Occupational health and

safety for computer users

Tjakie Naudé ABSTRACT

B.A., LL.D. (Stell.),
A growing body of evidence links personal computer use with musculo-skeletal disorders or
Senior Lecturer:
Law Faculty, discomfort in some computer users, which affect the productivity and emotional well-being of
University of employees. Regrettably, there still appears to be widespread ignorance amongst employers and
Stellenbosch,
Private Bag X1 employees of the benefits of ergonomic principles for the set-up of computer workstations.
Matieland There is, accordingly, a need for specific, detailed regulations under the Occupational Health and
Stellenbosch
Safety Act, 85 of 1993, on the proper set-up of personal computer workstations and on the
7602
Tel: 021 808 3179 information and training which should be provided to employees to prevent musculo-skeletal
Fax: 021 886 6235 disorders and discomfort. In this regard, the Department of Labour would do well to consider the
e-mail: tn@sun.ac.za
detailed regulations promulgated in response to European Community Directive No 90/270/EEC,
which sets minimum safety and health requirements for work with display screen equipment,
Stefanus Snyman
which includes personal computers. Such regulations would obviate the need for employers to
M.B., Ch.B. (Stell.)
(1991); Diploma in pay outside experts on ergonomics to adapt their workstations.
Occupational
Medicine
1. INTRODUCTION Undoubtedly some computer users may be more
(Stell.)(1997)
Occupational Computer use at work becomes more prevalent prone to develop musculo-skeletal disorders or dis-
Medicine every year. A growing body of evidence suggests a comfort than others due to their posture, work shift
Practitioner: Life
Occupational Health, link between computer use and musculo-skeletal patterns and their physical build and gender1,3,4,5.
Cape Town disorders1–12. This article will explore this phenom- Musculo-skeletal disorders affecting the upper
Member: Provincial
enon, consider the current regulatory framework limbs have been termed ‘work-related upper limb
Medical Advisory
Panel affecting computer users in South Africa and the disorders’13. This term is not comprehensive enough
(Western Cape), European Union, and make suggestions on address- to include injury to the neck and back area14, and
Compensation Fund
P.O. Box 6107, ing the problem. will therefore not be used exclusively in this contri-
Uniedal Unsuitable office set-up is an important factor bution. The term ‘work-related musculo-skeletal dis-
Stellenbosch
leading to musculo-skeletal disorders and ‘compu- orders’ is preferred, as this also includes neck and
7612
Tel: 082 557 1056 ter aches’. Monitors and keyboards are often placed back injuries. The common term ‘repetitive strain in-
Fax: 086 670 1842 on surfaces that are too high, causing users to strain jury’ will also be used alternatively, although it focuses
e-mail:
snymans@new.co.za their wrists, shoulders and necks and to adopt an on only one of the risk factors relating to computer
awkward posture1,2. Neck and shoulder strain is also work, namely repetitive movements, and ignores
increased by a lack of document holders on the same other risk factors, such as the awkward, sustained
level as monitors1. Many keyboards and mouses are posture adopted by many computer users.
badly designed, forcing users to cock their wrists Excessive computer use and bad posture in a
sideways in an unnatural position1. If a computer us- badly designed workplace may cause, inter alia,
er's arms rest against a sharp desk edge, this may overuse tendinosis and tenosynovitis in the forearms,
cause contact stress. Personal computer use con- carpal tunnel syndrome5,6, as well as muscle spasms
strains the operator in a sitting condition, often for in neck and shoulder areas, which may in turn cause
long periods, which can cause discomfort3. Bad pos- chronic tension headaches4. Permanent damage to
ture exacerbates the problem. Those typing at high tendons and nerves may occur4,7. Such injuries re-
speeds are especially at risk, due to the enormous lated to repetitive movements are mostly attributed
amount of repetitive movements by each finger . 2,4 to inflammation of tendon sheaths, degeneration of
There is also widespread ignorance about the tendons and swelling caused by cumulative micro-
severity of musculo-skeletal disorders that may trauma to tendons and nerves4,5. There is also a link
develop from computer use and the need to take between bad posture in front of a computer and
4
preventative and curative action . thoracic outlet syndrome7. Other possible negative

