Ergonomic risks and musculoskeletal pain in hospital cleaning workers: Convergent Care Research with mixed methods

Luz, Emanuelli Mancio Ferreira da; Munhoz, Oclaris Lopes; Greco, Patrícia Bitencourt Toscani; Santos, José Luís Guedes dos; Camponogara, Silviamar; Magnago, Tânia Solange Bosi de Souza

doi:10.1590/1518-8345.7048.4176

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 32 • 2024 • https://doi.org/10.1590/1518-8345.7048.4176 copy

Ergonomic risks and musculoskeletal pain in hospital cleaning workers: Convergent Care Research with mixed methods ^* * Paper extracted from doctoral dissertation “Ergonomic risks in the hospital cleaning service: a study convergent - assistance for pain prevention musculoskeletal”, presented to Universidade Federal de Santa Maria, Santa Maria, RS, Brazil. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001, Brazil and supported by Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS), Grant #20/2551-0000313-2, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to analyze exposure to ergonomic risks and the occurrence of musculoskeletal pain in workers in the Hospital Cleaning Service.

Method:

Convergent Care Research, with data production designed using mixed methods, implemented with 149 hospital cleaning workers. The methodological strategy of the convergent parallel project was employed, using observation, photographic records, questionnaires and convergence groups. The results were integrated through joint display. Data analysis with descriptive and inferential statistics and content analysis.

Results:

the mixing of data highlighted the multifactorial nature of exposure to ergonomic risks (uncomfortable work postures; repetitive movements; prolonged orthostatism; use of equipment not adapted to the psychophysiological needs of workers) and musculoskeletal pain in the population investigated. The latter was prevalent in the lumbar spine, ankles or feet, wrists or hands, thoracic spine and shoulders. The concept of ergonomic risk was expanded and was influenced by the psychosocial aspects of work.

Conclusion:

the workers investigated are exposed to modifiable multifactorial ergonomic risks related to musculoskeletal pain. It is possible to promote innovations and teaching-learning actions to minimize them, such as the continuing education program, collectively constructed with recommendations for improvements.

Descriptors:
Nursing; Occupational Health; Musculoskeletal Pain; Ergonomics; Housekeeping Hospital; Occupational Risks

Highlights:

(1) The investigated workers are exposed to multifactorial ergonomic risks.

(2) Ergonomic risks are associated with the occurrence of musculoskeletal pain.

(3) Innovation with the use of Convergent Care Research with mixed methods.

(4) Psychosocial aspects of work influence ergonomic risks and pain.

(5) A continuing education program has the potential to minimize ergonomic risks.

