Abstract: Previous retrospective record review studies, in several countries, have shown
that 3,4% to 16,6% of patients in acute care hospitals experience one or
more adverse events. Adverse events (AEâs) in hospitals constitute a serious
problem with grave consequences. The occurrence of AEâs in Portuguese
hospitals has not been systematically studied. The aims of this study were
to estimate the incidence, impact and preventability of adverse events in
Portuguese hospitals and based on that to contribute to drive research and
to develop innovative approaches in this healthcare setting.
The study was carried out at three acute hospitals in the Lisbon area. A
two-stage structured retrospective medical records review was done based
on the use of 18 screening criteria. A random sample of 1.669 charts,
representative of the 47.783 hospital admissions (which full fill the inclusion
criterions for this study) between 01 January 2009 and 31 December 2009,
were analyzed. The power calculation of this study was based on the results
of the Canadian Adverse Events Study, assuming an incidence of AEs
of 8% with a confidence interval of 95%. Oversampling was carried out,
with the expectation that 10% of charts would be unusable. The sampling
frame includes all admissions for patients over 18 years old who had a minimum
stay in hospital of 24 hours. Hospital admission with a most responsible
diagnosis related to psychiatry was excluded.
In the first stage, the nurses assessed each medical record for the presence
of at least one of the 18 criteria, indicating a potential adverse event. In stage
2, each record with those criteria was reviewed by a physician in order
to confirm the presence of an adverse event, estimate their impact and
determine their preventability, accordingly to the definition established
previously. The degree of agreement between the reviewers in each stage
was calculated using kappa coefficient.
In the preliminary analysis the main findings were: i) one or more screening
criteria were found in 365 (21,9%) charts; ii) in the second stage a 11,1%
incidence of adverse events (AEâs) was found; iii) from those, around 53,2%
were considered preventable; iv) most of AEâs (60,3%) resulted in no physical
impairment or disability, or in minimal impairment which was resolved
during the admission or within one month from discharge; v) 10,8% resulted
in death; vi) In 58, 2% of the AEâs cases the length of stay (LOS) was
prolonged; vii) In average, the LOS was prolonged 10, 7 days for those cases
who have an AEâs; viii) the reliability of the assessment of screening criteria
by nurses (first screening) was considered good (α 0.76); ix) among doctors
(in the second stage) the reliability of determination of AEâs and their
preventability were also good (α 0.79 and α 0.73, respectively). Our results
are similar to the findings of previous studies particularly the British (pilot
study) and the Danish study (national ones) on the rate, preventability and
main consequences of AEâs.
In Portugal, there is an overall awareness and a growing concern about
patient safety issues. Although judgment of presence of AEâs is difficult, retrospective
patient medical records studies are currently the gold-standard
methodology available to assess their incidence. This study shows that AEâs
in these Portuguese hospitals affect nearly one in ten patients. A substantial
part of these events are preventable. The main results of this study will
be a contribution to provide a foundation and driving force for research
and frontline initiatives in order to reduce harm to patient.
Abstract: Healthcare workers, namely registered nurses (RN), are frequently exposed to work-related musculoskeletal disorders
(WRMSDs) risk factors. Identifying the symptoms of these disorders is one of the first epidemiological steps to managing
them. This study aims to identify WRMSDs prevalence symptoms in Portuguese RN. During 8 months (2010-2011) the National
Public Health School and the Portuguese Registered Nurses Board made a call to all RN to answer an online WRMSDs
questionnaire. Respondents (n=2140) are mostly females (77.4%) and work mainly in hospitals (n=1396) and in primary
healthcare centers (n=421). Results show high symptoms prevalence (last 12 months) in the lower back (60.6%), the upper
back (44.5%), and the neck (48.6%). Nursesâ activity, especially patient hygiene in bed, is a strong contributor (p<0.05) to
pain in the upper back (OR=1.39 [1.09-1.80]) and lower back (OR=1.4 [1.08-1.84]). Patient holdup without mechanical support
has the highest relationship (p<0.05) between work tasks and symptoms in the last 12 months in the upper back (OR=1.50
[1.19-1.90]). Prevalence rates of WRMSDs symptoms in Portuguese nurses are no different from other studies with Swedish,
Italian and Greek nurses. Maybe changes in healthcare systems didnât change the way care is delivered and we must rethink
how to prevent nurses WRMSDs.