6 JULY/AUGUST 2005 OCCUPATIONAL HEALTH SOUTHERN AFRICA

side-effects of computer work may include eyestrain present’, which risk factors include ‘rapid or repeti-
15
or visual fatigue . Electronic equipment can be a tive motion’ and ‘awkward or non-neutral postures’
source of dry heat that may exacerbate pain for users (par 2.3 of Schedule 3)18.
with dry eyes16. In the Compensation Commissioner’s ‘Circular In-
Aches and pains related to computer usage, such struction Number 180 regarding the Compensation
as the above-mentioned, may of course reduce job of Work-Related Upper Limb Disorders (WRULDs)’,
satisfaction and productivity16, apart from the obvious a more extensive list of relevant risk factors is given,
effect on the computer user’s emotional well-being. including ‘movements at the end of reach’, ‘static
If computer-related aches and pains develop into muscle loading’ and ‘contact stress (e.g. uncomfort-
permanent impairment, the effect may be devastat- able gripping and twisting and sharp edges to…desk
ing. Capacity for work and leisure activities may be edges).’ The Circular Instruction provides for a work-
seriously affected. This disabling effect of work- related upper limb disorder to be presumed work-
related musculo-skeletal disorders is also costly to related if the nature of the work performed includes
society in general, due to loss of the employee’s exposure to the relevant risk factors (par 1)13.
potential tax contribution and treatment costs and Negligence on the part of an employer in not pre-
payments under the Compensation for Occupational venting such musculo-skeletal disorders, may lead
Injuries and Diseases Act, 130 of 1993 (COIDA)17, to punitive assessments of the amount payable by
incurred by the state. the employer to the Compensation Fund in terms of
It is therefore clearly in the economic interest of section 85(2). The Commissioner may also assess
employers and society in general that the workplace employers whose business is conducted in a man-
be suitably adapted and employees sufficiently ner calculated to avoid accidents at a lower rate than
trained to prevent such computer aches and that for other employers (section 85(1)). The Com-
musculo-skeletal disorders. missioner has in fact introduced a system of merit
Regrettably, there still appears to be widespread rebates, whereby employers are reimbursed every
ignorance in South Africa as to the benefits of ergo- three years according to a specific formula, should
nomic principles for the set-up of computer they meet predetermined criteria.
workstations. The inclusion of work-related musculo-skeletal
This may be due partly to the absence of regula- disorders under COIDA therefore provides an incen-
tions dealing specifically with computer work under tive for employers to ensure that computer
the Occupational Health and Safety Act, 85 of 1993 workstations are ergonomically correct and that ad-
(OHSA)18. This legislation and the regulations prom- equate training is given to employees to prevent
ulgated under it will be considered in the next sec- repetitive strain injuries.
tion, together with COIDA. A welcome development is the Compensation
Commissioner’s Guidelines for Health Practitioners
2. SOUTH AFRICAN REGULATORY FRAMEWORK and Employers to Manage Work-Related Upper Limb
2.1. Compensation for Occupational Injuries Disorders (WRULDs) in terms of Circular Instruc-
and Diseases Act, 130 of 1993 (COIDA)17 tion 18014. This document notes that in discussions
‘Occupational musculo-skeletal disorders’ are in- between the Compensation Commissioner and the
cluded in the list of Schedule 3 ‘occupational Chief Inspectorate of Labour during the drafting of
diseases’ for which compensation is payable by the the Guidelines, the following practical steps were
Compensation Fund. This term refers to ‘musculo- recommended by the Chief Inspectorate of Labour
skeletal diseases caused by specific work activities to guide employers in adhering to OHSA. The In-
or work environment where particular risk factors are spectorate should firstly be notified of a definitive

