Every year, over 15 million colonoscopies are performed in the United States – a number experts expect to grow as colorectal cancer rates continue to climb at alarming rates and updated screening recommendations expand to younger age groups. This heightened demand places stress not just on healthcare systems but also on the individual staff members performing procedures, raising an important question:
Endoscopy staff – including gastroenterologists, endoscopy nurses, technicians and others – face substantial risk of musculoskeletal disorders (MSDs), injuries caused by the repeating physical demands of colonoscopy and other endoscopy procedures. Frequently utilized, labor-intensive, tasks such as applying manual abdominal pressure or patient repositioning to address looping – the most common complication in colonoscopy – can lead to staff experiencing post-procedure pain or even long-term, chronic injuries.
Research into the risk of unsafe patient handling during colonoscopy has been historically limited to whether or not staff injury was reported after the procedure. This narrow focus fails to account for critical variables like:
There is a clear need to shift the focus toward proactively identifying and correcting ergonomic risks before injuries happen.
A recent abstract presented at ACG introduced the Colonoscopy Staff Strain Index (CSSI), a per-procedure scoring system designed to quantify ergonomic risk to endoscopy staff.
The CSSI was developed using the Liberty Mutual Materials Handling Tables – a resource that provides thresholds for how much physical strain is safe for male and female workers. Researchers scaled the CSSI so that a score of 1.0 represents a safe level of exertion for 75% of women – the most commonly used standard in ergonomic risk analysis.
The total CSSI score is the sum of risk values for manual pressure and patient repositioning during a colonoscopy.
Researchers validated the CSSI against a previously published study of 175 standard colonoscopies which met two criteria: manual pressure and/or patient repositioning was needed and nurses reported post-procedure musculoskeletal pain.
Here’s what researchers found:
These findings suggest a clear pattern.
Critically, researchers found that nurses were 38.6 times more likely to report pain in procedures with CSSI scores greater than 5.0 than they were compared to procedures with lower scores. In a univariate analysis, researchers determined CSSI scores greater than 5.0 to be “strong predictors” of acute injury risk to endoscopy nurses.
These findings highlight the clear need of monitoring both average CSSI scores and rates of excessive risk procedures. While CSSI > 5.0 flags high-risks cases that may lead to nurse injury, the frequent occurrence of procedures exceeding the safety threshold (CSSI > 1.0) indicates broader ergonomic problems.
Facilities with higher average CSSI scores tend to report increased rates of excessive-risk colonoscopies, validating CSSI > 1.0 as a key safety benchmark in endoscopy. By keeping facility-wide averages under the safety threshold of 1.0 and addressing excessive-risk procedures, facilities potentially may reduce the risk of musculoskeletal injury while ensuring overall safer conditions for endoscopy personnel and their patients.
Colonoscopies are becoming increasingly difficult and physically demanding as population needs evolve. Rising obesity rates, for example, mean heavier patients who may require more manual pressure, longer procedures, and more frequent repositioning -all of which increase strain on endoscopy staff and the risk of injury.
Prior research has acknowledged these risks but only in a binary fashion: Did manual pressure or patient repositioning occur or not?
This yes-or-no approach fails to account for key variables – such as patient size or the length of time pressure was applied – and hinders the design and efficacy of ergonomic interventions.
The Colonoscopy Staff Strain Index offers a singular, per-procedure risk score that allows endoscopy teams to:
Protecting the safety of endoscopy staff is essential - not just for their well-being, but to ensure that patients receive the highest quality care. Tools like the CSSI represent a leap forward, offering a way to measure and manage ergonomic risks before injury can occur.
By adopting proactive measures informed by CSSI scores, healthcare systems can create safer environments for their staff and move one step closer toward zero-harm endoscopy.