Abstract: The process for selecting observational methods for evaluating work-related
upper limb musucloskeletal disorders (WRULMSDs) is complex, but essential
to risk management. In a Portuguese automotive industry plant (Setúbal, 2004-
05), where all jobs had been previously analyzed, OCRA checklist was reapplied
(final assembling and painting) in workstations (n=152) classified as moderate/
high risk (score ⥠16.5 OCRA). In all risk confirmed cases (n=71) three other
methods were applied: RULA, SI, and HAL. Sequences of working activities were
recorded on video to estimate the predictive validity of the methods. The results
show differences in the final scores of the methods in the same workstations:
OCRA reveals 34 workplaces with high risk; SI only ranked 31 positions with high
risk; HAL has 35 high risk workplaces, and RULA only 7. Analysis of the effect of
each independent variable (risk factor) in the final scores of the methods, based
on linear regression analysis, reveals different contributions and, consequently,
different ways of assessing WRULMSD risk. The video analysis also highlights
different predictive validities for the risk factors in each method.
These results indicate the need to select the appropriate WRULMSD risk
assessment instrument adequate to each real work situation.
Abstract: The integrated and systemic ergonomics approach contributes decisively to promote
health care in institutions, and it is an advantage to its administrators, managers, health
care providers, patients and family.
Patient Safety should consequently integrate the ergonomics perspective in its multiple
dimensions: (1) ergonomic design in the conception of health care services and workplaces,
and in the prevention of hospital acquired infections; (2) better knowledge of the
characteristics, capacities and limitations of the human body, particularly in what regards
the physical and mental burdens of work; (3) âhuman factorâ integration in complex
systems, in real work situations, accounting their ability to detect, control, anticipate
and prevent accidents, errors and adverse events; (4) recognition that errors occur and
are mostly due to organization failures, inadequate working conditions, interconnected
incompatibilities, and lack of support in terms of technology, information and human
resources; (5) psycho-social harmonization between man and work, allowing to decrease
adverse effects such as stress and burnout.
The convergence between ergonomics and patient safety has been increasingly
acknowledged over the recent years. Although they have been poorly displayed, several
innovations and developments have been implemented that contribute to a better
prevention and harmony between man and hospital environment.
Abstract: Despite improvements in healthcare interventions, issues relating to Patient Safety, and in
particular to the occurrence of adverse events have constituted, for some time, a growing
concern for healthcare organizations, policy makers, health professionals and for patients
and their families.
More recently, there has been a growing movement towards enhancing research on patient
safety and also the need to develop and evaluate the impact of innovative solutions that
can add value in terms of clinical, social and economic gains.
Among others the priority topics for research in patient safety are: i) knowledge of
epidemiology (frequency, causes, types and impact) of adverse events and ii) the
development, implementation and evaluation of innovative solutions. The purpose behind
these two lines of research is to gain knowledge that enables the reduction of risk and
therefore enhance patient safety, and simultaneously, based on the translation of this
knowledge, improve and support decision-making (policy and clinical) locally, regionally,
nationally and internationally.
In this article three issues that are essential for patient safety research are highlighted:
i) the organization of various patient safety research initiatives; ii) the identification of
areas/priorities for research on patient safety, and iii) the methodological approaches
(paradigms, methods and techniques) that should be privileged as well as some of the
criteria which support that decision.
In parallel, the intention is still to refer briefly to some examples of innovative solutions
that have been developed and applied in the daily practice of health care services.
Abstract: Patient safety has become a core issue in the provision of health care in hospitals and in other health
care facilities. Nevertheless, it often does not consider health and safety of health professionals as
part of the range of approaches that contribute to an effective patient safety development strategy.
It is desirable to have an integrated systems approach to working situations recognizing, for example,
the inherent complexity of the substantial majority of the activities performed, the high health professionals
workload (physical and mental), the frequent inadequacy of environmental conditions
and physical demands and / or mental disabilities to the characteristics and capabilities of users
(health professionals and users) and, in general, the inadequacy of the interface between man and
system, for example in the design of layouts, equipments, instruments and ways and means of communication.
Only such systemic approach will answer the questions of the occurrence of incidents
and accidents, with damage to the patient. Reinventing health services is vital in an individual perspective
(consumer and professional) and in learning through error environment, towards the effective
prevention of adverse events.
Occupational Health can contribute to this aim through interventions, starting with the environment
adequacy, the working conditions, the layouts and the equipment, and including training and information
for health professionals.
