K. Kacjan Žgajnar, K. Govekar, M. Oder • Ergonomic burdens and harms at the workplace of accountants Workplace health-promotion programs should include attention to the work environment, especially occupational safety, health, and ergonomics. Unsuitable sitting can lead to discomfort, back pain, and upper limb disorders. Employers must assess risks in the workplace, including seating. InTroducTIon For a healthy and pleasant work, a workplace needs to be properly regulated and organized. The tendency to adapt the workplace to psychophysical abilities of the individual is very old, but now more relevant than ever [1]. The awareness of importance of ensuring health and safety in the workplace occurred many years ago, as legislation in this area has existed since 1974.The legislation is called The Health and Safety at Work Act [2]. An integrated approach to workplace health-promotion programs should include attention to the work environment, especially occupational safety, health, and ergonomics. Ergonomics is the scientific study of people at work. Occupational ergonomics attempts to improve the connection between the workforce and the work environment through the optimized design of jobs and work systems [3, 4]. The most common goal is avoidance of work-related musculoskeletal disorders such as low back pain and tendonitis, which represent a major cause of morbidity and absenteeism around the world [5, 6]. The ergonomics can design good workplaces that cannot only reduce injury risks but also enhance health and capacity of workers [7]. Many jobs require people to sit whilst working. Unsuitable sitting can lead to discomfort, back pain, and upper limb disorders. This may lead to staff absences from work and worse performance. Employers are re­quired to provide seating for employees that is suitable and safe. Em­ployers must assess risks in the workplace, including seating. A risk assessment involves identifying hazards and deciding whether enough has been done to prevent harm to people [8, 9]. The risk assessment must be comprehensive. There are five steps that may assist in assessing: Step 1: Look for the hazards. Step 2: Decide who might be harmed. Step 3: Evaluate the risks. Step 4: Record the findings. Step 5: Review the assessment regularly [9]. When choosing seating, employers need to consider the needs of the individual, the type of work being carried out and the dimensions of the workstation. It is important that a chair is comfortable for the worker, that the lower back is adequately supported, that the edges are appropriately shaped to prevent uncomfortable pressure on the thighs, that the height is adjustable, and that the backrest is properly adjusted in height and depth. However, we must not forget the armrests and in some cases the footrests as well. The aim should be to avoid employ­ee’s discomfort and to promote well-being. When people are working with computers, an employer must ensure that the seating is adjusta­ble to allow the hands to work at the elbow height. There should be place for the legs to fit comfortably under the boards. Armrests should not prevent the user from getting close to the workstation. When using a keyboard or mouse, it should be possible to place the feet flat and comfortably on the floor [9, 10]. © Inštitut za sanitarno inženirstvo, 2016 Ergonomic burdens and harms at the workplace of accountants Display Screen Equipment (DSE) is the equipment that has a display screen, regardless of the display process involved. It includes conven­tional display screens, laptops, touch-screens, and other similar devi­ces [10]. If the workplace with DSE is not adapted to the workers, various problems may occur. Some workers may experience fatigue, eyestrain, upper limb problems, and backache from overuse or improp­er use of DSE. These problems can also be experienced from poorly designed workstations or work environments. The causes may not al­ways be obvious and can be due to a combination of factors. Nina et al. discovered the importance of the correct posture while using a com­puter when they observed 67 workers working with their own compu­ters. They found that mouse-elbow height match was a significant pre­dictor for discomfort of the lower back. Inappropriate keyboard height could cause discomfort of the shoulders and upper back. Also, Demure et al. [12] warn that musculoskeletal pain requires rapid intervention for improving their work posture. Therefore, DSE workplace needs to ensure the proper relation between chairs, desks, and keyboards; the height of the screen is also very important (Figure 1). In providing an adequate job with DSE, we can help with the following recommendations: – Forearms should be in a horizontal position. – The user’s eyes should be at the same height as the top of the screen. – Make sure there is enough workspace to accommodate all docu­ments or other equipment. – Arrange the desk and screen to avoid glare or bright reflections. This is often easiest if the screen is not directly facing windows or bright lights. – Make sure there is space under the desk to move legs. International Journal of Sanitary Engineering Research . K. Kacjan Žgajnar, K. Govekar, M. Oder DSE workplace needs to ensure the proper relation between chairs, desks, and keyboards; the height of the screen is also very important. Figure 1: The correct posture while using the computer [1] Vol. 10 . No. 1/2016 K. Kacjan Žgajnar, K. Govekar, M. Oder • Ergonomic burdens and harms at the workplace of accountants Large variations of brightness in direct line of sight between the eyes and the surroundings are stressful for the body. – Avoid excess pressure from the edge of seats on the backs of legs and knees. A footrest may be helpful, particularly