Journal of Occupational

 
Table 1. Frequency distribution of demographic variables in surgical technologists (n = 201) working at Sari educational hospitals in 2019

 
 
Table 2. Frequency (percentage) of musculoskeletal disorders in surgical technologists working at Sari educational hospitals in 2019

 
 
 
 
 
 
 
Table 3. Pearson's correlation between demographic variables and musculoskeletal regions

*P<0.05
 

 
Table 4. Frequency of medical errors from the perspective of surgical technologists working at Sari educational hospitals in 2019

Table 5. Pearson's correlation between demographic variables and medical errors

*P<0.05
 

 
Table 6. Pearson's correlation between musculoskeletal regions and medical errors

*P<0.05
 

Discussion
Musculoskeletal disorders are among the most important ergonomic outcomes in the contemporary world, which are caused by various risk factors [30]. Musculoskeletal disorders are prevalent among operating room personnel [31]. In this study, the vast majority of the study population had experienced some work-related musculoskeletal disorders during the past 12 months. Accordingly, lower back and lumbar disorders were the most prevalent problems. This finding is consistent with those of Sheikhzadeh [31], Keriri [32], and Nützi [15] on the lower back and lumbar pain prevalence in operating room surgical technologists, which amounted to 51.2%, and with other studies conducted on healthcare workers [33, 34). Bos et al [35] and Nützi [15] found higher prevalence of lower back and lumbar pain in the operating room surgical technologists at 76.6% and 52.7%, respectively. This finding could be due to different assignments as well as the variety of tasks and activities, such as changing patient positions in the operating room, inappropriate postures, repeated movements, lifting and transporting heavy equipment, such as retractors during surgical procedures, incongruity between bed height at the operating room and technologists' height, as well as the inappropriate position of the monitor in the operating room. These factors increase the risk of postural damage to the neck, shoulders, and back in the staff. To prevent it from happening, ergonomic and safety principles must be adhered to in a variety of postures by this group of healthcare workers. In the studies conducted by Marras and Ferguson [36] as well as Choobineh [13], individual factors were found out to be effective in developing musculoskeletal disorders. In this study, a significant relationship was observed between some factors, such as gender, BMI, regular exercise, and working hours per week with musculoskeletal disorders. Accordingly, the incidence of these disorders was reported to be more in women than in men. This finding was consistent with those of Zarea [37] and Raeisi [8], which could be attributed to the relatively lower muscle strength in women than in men, thereby being more prone to damage to their musculoskeletal system. It should be noted that the average BMI in women was higher than that in men, which was on the verge of obesity, having been one of the main causes of musculoskeletal injuries. In addition, people with higher BMI suffered more from disturbances in the leg, with the main reason of which being that standing on one's feet for long in the operating room could increase pressure on the feet in these people. The results of this study, in this regard, were consistent with those of Darby [38], Dadarkhah [39], and Nasiry Zarrin Ghabaee [40]. In addition, there was a significant relationship between regular exercise and musculoskeletal disorders. This could be due to the fact that people doing regular exercise have higher physical fitness and muscle strength, thereby inhibiting musculoskeletal disorders; this finding was consistent with those of Haghdoost's study [6].
Furthermore, there was a significant relationship between weekly working hours and musculoskeletal disorders. This could be due to the fact that, because of the high workload in the operating room, more time is spent in this place, thereby intensifying musculoskeletal disorders in surgical technologists. This finding was in line with those of Rokni's study [10]. The operating room is one of the riskiest parts of the hospital, in which medical errors could inflict serious injuries to patients. Medical errors are defined as negligence in providing services or committing a mistake in planning or execution phases, which potentially or actually leads to an unintended consequence [41]. If these errors occur frequently, they will endanger patients' life, increase hospital stay, and impose additional costs on patients and their family; therefore, minimizing these errors is one of the major goals of healthcare organizations. Minimizing medical errors, as one of the main pillars of clinical governance in the field of risk management, is pretty significant. Accordingly, since the cause of the majority of errors is functional, the study of their occurrence process is of significant importance. In this study, the most common cause of medical errors in surgical technologists was disregard for sterile technique, having been consistent with the study of Azarbad et al [27]. The research community in this study was operating room surgical technologists, yet operating room students were selected as the research community in the study of Azarbad et al. In a study by Darabi et al [42] on errors made in the operating room at Imam Reza hospital in Kermanshah City, electrocautery burns were reported as the major medical error in the operating room. In the study of Stomberg et al [30], it was suggested that the retention of surgical items in the body of treated patients could lead to dangerous complications in patients, including pain, abscess, infection, and bowel obstruction. Each of these complications could increase patient length of stay and endanger patient safety. In this study, there was a significant relationship between medical errors and musculoskeletal disorders in the wrist and knee regions. In other words, with an increase in disturbances in the wrist and knee regions, the probability of committing medical errors increased among operating room surgical technologists. These errors could have been mainly caused by improper postures, the use of manual retractors at most hospitals, as well as the use of inappropriate and old surgical instruments that could damage the wrist.
In addition, the sensory focus of operating room surgical technologists has been diminished because of long-term standing, lifting, and handling of heavy objects that cause pain in the knee region, thereby leading to such errors. In a study conducted by Shamsali et al [43], demographic factors were considered effective in the occurrence of medical errors. In the mentioned study, a significant relationship was observed between gender and the level of education with the occurrence of medical errors. The results of this study showed that women were less likely than men to commit medical errors, which could be due to the delicate and sensitive nature of women in performing their duties. This finding of the study was in line with that of the study of Shamsali [43] and Azarbad [27]. At the same time, the incidence of medical errors had a significant negative relationship with the level of education among surgical technologists so that people with higher levels of education committed fewer errors. This could be primarily attributed to the increase in the level of information and self-awareness among individuals, and secondly to their job position where people were more engaged in supervisory tasks than in directly getting involved in surgery.
 