Abstract: The major challenges facing health care systems include (i) the demographic change and the
aging population; (ii) the increasing complexity of health care and technological developments;
(iii) the high patient expectations and the growing pressure for accountability (iv) the greater
than ever costs. All these challenges have influenced the quality and sustainability of health care
services.
Patient safety is a key component of quality in health care and it is considered for several authors
as the first and the most essential one. New knowledge leading to improve patient safety
intimately contributes to develop the quality of health care.
Improving the safety of patient care requires system-wide action on a broad range of fronts to
identify and manage actual and potential risks to patient safety, and implement long-term
solutions. This requires actions in performance improvement, environmental safety, and risk
assessment and management, including infection control and occupational health and safety and
ergonomics, safe use of medicines, safety equipment, safe clinical practice, and safer and
healthier environment of care.
It is important to be aware that research for patient safety is not only about increasing knowledge;
it is also about translating knowledge into practice. Itâs also important the bridging between the
levels of research, dissemination, and adoption at policy, practice, managerial and consumer.
Occupational Health & Safety and Ergonomics studies have demonstrated that the great majority
of causes related with error are, most of the times, beyond the control of each individual. If we
want to undertake the prevention approach of that, it will be necessary to understand error
related circumstances and factors.
Abstract: Despite improvements in healthcare interventions, the
incidence of adverse events and other patient safety
problems constitutes a major contributor to the global
burden of diseases and a concern for Public Health. In the
last years there have been some successful individual and
institutional efforts to approach patient safety issues in
Portugal, unless such effort has been fragmented or
focused on specific small areas. Long-term and global
improvement has remained elusive, and most of all the
improvement of patient safety in Portugal, must evaluate
not only the efficacy of a change but also what was effective
for implementing the change.
Clearly, patient safety issues result from various
combinations of individual, team, organization, system and
patient factors. A systemic and integrated approach to
promote patient safety must acknowledge and strive to
understand the complexity of work systems and processes
in health care, including the interactions between people,
technology, and the environment. Safety errors cannot be
productively attributed to a single human error.
Our objective with this paper is to provide a brief overview
of the status quo in patient safety in Portugal, highlighting
key aspects that should be taken into account in the design
of a strategy for improving patient safety. With these key
aspects in mind, policy makers and implementers can move
forward and make better decisions about which changes
should be made and about the way the needed changes to
improve patient safety should be implemented.
The contribution of colleagues that are international
leaders on healthcare quality and patient safety may also
contribute to more innovative research methods needed to
create the knowledge that promotes less costly successful
changes.
Abstract: Background: Work-related Musculoskeletal Disorders (WRMSD) are common
occupational diseases. The present study aims at examining an integrated perspective
of risk assessment and health surveillance at a meatpacking plant. Methods:
The strategy adopted was of obtaining information about WRMSDs awareness at
all workstations and from all their workers. This was based on: (i) questionnaire
application - an adaptation of the Nordic musculoskeletal questionnaire, including
a biomechanical item, (ii) WRMSDs clinical protocol (iii) RSI risk filter and Strain
Index application, (iv) instrumentation with electrogoniometry and force sensors at
previously classified as high risk workstations. Results: WRMSDs signs and symptoms
mainly in wrist/hands (n=27) and in lumbar region (n=32) were identified. Results
revealed an important prevalence of WRULMSDs associated to meatpacking industry
activities (30%) and high risk scores based on Strain Index (n=26 Right UL; n=7 Left
UL). Instrumentation showed details of recurrency, of postures and of force, which can
be used for intervention. Conclusions: Itâs necessary to develop ergonomic strategies
and approaches on WRMSDs prevention (risk assessment and management) that
will lead to changes on workstations and working processes.
Abstract: Several methods may be used for Work-Related Upper Limbs
Musculoskeletal Disorders (WRULMSDs) risk assessment. We
compare different methods and their results at the same workplace
trying to increase a more accurate WRULMSDs risk assessment
based at the hazard identification.
This study took place at an automotive plant and included all
the workstations (n=366) which has been previously studied with
OCRA checklist. The methodology included the re-application of
OCRA checklist at all workstations with scores OCRA>16,5
(n=152). At workplaces with high risk (n=71) we also applied
three other methods of "risk evaluation": (a) Rapid Upper Limb
Assessment; (b) Strain Index; and (c) Hand Activity Level. Work
activity has been also videotaped and the main risk factors were
analyzed. The analysis is focused on the right upper limb.
