Taking care of ergonomics: one library's experience.

C. Lyn Currie, Laurel Ritmiller and Dan Robinson

Paper presented at the CLA/CACUL session: Ergonomics or else.
Victoria, CLA Annual Conference, June 1998

Table of Contents

Introduction
The Work Environment
Occupational Health Problems
Review of Literature
Library Management's Response
The Ergonomic Analysis
Design Recommendations
Follow Up Evaluation
Outcomes
Conclusions
Our Successes
Lessons we learned... What we would do differently
Works Cited

Introduction

Ergonomics, the study of how we interact with our physical environment, has assumed an importance in libraries with the increasing incidence of musculoskeletal injuries. These injuries include repetitive strain injuries (RSI), repetitive motion injuries and cumulative trauma disorders (CTD) such as tendinitis and carpal tunnel syndrome (Summer 84). Within the library environment there is a growing awareness of ergonomic issues and the literature reflects the concerns with workstation design, purchase of ergonomic equipment and furnishings, posture and work habits, development of ergonomic programs and staff training in ergonomics (Wilkinson, Switzer, Chadbourne).

This case study reports on the experience of the Education Library at the University of Saskatchewan in dealing with some significant ergonomic issues in the workplace and describes the measures taken by the Library to identify what contributed to the problems experienced by staff, to determine what changes were needed - organizational, procedural and physical and to plan and implement the required changes. In most other library studies the focus has been on the ergonomics associated with the use of computers and in particular keyboard tasks. Our project concentrated on two other areas of library work, shelving and Circulation Desk duties, which were associated with the occurrence of injuries amongst our staff. The part played by the three key players - the library staff, library management and the external consultants in a fully participative process, was integral to the success of the project.

The Work Environment

The Education Library, one of 7 branch libraries of the University of Saskatchewan Libraries, serves the information and research needs of the College of Education and the Department of Music. The library has 3 main collections:

• the Education/Music stacks - resources related to the theory and philosophy of education and teaching methodology and music resources including scores and CDs;
• the Curriculum collection of print and audiovisual materials supporting the K-12 curriculum in Saskatchewan schools;
• an Historical Textbook collection of textbooks authorized for use in Saskatchewan schools since the mid 1800's. These collections house approximately 148,200 monograph and serial volumes, 628,796 microforms and 56,648 audiovisual items.

In the 1997-98 academic year the Education Library served 1,734 students in education and music programs and 74 education and music faculty plus sessional lecturers. Annual circulation statistics were 202,199 in 1997/98. The library is staffed by 2.4 librarians, 9.5 library assistants and 7 student assistants. The library provides facilities for research and study with 10 computers for public access to the libraries' catalogue, electronic databases and the Internet and individual and group study space for 355 patrons. The library provides 17 music listening carrels equipped with compact disc players, cassette recorders and record players. Video, slide and filmstrip preview equipment are also provided as are photocopying and microform reader/printer facilities.

Occupational Health Problems

By the summer of 1996 at least six of the Circulation staff of the Education Library had either been diagnosed with or showed symptoms of some form of physical stress or discomfort. The health problems of staff included tendinitis, severe strain to wrists, forearms and elbow joints and carpal tunnel syndrome. These injuries are known collectively as repetitive strain injuries, repeated trauma disorders or cumulative trauma disorders. The terms refer to the group of musculoskeletal disorders involving injuries to the tendon, tendon sheaths, and related bones; and the muscles, ligaments and nerves of the hands, elbows, arms, shoulders, neck, back or legs (Thornton 9).

Kusack's observation that carpal tunnel syndrome and related repetitive strain injuries are removing employees from their jobs and requiring hours of rehabilitative therapy and sometimes surgery was supported by the Education Library experience (56). One staff member had received surgery. Another had been off work on compensation leave for more than a year while receiving treatment on an extended rehabilitation program and had only recently returned to work through a managed return-to-work program. Six other staff members had resorted to wearing wrist or forearm braces or supports as a therapeutic or preventive measure.

