AORN Ergonomic Tool 4: Solutions for Prolonged Standing in Perioperative Settings

Abstract

Prolonged standing during surgical procedures poses a high risk of causing musculoskeletal disorders, including back, leg, and foot pain, which can be chronic or acute in nature. Ergonomic Tool 4: Solutions for Prolonged Standing in Perioperative Settings provides recommendations for relieving the strain of prolonged standing, including the use of antifatigue mats, supportive footwear, and sit/stand stools, that are based on well-accepted ergonomic safety concepts, current research, and access to new and emerging technology.

Clinical Issues—November 2018

“…The AORN Ergonomic Tool #4: Solutions for Prolonged Standing in Perioperative Settings (Figure ) provides guidance for team members who are scrubbed in for two hours or longer for more than 30% of the workday or for any amount of time while wearing a lead apron . Using antifatigue mats adjusting the height of the OR bed, determining ergonomic placement of monitors, wearing supportive footwear, alternating propping of one foot on a low footstool, and wearing compression stockings are effective fatigue‐reducing techniques when perioperative team members (eg, scrub persons, surgeons, first assistants) are required to stand in the same position for a prolonged period.…”

“…Prolonged standing at work is related to lower extremity pain or discomfort, swelling, and venous disorders . Additionally, prolonged standing is associated with lower back pain, cardiovascular problems (eg, atherosclerosis), fatigue, discomfort, and pregnancy complications …”

Workplace Safety Equals Patient Safety

“…A partnership between AORN, the Veterans Health Administration, and the National Institute for Occupational Safety and Health resulted in development of a series of ergonomic guidelines for safe patient handling in the OR environment 18‐25 . The guidelines incorporated the latest scientific knowledge in biomechanics, psychophysics, and physiology to develop safe recommended exposure limits for various patient handling and lifting tasks with high risk of causing musculoskeletal disorders, such as back and shoulder disorders.…”

“…The guidelines incorporated the latest scientific knowledge in biomechanics, psychophysics, and physiology to develop safe recommended exposure limits for various patient handling and lifting tasks with high risk of causing musculoskeletal disorders, such as back and shoulder disorders. The guidelines address recommendations for transferring a patient laterally from a stretcher to an OR bed, 19 positioning a patient on an OR bed, 20 lifting and holding the patient's limbs, 21 prolonged standing in the OR, 22 manual retraction tasks, 23 lifting supplies and equipment in the OR, 24 and pushing and pulling wheeled objects and equipment 25 From a safety engineering standpoint, the data used to derive the guidelines (ie, muscle strength capability, spinal force limits, and physiological fatigue limits) were selected with the goal of providing a safe level of exposure for nearly all OR personnel.…”

Influence of unstable footwear on lower leg muscle activity, volume change and subjective discomfort during prolonged standing

“…Therefore, one of the priorities in many countries is prevention of musculoskeletal problems which are associated with prolonged standing in the workplace. Various ergonomic solutions to reduce these problems have been proposed in the literature, including anti-fatigue mats, shoe inserts, footrest, sit/stand chairs, and footwear (Chiu and Wang, 2007;Hughes et al, 2011;Thomas and Dick, 2014). More physical variation is commonly suggested to be an effective intervention against musculoskeletal disorders in jobs with low-level, long-lasting loads or repetitive operations (Mathiassen, 2006).…”