Outcomes were different with the use of each method,
notably, they show disagreement in the categorization of high-risk
workstations. So, (a) OCRA has a moderate correlation (p<0,001)
with SI (r
Sp
=0,52) and with (b) HAL (r
Sp
=0,42); (c) HAL has a
strong correlation with SI (r
Sp
=0,77) and (d) RULA scores are not
correlated with the others methods.
OCRA, SI, RULA and HAL show evidence of distinct risk
results that confirm the need of a selection criterion. The knowing
of witch risk factors are presents at each workstation permit the
selection of the most accurate method. Different WRULMSDâs
risk assessment results will influence risk management and just
with a workstation rigorous knowledge and the consequent method
selection criterion, the process may be more effective.
Abstract: Meatpacking for human supply generates activities susceptible of being exposed to risk
factors of professional nature that can lead to adverse effects on human health. In this
context, an important prevalence of injuries at work (WRMSD) has been referred and in
particular at upper limbs (WRULMSD).
The demands of this kind of activity that determines the exposition to risk factors above
the physiological capacities, such as, the level of force, frequency, extreme postures or
vibrations lead, almost inevitably, to WRMSD.
The risk situations must be identified in the perspective of the management of these
risks, through the use of methods of identification and evaluation of the risk of WRMSD
and, consequently, the right priorities must be established and action should be taken
accordingly.
Finally, the prevention of the WRMSD will only be possible through integrated
interventions of multidisciplinary team approach from Occupational Health.
Abstract: WORK-RELATED UPPER LIMB MUSCULOSKELETAL
DISORDERS RISK EVALUATION: THE USE OF SI AND
RULA METHODS
The frequent lack of information data and even perhaps the use
of scientifically weak components to estimate the procedure of
attainment of the final results (scores) with each method of
WRULMSDs (Work-Related Upper Limb Musculoskeletal
Disorders) risk evaluation, is judged to determine the distinct
results in the same workstation that are relevant to analyse.
The current study took place at a motor-car factory and
analyzed the strategy of selection of tools for WRULMSDs
risk assessment, to contribute to the effectiveness of the process
of risk identification and assessment of these injuries in the
industrial field. To categorize workstations risk we used
OCRAâs method â base of the European norm prEN 1005-5
for the estimate of the WRULMSDs risk â identifying moderate
â and/or high-risk levels (score OCRA ⥠16,5).
Workstations (n = 71) risk was analyzed and categorized using
SI (Moore; Garg, 1995) and RULA (McAtamney; Corlett,
1993) methods. We videotaped work activity and analyzed the
main risk factors (posture, force, repetitiveness and vibrations)
within one second sampling.
Globally, results were quite different with the use of methods:
SI classified 41 workstations with high risk and RULA only
classified 26 situations of risk. One should highlight the disagreement
between the methods in the categorization of highrisk
workstations, for example: the 41 workstations classified
with high risk scores using SI only include 12 classified as
high WRULMSDs risk using the RULA method.
Using the different methods we reached different weights for
the risk factors studied: use of force (SI = 0,80; RULA = 0,66),
extreme postures (SI = 0,68; RULA = 0,48) and repetitiveness
(SI = 0,35; RULA = 0,43).
Results suggest the need of using a filter to identify the main
risk factors present at each workstation and thus guiding either
the selection of the most appropriate method or the rejection of
the most inappropriate. As a contribution to an effective
WRULMSDs risk assessment, our work stresses the need to
build one checklist of the checklists and of more accurate data
on the different methods and its application allowing for more
effective risk management of this type of injuries.
Abstract: ORTHOPAEDIC SURGERIES: ASSESSMENT OF IONISING
RADIATION EXPOSURE IN HEALTH CARE WORKERS
Health care workers are exposed to ionizing radiations during
their professional activities. In the theatre rooms, ionizing
radiations are frequently used during orthopedic surgery and
the dose received by the staff depends on various factors, such
as the characteristics of the equipment used. This study aimed
to:
⢠assess the radiation dose received and study the characteristics
of the X ray equipment used during orthopedic
surgeries, in a Portuguese theatre room;
⢠estimate the occupational dose of ionizing radiation exposure
received by orthopedic surgeons and nurses;
⢠bring awareness to health care professionals to the importance
of the use the individual dosimeter and to the adoption
of radiation protection measures.