Recognizing that awareness and prevention are the best strategies to minimize injuries, the library management had introduced a number of preventive measures including the purchase of ergonomic workstations and chairs for each employee, multi-tasking to vary the tasks performed, job rotation and ergonomics training for staff. With the increasing incidence of injuries the following initiatives were introduced:

• an additional library assistant position was added to the ranks of staff undertaking shelving and circulation duties. It was thought that another staff member added to the roster would further distribute and therefore reduce the shelving and Circulation Desk activities for each staff member.
• the length of the Circulation Desk shifts was reduced from 2 hours to 1 hour for all Circulation Desk staff at the suggestion of the health professionals involved in negotiating the return-to-work program for one of the staff. It was a strategy that was applied to all staff in the interests of equity. This helped reduce the sustained time spent on repetitive actions at the Circulation Desk.
• all book trucks were loaded on the top 2 shelves only to reduce the push-pull force required to move the trucks.
• a training workshop conducted by an occupational therapist covering good practices for shelving, lifting, bending, etc. was offered to all staff. A second session focussed on work station design and prevention of repetitive strain injuries at the keyboard. It was evident however that educating staff in correct work practices as well as introducing these changes did not resolve the problems staff were experiencing. Ultimately the matter was raised by the union on behalf of all library support staff. In this, the University of Saskatchewan Libraries' experience was similar to libraries elsewhere. Kusack observed that awareness of the problem within collective bargaining units was rising and it was not surprising that employees and their unions looked to management to take active measures to reduce worker injuries (59).

It was generally believed that factors associated with both shelving and Circulation Desk activities had contributed to the injuries sustained by staff. Amongst the shelving duties the factors were:

• widespread use of wire bookends which clip into the top of the shelf;
• overcrowded shelves requiring constant shifting of resources in order to shelve daily;
• too much sustained time each day on shelving duties;
• shelving of large and heavy resources (especially music scores and bound journals) onto top shelves; and
• pushing of overloaded book trucks were all identified as contributing to the physical stress and discomfort.
• In performing Circulation Desk duties, the contributing factors were:
  amount of sustained time each day performing repetitive actions at the Circulation Desk;
• inefficient design of the Circulation Desk (See Figure 1) contributing to impeded workflow and multiple handling of materials; and
• frequent lifting of heavy book bins from floor to the campus mail distribution point.

Review of the Literature

A search of the literature to see what others had attempted in similar settings was conducted. The increase in musculoskeletal injuries and subsequent consciousness about ergonomics has given rise to a large body of literature describing workstation design, programs for prevention and treatment of RSI, exercise routines, and guidelines for posture and handling of materials. Surveys of ARL libraries in the past 5 years (Summer, Thornton) revealed that ergonomics has become an important matter for libraries. A number of libraries have formed ergonomics committees tasked with workstation evaluation and design and the development of education and training programs. Much of the focus however has been on the occupational health factors associated with keyboard use with little attention to the work carried out at the Circulation Desk. Kusack's survey of 58 large public libraries did report 8 cases of injuries amongst circulation clerks responsible for sensitizing and desensitizing library materials (58). He identified the nature of the work, the amount of time spent on a single task, incorrect workstation design and poor work methods as contributing factors to potential injuries. Seaman's case study described how the University of Colorado Library successfully incorporated ergonomic concerns into the Circulation desk design. It is one of the few reports of efforts to redesign and reconfigure work areas such as Circulation desks to address ergonomic considerations.

Library Management's Response

In the summer of 1996 a number of initiatives were undertaken by the library management to address the situation in the Education Library. This was done in four steps:

Identifying an appropriate consultant with the ergonomics expertise and the experience in a library environment proved to be the next hurdle. The University's Occupational Health and Safety unit was instrumental in discovering a British Columbia firm who had worked with the Vancouver Public Library during the design phase of their new library. BC Research Inc. was commissioned to perform ergonomic and workflow analysis of the Circulation Desk to determine the risks and inefficiencies and recommend changes to the design of the circulation area.

The Ergonomic Analysis

The technical evaluation performed by BC Research focused on risk factors associated with musculoskeletal injury (MSI), work flow, and traffic patterns within the circulation area. A baseline assessment was performed to provide a quantifiable reference point from which to evaluate the effectiveness of future changes to the circulation area. A questionnaire was administered to library staff to establish baseline data on body part discomfort (Corlett and Bishop) and to elicit perceptions regarding aspects of work in the circulation area that were likely contributing to discomfort or inefficiency. The questionnaire also invited suggestions for improvement to the design of the circulation area. Staff responses to the questionnaire generated valuable information on existing issues and potential solutions to improve both comfort and process flow.

A technical assessment of tasks, traffic and materials flow within and around the circulation area was performed. This included a detailed "task analysis" to identify and prioritize ergonomic risk factors associated with job tasks in circulation. In addition traffic and material flow was characterized using "link analysis" techniques to identify inefficiencies and critical links between areas or tasks.