Conclusion
In this study, it was found that musculoskeletal disorders in the wrist and lumbar region in operating room surgical technologists were significantly associated with medical errors in these. Therefore it is suggested that the principles of ergonomics and maintaining the physical health of surgical technologists considered from the beginning, and teaching the principles of ergonomics as a course for operating room surgical technology students, as well as the operating room surgical technologists’ continuous training. Also, operating room managers can help to increase the satisfaction of operating room surgical technologists, improve and provide medical services and improve patient safety by creating suitable work environment and adopting strategies to identify, reduce and eliminate effective factors in creating and aggravating musculoskeletal disorders.
 
Acknowledgement
The present study was approved by the Research Committee of Mazandaran University of Medical Sciences (IR.MAZUMS.REC.1398.5115). The authors of this study would like to thank the deputy of research and technology at Mazandaran University. In addition, we would like to thank the operating room staff for their assistance and cooperation.
 
Conflict of interest: None declared.
 
References

1. Dehghan M, Amiri Z, Rabiei M. Prevalence of musculoskeletal pain among a group of Iranian dentists, (Tehran-1999). Journal of Dental School Shahid Beheshti University of Medical Science 2003; 21(2):185-92.

2. Zamanian Z, Norouzi F, Esfandiari Z, Rahgosai M, Hasan F, Kohnavard B. Assessment of the prevalence of musculoskeletal disorders in nurses. Armaghane-e-Danesh 2017; 21(10):976-86.

3. Genc A, Kahraman T, Göz E. The prevalence differences of musculoskeletal problems and related physical workload among hospital staff. J Back Musculoskelet Rehabil 2016; 29(3):541-7.

4. Poorabbas R, Shakouri SK, Hajidizji R. Prevalence and risk factors of musculoskeletal disorders among dentists in Tabriz. Medical Journal of Tabriz University of Medical Sciences 2004; 38(64):34-9.

5. Fallahi M, Razavi SM, Khosroabbadi A, Akaberi A. The Prevalence of musculoskeletal disorders in health- treatment employees at Sabzevar University of Medical Sciences, Iran in 2008. Journal of Sabzevar University of Medical Sciences 2010; 17(3):218-23.

6. Sharifnia SH, Haghdoost AA, Hajihosseini F, Hojjati H. Relationship between the musculoskeletal disorders with the ergonomic factors in nurses. Koomesh, Journal of Semnan University of Medical Sciences 2011; 12(4):372-8.