The measurements were undertaken on nine orthopedic surgeons
and two nurses involved in orthopedic surgery in a hospital
at the neighborhood of Lisbon. We made a risk evaluating
dose. Assessment was undertaken by:
⢠the radiation dose in different locations of the body, corresponding
to gonads, hands and crystalline lens levels of
all the professionals, during the surgeries;
⢠the average period of radiation in the orthopedic surgeries;
⢠the number of annual orthopedic surgeries, found in the
surgery registers, to estimate the annual ionizing radiations
dose of each orthopedic doctor and nurse.
The effective doses (annual) estimated at different levels for
orthopedic doctors were the following: gonads: between 20.63
and 68.75 mSv; hands: 8.25-27.50 mSv; crystalline lens: 4.95-
16.50 mSv. For the orthopedic nurses: gonads: 130.63-151.25
mSv; hands: 52.25-60.25 mSv; crystalline lens 31.35-36.30
mSv.
Although the location and positions of health care workers are
not the same during the various interventions and the equipment
has an automatic control of the X ray emission, the annual
ionizing radiations dose exposure for health care workers
is an important one. The risk rating justifies the use of individual
dosimeters for better individual dose assessment as part
of an ionizing radiations prevention program. As a matter of
fact preventive measures begin with a good quantitative risk
assessment of hazards as part of risk control measures.
Abstract: Work-related musculoskeletal disorders (WRMSDs) have been referred to as a frequent
cause of health impairment in work environment. New production methods and
techniques, assembly lines and generalization of Video Display Units equipments may
explain the significant (and increasing) incidence of those disorders in workers, between
many other possible factors.
Data concerning this topic in Portugal is scarce however the existing ones allow us to
observe a gradual increase in the number of cases registered at the National Board of
Protection Against Professional Risks.
Focusing on a prevention perspective, the most important aspects and concepts for the
diagnosis of the main nosologic entities and professional hazards are reviewed by the
authors. WRMSDs risk management in an âergonomic perspectiveâ is particularly
emphasized by the authors, which, far beyond analysis of the work and risk evaluation,
should involve medical monitoring and surveillance and workers education concerning
occupational and individual risk factors.
The development of integrated programs for prevention of WRMSDs becomes an answer
to face potential risk situations namely in the fighting of professional risk factors that
use human work as an extension of the "machine" when production methods are
organized around âwork fragmentsâ and fast work rhythms.
Abstract: SELF-REPORTED WORK-RELATED MUSCULOSKELETAL
PAIN AT A LARGE COMPANY IN PORTUGAL
Work-related musculoskeletal discomfort or pain, primarily
from high demanding jobs (e. g., specific postures, strain, repetition
or wrong break/rest distribution), is an accepted indicator
of a risk situation and likely to add to the development of
musculoskeletal disorders (MSDs) (Stuart-Buttle, 1994). We
evaluated several symptoms of work-related musculoskeletal
disorders (WRMSDs) at a large automobile company located
near Lisbon in 2001. Data was collected using an adaptation of
Nordic Musculoskeletal Questionnaire (NMQ) (Kuorinka et
al., 1987). The questionnaire was distributed to all workers by
the company occupational health service (response rate
63,2%). The study included 574 workers, aged 18 to 65 (mode
26-33 years), mostly female (83,9%). We found a high prevalence
of symptoms and significant differences among several
professional categories: (1) sewing operators; (2) warehouse
(storage) and merchandise transportation; (3) logistics, quality
and offices. Operators reported significantly (p < 0,05) more
symptoms at the cervical region, shoulders, elbows, hips/thigh,
legs/knee and ankle/feet in the last 12 months, and wrists in
the last seven days, probably due to work-related activity.
These findings seem to indicate that the nature and characteristics
of sewing workplaces (cervical flexion > 20°, static muscular
strain at shoulder level, arm flexion > 45°, standing, and
high wrist/hand/fingers demands) are linked with these work
related self-reported symptoms.
Abstract: The major challenges facing health care systems include (i) the demographic change and the
aging population; (ii) the increasing complexity of health care and technological developments;
(iii) the high patient expectations and the growing pressure for accountability (iv) the greater
than ever costs. All these challenges have influenced the quality and sustainability of health care
services.