During the onsite analysis, traffic patterns within the circulation area and between the circulation area and other library areas were documented to identify inefficiencies (excessive distances or obstacles) and high traffic areas (nodal crossings or high frequency paths). The sequential activities required to perform specific tasks were documented by observing several different staff members performing each task over a four day period. Variation in task requirements and flow, as well as variation between individual staff, were considered at different times of day on both weekdays and weekend days. Activities were functionally categorized as operation, inspection, transport, delay, or storage. The efficiency of the work flow was then evaluated relative e to the complexity of the activity sequence and by the rationale for transport and delay functions. Circulation area tasks were assessed in terms of risk factors associated with MSI, including: force; repetition; awkward joint posture; frequency; duration; and use of equipment. Library staff were interviewed to discuss their experiences and perspectives on the circulation area.

The onsite evaluation was used to generate design recommendations that would help mitigate identified risk factors and inefficiencies. The specific design recommendations evolved as a result of a three stage process which incorporated aspects of the technical ergonomic evaluation, general ergonomic guidelines and preferences of library staff. Several alternative work station layouts for both the check-out and the check-in areas were generated. The design concepts and rationale for modifications were presented to library staff to obtain their feedback and to encourage an active role in testing some of the ideas through simple "mock up" exercises. This included testing spatial concepts by taping floor areas and arranging book trucks to represent shelf configurations as well as exploration of the direction of work flow (left to right or right to left). Testing concepts through mock ups helped identify unforeseen problems, assisted in fine tuning concepts and increased the probability of success during the implementation phase. Library staff participated in two additional round table discussions to further explore requirements and options. Through this process library staff consolidated their requirements with some of the initial design concepts into a proposed layout of the circulation area. This preferred design incorporated components of the ergonomic evaluation, staff preferences and experience as well as planned changes to office areas, work patterns and library circulation. The staff's preferred design was presented as such in the BC Research final report to the library administration.

Design Recommendations

Some of the general ergonomic guidelines incorporated into the design of the circulation area included the following:

• Reach envelopes were designed to ensure that the smallest individual was able to reach necessary items (thus ensuring larger individuals are also accommodated) High use items were placed within approximately 40 cm of the counter edge and occasional use items within 65 cm of the counter edge.
• Workstation/counter height is generally based on the type of task being performed. For library circulation work the recommended height for counters was set at 92 cm.
• Safe lifting occurs between shoulder and knee heights. Book crates were placed for lifting from a shelf above knee level (>60 cm).
• Adjustable keyboard trays were located just below the counter level and were large enough to accommodate the keyboard and mouse typically a minimum width of 66 cm and minimum retracted depth of 23 cm (plus length required for tray glides beneath the counter).
• Monitor height was set so as to present the top of the computer screen at approximately standing eye level. (Human eyes can comfortably scan 30-45 degrees below the horizontal line of vision without requiring forward neck flexion).
• Counter width in the cutaways of the check-out area was set at 45 cm to allow library patrons to present library materials within easy reach of staff. The counter width on either side of the cutaway areas was set at 90 cm.
• Work surfaces were cleared of computer components in order for work to flow through the computer work station effectively. All peripherals, cabling and keyboard mouse and wand were relocated under the counter to provide a clear uncluttered work surface.

Follow up Evaluation

BC Research performed a follow up analysis approximately three months after completion of renovations to the circulation area. The technical evaluation was repeated to determine whether there was a reduction in MSI risk and discomfort, and whether there was a positive effect on work and traffic flow. The results indicated that the design changes to the Circulation area resulted in more efficient material flow, as well as decreased risk for MSI and reported body part discomfort. Staff also indicated a high rate of satisfaction with the new design, particularly in terms of decreased physical stress as well as improvement to patron service. Responses from the follow-up body part discomfort questionnaire and focus groups indicated a decrease in the severity of body part discomfort in the upper extremities and neck area. Where discomfort was present, there was a greater delay between start of work and pain onset and reduced pain duration after work. It is expected that these levels of discomfort will continue to decrease with time as staff members physically adjust to the new design.

Overall, the benefits from the new design included:

• improved access to equipment, allowing better physical postures and reduced stress;
• decreased manual handling of materials throughout the process;
• shorter and more direct transfer links for processing materials through the discharge and check out systems;
• increased adjustability in equipment and processes to meet the capabilities of all staff members;
• increased variety in tasks to address repetitive physical actions leading to MSI; and
• decreased requirements of repetition, force and awkward postures in all tasks associated with the circulation area.

