PSM Presentation

INVESTIGATION OF MUSCULOSKELETAL SYMPTOMS AND ERGONOMIC RISK

FACTORS AMONG ROOM ATTENDANTS IN HOTEL INDUSTRIES

MOHD SYAHIR BIN MUHAMAD JAFFAR (DD130028)SUPERVISOR : DR. MOHD NASRULL BIN ABDOL RAHMANPANEL 1 : PROF. DR. KHALID BIN HASNANPANEL 2 : PROF. MADYA DR. SH SALLEH BIN SH AHMAD

1. Background of Study2. Problem Statement3. Objectives of Study4. Scopes of Study5. Significance of Study6. Literature Review7. Research Methodology8. Data Collection9. Data Outcome10. Results and Discussion11. Conclusion12. Recommendations13. Gantt Chart14. References

OUTLINE

BACKGROUND OF STUDY

Hotel industry was intentional because of their cultural and economic significance for the tourism (Valtonen and Veijola, 2011).

Every hotel has a housekeeping department (Kensbock et al., 2016)

Room attending is mostly female occupation which involves physically and psychologically hard work (Liladrie, 2010; Sherman, 2011).

High workloads experience contributes to tiredness, anxiety and stress (Knox, 2011).

Room attendants have high injury rates with MSDs (Kensbock et al., 2016).

PROBLEM STATEMENT

Room Attendants(Housekeeping

Tasks)

Experienced awkward postures (CCOHS, 2016).

Experienced neck and muscular pain, and CTS

(VIRWC, 2010).

Experienced low back pain(EU-OSHA, 2016).

Musculoskeletal Disorders

(MSDs).

Need maximum energy to push the carts which lead to forceful exertions

(SCIF, 2016).

Certain tasks would trigger knee pain among

room attendants (Liladrie, 2008).

Vibrating cleaning tools expose to hand-arm vibrations (EU-OSHA,

2009).

OBJECTIVES OF STUDY

To determine Musculoskeletal Disorders (MSDs) prevalence among room attendants in hotel industries using Nordic Musculoskeletal Questionnaire (NMQ).

To identify the caution or hazard level of ergonomic risk factors using Washington Industrial Safety and Health Act (WISHA) Checklist.

To examine the exposure level of ergonomic risk factors using Workplace Ergonomic Risk Assessment (WERA) and Quick Exposure Checklist (QEC).

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SCOPE OF STUDY

This research was conducted at a few selected hotels in Peninsular Malaysia.

This research was focused on housekeeping department only.

Subjects selected were among room attendants in which sample size of 65 and age between 20 and 60.

This investigation was using NMQ to identify the Musculoskeletal Symptoms (MSi) among the selected subjects.

This investigation was using WERA and QEC to examine the ergonomic risk factors for work related to MSDs among room

attendants.This investigation was using WISHA Checklist to identify the

caution or hazard level of ergonomic risk factors among room attendants.

Data analysis for the investigation is presented as number, percentage, mean and standard deviation (SD).

SIGNIFICANT OF STUDY

Significance of study

Benefits for employees- ERFs for MSDs among room

attendants can be reduced.- Improve working performance.- Encourage room attendants to stay longer as employees to an organization.

Benefits for employer- Increase the productivity of an organization. - Improving the standards of

safety and health for all workers. - Reduced MSDs among both

employer and employees.

LITERATURE REVIEW

MSDs among Room Attendants

Low Back Pain (EU-OSHA, 2016; Yu-Chin et al., 2014)

Carpal Tunnel Syndrome (EU-OSHA, 2016; Tiffany,

2014; VIRWC, 2010)Neck Pain (VIRWC, 2010;

Kensbock, 2011; Yu-Chin et al., 2014)

Knee Pain (Liladrie, 2008)

Elbow Pain (CCOHS, 2014a; Ehrenreich, 2014)

Ergonomic Risk Factors

Awkward Postures (CCOHS, 2016)

Repetition Motion (VIRWC, 2010; Kensbock et al., 2016;

Tiffany, 2014)

Forceful Exertions (SCIF, 2016)

Vibration (OSHAcademy, 2013; EU-OSHA, 2016)

Contact Stress (WorkSafeBC, 2016; Oregon, 2016)

Four Weeks Prevalence of Pain by Body Region and Severity among Hotel Room Attendants in Las Vegas (Krause et al., 2005)