Patient safety is a key component of quality in health care and it is considered for several authors
as the first and the most essential one. New knowledge leading to improve patient safety
intimately contributes to develop the quality of health care.
Improving the safety of patient care requires system-wide action on a broad range of fronts to
identify and manage actual and potential risks to patient safety, and implement long-term
solutions. This requires actions in performance improvement, environmental safety, and risk
assessment and management, including infection control and occupational health and safety and
ergonomics, safe use of medicines, safety equipment, safe clinical practice, and safer and
healthier environment of care.
It is important to be aware that research for patient safety is not only about increasing knowledge;
it is also about translating knowledge into practice. Itâs also important the bridging between the
levels of research, dissemination, and adoption at policy, practice, managerial and consumer.
Occupational Health & Safety and Ergonomics studies have demonstrated that the great majority
of causes related with error are, most of the times, beyond the control of each individual. If we
want to undertake the prevention approach of that, it will be necessary to understand error
related circumstances and factors.
Abstract: Among the etiologic contributions of the main WRULMSDs we observe distinct pathophysiologic
perspectives, diverse risk factors - decisive for the investigators â as well as several conceptual
frames developed at the elaboration of the identification and evaluation methods of
WRULMSDs risk assessment. The frequent lack of information data and even perhaps the use
of scientifically weak components to estimate the procedure of attainment of the final results
(scores) with each method of risk evaluation, is judged to determine the distinct results in the
same workstation and raised to the main question of inquiry: will it be possible to identify the
most appropriate method (or methods) of WRULMSDs risk evaluation through the presence of
certain risk factors at the workstation?
The current study took place at an motor-car factory and analyzed the strategy of selection of
tools for WRULMSDs risk factor identification and risk assessment, to contribute to the
effectiveness of the process of risk identification and assessment of these injuries in the
industrial field. Essentially, we used and adaptation of Malchaireâs strategy of risk assessment
(Malchaire, 1999), analyzing the first two and more frequent steps considered essential: the
identification of risk factor identification and risk analysis. To categorize workstations risk we
used OCRAâs method - base of the European norm prEN 1005-5 for the estimate the
WRULMSDs risk - identifying moderate- and/or high-risk levels (score OCRA⥠16,5).
Workstations (n=71) risk was analyzed and categorized as moderate (n=37) and high (n=34)
using OCRA checklist (Occhipinti, 1998). We videotaped work activity and analyzed the main
risk factors (posture, force, repetitiveness and vibrations) within one second sampling. Several
tools were used: (1) identification of risk factors â HSE and OSHA filters (U.K. HSE, 2002;
Silverstein, 1997) â and (2) risk analysis - RULA, SI and HAL risk assessment methods
(McAtamney; Corlett, 1993; Moore; Garg, 1995; Lakto et al., 1997).
Globally, results were similar with both filters, but quite different with the use of methods: OCRA
categorized the 71 workstations as moderate and high risk, SI classified 41 workstations with
the same level, HAL classified 35 workstations as high risk and RULA only classified 26
situations of risk. Nonetheless the existing relations between the results, present some
similarities (p<0,001): OCRA-SI rSp=0,520 e OCRA-HAL rSp=0,422. Notably, the disagreement
among the several methods in the categorization of high-risk workstations, that is, for example
the 41 workstations with high risk scores with SI just enclosures 12 classified as high
WRULMSDs risk with RULA.
The results of the filters had allowed, in generality, to identify the presence or absence of the
main risk factors, notwithstandingly different results in predictive validity, especially with posture
(HSE=0,75; OSHA=0,57) and force (HSE=0,59; OSHA=0,80). Using the different methods we
reached different weights for the risk factors studied with similarities for the use of force
(OCRA=0,80; SI=0,80; HAL=0,78) and differences in the use of extreme postures (OCRA=0,62;
SI=0,68; RULA=0,48) and repetitiveness (OCRA=0,66; SI=0,35; RULA=0,43; HAL=0,39) or, in
opposition, not including the risk factor in the definitive evaluation, as it is the case of the
vibrations (SI, RULA and HAL) or posture (HAL).
Results suggest the need of using a filter to identify the main risk factors presents at each
workstation and thus guiding the selection of the most appropriate method or the rejection of the
most inappropriate. As a contribution to an effective WRULMSDs risk assessment, our work
stresses the need to build one checklist of the checklists and of more accurate data on the
different methods and its application allowing for more effective risk management of this type of
injuries.