As part of the final evaluation, BC Research provided additional recommendations, including adjustments in the circulation area design, staff training options to promote personal intervention strategies, and the inception of an ergonomics program to continue addressing issues of MSI in a proactive and participatory manner.

Outcomes

It took 18 months for the study and recommendations to be implemented and for work to begin on the redesign of the Circulation Desk. The significant achievements of the project were the ergonomically improved, re-designed Circulation Desk; the improved functionality at the Circulation Desk; and the transformation of the staff through their involvement in the process.

Re-design of the Circulation Desk

The key features of the new Circulation Desk (see Figure 2) which staff liked the most included the following:

• Installation of new sensitizer/desensitizer units in the desktop replacing the old 3M 955 model bookcheck units which were housed on a shelf under the counter. This eliminated the action of bending to desensitize each item on checkout. Although the consultants' recommended installation of the 3M desensitizer units flush mounted with the counter we chose the 3M Model 966 in counter bookcheck for its dual functionality as a sensitizer/desensitizer unit. Unfortunately this unit extends above the counter so does create some obstruction to materials flow across the counter.
• Installation of height adjustable keyboard trays for the keyboard and mouse. This accommodated the keying needs of staff ranging in height from 5'2" to 6'.
• Clear countertops. We removed the keyboards and mouse from the countertop to the adjustable keyboard trays and relocated the barcode wands to brackets below the counter at "hip height" within easy reach of staff. This uncluttered countertop free of equipment and cords allowed for easier handling and movement of resources across the counter.
• Creation of cut-away counters to bring library patrons closer to staff. Reducing the width of the counters at these cut-aways served to direct patrons to that area of the Circulation Desk for service. The narrower counters (45 cm) reduced the arm extension and forward reaching required by staff to receive items from patrons.
• Construction of a cart on wheels to accommodate book bins used to store resources in transit to other libraries. This eliminated the practice of storing bins on the floor and the bending required to lift these.
• Reorientation of check-in station. The check-in workstation was moved to the front counter corner and oriented to provide direct line of sight to the check-out area. This simplified the processing of returned materials, introduced a unidirectional flow of resources from the return bin through the wanding, keying and resensitizing operations and onto book trucks awaiting shelving. This new arrangement created more room, significantly improved workflow and streamlined work processes with reduced amount of material handling.
• Customization of desk drawers and shelves to accommodate specific requirements such as deep drawers (38.75 cm) to house headphone sets, CD and video cases. These high use items were relocated to drawers or shelves directly below the counter in the primary work area. This reduced travel required to retrieve items from their former location on back shelves or other counters.
• Installation of a computer workstation built-in to the desk. This workstation previously located behind the Circulation Desk required staff to sit with their back to patrons while working at the computer. There were many other aspects of the new circulation area such as improved lighting over the reserve collection, installation of gates to close off access to the desk area and rearranged shelving for the reserve collection all of which improved the work environment for staff.

Improved functionality

Given the redesigned Circulation Desk, staff realized they could change the way they were performing the various tasks. The customary practices at the Circulation Desk became the subject of much discussion about how to do things differently to accommodate the changes at the desk. Often it involved a procedural change such as deciding to stack and wand a pile of books and desensitize them in batches as opposed to the former practice of wanding and desensitizing each book separately. By moving the check- in station to the front counter staff could choose to service a patron at the check-in station without physically moving to the check-out stations. The design of the new check-in station tended to promote greater variety in the sequencing of task components. For example resensitizing materials prior to wanding was observed at the new station - something that was not prevalent in the original check-in station. (BC Research Inc, 1998). Another decision involved separating the Holds function from the Reserve function and shelving these Hold books on shelves adjacent to the check-in area.

Library Staff Contribution

From the outset the project to address the ergonomic issues at the Circulation Desk was conceived as a joint effort on the part of the library staff and the management. Eissenger and Rick concluded that working within a cooperative rather than an adversarial environment can allow the fullest use of new technologies where productivity and a healthy environment coexist (162). Two staff were appointed team leaders and tasked with coordinating the input of staff and liaison with Library Management and Facilities Management staff. All staff who worked at the Circulation Desk were involved at every stage of the consultation. Staff:

• responded to questionnaires administered by the consultants to determine areas of physical stress experienced by the workers;
• participated in the focus group meeting to identify and discuss problems experienced in the conduct of their work;
• performed circulation activities while the subject of observation by the consultants;
• reviewed the draft report with recommendations of the consultants and translated these into an action plan;
• trialled various options for changes to the work area;
• developed their own recommendations for change which were incorporated into the consultants' final report as the Preferred Staff Option; and
• assumed the role of "project supervisors" as the work to redesign the Circulation desk progressed. This involved casting a watchful eye over the construction work and the installation of equipment and identifying potential problems as they became apparent.