LITERATURE REVIEW

RESEARCH METHODOLOGY

Methodology Flowchart

Selected Hotel Number of Participants

KT Mutiara Hotel 4Kenangan Hotel 4

UiTM Dungun Hotel 9Ming Star Hotel 8

Asia Premium Hotel 7Rail Hotel 8

Moonlight Hotel 7Lavana Hotel 5

Kluang Merdeka Hotel 8Golden Pearl Hotel 5

Total 65


Number of Participants from each Hotel

Sample of Ergonomic Risk Factors (ERFs) evaluation process among room attendants

(a) (b)

(c) (d)


(a) Cleaning room with back bent forward more than 30°, (b) Pushing trolley with high force, (c) Cleaning toilet with repetitive motion, (d) Making bed with improper body

posture

Nordic Musculoskeletal Questionnaire (NMQ)

Nordic Council of Ministers has funded a project in developing the Nordic Musculoskeletal Questionnaire (NMQ) in purpose for analysis of musculoskeletal symptoms (Kuorinka et al., 1987).

The purpose was to develop and test a standardized questionnaire methodology allowing comparison of neck, low back, shoulder and general complaints for use in epidemiological studies (Crawford, 2016).


Demographic Items (Kuorinka et al., 1987)

General Questionnaire about Trouble with the Locomotive Organs (Kuorinka et al., 1987)


NMQ

Workplace Ergonomic Risk Assessment (WERA)

Screening method by observant in detecting exposure to risk factors (Rahman et al., 2012).

WERA assessment consists six physical risk factors which are posture, repetition, forceful, vibration, contact stress and task duration.

WERA assessment involves five main body regions which are shoulder, wrist, back, neck and leg.


WERA

Quick Exposure Checklist (QEC)

QEC is a tool for Occupational Health and Safety (OHS) practitioners to assess task exposure to risks for work-related musculoskeletal disorders (WMSDs) (Li and Buckle, 1999).

QEC is easy and straightforward tool to use and provide exposure scores for body areas which include the back, shoulder/arm, wrist/hand, and neck, with related to posture and repetitive movements.


QEC

Washington Industrial Safety and Health Act (WISHA) Checklist

In the late 1990’s, the tool was developed in Washington State as part of a regulatory effort in order to control exposures to musculoskeletal risks in the workplace (Washington State Department of Labor and Industries, 2000)

Observation method in determining whether the risk is ‘caution’ or ‘hazard’.

Common factors include awkward posture, high hand force (pinch and grasp), highly repetitive motion, repeated impact, heavy, frequent or awkward lifting, and moderate to high hand-arm vibration.


WISHA

Data Collection Flowchart

DATA COLLECTION

DATA OUTCOME

Data Outcome Flowchart

NMQ ResultsCharacteristic N % Mean SD

Gender Male 39 60.0 - -Female 26 40.0Age ≤20 3 4.6

29.9 8.421-40 52 80.0≥41 10 15.4

Working Experience (Year) 1-5 61 93.8 2.4 2.5≥6 4 6.2

Weekly Working Time (Hours) 40-50 65 100.0 46.5 3.1≥51

Body Mass Index (BMI) Underweight 2 3.1

23.5 2.8Normal Weight 47 72.3Overweight 14 21.5

Obesity 2 3.1Hand Dominance

Right-handed 53 81.5 - -Left-handed 12 18.5

RESULTS AND DISCUSSION

Demographic Variables, (n=65)

RESULTS AND DISCUSSIONNMQ Results

Neck

Shoulders

Elbows

Wris

ts/Han

ds

Upper Back

Low Back

Hips/Thighs

Knees

Ankles/Feet

0.010.020.030.040.050.060.070.080.090.0

100.0

3.1

12.3

3.1

41.5

30.8

60.0

20.0

36.9

1.52.6

0.0

0.0

23.1

23.1

51.3

17.9

30.8

0.03.

8

30.8

7.7

69.2

42.3

69.2

23.1

46.2

3.8

Total (%)Male (%)Female (%)

Body Part

% o

f Res

pond

ents

Percentage of Nordic Questionnaire Respondents with Body Part Trouble in Last 12 Months , (n=65)


The Prevalence of Musculoskeletal Symptoms by Body Parts among Room Attendants , (n=65)

SymptomsLower Back,

% (n)Neck, % (n)

Shoulder, % (n)

Any trouble ever 60.0 (39) 3.1 (2) 12.3 (8)Ever had in accident 0 (0) 0 (0) 0 (0)Change job or duty 1.5 (1) 0 (0) 0 (0)Total time with trouble last 12 months 0 days 0 (0) 0 (0) 0 (0) 1-7 days 3.1 (2) 0 (0) 1.5 (1) 8-30 days 32.3 (21) 3.1 (2) 10.8 (7)