OCCUPATIONAL HEALTH SOUTHERN AFRICA JULY/AUGUST 2005 7

 diagnosis of a work-related upper limb disorder, af- tion 3 of the Environmental Regulations for
ter which the employer should obtain an ergonomic Workplaces20 requires employers to prevent glare.
assessment, compile a plan of action and review OHSA itself also contains generally worded require-
implementation of such plan at appropriate intervals. ments on establishing a safe working environment
The assessment and plan of action should not only (for example, section 8(1)). Once again these do not
focus on the employee who was diagnosed with a give detailed guidance on how a workplace for com-
WRULD, but also on the risk to other employees. puter users should be organised. Although section
Thus, according to the Guidelines, the Chief Inspec- 8(2)(d) provides for a risk assessment of the working
torate of Labour ‘advises’ employers that they should environment, there are no particular minimum require-
have a plan of action ready within three months of ments for typical components of a computer
the definitive diagnosis being made, which should workstation. The same is true for section 8(2)(e) deal-
include a plan to manage the health surveillance of ing with training of and information to employees.
employees and a plan to negotiate a health and A move in the right direction is regulation 8 of the
safety policy on prevention of WRULDs. Facilities Regulations, 200421. It provides that ‘every
These Guidelines do not, however, necessarily employer shall where reasonably practicable, pro-
assist in preventing of musculo-skeletal injuries vide a seat that is ergonomically sound for every
where an employer had not as yet had reason to employee whose work can be effectively performed
report an occupational injury or disease. The Guide- while sitting.’ What is meant by ‘ergonomically sound’
lines only require an ergonomic assessment and plan is, however, not spelt out.
of action after a definitive diagnosis of a WRULD. Consequently the Act and regulations fail to give
This is understandable, as the Guidelines were guidelines on setting up safe computer workstations.
drafted by the Compensation Commissioner and the Employers concerned about avoiding work-related
primary purpose of COIDA is to react to occupa- musculo-skeletal disorders and injuries among their
tional injuries and not to prevent them. A preventa- computer workers, must therefore obtain informa-
tive approach should rather be expected under tion from outside experts, often at great cost.
OHSA. In addition, although the Guidelines purport
to elucidate employers’ duties under OHSA, the 3. POSITION IN THE EUROPEAN UNION
specific time frames for submission of a plan of action By contrast, European Union countries do have spe-
and review thereof as laid down in the Guidelines, cific health and safety rules. These were promulgated
have no statutory force, as they were not promul- in response to EC Directive No 90/270/EEC of
gated as regulations under OHSA. 29 May 199022, which sets minimum safety and
health requirements for work with display screen
2.2. Occupational Health and Safety Act, 85 of equipment (which includes personal computers).
1993 (OHSA) 19 The EC Directive is not, however, applicable to
South Africa has no legislation on specific require- all display screen equipment. For example, it is not
ments for the set-up of computer workstations. OHSA applicable to calculators, cash registers and other
and regulations promulgated under it contain no ref- small display screen equipment (article 1(3)(e)), nor
erence to display screen equipment or computers. to laptops not in prolonged use at a workstation
However, there are additional general regulations (article 1(3)(d)) or computer systems on board a
applicable to computer users. For example, regula- means of transport (article 1(3)(b)).

TABLE 1. FIVE MAJOR OBLIGATIONS IN TERMS OF THE EC DIRECTIVE FOR WORK WITH DISPLAY SCREEN EQUIPMENT
(INCLUDING PERSONAL COMPUTERS).

1. The employer must undertake an analysis of workstations, with particular emphasis on risks to eyesight, physical
problems and mental stress, and to take appropriate measures to remedy the risks identified (article 3). A
‘workstation’ includes the ‘assembly comprising display screen equipment’ plus all other related office equipment,
including document holders, chairs and work surfaces. Annex 1 to the Directive provides more detailed and
technical requirements for elements of such workstations.
2. The employer is obliged to provide information and training to workers on the assessment and risks of computer
use (article 6).
3. The employer must plan for breaks or changes of activity reducing the workload on the display screen (article 7).
4. Employers are enjoined to consult with workers and/or their representatives on matters covered by the Directive
(article 8).
5. Eye tests at workers’ request (article 9).