for smaller users. – Adjust the brightness and contrast controls on the screen to suit the lighting conditions in the room. – Make sure the screen surface is clean. – Select colours that are easy on the eye [9]. While at work using a computer, fatigue, eyestrain, upper limb problems and backache may occur. This can be prevented if users make stretch and change the position, look into the distance from time to time, blink often, change the activity, and short, frequent breaks are better than longer ones. Interventions aimed at reducing the musculoskeletal disorders due to computer work should be directed at both physical/ ergonomic factors and work organizational and psychosocial factors [9]. In addition, microclimatic conditions are important factors in the working environment, which can affect workers in a positive or negative way. In case of extreme conditions, they can be perceived as harmful effects on human health. Microclimatic parameters are determined by temperature, relative humidity, and airflow. These physical quantities define subjective well-being (comfort) or ill-being (discomfort). The temperature of the working environment depends on the body heat production affected by the intensity of employee’s activity: sitting at work, standing at work, mechanics work, intensive, and very intensive work [13]. Humidity in the working environment is a specific factor. The scope of permissible values of relative humidity depends on the temperature of the environment. Human feelings can be negatively affected by a low value of humidity (< 20 %) and humidity in excess of 60 % [14]. People with sedentary work in confined spaces are more responsive to airflow than to the movement in the nature [15]. In addition, the airflow in workplaces is prescribed to be at the maximum levels, which are also dependent on the air temperature. The lower the temperature, the lower the permissible airflow. An air temperature of 20 °C prescribes  0.18 ms-1 , at 22 °C  0.22 ms-1 , at 24 °C  0.26 ms-1 , and at air temperature of 26 °C, the permitted value of airflow is  0.30 ms-1[16]. The eye is a sensory organ that detects the brightness of objects and surroundings and must constantly adapt to its environment. Large variations of brightness in direct line of sight between the eyes and the surroundings are stressful for the body. The consequences of these differences may be manifested as pain in the eyes and head, general discomfort and rapid and unnecessary fatigue [17]. Good lighting of workplaces has long been considered as one of the most important tasks that are associated with productivity and work efficiency. Numerous researches have indicated that good lighting will positively contribute to work performance. Optimal level of lighting is important for the comfort during continuous work of long duration [18, 19,20, 21]. Workplace in office must be designed so that light sources do not cause glare or disturbing reflections on the screen. In the office, the most suitable is natural lightning or artificial lighting, which is the closest to the natural one. Windows must have adequate shading to prevent the incidence of © Inštitut za sanitarno inženirstvo, 2016 Ergonomic burdens and harms at the workplace of accountants . K. Kacjan Žgajnar, K. Govekar, M. Oder sunlight on the job. Distracting reflections on the screen reduce the visibility of characters. Workers unconsciously respond by holding the head in the unnatural position and this causes neck pain [1]. The minimum required illumination at fixed positions is 200 lux. Workplaces where workers perform work with greater visual requirements (DSE definitely is) must be equipped with the additional local lighting [22]. This study explored three workplaces of accounting companies. We de­termined the ergonomic position of workers who work mainly seden­tary work with Display Screen Equipment. The welfare of employees is also influenced by microclimatic conditions and lighting of the work­place, therefore, we also measured these parameters. MeTHodS The study was performed among a group of workers, working in a small accounting company, who had been using DSE daily. Data were obtained on the basis of a five-day observation of three accountants at work. The welfare of employees is Workers were monitored daily for eight hours. We used the OWAS method also influenced by (Ovako Working posture Assessment System). The OWAS method was microclimatic conditions and used to determine an improper posture during work. In the second part of lighting of the workplace. the research, we measured the microclimatic conditions (temperature, humidity, airflow) in the office and lighting in all three workplaces. In the office, the most oWaS method suitable is natural lightning OWAS identifies the most common work postures for the back (4 or artificial lighting, which is postures), arms (3 postures) and legs (7 postures), and the weight of the load handled (3 categories). These postures have been classified into the closest to the natural four categories indicating needs for ergonomic changes. The observations one. are made as “snapshots” with constant time intervals. The observed posture combinations are classified into four ordinal scale action categories, which are based on expert’s estimates of the health hazards The OWAS method was used of each work posture or posture combination [23]. This method is to determine an improper suitable for different jobs, which also include sedentary job [24]. Using posture during work. this method is time-consuming, as the employees must be monitored all their working day for several days. The OWAS method has its limitations, since it does not separate the right and left upper extremities: also, the assessments of