What happened during this participative process was an increasing acceptance of responsibility for and ownership of the project on the part of the staff. Switzer observed that creating a sense of ownership and helping staff realize that their well being is important are key elements to a successful ergonomics program (317). In our situation staff became committed to ensuring those changes that were made were:

• Necessary.
  
  Staff made the decision to adopt only those recommendations made by the consultants which were considered to be "essential" to the occupational health of staff. For example, staff were comfortable with the height of the monitors and had not experienced any eye strain or neck strain from inappropriate tilting of the head to read the screens. Ideally the centre of the screen should be 7 to 10 inches below the horizontal line of sight for the operators (Anshel 21). It was therefore decided to leave the monitors sitting on the CPUs and not to proceed with ordering height adjustable, swivel action monitor arms at the two check-out stations. Staff were also very clear about the low level of leg/foot discomfort experienced and decided not to introduce chairs or stools at the Circulation Desk nor take up the suggestion to install a floor mat to increase cushioning and reduce leg and foot fatigue.
• Addressed ergonomic concerns.
  
  Staff awareness of the ergonomics of the situation became evident and each change made to the Circulation Desk or installation that was made was scrutinized to ensure these concerns were addressed. For example, the Facilities Management crew tasked with the construction work developed in-house a keyboard tray to be used at the Circulation Desk. These trays on installation were found to be too short to accommodate the keyboard, mouse and barcode want. They were also not height adjustable. A subsequent adjustable arm proposed for the keyboard trays was rejected by library staff on the grounds that it required three separate actions - an extended reach underneath the counter to locate a lever, a grasp and pull action to release a lever and a strong wrist action to screw the keyboard into position all of which posed difficulties for staff with wrist problems.
• Did not create any new potential occupational health issues.
  
  For example, when we were positioning the sensitizer/desensitizer units and the monitors on the desk top, staff were alert to possible vision difficulties presented by moving the monitors a sufficient distance away from the sensitizer units to avoid interference. Since most of our staff were over 40 or fast approaching it we could expect increasing difficulties with changing focus - the normal decrease in the eye's abilities to focus as we age (Anshel 21). It was important to keep the monitors close enough to the operators to avoid eye strain for staff peering at screens that were now further removed from the operator than previously.
• Would be applicable to other libraries.
  
  The staff were aware that those changes made in the Education Library would serve as a model for future changes and installations at other circulation desks elsewhere in the library system. Library staff were vigilant throughout the design stage (the Circulation Desk plans were reviewed three times by staff and returned to the drawing board for corrections and fine tuning) and during the construction phase out of a sense of responsibility to their co-workers elsewhere to "get it right in Education".
  Through this project staff learned to work together as a team to critically assess both their work practices and the physical arrangement of the circulation area. Problem solving and consensual decision making became the order of the day as staff reached agreement on the requirement of the desk design. Individual staff members were also presented with opportunities to undertake new tasks and develop/acquire skills. Some latent talents were discovered in the process.

Conclusions

Did we address the ergonomic issues? It is still early days to conclude that staff will no longer experience stresses and strains in the performance of their work. In fact, it is unrealistic to expect that staff who have sustained injuries in the past will ever be free of stress in the workplace. We do know however that we have identified those aspects of the performance of the work likely to contribute stress. The physical changes we made to the circulation area have gone a long way towards reducing the incidence of risk. The follow-up evaluation conducted by the consultants three months after the renovations confirmed to a large extent the changes that were made. Staff reported a decease in body part discomfort after the design modifications. We plan to conduct another evaluation in 3 to 6 months time - after staff have had time to adjust to the new design and the revised routines at the Circulation Desk. The costs of the project included the following:

consultants' fees $25,711
Circulation desk renovations $22,630
equipment $11,051
bookends $11,162
lighting $ 1,253
shelving $ 31,924*
Total $ 104,730

* Not all shelving costs were directly attributed to the ergonomic changes.