*Prevalent body region of MSP ^ * Musculoskeletal pain; , in the last 7 days:**	QUAN ^† † Quantitatives; Results	QUAL ^‡ ‡ Qualitatives; Results			Convergences
	Factors associated with the occurrence of MSP ^* * Musculoskeletal pain; :	Observation	Photographic records	Convergence Groups	Convergences
Lower back (42.3%)	Self-medication (p=0.020) ^§ § Pearson’s Chi-Squared Test .	– Practice of self-medication for MSP ^* * Musculoskeletal pain; carried out before the start of the work shift; – Use of the squeegee with the need to squat, dip the cloth in the bucket, stand up, bend over and wring the cloth.	– Standing posture with trunk rotating; – Posture of anterior flexion of the spine and inclination of the trunk to wring out the cloth, pick up the bucket or remove the garbage bag; – Squeegee extender not adapted to the worker’s psychophysiological needs.	– Symptoms of lower back pain during work activities with the use of floor cleaning equipment (washing machine and mop); – Use of analgesic and anti-inflammatory medications for MSP symptoms ^* * Musculoskeletal pain; .	Self-medication is used routinely and preventively to alleviate the symptoms of MSP ^* * Musculoskeletal pain; , without recognizing the risks inherent to this practice.
Ankles or feet (28.2%)	– Sedentarism (p=0.041) ^§ § Pearson’s Chi-Squared Test ; – Sleep less than eight hours a day (p=0.039) ^§ § Pearson’s Chi-Squared Test .	– Prolonged orthostatism; – Inadequate workstation furniture and lack of swivel casters; – High physical demand; – Improperly distributed shifts and workload; – Lack of scheduled breaks between work tasks; – Repetitive efforts.	– Use of inappropriate protective footwear (straight base, without elevation and with heat and moisture retaining insoles); – Repetitiveness of movements; – Workplace furniture not adapted to the psychophysiological needs (height and demand) of cleaning workers working in the sector, with the absence of swivel casters to reduce effort.	– Difficulty taking breaks at work and raising the lower limbs; – Lack of appropriate environment for the planned interval; – Dynamic activity; – Overweight/obesity; – Workplace furniture not adapted to the needs of cleaning workers in the sector. – Use of non-functional/uncomfortable protective footwear.	– Practicing physical activity can be a “protective factor” for workers not to report MSP ^* * Musculoskeletal pain; ; – Workers who sleep less than eight hours a day have a higher prevalence of MSP ^* * Musculoskeletal pain; in this region. Qualitative data confirm this association, due to the insufficient rest reported.
Wrists or hands (27.5%)	–Ex-smoking (p=0.015) ^§ § Pearson’s Chi-Squared Test ; – Use of some type of medication (p=0.004) ^§ § Pearson’s Chi-Squared Test .	– Inadequate use of equipment (squeegee extenders, mop and washing machine) not adapted to the psychophysiological needs (height and demand) of workers; – Force used in twisting the cloth; – Difficulty adapting to replacing the cleaning technique with the use of cloths and buckets with the use of a multipurpose mop.	– Wrist flexion posture when using cleaning equipment and materials; – Constant physical pressure from hands on work objects; – Constant use of upper limbs to clean and disinfect surfaces, benches and equipment.	– Use of equipment with fixed extenders/cables that are not adjustable to the worker’s psychophysiological needs (height and demand); – Use of analgesic and anti-inflammatory medications to live with MSP ^* * Musculoskeletal pain; in wrists and hands.	– Former smokers have a higher prevalence of MSP ^* * Musculoskeletal pain; in the wrists or hands. This significant association was reaffirmed in the observations and statements of the convergence groups; – Workers use analgesic and anti-inflammatory medications for MSP ^* * Musculoskeletal pain; on their wrists or hands. This finding converges with the high prevalence of pain in these regions in the last seven days (38.6%).
Upper back/thoracic spine (25.5%)	There was no statistically associated factor (p<0.005) ^§ § Pearson’s Chi-Squared Test .	– Rapid repetitive movements when cleaning under hospital beds; – Requirement of flexion of the vertebral trunk when cleaning horizontal surfaces.	– Flexion and rotation posture of the spine required in cleaning activities; – Manual lifting and transport of weight (garbage bag).	– Neutral postures and repetitive movements of the upper limb joints; – Trunk flexion posture when using the multipurpose mop.	There was no statistically associated factor (p<0.005) ^§ § Pearson’s Chi-Squared Test to analyze convergence.
Shoulders (23.5%)	Self-medication (p=0.026) ^§ § Pearson’s Chi-Squared Test .	– Posture with arms raised, without support; – Elbow extension posture in shoulder abduction or elevation.	– Non-ergonomic body posture when handling the rotary washing machine; – Arm position above shoulder height for cleaning ceilings and vertical surfaces.	– Usual practice of self-medication to relieve MSP ^* * Musculoskeletal pain; symptoms in the shoulders.	Convergence of QUAN ^† † Quantitatives; +QUAL ^‡ ‡ Qualitatives; research approaches on the routine practice of self-medication, with the use of analgesics and anti-inflammatories by the workers investigated.

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[1] Corresponding author: Tânia Solange Bosi de Souza Magnago E-mail: magnago.tania@gmail.com https://orcid.org/0000-0002-5308-1604