More than 30 days, but not every day 24.6 (16) 0 (0) 0 (0) Every day 0 (0) 0 (0) 0 (0)Reduce of work activity last 12 months 1.5 (1) 0 (0) 0 (0)

Reduce of leisure activity last 12 months 7.7 (5) 0 (0) 0 (0)Total time prevented work last 12 months 1-7 days 4.6 (3) 0 (0) 0 (0) 8-30 days 9.2 (6) 0 (0) 0 (0) More than 30 days 0 (0) 0 (0) 0 (0) Sought a professional 0 (0) 0 (0) 0 (0) Hospitalized 1.5 (1) 0 (0) 0 (0)

Anatomical Region

Any trouble last

12 months, % (n)

Prevented from normal work, %

(n)

Trouble last 7 days, %

(n)Upper ExtremityShoulders 12.3 (8) 0 (0) 0 (0)Elbows 3.1 (2) 0 (0) 0 (0)Hands/Wrists 41.5 (27) 1.5 (1) 1.5 (1)Lower ExtremityHips/Thighs 20.0 (13) 0 (0) 1.5 (1)Knees 36.9 (24) 1.5 (1) 0 (0)Ankles/Feet 1.5 (1) 0 (0) 0 (0)Axial SkeletonNeck 3.1 (2) 0 (0) 0 (0)Upper back 30.8 (20) 6.2 (4) 3.1 (2)Lower back 60.0 (39) 13.9 (9) 20.0 (13)


Twelve-month Prevalence of Musculoskeletal Symptoms and Work Interference by Body Region , (n=65)

Physical Risk Factors

ScoreExposure Level

Mean SD

Shoulder(a) 4.4 0.5 Medium

Wrist(a) 4.4 0.7 Medium

Back(a) 5.0 0.0 High

Neck(a) 3.9 0.3 Medium

Leg(b) 5.1 0.3 High

Forceful(c) 4.8 0.4 High

Vibration(d) 4.5 0.5 High

Contact Stress(e) 3.5 0.5 Medium

Task Duration(f) 3.8 0.5 Medium

RESULTS AND DISCUSSIONWERA Results

Notes: - (a) Posture & Repetition, (b) Posture, (c) Lifting the load, (d) Using of vibration tool,

(e) Using of tool handle or wearing hand gloves, (f) Task-hour/day

Exposure Level Standards for WERA Physical Risk Factors , (n=65)

Final Score

Risk Level Action N %

18-27 Low Task is acceptable - -

28-44 Medium Task is need to further investigate & required change 65 100.0

45-54 High Task is not accepted, immediately change - -

RESULTS AND DISCUSSIONWERA Results

WERA Final Score and Action Level , (n=65)

Risk Factors

ScoreExposure

LevelMean SD

Back (Static) - - -

Back (Movement) 29.8 4.3 Moderate

Shoulders/arms 30.4 3.6 Moderate

Wrists/hands 28.2 3.0 Moderate

Neck 10.3 1.1 Moderate

RESULTS AND DISCUSSIONQEC Results

Exposure Level Standards for Back, Shoulder, Wrist and Neck , (n=65)

Score Exposure Level

Driving Vibration Work Pace Stress

N % N % N % N %

1 Low 65 100.0 13 20.0 5 7.7 23 35.4

4 Medium - - 52 80.0 60 92.3 35 53.9

9 High - - - - - - 7 10.8

16 Very High - - - - - - - -

Total 65 100.0 65 100.0 65 100.0 65 100.0


Exposure Level Standards for Driving, Vibration, Work Pace and Stress , (n=65)

Score Action Level N %

≤40% Acceptable - -

41-50% Investigate further 11 16.9

51-70% Investigate further and change soon 54 83.1

≥70% Investigate and change immediately - -

Total 65 100.0


QEC Final Score and Action Level, (n=65)

Awkward Posture

Risk LevelCautionh Hazardi

N % N %

Shouldera 65 100.0 - -

Shoulderb - - - -

Neckc - - - -

Backd - - - -

Backe (h) N/A N/A 65 100.0

Kneesf 65 100.0 - -

Kneesg 65 100.0 - -

RESULTS AND DISCUSSIONWISHA Checklist Results

Risk Level of Awkward Posture , (n=65)

Notes: - Non-applicable (N/A), (a) Working with the hand(s) above the head or the elbow(s) above shoulder(s), (b) Repetitively raising the hand(s) above the head or the elbow(s) above the shoulder(s) more than once/minute, (c) Working with the neck bent more than 45° (without support or the ability to vary posture), (d) Working with the back bend forward more than 30° (without support or the ability to vary posture, (e) Working with the back bent forward more than 45° (without support or the ability to vary posture, (f) squatting, (g) kneeling, (h) Duration-more than 2 hours total/day, (i) Duration-more than 4 hours total/day