Our Successes

The real success of the project can be found in the changes noticeable in staff. There is an increased awareness of ergonomic considerations and a willingness to change work practices. Staff are better informed, more vigilant about their work habits, disposed to seek remedies to situations and to experiment with new ways of performing their duties. They are concerned to use proper body mechanics for lifting and transporting materials. Preventive measures are undertaken such as wearing of wrist and arm supports, performing required exercises and taking breaks from keyboard tasks.

Through the experience of the consultative process staff have learned to problem solve and derive effective solutions to work problems. These critical thinking and problem solving skills developed during the planning and design of the Circulation Desk are now being applied to other areas of their work.

There has been significant improvement in staff-management relations. Staff have acknowledged the commitment by the library management to improving their work environment. The management's response to this situation facilitated changes to the work place but also informed and educated staff about future work practices. This recognition of "good will" has improved staff-management relations. Thornton reported a similar outcome elsewhere noting the pleasure for staff that library administration is encouraging them to learn more about preventing work-related injuries (16). At the University of Saskatchewan, the libraries moved from a situation involving a union grievance and class action on behalf of all library support staff, to one in which a good deal of respect for the part played by each party in the resolution of the problem was engendered.

There is a general recognition that dealing with the ergonomics of the workplace and ensuring the occupational health of the workforce is not a one-time solution but a continuous process. It requires an ongoing effort to monitor work performance, modify work practices and introduce change as necessary. As Switzer observed, ergonomics training should not be done once and then forgotten (317). Staff need refresher sessions on how to adjust their chair and other equipment, how to pick up books, how to lift and carry objects, and what to do if an injury occurs.

During the course of the project, we identified much that should form the content of a staff training program. Our experience confirmed the importance of training and refresher sessions for staff in ergonomic awareness and in developing appropriate work practices and postures when lifting and bending and when moving and handling resources. Ergonomics and wellness issues have been forwarded to the Libraries' Staff Training and Development Committee in the hope that these will generate a framework for broad and systematic staff training.

Lessons we learned ... What we would do differently

With hindsight, we acknowledge the importance of ensuring the following steps:

• Appoint a project manager to coordinate all phases of the design, equipment purchase, construction and installation work, to supervise the project and liaise with all parties - Library Staff, Library Management, Facilities Management - including interior designer and workshop crew, and commercial suppliers.
• Negotiate a schedule for renovations/installations and agree on a completion date.
• Investigate equipment specifications more closely and incorporate them into the designs and drawings prepared.
• Liaise with consultants during design stage and equipment selection phase.
• Close the library during renovations if possible.
• Increase the counter width at cut-aways from 45 cm to 50 cm. At 45cm the counter is too narrow to accommodate patrons' bags and library resources. It is also too narrow for the drawers and cabinetry underneath the counter.
• Add a bag/backpack shelf in front of the counter for patrons to use. This will prevent patrons depositing bags and wallets on the countertop too close to the desensitizer units.

Works Cited

Anshel, Jeffrey. "Visual ergonomics in the workplace: how to use a computer and save your eyesight." Performance and Instruction 33.5 (1994): 20-22.

BC Research Inc. Ergonomic design recommendations: Circulation area of Education Library. Vancouver: BC Research Inc., Ergonomics and Human Factors Group, 1997.

BC Research Inc. Ergonomic design recommendations: Circulation area of Education Library. Follow-up evaluation. Vancouver: BC Research Inc., Ergonomics and Human Factors Group, 1998.

Chadbourne, Robert D. "Ergonomics and the electronic workplace." Wilson Library Bulletin Jan. 1995: 24-26

Corlett, E.N. and Bishop, R.P. "A technique for assessing postural discomfort." Ergonomics 19.2 (1976): 175-182.

Eissenger, Richard and Thomas W. Ricks. "Coping with repetitive motion injuries in a large academic library." College and Research Libraries News Mar. 1992: 161-162.

Kusack, James M. "The light at the end of the carpal tunnel." Library Journal July 1990: 56-59.

Seaman, Scott. "Designing an ergonomic circulation desk: a case study." LIBRES: Library and Information Science Research 7.1, 31 Mar. 1997.

Summer, Susan. "Ergonomics programs and activities in research libraries." Library Resources and Technical Services 40.1 (1996): 84-92.

Switzer, Teri R. "Ergonomics: an ounce of prevention." College and Research Libraries News May 1995: 314-317.

Thornton, Joyce K. "Carpal tunnel syndrome in ARL libraries." College and Research Libraries 58 (1997): 9-18.

Wilkinson, Frances C. and Unver, A. "Workstation ergonomics and computer calisthenics." Serials Libraries 25.3-4 (1995): 349-351.