the neck, elbows, and wrists are missing [25]. Temperature, humidity, airflow, and lighting measurements Measurements of microclimatic conditions were performed using a measuring device Testo 445. The temperature, humidity, and airflow were measured 10 cm and 110 cm above the ground. The first mea­surements were performed at 4 pm, when the air conditioner was switched on. The outside air temperature was 26 °C, the weather was cloudy. The second measurements were performed in the evening, at 10 pm, when the outside temperature was 19 °C. The lighting was measured with a luxmeter Testo 545. Measurements of lighting were performed at three workplaces. The measurement of the daylighting was influenced by the two windows of size 1.14 m2 International Journal of Sanitary Engineering Research Vol. 10 . No. 1/2016 K. Kacjan Žgajnar, K. Govekar, M. Oder • Ergonomic burdens and harms at the workplace of accountants and a transparent surface 0.82 m2. Measurement of artificial lighting was performed in the evening at 10 pm. When taking measurements of the artificial and combined lighting, four ceiling lights were turned on and additionally two table lamps at the desk. Environmental conditions on the workplace in the office are provided by the ISO Standard 9241 [26]. ISO 9241 is a standard from the in­ternational organization for standardization covering ergonomics of hu­man-computer interaction. According to the regulations, they must pro­vide the following values: – Temperature 19–23 °C – Humidity 40–60 % – Airflow < 0.25 ms-1 – Lighting 300–500 lux [26]. reSuLTS and dIScuSSIon results of ergonomic burdens (oWaS) By using the OWAS methods, we were estimating ergonomic burdens of three accountants at their workplace. The results of the OWAS method showed an excessive burden for certain positions and they are shown in Figures 2–6. In determining prohibited positions, we used symbols, which are shown in Table 1. The symbols of different mea­sures are used in Figures 2–6. Measures depend on the positions of different parts of the human body at the workplace. For each position are prescribed the maximal permitted limit values [27]. Observing the thoracolumbar spine in all three workers, we found that they were in the so-called prohibited position 1.4 (Figure 2). In the situation 1.4, a stooped posture is noticed, since the deflection is greater than 15°, combined with a torsion or lateral flexion greater than 30°. This situation was mostly recorded when employees were sitting at the table, leaning to the side, and opening or closing drawers of the desk. The measures are necessary in the foreseeable future. When observing the arm, we noticed that the most problematic posi­tion 2.2 occurs when one or both arms are away from the midline of the body (abducting). This position was present in all workers during all observation days, and it exceeded the physiological recommenda­tions. Corrective measures are needed immediately (Figure 3). This situation occurs when people working with computers have a lot of documents in front of them. In this case, the keyboard is too far from Table 1: The legend of measures and symbols used in the Figure 2–6. Symbols Legend Measures are not required Measures are needed in the short term Measures are needed immediately Further research is needed © Inštitut za sanitarno inženirstvo, 2016 K. Kacjan Žgajnar, K. Govekar, M. Oder • Ergonomic burdens and harms at the workplace of accountants the body and arm abduction occurs. We suggest the workers having only the documents they need in front of them. Concerning hands positioning, load was detected in the position 3.2., which was the result of typing. Because of the nature of work, the workers cannot avoid these situations; therefore, it is difficult to provide adequate measures (Figure 4). It would be necessary to do additional research. One of the options is that the employer would adapt computer programs in the way workers could be able to do more work with a computer mouse. Figure 5 shows the position of the legs. It can be seen that it often comes to a position 4.1, which represents physiological or non-physio­logical seating. Taking measures is necessary shortly. By doing so, the workers could change positions of the lower limbs. Part of the work could be done in the sitting position (work on the computer) and a part in the standing position (while organizing documents). On the fourth day, the worker 1 was repeatedly observed in the situation 4.4. This position means standing on one or both legs, which are highly curved in the hips, knees, and ankles. On the fourth day, the worker 1 greatly exceeded the physiological re­commendations for this position, because she was cleaning up the warehouse, which is not part of the everyday tasks. This situation oc­curred during the cleaning of the lower shelves and that caused curves in the hips, knees, and ankles. Figure 6 shows the positions of the cervical spine. In all subjects, there was a load in the position 5.2. In this situation, the head is bent forward for more than 30°. The excessive burden of cervical spine in this position Figure 4: The position and shape of the hands of the three workers © Inštitut za sanitarno inženirstvo, 2016 K. Kacjan Žgajnar, K. Govekar, M. Oder • Ergonomic burdens and harms at the workplace of accountants is due to viewing of documents that are placed too close to the body of the worker, which is on the edge of the table. Thus, the workers’ heads were heavily bent forward. The burden in the position 5.2 is also due to inadequate height of a screen. Annex to the Rules on safety and health requirements for work with visual display units [28] states the necessity of guaranteed possibility of adjusting the height of the screen