7. Ali Arabian F, Motamedzade M, Golmohammadi R, Moghim Beigi A, Pir Hayati F. The Impact of Ergonomics Intervention on Musculoskeletal Disorders among Nahavand Alimoradian Hospital Staff. Journal of Ergonomics 2013; 1(1):23-32.

8. Raeisi S, Hosseini M, Attarchi MS, Golabadi M, Rezaei MS, Namvar M. The association between job type and ward of service of nursing personnel and prevalence of musculoskeletal disorders. Razi Journal of Medical Sciences 2013; 20(108):1-10.

9. Tirgar A, Aghalari Z, Salari F. Musculoskeletal disorders & ergonomic considerations in computer use among medical sciences students. Journal of Ergonomics 2014; 1(3):55-64.

10. Rokni M, Abadi MH, Saremi M, Mohammadi MT. Prevalence of musculoskeletal disorders in nurses and its relationship with the knowledge of ergonomic and environmental factors. Journal of Gorgan University of Medical Sciences 2016; 18(1):128-32.

11. Abedini R, Choobineh A, Hasanzadeh J. Musculoskeletal disorders related to patient transfer in hospital nursing personnel. Health System Research 2012; 8(3):385-96.

12. Barzideh M, Choobineh AR, Tabatabaei HR. Job stress dimensions and their relationship to musculoskeletal disorders in Irannian nurses. Work 2014; 47(4):423-9.

13. Choobineh A, Movahed M, Tabatabaie SH, Kumashiro M. Perceived demands and musculoskeletal disorders in operating room nurses of Shiraz city hospitals. Ind Health 2010; 48(1):74-84.

14. Gutierrez-Diez MC, Benito-Gonzalez MA, Sancibrian R, Gandarillas-Gonzalez MA, Redondo-Figuero C, Manuel-Palazuelos JC. A study of the prevalence of musculoskeletal disorders in surgeons performing minimally invasive surgery. Int J Occup Saf Ergon 2018; 24(1):111-7.

15. Nützi M, Koch P, Baur H, Elfering A. Work–Family conflict, task interruptions, and influence at work predict musculoskeletal pain in operating room nurses. Saf Health Work 2015; 6(4):327-9.

16. Ashghali Farahani M, Shahryari M, Saremi M, Mohammadi N, Haghani H. Effectiveness of Patient Handling Training on Musculoskeletal Disorders of Nurses Assistance. Iran Journal of Nursing 2017; 30(107):10-9.

17. Khorasani F, Beigi M. Evaluating the Effective Factors for Reporting Medical Errors among MidwivesWorking at Teaching Hospitals Affiliated to Isfahan University of Medical Sciences. Iran J Nurs Midwifery Res 2017; 22(6):455-9.

18. El-Shazly AN, Al-Azzouny MA, Soliman DR, Abed NT, Attia SS. Medical errors in neonatal intensive care unit at Benha University Hospital, Egypt. East Mediterr Health J 2017; 23(1):31-9.

19. Lo CL, Tseng HT, Chen CH. Does Medical Students' Personality Traits Influence Their Attitudes toward Medical Errors? Healthcare (Basel) 2018; 6(3):101-5.

20. Anderson E, Thorpe L, Heney D, Petersen S. Medical students benefit from learning about patient safety in an interprofessional team. Med Educ 2009; 43(6):542-52.

21. Alkhenizan AH, Shafiq MR. The process of litigation for medical errors in Saudi Arabia and the United Kingdom. Saudi Med J 2018; 39(11):1075-81.

22. Waters NF, Hall WA, Brown H, Espezel H, Palmer L. Perceptions of Canadian labour and delivery nurses about incident reporting: a qualitative descriptive focus group study. Int J Nurs Stud 2012; 49(7):811-21.

23. Hignett S, Moss EL, Gyi D, Calkins L, Jones LL. Save our surgeons: an ergonomics evaluation of laparoscopic hysterectomy. Paper presented at: The Ergonomics & Human Factors Conference & Exhibition; 2017 April 25-27; Daventry, Northamptonshire, UK.

