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

person Emanuelli Mancio Ferreira da Luz

Study concept and design · Obtaining data · Data analysis and interpretation · Statistical analysis · Drafting the manuscript · Critical review of the manuscript as to its relevant intellectual content

schoolUniversidade Federal do Rio Grande, Escola de Enfermagem, Rio Grande, RS, Brazil.

0000-0002-7799-5232

person Oclaris Lopes Munhoz

Study concept and design · Obtaining data · Data analysis and interpretation · Drafting the manuscript · Critical review of the manuscript as to its relevant intellectual content

schoolUniversidade Federal do Rio Grande, Escola de Enfermagem, Rio Grande, RS, Brazil.

0000-0001-8901-7148

person Patrícia Bitencourt Toscani Greco

Data analysis and interpretation · Statistical analysis · Drafting the manuscript · Critical review of the manuscript as to its relevant intellectual content

schoolUniversidade Federal do Rio Grande, Escola de Enfermagem, Rio Grande, RS, Brazil.

0000-0001-6999-5470

person José Luís Guedes dos Santos

Study concept and design · Data analysis and interpretation · Drafting the manuscript · Critical review of the manuscript as to its relevant intellectual content

schoolUniversidade Federal de Santa Catarina, Departamento de Enfermagem, Florianópolis, SC, Brazil.schoolScholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.

0000-0003-3186-8286

person Silviamar Camponogara

Study concept and design · Obtaining data · Data analysis and interpretation · Statistical analysis · Drafting the manuscript · Critical review of the manuscript as to its relevant intellectual content

schoolUniversidade Federal de Santa Maria, Departamento de Enfermagem, Santa Maria, RS, Brazil.schoolScholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.

0000-0001-9342-3683

person Tânia Solange Bosi de Souza Magnago

Study concept and design · Obtaining data · Data analysis and interpretation · Statistical analysis · Obtaining financing · Drafting the manuscript · Critical review of the manuscript as to its relevant intellectual content

schoolUniversidade Federal de Santa Maria, Departamento de Enfermagem, Santa Maria, RS, Brazil.schoolScholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil.

0000-0002-5308-1604

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

Conflict of interest: the authors have declared that there is no conflict of interest.

Associate Editor:

Maria Lucia do Carmo Cruz Robazzi

*Prevalent body region of MSP , in the last 7 days:**	QUAN † Results	QUAL ‡ Results			Convergences
*Prevalent body region of MSP , in the last 7 days:**	Factors associated with the occurrence of MSP * :	Observation	Photographic records	Convergence Groups	Convergences
Lower back (42.3%)	Self-medication (p=0.020) § .	– Practice of self-medication for MSP * 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 * .	Self-medication is used routinely and preventively to alleviate the symptoms of MSP * , without recognizing the risks inherent to this practice.
Ankles or feet (28.2%)	– Sedentarism (p=0.041) § ; – Sleep less than eight hours a day (p=0.039) § .	– 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 * ; – Workers who sleep less than eight hours a day have a higher prevalence of MSP * in this region. Qualitative data confirm this association, due to the insufficient rest reported.
Wrists or hands (27.5%)	–Ex-smoking (p=0.015) § ; – Use of some type of medication (p=0.004) § .	– 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 * in wrists and hands.	– Former smokers have a higher prevalence of MSP * 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 * 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) § .	– 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) § to analyze convergence.
Shoulders (23.5%)	Self-medication (p=0.026) § .	– 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 * symptoms in the shoulders.	Convergence of QUAN † +QUAL ‡ research approaches on the routine practice of self-medication, with the use of analgesics and anti-inflammatories by the workers investigated.

[TFN1] ^*
Musculoskeletal pain;

[TFN2] ^†
Quantitatives;

[TFN3] ^‡
Qualitatives;

[TFN4] ^§
Pearson’s Chi-Squared Test

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

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