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HCWs face higher injury risk at public hospitals
Assaults, soreness and even falls are frequent
Health care workers at public hospitals are at much greater risk of injury than workers at private hospitals, according to new data from the U.S. Bureau of Labor statistics.
Assaults are significantly higher at both state and local hospitals, the data reveal in the first-ever BLS report of injury data for the nation's public hospitals. Soreness and pain are also higher at local hospitals, as is the overall injury rate. Injuries are sky-high in all categories at state hospitals, which are predominantly psychiatric facilities.
The overall injury rate in private hospitals was 138.6 per 10,000 fulltime employees in 2009, but it was 173.1 in local hospitals and 372.1 in state hospitals. Meanwhile, state and local workers are less likely to be covered by safety and health regulations.
Public employers are not covered by the U.S. Occupational Safety and Health Administration in the 25 states that do not run their own safety and health programs or have programs that specifically cover public workers (Illinois, New York, Connecticut and New Jersey).
"There's an incredible amount of variability [in enforcement] across the states that have the state plans," says Katherine Cox, MPH, MEd, director of the health and safety program at the American Federation of State, County and Municipal Employees (AFSCME).
"In states that don't have state plans, public sector workers don't have any coverage at all," she says. "It's up to good contract language or a state that tries to do the right thing to keep employees safe."
State and local hospitals are riskier workplaces in part because of their circumstance and mission. Local hospitals are often trauma centers, where violence in the community sometimes spills into the emergency room. State hospitals include psychiatric facilities that house the criminally mentally ill.
Public facilities also have suffered from budget constraints that lead to staffing shortages. "With the fiscal crisis, there have been hiring freezes and major cuts in services," says Jonathan Rosen, MS, CIH, director, of the Occupational Safety and Health Department at the New York State Public Employees Federation, an affiliate of the AFL-CIO.
With fewer co-workers to back them up, health care workers are more vulnerable to assaults as well as patient handling and other hazards, he says.
Staffing linked to HCW risk
At a large, state psychiatric facility, just walking alone on the campus can be dangerous. In October, co-workers at Napa State Hospital in California found Donna Gross, a 54-year-old psychiatric technician, dead on a patio. She had been strangled. A patient with a previous history of violent crimes was arrested in the killing.
Napa State is a 400-acre campus that houses about 1,200 patients most of them referred by criminal courts, a state mental hospital, or the Department of Juvenile Justice. Forensic patients were able to roam within a 70-acre secured area, which has guard kiosks at its perimeter.
"It was a very stormy day in Napa the day Donna Gross was murdered. It was darker than usual," says Tony Myers, state president of the California Association of Psychiatric Technicians. "She had gone on a break. In between the time she left and when she was found, it was alleged he attacked her. He was found with some of her possessions."
State psychiatric hospitals are not required to have the same staffing ratios as required of private hospitals by California law, Myers notes.
Meanwhile, state hospitals must take the patients that are sent to them. "They bring [prisoners] to our admissions unit and they take the shackles off and now they're in a clinical setting," he says. "They're the potentially most dangerous individuals in the state. If the courts say you will take this person, they take them."
After the murder, the hospital required patients to be escorted by a staff member when they walked on hospital grounds. Then, in December, another employee was assaulted while escorting a patient. The employee was hospitalized and the patient was arrested.
Unions have asked for a better alarm system and security coverage. "We've said all along that we need more staff to provide the services," says Myers.
The Napa incidents are just a high-profile example of the risks that exist in many state psychiatric hospitals across the country, says Rosen. "You will find astounding rates of violence, some as high as 100 incident per 100 employees per year, which in the field of occupational safety and health is unheard of. In the most difficult wards, that's what exists," he says.
Falls, overexertion also high
Other hazards abound in public facilities, from overexertion to falls. The condition of aging facilities may be a culprit slippery flooring, narrow corridors, poorly designed work areas.
"The decisions about funding in a public facility are oftentimes political decisions rather than good clinical [decisions]," says Cox. "They are competing with roads and bridges and all the other infrastructure issues that public dollars are spent on."
The Center for Medicare & Medicaid Services (CMS) requires hospitals to comply with OSHA's Bloodborne Pathogens Standard, even if they are not otherwise subject to other OSHA regulations. Even public hospitals must have safe sharps devices, an exposure control plan that is updated annually, and frontline worker input into the device selection.
The Protecting America's Workers Act would have expanded OSHA's authority to cover public workers, but despite a large number of sponsors in the House and Senate, the bill did not pass in the last Congressional session.
"History shows us that people who have had OSHA coverage have had remarkable reduction in injuries and illnesses as a result of the [Occupational Safety and Health] act," says Bill Borwegen, MPH, health and safety director of the Service Employees International Union (SEIU).
For example, a recent study found that nurses in Washington state, which has a law requiring the use of lift equipment, have greater access to lifts than nurses in Idaho, which has no state law. Hospitals in Washington also were more likely to have safe patient handling policies, reported Barbara Silverstein, MSN, PhD, MPH, CPE, research director with the Safety and Health Assessment and Research for Prevention (SHARP) program of the Washington State Department of Labor & Industries in Olympia.
But neither public nor private hospitals are specifically required to purchase lift equipment to assist with patient handling, unless they are covered by a state law. (OSHA can cite employers under its "general duty clause" that requires workplaces to be free of hazards that are "likely to cause death or serious physical harm," but it is much more difficult for OSHA to cite employers for hazards under that provision.)
"A lot of health care hazards are not covered by OSHA standards," says Rosen. "There's no OSHA standard on workplace violence. There's no OSHA standard on patient handling. There's no OSHA standard on aerosol infectious diseases."
Ironically, while public facilities suffer from a lack of funding, they could actually save money by preventing costly injuries, says Rosen.