Santiaguel Joel M, Zamora Mithi Kalayaan S
Division of Pulmonary Medicine, Department of Medicine, Philippine General Hospital, University of the Philippines Manila.
Acta Med Philipp. 2023 Aug 29;57(8):85-98. doi: 10.47895/amp.vi0.5437. eCollection 2023.
This single-subject case study was done to evaluate the presence and evaluate the risk factors for the development of Work-Related Musculoskeletal Disorders (WMSDs) among the staff performing bronchoscopy in the bronchoscopy suite.
A single-subject case study to describe the ergonomic issues in bronchoscopy including identifying multiple factors that can potentially, either singly or in combination, affect physical work capacity. The study focused on the evaluation and control of occupational factors during bronchoscopy to improve awareness of ergonomic issues in bronchoscopy using the following data collection tools: 1) hierarchical task analysis, 2) activity sampling, 3) direct observation of the procedure (walk-around), 5) structured interview of the subject, and 5) utilization of checklists.
During the process of bronchoscopy, identified factors that can cause pain in the wrists, fingers, and shoulders include repetitive movement and awkward positions of the hands and wrists coming from the need to move the directional controls and position the bronchoscope. For the back, prolonged standing with awkward postures is a concern. For the neck, the need to look at the monitor which is situated at the side of the patient and frequent shifting of the eyes and head from the monitor to the patient can cause neck pain and stiffness. Aside from the above, other factors would include job stress from the workload, inadequate time for rest and recovery, and the possibility of an uncomfortable environment due to poor air quality. Chronic exposure and repeated injury followed by inflammation and repair lead to structural and biochemical changes in the tissues affected by Cumulative Trauma Disorders (CTDs) leading to the development of WMSDs.
Although CTDs do not account for work-related deaths, they do account for a significant amount of human suffering, loss of productivity, and economic burden on the compensation system. Thus, ergonomic concerns must be addressed early to prevent WMSDs/CTDs.
本单病例研究旨在评估支气管镜检查室中进行支气管镜检查的工作人员是否存在与工作相关的肌肉骨骼疾病（WMSDs），并评估其发展的风险因素。
一项单病例研究，以描述支气管镜检查中的人体工程学问题，包括识别可能单独或联合影响身体工作能力的多个因素。该研究重点关注支气管镜检查期间职业因素的评估和控制，以使用以下数据收集工具提高对支气管镜检查中人体工程学问题的认识：1）层次任务分析，2）活动抽样，3）对操作过程的直接观察（巡视），5）对受试者的结构化访谈，以及5）检查表的使用。
在支气管镜检查过程中，确定的可导致手腕、手指和肩部疼痛的因素包括由于需要移动方向控制装置和定位支气管镜而导致的手部和手腕的重复运动和 awkward 姿势。对于背部，长时间以 awkward 姿势站立是一个问题。对于颈部，需要查看位于患者一侧的监视器，以及眼睛和头部频繁从监视器转移到患者身上，可能会导致颈部疼痛和僵硬。除上述因素外，其他因素还包括工作量带来的工作压力、休息和恢复时间不足，以及空气质量差导致环境不舒服的可能性。慢性暴露和反复损伤，随后是炎症和修复，会导致受累积性创伤疾病（CTDs）影响的组织发生结构和生化变化，从而导致 WMSDs 的发展。
虽然CTDs 并不导致与工作相关的死亡，但它们确实造成了大量的人类痛苦、生产力损失以及赔偿系统的经济负担。因此，必须尽早解决人体工程学问题，以预防 WMSDs/CTDs。