8 JULY/AUGUST 2005 OCCUPATIONAL HEALTH SOUTHERN AFRICA

 Employers are subject to five major obligations in In view of the recognised link between personal
terms of the EC Directive, which sets minimum safety computer work and work-related musculo-skeletal
and health requirements for work with display screen disorders, it is clear that South African employers
equipment (including personal computers) (See currently have an obligation to provide an ergonomi-
Table 1). cally correct workstation in terms of the more gen-
The UK Health and Safety (Display Screen Equip- eral regulations mentioned above and OHSA itself.
ment) Regulations 1992 is an example of regula- The problem is that this duty is not clearly de-
23
tions made in response to the EC Directive . The fined in respect of computer workstations, and that
UK regulations exclude the same categories of users there is widespread ignorance on how an ergonomi-
of display screen equipment from these regulations cally correct workstation should be organised. More
(regulation 1(4)). These excluded users are never- detailed regulations such as those made in response
theless protected by more general health and safety to the EC Directive would eliminate this problem and
regulations. would be less costly to the employer than if a quali-
The employer’s basic obligations are the same fied ergonomist had to be consulted for each and
as under the EC Directive. The UK regulations also every risk assessment.
contain a Schedule providing more detailed minimum The argument that South African companies can-
requirements for workstations, including for the dis- not afford ergonomically correct computer
play screen itself, keyboards, work surfaces, chairs, workstations can be countered by a number of
as well as requirements as to space, lighting and arguments. Firstly, the cost of musculo-skeletal dis-
humidity, rules to prevent unacceptable levels of re- orders or mere discomfort with the subsequent loss
flection, glare, noise, heat and radiation and rules of productivity, may justify increased cost to employ-
on the interface between computer and user (deal- ers of setting up correct workstations24. Secondly, it
ing mainly with software). The employer therefore is not prohibitively expensive to adapt a computer
does not need to employ an outside expert on workstation. If a desk is too high for a particular
ergonomics to adapt the workstation, but is fully in- worker, a footrest may be utilised to obtain the cor-
formed about what is required by the regulations rect 90° angle of the forearms. If the monitor is too
themselves. low, a telephone directory can raise it. An ergonomi-
In addition, the UK Health and Safety Executive cally correct, and therefore adjustable chair, would
15
publishes a very useful short ‘Guidance’ , which ex- constitute the biggest cost in correcting a workstation
plains the regulations and their rationale in layman’s and is currently required by regulation anyway. Pro-
terms. It also provides guidelines on setting up work- viding employees with information is even less costly,
stations by means of pictures, and refers readers to as the Department of Labour can distribute a poster
additional publications and sources of expertise. or pamphlet free of charge or make such informa-
tion available on its website. Such information could
4. CONCLUSION include basic ergonomic principles on setting up a
More detailed regulations dealing with personal com- workstation, an emphasis on the need for breaks,
puter or other display screen equipment work should good posture and the importance of consulting a
be considered under OHSA, in order to prevent work- physiotherapist or doctor for aches and pains in order
related musculo-skeletal disorders. At the very least, to prevent chronic repetitive strain conditions.
employers should be obliged to provide employees It may be asked whether additional regulations
who are computer users with information on how to will contribute to the solution of the problem in the
prevent such disorders when using computers, for absence of proper policing by the Department of
example, by means of a pamphlet or poster. Labour. To some extent, however, such regulations