24. Mokhtarinia H, Shafiee A, Pashmdarfard M. Translation and localization of the Extended Nordic Musculoskeletal Questionnaire and the evaluation of the face validity and test-retest reliability of its Persian version. Journal of Ergonomics 2015; 3(3):21-9.

25. Crawford JO. The Nordic Musculoskeletal Questionnaire. Occup Med (Lond) 2007; 57(4):300-1.

26. Knudsen ML, Ludewig PM, Braman JP. Musculoskeletal pain in resident orthopaedic surgeons: results of a novel survey. Iowa Orthop J 2014; 34:190-6.

27. Azarabad Sh, Zaman SS, Nouri B, Valiee S. Frequency, Causes and Reporting Barriers of Nursing Errors in the Operating Room Students. Research in Medical Education 2018; 10(2):18-27.

28. Chard R. How perioperative nurses define, attribute causes of, and react to intraoperative nursing errors. AORN J 2010; 91(1):132-45.

29. Taifoori L, Valiee S. Understanding or Nurses' Reactions to Errors and Using This Understanding to Improve Patient Safety. ORNAC J 2015; 33(3):13-22.

30. Stomberg MW, Tronstad SE, Hedberg K, Bengtsson J, Jonsson P, Johansen L, et al. Work-related musculoskeletal disorders when performing laparoscopic surgery. Surg Laparosc Endosc Percutan Tech 2010; 20(1):49-53.

31. Sheikhzadeh A, Gore C, Zuckerman JD, Nordin M. Perioperating nurses and technicians’ perceptions of ergonomic risk factors in the surgical environment. Appl Ergon 2009; 40(5):833-9.

32. Keriri HM. Prevalence and risk factors of low back pain among nurses in operating rooms, Taif, Saudi Arabia. Am J Res Commun 2013; 1(11):45-70.

33. Trinkoff AM, Lioscomb JA, Geiger-Brown J, Storr CL, Brady BA. Perceived physical demands and reported musculoskeletal problems in registered nurses. Am J Prev Med 2003; 24(3):270-5.

34. Menzel NN, Brooks SM, Bernard TE, Nelson A.
    The physical workload of nursing personnel: association with musculoskeletal discomfort. Int J Nurs Stud 2004; 41(8):859-67.

35. Bos E, Krol B, van der Star L, Groothoff J. Risk factors and musculoskeletal complaints in non-specialized nurse, IC nurses, operation room nurses, and X-ray technologists. Int Arch Occup Environ Health 2007; 80(3):198-206.

36. Ferguson SA, Marras WS. A literature review of low back disorder surveillance measures and risk factors. Clin Biomech, (Bristol, Avon) 1997; 12(4):211-26.

37. Zarea K, Negarandeh R, Dehghan-Nayeri N, Rezaei-Adaryani M. Nursing staff shortages and job satisfaction in Iran: issues and challenges. Nurs Health Sci 2009; 11(3):326-31.

38. Darby B, Gallo AM, Fields W. Physical attributes of endoscopy nurses related to musculoskeletal problems. Gastroenterol Nurs 2013; 36(3):202-8.

39. Dadarkhah A, Azema K, Abedi M. Prevalence of musculoskeletal pains among nursing staff in AJA hospitals-Tehran. Ebnesina 2013; 15(3):10-7.

40. Nasiry Zarrin Ghabaee D, Haresabadi M, Bagheri Nesami M, Talebpour Amiri F. Work-related musculoskeletal disorders and their relationships with the quality of life in nurses. Iranian Journal of Ergonomics 2016; 4(1):39-46.

41. Göras C, Wallentin FY, Nilsson U, Ehrenberg A. Swedish translation and psychometric testing of the safety attitudes questionnaire (operating room version). BMC Health Serv Res 2013; 13:104.

42. Darabi F, Amolaee Kh, Asarzadegan M, Seifi F, Razlansari H, Darestani K, et al. Frequency of Nursing and Midwifery errors in referred cases to the Iranian Medical Council and Imam Reza Training Hospital of Kermanshah. Journal of Kermanshah University of Medical Sciences 2009; 13(3):e79602.

43. Shamsaii M, Faraji O, Ramazani A, Hedaiati P. The viewpoints of Zabol’s General Practitioners about medical errors in 2010. Hospital 2012; 10(4):31-6.