Work-related musculoskeletal disorders are a leading cause of lost workdays and workers' compensation costs and one of the important challenges facing ergonomists around the world. One of the major problems in hospital ergonomics leading to musculoskeletal disorders in health care workers is patient handling. Patient handling include transferring tasks, lifting tasks, repositioning tasks and etc. Patient lifting and handling is significantly more difficult and more demanding than moving boxes and is unpredictable. In hospitals, variables such as the heavy load, the distance of the load (patient) from the lifter’s center of gravity, the duration of the lift, awkward lifting positions, confined work space, unpredictable patient behaviors along with stressful situations and time constraint are leading to developing musculoskeletal disorders.

In Iran no ergonomics intervention for prevention of musculoskeletal disorders has implemented in a hospital yet. Limited local studies have focused on prevalence of musculoskeletal disorders among health care workers and ranked hospital wards according to ergonomic risks.  
This study was designed and implemented in three phases including educational intervention, design /building an ergonomic repositioning device and improvement in layout of hospital rooms. Before intervention, using Nordic Musculoskeletal Questionnaire, 46 health care workers from 4 wards were assessed.
The results of pre-intervention discomfort assessment showed high prevalence of musculoskeletal disorders among health care workers especially in low pack, shoulder and wrist regions.Design of an ergonomic repositioning device and its application along with improvement in layout of hospital rooms showed significant reduction in discomfort experienced by health care workers. Our findings showed that training programs had no effect on reducing back injury rates and viewed as ablative procedure in some persons for a short period.

This research showed that in emergency situations in which rapid performance for health care workers are critical, following ergonomic procedures is difficult. On the other hand, non ergonomic design of available technologies and unfitness of them with health care workers leading to non ergonomic performance. This urges ergonomic design of all equipment and improvement of layout. Using ergonomic equipment along with ergonomic training will have a dramatic impact on musculoskeletal disorders.

Health care workers have unique health hazards in the workplace environment. These hazards include physical risk factors and agents such as communicable diseases, exposure to chemical and biological agents, carcinogens, ionizing and non ionizing radiation, and ergonomic hazards; as well as psychological risk factors, chemical dependency, marital dysfunction, and suicide. Paradoxically, these same workers are responsible for the health care of others.
 
Back injury to health care workers from lifting patients has been studied for decades. Lifting the weight of adult patients greatly exceeds established tolerance limits of compressive force to spinal structures.
Safe lifting training has proven ineffective in preventing injury with lifting hazardous amounts of weight far above safe lifting limits set by the National Institute for Occupational Safety and Health (NIOSH) at 23 Kg for men, and by the “Snook Tables” at 20 Kg for women.
Many researchers believe the back pain problem is resultant from a combination of biomechanical and postural stressors. Variables such as the heavy load, the distance of the load (patient) from the lifter’s center of gravity, the duration of the lift, awkward lifting postures, confined work space, unpredictable patient behaviors, and the amount of stooping, bending and twisting endured in the job, have an impact leading to excessive forces in the spinal area.

Many people (both within the nursing profession and elsewhere) take the view that nurses have back problems because they are under-trained. The reality is that they are physically overloaded by their work activities. In situations of this kind, training alone is necessary but not sufficient. To make further progress, we need to identify the working conditions which are responsible for the physical overload. Therefore, an approach to prevention must also incorporate job design, workplace design, and the impact that these factors have on patient care and the health and safety of health care workers. 

The science or discipline of ergonomics whereby we match job tasks to the capabilities of workers is receiving much attention today. Through the principles of ergonomics, jobs must be redesigned and improved to be within reasonable limits. The basic principles of ergonomics seem to offer the best hope in improving the problems associated with occupational back disorders.

Before beginning the actual implementation of an ergonomics systems approach, an appropriate foundation must be laid in order for the program to have a chance to succeed. As with any program within an organizational structure, top management must be committed to the implementation of ergonomics based systems approach aimed at the prevention of back injuries. Without this support from top management, chances for success will be diminished and limited. Goals and objectives might include reduction in the incidence of back injuries, improved working conditions for employees, improved quality of care, and standardization of lifting procedures.
The method for ergonomics program implementation being suggested here involves a five-step methodology. The five steps include:
1. Risk identification and assessment
2. Risk analysis
3. Recommendations for improvements
4. Implementation of recommendations
5. Monitoring and evaluation program to measure success of the program