OCCUPATIONAL HEALTH SOUTHERN AFRICA JULY/AUGUST 2005 9

 can police themselves, especially if the department 2. Gaskins, P. I didn’t think typing would hurt me. Scholastic
Choices. 1999; 14(6):27.
endeavours to bring their existence to the attention 3. Davies, S.E.H. Unique demands of Visual Display Unit (VDU)
operation in finance-auditing type tasks: a case study.
of employees and the public at large. If health care
Ergonomics SA. 2001; 13(2):40.
workers were to know about the regulations, they 4. Tittiranonda, P., Burastero, S., Rempel, D. Risk factors for
musculoskeletal disorders among computer users. Occup
could advise patients presenting with computer- Med. 1999; 14(1):17.
related pain to insist on an improved workstation as 5. Tremblay, F., Mireault, A.C., Letourneau, J., et al. Tactile
perception and manual dexterity in computer users.
a basic right under OHSA, and will be able to furnish Somatosens. Mot. Res. 2002;19(2):101.
the patient with a detailed set of regulations on how 6. Roelofs, A., Straker, L. The experience of musculoskeletal
discomfort amongst bank tellers who just sit, just stand or sit
such a workstation should be set up. and stand at work. Ergonomics SA. 2002; 14(2):11.
The Department of Labour is therefore urged to 7. Pascarelli, E.F., Hsu, Y. Understanding work-related upper
extremity disorders: clinical findings in 485 computer users,
consider the need for more detailed regulations un- musicians and others. J. Occup. Rehabil. 2001; 11(1):1.
8. Aarås, A., Ro, O. Computer mouse use. In Karwowski, W.,
der OHSA, specifically aimed at computer users.
editor. International Encyclopaedia of Ergonomics and
In the meantime, if ergonomically correct compu- Human Factors. Vol 1. London: Taylor & Francis; 2001. p. 802.
9. Sparks, K., Faragher, B., Cooper, C.L. Well-being and
ter workstations are not provided, and a work-related occupational health in the 21st century. Journal of
upper limb disorder occurs, the employer must in Occupational and Organizational Psychology.
2001;74:489.
any event carry out an ergonomic assessment and 10. Keir, P.J., Bach, J.M., Rempel, D. Effects of computer mouse
draw up a plan of action14. Although the Compen- design and task on carpal tunnel pressure. Ergonomics.
1999; 42(10):1350.
sation Commissioner’s Guidelines will do much to 11. Dembe, A.E. The changing nature of office work: effects on
inform employers of the dangers of work-related repetitive strain injuries. Occup Med. 1999; 14(1):61.
12. Cone, E. Why RSI suits are failing. Information Week. 1997;
upper limb disorders, new detailed regulations under 640:82.
13. South Africa. Circular Instruction 180 regarding the
OHSA dealing specifically with computer users, will
Compensation of Work-Related Upper Limb Disorders
introduce a more preventative approach. (WRULDs). Government Gazette 2004; 26270:3–7.
14. South Africa. Compensation Commissioner’s Guidelines to
Health Practitioners and Employers to Manage Work-related
REFERENCES Upper Limb Disorders in terms of Circular Instruction 180
1. Doheny, M., Linden, P., Sedlak, C. Reducing orthopaedic regarding compensation for work-related upper limb
hazards of the computer work environment. Orthopaedic disorders (WRULDs) (Compensation for Occupational
Nursing. 1995; 14(1):7. Injuries and Diseases Act, 1993 (Act No 130 of 1993), as
Amended). Available at: http://www.labour.gov.za/
useful_docs/doc_display.jsp?id=10173 (last accessed 14
July 2005)
15. Health and Safety Executive. Work with display screen
equipment – Health and Safety (Display Screen Equipment)
Regulations 1992 as amended by the Health and Safety
(Miscellaneous Amendments) Regulations 2002 – Guidance
on Regulations L26 (second edition). 2003.
16. Grant, S. Ergonomics – a big part of office productivity.
Executive Business Brief. 2001; 6(6):38.
17. The Compensation for Occupational Injuries and Diseases
Act, 130 of 1993. Available at: www.labour.gov.za/
programmes/programme_display.jsp?programme_id=2668
(last accessed on 14 July 2005).
18. Amendment of Schedule 3 of Act No. 130 of 1993.
Government Gazette. 2003; 25700:3–7.
19. The Occupational Health and Safety Act, 85 of 1993.
Available at: www.labour.gov.za/legislation/
original_act.jsp?legislationDetail_id=7336 (last accessed on
14 July 2005).
20. Environmental Regulations for Workplaces. Government
Notice R:2281 (16 October 1987). Available at:
www.labour.gov.za/legislation/notice_display.jsp?id=8298
(last accessed on 14 July 2005).
21. Facilities Regulations. Government Notice R:1593
(12 August 1988). Available at: www.labour.gov.za/legislation/
notice_display.jsp?id=8300.
22. European Commission (European Agency for Safety and
Health at Work). Council Directive 90/270/EEC of 29 May
1990 on the minimum safety and health requirements for
work with display screen equipment. http://
europe.osha.eu.int/data/legislation/5 (last accessed on
14 July 2005).
23. The Health and Safety (Display Screen Equipment)
Regulations 1992. Statutory Instrument 1992:2792.
www.opsi.gov.uk/si/si1992/Uksi_19922792_en_1.htm (last
accessed on 14 July 2005).
24. Bridger, R.S. Macroeconomic and demographic factors
influencing the global development for ergonomics: some
implications for ergonomics in South Africa. Ergonomics SA.
1996; 8(1):17.

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