OSHA turns ergonomic radar on hospitals

High injury rates raise red flags

Hospitals with high injury rates or a high proportion of ergonomic injuries will receive targeted inspections in some regions of the country under a new enforcement program for ergonomics.

Four regions have adopted a local emphasis program in at least some areas, including New England, New York-New Jersey, the Plains states of Region 7, and the Mountain states of Region 8. Each of the 14 local emphasis programs within those regions may be structured differently, but the bottom line is the same: Reducing ergonomic injuries due to patient handling.

"This is a piece of the strong enforcement" as part of the four-pronged approach to ergonomics announced by Labor Secretary Elaine Chao, says Mark Hatch, senior industrial hygienist in the Occupational Safety and Health Administration’s (OSHA) office of health enforcement. "It’s not limited to just enforcement. We’re also dealing with outreach as well," he adds.

The regional programs complement the National Emphasis Program which has targeted nursing homes for inspection. So far, 475 facilities have been inspected, resulting in three citations of nursing homes in Idaho that are owned by the same corporation. Another 60 nursing homes received "hazard alert letters" warning them of high ergonomic injury rates.

Seven hospitals have received hazard alert letters among the 253 hospitals inspected since Oct. 1.

Worker advocates press for citations

The ergonomics enforcement failed to impress some worker advocates, such as Bill Borwegen, MPH, occupational safety and health director for the Service Employees International Union in Washington, DC. Borwegen notes that many of the citations of nursing homes address building safety issues, such as electrical hazards, rather than hazards related to patient or resident care.

"They’re refusing to cite employers on ergonomics, which is the No. 1 hazard these employees face," he says. "It’s just breathtaking that they’re so out of sync with the hazards that are actually threatening workers."

About 13,000 hospital workers lost at least one day of work in 2001 due to overexertion in lifting, according to data from the Bureau of Labor Statistics (BLS). Although the injuries have decreased in recent years, the health care industry still has among the highest rates of work-related musculoskeletal disorders (MSDs). Nurses who missed work due to an MSD were out for a median of five days.

The BLS statistics don’t even reflect the full magnitude of the problem, asserts Butch de Castro, PhD, MSN, MPH, RN, senior staff specialist with the American Nurses Association Center for Occupational Health and Safety in Washington, DC. BLS only reports lost-time injuries.

"An OSHA standard is sorely needed in order to protect health care workers, as well as other types of workers, from ergonomic hazards," he says. "Workers are continuing to be injured at great rates and are being debilitated."

Without a standard, OSHA issues ergonomics citations under the "general duty" clause of the Occupational Safety and Health Act, which requires employers to provide a workplace free of serious hazards. "The burden of proof is higher" than with a standard, says Rich Fairfax, CIH, OSHA’s director of enforcement.

Yet most employers will respond to OSHA’s more cooperative approach, asserts Fairfax. "We’ll use [the enforcement action] on the employers who are not complying and meeting their obligations under the OSHA act. There are far more employers who just need a little push. We’re there with assistance and outreach and guidelines," he says.

The push may come from the threat of inspection. Local emphasis programs may differ in details, but they all involve a focus on MSDs and ergonomic interventions.

For example, the New England (Region 1) program covers hospitals in Connecticut, Maine, New Hampshire, and part of Massachusetts. Inspectors will conduct a comprehensive inspection of hospitals that have an injury rate of eight or more lost work-time cases per 100 employees, or if more than 50% of the lost and restricted time cases resulted from "ergonomic stressors."

States are not part of the national or local emphasis programs, but may have comparable efforts. Washington and California are the only states with an ergonomics standard.

Ergonomics expert Guy Fragala, PhD, PE, CSP, says he is encouraged by OSHA’s emphasis on ergonomics. "This demonstrates that they are taking ergonomics seriously," says Fragala, who is director of environmental health and safety at the University of Massachusetts Medical Center in Worcester.

OSHA’s strategic management plan calls for reducing occupational injuries by 20% by the year 2008. Reducing musculoskeletal disorders, the most prevalent work-related injury, will need to be a significant part of that.

General duty sets a high threshold

Employers don’t have to follow specific requirements as they address ergonomic hazards. If an employer is making an effort to apply ergonomic interventions, that is enough to avoid a general duty clause citation, Fairfax says.

To make a case, OSHA inspectors must find that four criteria apply, Fairfax says: "The employer failed to keep the workplace free of a hazard that the employees were exposed to. The hazard was recognized — the employer knew there was a hazard. The hazard was causing or likely to cause serious injury or death. [And] there has to be a feasible method of abatement.

"If we go into a hospital and we find they have what appears to be a problem with resident handling, we have to go back and establish that all four of these elements are there," he says.

In the case of the Idaho nursing homes, any existing lifting equipment was either broken or unused. The staff had not been trained to use the equipment and the administration had not implemented an ergonomics program, Fairfax says. The nursing home reached a settlement agreement with OSHA. "The employer indicated to us that they wanted to correct the problems and comply, and we cut the penalties down significantly," he says. "We also worked out a penalty payment plan so they could spread it out over the course of a year."

An employer that has begun implementing an ergonomics plan but still has a high rate of injuries would likely receive a hazard alert letter with suggestions for improvement, but not a citation, says Fairfax.

OSHA administrator John L. Henshaw has stressed that "as long as the employer is exercising good faith, they are not likely to be a candidate for our enforcement efforts."

In one case, a manufacturing employer began an ergonomics program when the OSHA standard was imminent. When Congress repealed the standard, the employer halted the program. Then when OSHA inspectors appeared and began asking about ergonomic hazards, the employer renewed the program. That is not a show of good faith, says Fairfax.

"They didn’t start again until we started to do an inspection," he says. "For two years they were injuring people. They are likely to get a citation."