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All inspections of hospitals and nursing homes will include a focus on musculoskeletal disorders (MSDs) and injuries related to safe patient handling and four other top hazards in healthcare: workplace violence, bloodborne pathogens, tuberculosis, and slips, trips and falls, the Occupational Safety and Health Administration recently announced.
Inspectors also may look for other known hazards, such as exposure to multi-drug-resistant organisms or hazardous chemicals, according to an OSHA memo to regional administrators. When an employee files an OSHA complaint, the resulting inspection is usually confined to just the issue raised in the complaint, but this action opens all inspections to a wide review.
The rationale for the tough, new policy: Hospitals have an injury rate that is almost twice as high as that of private industry as a whole, OSHA noted. U.S. hospitals recorded nearly 58,000 work-related injuries and illnesses in 2013, amounting to 6.4 work-related injuries and illnesses for every 100 full-time employees — almost twice as high as the overall rate for private industry, OSHA said in announcing the new enforcement program. While the other issues are critical areas of occupational safety, an epidemic of patient-handling injuries is likely the primary driver of the OSHA action. Scathing reports of nurses with chronic back pain and permanent disabilities caused by patient handling incidents have continued to raise the inevitable question: Why doesn’t OSHA do something about this?
For example, patient handling hazards in hospitals received national attention earlier this year when National Public Radio aired a series on MSD injuries of nurses. Meanwhile, OSHA observers had predicted increased scrutiny of hospitals after the agency created a new, detailed website (www.osha.gov/dsg/hospitals) that emphasizes MSD injuries and other hazards in hospitals. (See HEH, March 2014.)
The American Nurses Association released voluntary national standards in 2013, outlining the components of a comprehensive safe patient handling program.
“It’s pathetic that so many healthcare workers have been lost to preventable injuries all these years. The progress to this point is littered with their bodies,” says Anne Hudson, RN, of Coos Bay, OR, who formed the Work Injured Nurses’ Group USA (WING USA) after she was injured and was unable to return to bedside nursing.
“It’s very gratifying to see this come about. It’s an important step forward,” says Hudson, who has pushed for national legislation to require hospitals to adopt safe patient handling. She recently retired from nursing and from WING USA, but she hopes younger nurses will carry on her work.
In an era of heavier patients, safe patient handling equipment is still not used in many hospitals. For example, the federal Occupational Health Safety Network recently reported that of all patient handling injury reports collected, 62% included data on the use of lifting equipment. Of those, 82% of the injuries occurred when lifting equipment was not used.1
“Body mechanics are no longer going to save the day,” says Lori Severson, CSP, vice president and senior loss control consultant at Lockton Companies, a Kansas City-based risk management consulting firm. “Even if you have lifts, you have to prove that they really do get used.”
Severson has worked with nursing home clients who were cited by OSHA for failing to have an adequate program to prevent musculoskeletal disorder injuries. The take-away message: Employers need to make sure they are training workers and maintaining an injury prevention program, she says.
‘Simply not right’
“Workers who take care of us when we are sick or hurt should not be at such high risk for injuries — that simply is not right. Workers in hospitals, nursing homes and long-term care facilities have work injury and illness rates that are among the highest in the country, and virtually all of these injuries and illnesses are preventable,” David Michaels, PhD, MPH, assistant secretary of labor for occupational safety and health, said in a statement.
“OSHA has provided employers with education, training, and resource materials, and it’s time for hospitals and the healthcare industry to make the changes necessary to protect their workers,” he said.
The OSHA action does not by itself trigger an increased number of hospital inspections, but regional or local OSHA offices may decide to focus additional inspection resources on hospitals. For example, emphasis programs currently target healthcare facilities in Philadelphia and Arkansas, Louisiana, Oklahoma, and Texas. While those are due to expire on September 15, they could be extended.
States with their own occupational safety and health programs also must widen the scope of inspections of hospitals and nursing homes.
With this action, OSHA concludes its three-year national emphasis program on nursing homes. OSHA simply doesn’t have the resources to continue it, says Dionne Williams, MPH, director of OSHA’s Office of Health Enforcement. But they also will be subject to the broader inspections.
The Nursing Home National Emphasis Program lasted from April 2012 to April 2015, and its results are revealing. OSHA conducted 1,100 inspections, issued 1,755 citations and assessed $3.9 million in proposed fines.
While the Bloodborne Pathogen Standard was the top-cited rule, the agency cited 11 facilities for ergonomic hazards related to patient/resident handling and issued 192 hazard alert letters. Those citations were under the “general duty clause” of the Occupational Safety and Health Act, which requires employers to maintain workplaces free of recognized, serious hazards.
Although OSHA is not launching an emphasis program that involves additional enforcement, “our hope is that hospitals and nursing homes will take action on their own just knowing there’s a potential for them to get inspected and each inspection will involve us looking into these hazards,” Williams says.
Tressi Cordaro, JD, an occupational safety and health attorney with Jackson Lewis in Washington, DC, says she will advise healthcare employers to review their injury prevention programs and employee training. “[They have] automatically expanded the scope of inspections, even on an employee complaint, even before OSHA walks in the door,” she says.
Guidance or ‘back-door’ rulemaking?
Cordaro also cautions employers to look carefully at the ergonomic section of the OSHA memo. It states that facilities should have “a minimum of one sling per resident that needs the device and some extras to account for laundering and repair.”
The memo suggests that facilities should have “appropriate” types and quantities of devices, slings, batteries, and other supplies. “Manual pump or crank devices may create additional hazards,” it states.
OSHA does not have an ergonomics standard; Congress voted to rescind the agency’s newly drafted ergonomics rule in 2001 and prohibited the agency from developing one that is “substantially” the same. OSHA has successfully used the general duty clause to cite employers for ergonomic hazards that led to serious injuries, but those citations must meet a higher standard than for hazards covered by a rule, the agency has said.
Yet with this memo, OSHA is essentially conducting “backdoor rule-making,” Cordaro says. “[They’re] putting out requirements for employers in the guise of guidance.”
OSHA says its goal is “to significantly reduce overexposures to these hazards through a combination of enforcement, compliance assistance, and outreach.”
Hazard alert letters provide information to employers about what steps they can take to reduce the hazards. Yet OSHA expects employers to take corrective action in response to the letters, says Williams. “We follow up on each and every one of those hazard alert letters,” she says.
Union leaders expect to work with employers to address the hazards mentioned in the memo, says Mark Catlin, health and safety director of Service Employees International Union in Washington, DC. Hospital administrators also are becoming more aware of costly worker injuries, he says. “Just the discussion created by this announcement is going to be helpful,” he says.
Editor’s note: OSHA’s “Inspection Guidance for Inpatient Healthcare Settings,” released on June 25, is available at www.osha.gov/dep/enforcement/inpatient_insp_06252015.html.