High Hand Force

Risk Level

Hazardc Hazardd Cautione Hazarde

N % N % N % N %

Pincha - - 3 4.6 62 95.4 - -

Graspb - - 3 4.6 62 95.4 - -


Risk Level of High Hand Force - Pinch & Grasp (arms, wrists & hands) , (n=65)

Notes: - (a) Pinching an unsupported object(s) weighing 2 or more pounds/hand, or pinching with a force of 4 or more pounds/hand (comparable to pinching half a ream of paper), (b) Gripping an unsupported object(s) or with a force weighing 10 pounds or more pounds/hand (comparable to clamping light duty automotive jumper cables onto a battery, (c) Highly repetitive motion (more than 3 hours total/day), (d) Wrists bent in flexion 30° or more, or in extension 45° or more, or in ulnar deviation 30° or more (more than 3 hours total/day), (e) No other risk (caution - more than 2 hours total/day, hazard - more than 4 hours total/day

Physical Risk FactorRisk Level

Caution HazardN % N %

Using same motion with little or variation every few secondsa 14 21.5 - -Using same motion with little or variation every few secondsb N/A N/A 51 78.5

Intensive keyingc N/A N/A - -

Intensive keyingd - - - -


Risk Level of Highly Repetitive Motion (Neck, shoulders, elbows, wrists, & hands) ,

(n=65)

Notes: - Non-applicable (N/A), (a) No other risk factor (Caution - more than 2 hours/day & Hazard - more than 6 hours/day, (b) Wrists bent 30°/45° or more, AND high, forceful exertions with hand(s) (more than 2 hours/day), (c) Awkward posture including wrists bent 30°/45° or more, or in ulnar deviation 30° or more (more than 4 hours/day), (d) No other risk factor (Caution - more than 4 hours/day & Hazard - more than 7 hours/day)

Body PartRisk Level

Cautionc Hazardd

N % N %Handsa 30 46.2 - -Kneesb 65 100.0 - -


Risk Level of Repeated Impact for more than 2 hours total per day , (n=65)

Notes: - (a) Using the hand (heel/base of palm) as a hammer, (b) Using the knee as a hammer, (c) more than 10 times/hour, (d) more than 60 times/hour

Physical Risk FactorRisk Level -

CautionN %

Using hand tools that typically have high vibration levelsa - -Using hand tools that typically have moderate vibration levelb 65 100.0


Risk Level of Moderate to High Hand-Arm Vibration (Hands, wrists &

elbows) , (n=65)

Notes: - (a) more than 30 minutes total/day, (b) more than 2 hours total/day

• Highest prevalence of MSDs among room attendants including low back (52.7), wrists/hands (46.5%) and elbow region (27.3%).Jong-Yu et al (2004)

• Symptoms in the lower back were most prevalent (49%) followed by the wrists/hands (43%), ankles/feet (35%), and shoulders (25%).

Kirtigandha et al (2011)

• The highest prevalence among hotel room attendants in Las Vegas was reported for very severe pain in the lower back (40%) and upper back (38%).Krause et al (2005)

Low back pains are a common complaint among room attendants due to their bad working posture for housekeeping tasks.Andrews (2009)

Ergonomic injuries of body impacts among housekeepers involving back (52%), shoulders (18%), arms and legs (5%) due to overexertion and wrists (43%), back (11%) and hands (5%) due to repetitive motion.

Bureau of Labor Statistics (2010)

High exposure level for back physical risk factor had been found to be associated with heavy lifting and forceful movements.Punnett et al (1991)


• Use of vibrating cleaning tools such as electrical vacuum cleaner which used to clean floors exposes room attendants to hand-arm vibrations and lead to musculoskeletal problems.

EU-OSHA (2009)

• Vibration from the work equipment or machines can contribute to hand-arm vibration syndrome, tingling, numbness or white fingers from reduced blood flow.

EU-OSHA (2016)

• Cumulative injuries of body parts most affected due to awkward posture for room attendants involving back (40%), hands/wrists (22%), shoulder (13%) and other (25%).

SRI-Ergonomics (2016)

• Room attendants are more likely than other hotel workers to suffer repetitive motion injuries and are susceptible to an assortment of musculoskeletal injuries.Yu-Chin et al (2014)

Most of room attendants suffered knee pain due to constant bending and kneeling.Liladrie (2008)


Objectives of study are achieved.

Most of room attendants have high prevalence of MSDs involving low back (60%), wrists/hands (41.5%) and knees (36.9%).