in the way that the upper row on the screen is approximately 5cm below the eye level of a worker. Screens at workstations in the accounting firm have no possibility of adjusting the height, they are positioned too low and this does not meet the policy requirements. We recommend the employees to raise the screen or the monitor by putting it on a shelf. results of microclimatic conditions and lighting at workplaces Table 2 shows the results of measurement of microclimate conditions in the office in the three workplaces. Microclimate conditions in the work area were measured when employees were there (4 pm), and in the evening, when the office was empty (10 pm). The average air tem­perature at 4 pm was 26.2 °C, and at 10 pm 27.1 °C. When the em­ployees were present at the workplace, the air conditioning was turned on. Rules on requirements for ensuring the safety and health of work­ers at the workplace [22] say that the air temperature should not exceed 28 °C. The measured values were not exceeded. According to the standard ISO 9241 [26], which sets more stringent range of permissible levels of air temperature in the office premises, the values of air temperatures were exceeded. The standard requires a temperature range of 19–23 °C. In the office with air-conditioning, we could meet the criteria of this standard by increasing the cooling acti­vity of air conditioners. Considering the fact that employees do not feel the discomfort because of the temperature, these measured values will not be highlighted as problematic. When workers were present, the average measured humidity in the work area was 47 % and 50 % when the office was empty and the air condi­tioner was turned off. According to the Regulation on requirements to ensure the safety and health of workers at the workplace [22], the value of humidity was not exceeded. We also measured the airflow during working hours, which was 0.11 ms-1, which means it does not pose a risk to workers’ health. Based on the measured parameters and an interview con­ducted with the employees, the accountants feel good in their workplaces. Table 2: The results of microclimate conditions in the office at three workplaces Microclimatic conditions Humidity [%] Air temperature [°C] Airflow [ms-1] 10 cm 110 cm 10 cm 110 cm 10 cm 110 cm Workplace 1 at 4 pm 46.10 47.10 26.1 26.2 0.2 0.03 at 10 pm 49.20 49.20 27.1 27.1 0.01 0.04 Workplace 2 at 4 pm 46.30 46.60 26.3 26.4 0.03 0.02 at 10 pm 49.30 49.50 27.1 27.1 0.02 0.01 Workplace 3 at 4 pm 47.00 46.90 26 26 0.26 0.1 at 10 pm 49.60 50.20 27.1 27.1 0.09 0.03 © Inštitut za sanitarno inženirstvo, 2016 Ergonomic burdens and harms at the workplace of accountants . K. Kacjan Žgajnar, K. Govekar, M. Oder Table 3: The results of lighting in the office at three workplaces daylighting [lx] artificial lighting [lx] combined lighting [lx] Workplace 1 1925 349 2180 Workplace 2 326 245 (822)* 562 (1025)* Workplace 3 1055 545 1426 *Value in the bracket is lighting with extra table lamp Table 3 shows the results of measurements of daylighting, artificial light­ing, and the combined lighting at three workplaces. In the Annex of the Rules on safety and health requirements for work with visual display units [28], it is indicated that the overall lighting of the workplace should be 400 lx ± 100 lx, which would ensure satisfactory lighting conditions. We found out that daylighting at the workplace 2 does not meet the con­ditions laid down in the Rules on safety and health at work on a display unit [28], but the employer had an additional lamp, which reached the prescribed value of the combined lighting. concLuSIon The ergonomic arrangement of the working environment is a concern of an employer. The accounting firm is aware of the problem of overload in the workplace and is taking care of the realignment, improvements, and appropriate measures. We spend a great part of our life at the workplace, therefore, it is important that the work conditions are good and the work itself does not pose a risk to health. The study of ergonomic strains in the workplace of three accountants showed that the workers are in some inadequate positions. Due to improper seating, abduction of arms, and long-term and excessively bent position of the head, employees feel discomfort in the shoulders, back of the neck, upper back, lower back, and on the buttocks. Because of using the computer and incorrect position of the forearm, they have pain in the wrists. The measurement of microclimate conditions showed a deviation of an air temperature in the office, which was too high according to the standard ISO 9241. However, the workers feel good at the workplace; therefore, this failure has no particular meaning. Furthermore, they have an option for cooling the office using air conditioners. reFerenceS [1] Belič M, Korošec E, Železnik J. Ergonomija in varstvo pri delu. Ljubljana: Zavod IRC. 2010; 647–77, 93–116. [2] The Health and Safety at Work Act. Part I General duties. Section 2 c.37. 1974. [3] Punnett L, Cherniack M, Henning R, et al. A conceptual framework for integrating workplace health promotion and occupational ergonomics programs. 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[25] OWAS, (Ovako Working posture Assessment System. www.ttl.fi/ workloadexposuremethods June 2009. p. 4 (20. 9. 2016)). [26] ISO Standard 9241. Ergonomics of human-system interaction. Part 210: Human-centred design for interactive systems. [27] Sušnik J. Položaji in gibanje telesa pri delu. Ljubljana: Univerzitetni zavod za zdravstveno in socialno varstvo. Knjižnica UZZSV, 1987: 11–159. [28] Rules on safety and health requirements for work with visual display units, Official Gazette of RS, No. 30/00, 73/05, 43/11. © Inštitut za sanitarno inženirstvo, 2016