the surface. Employees also need to be educated in the correct way to use their equipment.
So how do you go about implementing a comprehensive computer health and safety program for your business? Union officials and managers at Newsday asked NIOSH the same question, and NIOSH prepared a report in conjunction with University of Michigan ergonomics researchers that provides some guidelines. Among their recommendations is the formation of a joint labor-management ergonomics committee to determine such things as what equipment to purchase and how tasks can be redesigned to minimize the impact of work intensity, pacing, and repetition.
According to the report, "Typing on computer keyboards requires repetitive motions, prolonged static postures and awkward postures. Holding the arms in position over a keyboard for a prolonged period can result in fatigue of the muscles in the neck and shoulders area." The report also suggests "...changing work methods to avoid working at a computer terminal for long, uninterrupted periods."
Even with an ergonomically-correct workstation, it's just not a good idea for the body to be locked into one posture all day long. Some jobs will need to change to guarantee that an employee maintains good health. Office workers need the chance to move around and rest their hands and arms rather than sitting in one position at the keyboard all day. A 15 minute break in the morning and afternoon is not enough to adequately rest a keyboard worker's tendons and nerves. Shorter breaks throughout the day can vary the pace of the work and prevent strain injuries. Workers can be rotated among tasks that require using different motions or muscles, and their jobs can be reorganized in ways that create more rest or variety.
The keyboard technique of individual operators is also worth taking a look at. When typing, some people use undue pressure that, over time, can send waves of pain through the tendons of their forearms. A light and easy touch at the keyboard should be cultivated.
The pace of work is addressed in the SF ordinance which calls for at least fifteen minute alternative work breaks every two hours instead of just one break in the morning and one in the afternoon. Computer users should also take a few minutes every hour to stretch their arms and focus their eyes on an object in the distance.
Other health factors also need to be considered. Coffee drinkers can be more susceptible to carpel tunnel syndrome, as caffeine can lead to spasms in blood vessels. Smokers are prone to circulation problems and should be especially aware of the need to exercise their hands and arms at regular intervals.
The NIOSH report recommends that the purchase of adjustable equipment should be based on such factors as employee height, weight, work methods, and personal preferences. The keyboard, monitor, chair, and the document should all be able to be modified to suit the individual needs of the worker. Ideally, those who are going to use the system need to be interviewed during the planning stage.
The fabric-covered chair should be of the correct height so that a person's feet can be flat on the ground, or a foot rest should be used. The curve of a chair's backrest should have a slight backward angle. This insures that the weight will not settle flat on the base of the spine. It should also provide proper lumbar support for the lower back.
Positioning of the keyboard and mouse is especially important in preventing RSI. Many keyboards are placed on tables or desks that are much too high to be used comfortably. This forces the user to hunch forward which creates tension in the shoulder and neck areas, and can encourage the user to rest their wrists on the edge of the table.
It's not easy to find a table that's the right height. Ideally the keyboard should rest just above a person's lap, with their arms hanging naturally at their sides and their wrists floating lower than their elbows. Foam rubber wrist rests can help keep a person's wrists parallel to the ground.
All of the research is still not in as far as VDTs causing miscarriages and cataracts are concerned. However, experts all agree that the correct position of the monitor is vital to avoid eyestrain, fatigue, and headaches. The monitor should be at least 28 inches away from the user, about an arm's length. The top of the monitor should be at eye level. This can be achieved by either adjustable arms mounted to the wall or monitor stands placed under the VDT. A wall-mounted monitor has the advantage of both freeing up desk space and providing flexibility in terms of screen height and viewing angle. Home office workers can use old phone books to raise the level of their monitors in a pinch.
To reduce glare, floorplans should minimize the number of VDT's parallel to windows. Lowering general lighting levels will also diminish glare, and work stations can be equipped with task lights to provide higher lighting levels for paper-based work.
Noise pollution is dealt with in the SF ordinance by requiring that "direct noise from impact printers shall be reduced ...by placing covers over the printers or by isolating the printers from the rest of the work environment."
If these changes are viewed as a necessary element of the office automation process then the costs associated with them will not seem like a burden, but just good business. Understanding that all the various elements are essential for the successful use of technology will make their value evident.
The ordinance also guarantees the job protection of employees who request compliance with the new regulations or who file complaints or institute any legal proceedings against an employer for non-compliance.
Studies have shown that companies that can implement these new procedures and make their employees more comfortable will also have more productive employees, lower insurance costs, and can gain the competitive advantage in their fields. Let's hope that all businesses will begin to recognize the potential benefits of providing an ergonomically balanced work environment.
And what about my arm? I have changed my work area to better accommodate my needs and I try to take regular breaks from the keyboard. I go out on the deck and water the plants or feed the chipmunks who will eat sunflower seeds right out of the palm of my now-rehabilitated hand.
Where to write for more information
Center for Office Technology, 1801 K St. NW, Suite 905L, Washington, DC 20006. A national coalition of industry officials and workplace buyers, the COT conducts research and has developed an educational videotape, "Working Smarter with VDT's."
Human Factors Society, PO Box 1369, Santa Monica, CA 90406. In conjunction with the American National Standards Institute the HFC has published a 100-page guidebook ($25) about ergonomics and VDTs that was used in drafting the SF ordinance.
National Institute for Occupational Safety and Health (NIOSH), PO Box 36165, Cincinnati, OH 45236. This research agency publishes findings and issues recommendations that are somewhat stricter than OSHA's.
New Jersey State Department of Public Health, Trenton, NJ 18625-1360. A set of "voluntary guidelines" for VDT use in the office has been prepared by this group and they will send them to you at no charge.
New York Committee for Occupational Safety and Health (NYCOSH), 275 Seventh Ave., 25th Floor, New York, NY 10001. Specializing in investigating and reporting VDT and safety issues, this enterprising group makes available a wide range of data on the subject.
Statistical/Technical Support, Occupational Health and Safety Agency (OSHA) 200 Constitution Ave., Rm. 2625 Washington, DC 20210. This agency sets workplace standards and monitors industry compliance through inspections.
VDT News, PO Box 1799, Grand Central Station, New York, NY 10163. Published by a physicist, VDT News covers the latest developments regarding VDT health and safety.
Before the advent of personal computers Toni Will-Harris was an investigative journalist. Today she is primarily involved with the design and production of books and is the co-creator of Designer Disk Stylesheets.
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