Room attendants had high exposure level for physical risk factors including leg, back, forceful and vibration.

All room attendants had moderate exposure level for risk factors involving back for movement use, shoulders/arms, wrists/hands and neck.

Most of room attendants were found in hazard level for risk level involving awkward posture and highly repetitive motion.

CONCLUSION

• Test which conducted by a medical specialist for the purposes of efficiently determining a patient’s physical capabilities.

Functional Capacity Evaluations (FCEs)

• Educating employees coping strategies and ergonomics techniques can be effective for reducing ERFs at workplace.

Personalized communication program

• Overloaded housekeeping carts require great amount of force to pull or push them.Empty carts frequently

• Reduce bending and reaching and avoid awkward posture.Use tools with long handles

• Protect knees using kneepad or towel when kneeling for room or toilet cleaning tasks.Safe kneeling

RECOMMENDATIONS

GANTT CHART (PSM 1)

GANTT CHART (PSM 2)

Canadian Centre for Occupational Health and Safety (CCOHS), (2016), Hotel Housekeeping Retrieved from https://www.ccohs.ca/oshanswers/occup_workplace/hotel_housekeeping

EU-OSHA, European Agency for Safety and Health at Work, (2016). E-fact 39: Cleaners and musculoskeletal disorders.

Kensbock, S. L., Jennings, G., Bailey, J., and Patiar, A., (2016). Performing: Hotel room attendants’ employment experiences. Annals of Tourism Research, (56), 112-127

Kuorinka, I., Jonsson, B., Kilbom, A., Vinterberg, H., Biering-Sørensen, F., Andersson, G., & Jørgensen, K. (1987). Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Applied Ergonomics, 18(3), 233-237.

Li, G., Buckle, P., (1999). Evaluating Change in Exposure to Risk for Musculoskeletal Disorders-A Practical Tool. Prepared by Robens Centre for House Ergonomics, University of Surrey, for the Health and Safety Executive (HSE) Books, Contract research report; 251/1999

Rahman, M.N.A., M.R.A. Rani, and M.J. Rohani, Investigation of work-related musculoskeletal disorders in wall plastering jobs within the construction industry. WORK: A Journal of Prevention, Assessment and Rehabilitation, 2012, 43 (4), 507-514

Washington State Department of Labor and Industries, (2000). Evaluation Tools. Retrieved from http://www.lni.wa.gov/Safety/Topics/Ergonomics/Services Resources/Tools/default.asp.

Yu-Chin, J. H., Apostolopoulos, Hatzudis, K., and Sönmez, S. (2014), Occupational Exposures and Health Outcomes among Latina Hotel Cleaners, Hispanic Health Care International, Vol. 12, No. 1: University of North Carolina at Greensboro

REFERENCES

REFERENCES

Bureau of Labor Statistics, United States Department of Labor. (2010). BLS Annual Summary Data.

Andrews, S. (2009). Tata McGraw-Hill Education. Human Resources Management: A Textbook for the Hospitality Industry

EU-OSHA, European Agency for Safety and Health at Work (2009). Working Environment Information, Preventing Harm to Cleaning Workers. ISBN 978-92-9191-259-9

Jong-Yu Adol Chyuan, Chung-Li Du, Wen-Yu Yeh and Chung-Yi Li, Occupational Medicine (2004); 54:55–57, Musculoskeletal Disorders in Hotel and Restaurant

Kirtigandha Salwe, Shrawan Kumar, and Joyce Hood, Journal of Environmental and Public Health. Volume 2011 (2011), Article ID 382510, Nonfatal Occupational Injury Rates and Musculoskeletal Symptoms among Housekeeping Employees in Texas

Krause, N., Scherzer, T., and Rugulies, R., (2005), Physical Workload, Work Intensification, and Prevalence of Pain in Low Wage Workers: Results from a Participatory Research Project With Hotel Room Cleaners in Las Vegas: American Journal of Industrial Medicine

Punnett, L., Fine, L. J., Keyserling, W. M., Herrin, G. D., Chaffin, D. B., (1991). Back disorders and non-neutral trunk postures of automobile assembly workers. Scandinavian Journal of Work and Environmental Health 17, 5, 337–346.

SRI-Ergonomics (2016), Institute for Ergonomics, The Ohio State University, Columbus Ohio. Housekeeper Managers: Improving Housekeeping Work using Ergonomics

Liladrie, S. (2008). "Do Not Disturb/Please Clean Room: The Invisible Work and Real Pain of Hotel Housekeepers in the GTA". Theses and dissertations. Paper 106.

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