OSHA warning letters double for hospitals

Injury rates are too high, agency says

More hospitals than ever have received warning letters from the Occupational Safety and Health Administration (OSHA) because they have lost-time injury and illness rates that are twice the national average for all industry.

When OSHA lowered its threshold this year to six lost-time injuries per 100 full-time equivalent (FTE) employees, 156 hospitals received letters alerting them to their high rates, or about 9% of the 1,600 hospitals surveyed. Last year, 73 hospitals received the letters. While the letters point out specific issues for individual hospitals, they also highlight the relatively high rate of injuries in the hospital sector. Hospitals overall have a lost-time rate of four injuries per 100 FTE, compared to a rate of 3.1 among private sector employers as a whole.

The high injury rates reflect, in part, the stressful environment for health care, says Bradley Evanoff, MD, associate professor of medicine at the Washington University School of Medicine and medical director of the BJC ergonomics program at BJC Health Care Inc. in St. Louis. Barnes-Jewish West County Hospital in St. Louis was one of the hospitals on the list. "Patient acuity has gone up, and length of stay has gone down. This means that patients are turning over much more quickly," he says. "The nursing workload goes up significantly when you have patients staying for a shorter period of time.

"I think hospitals everywhere are short-staffed. Nurses and nursing aides are working longer hours," Evanoff says. "You crank up the production rate; you decrease the number of people working. That will lead to an increase in injury rates unless you make some fundamental changes in the way people do their jobs."

BJC Health Care has a number of programs designed to reduce injury rates, including one targeting slips and falls.

Overall last year, OSHA cited hospitals most frequently for violations of the bloodborne pathogen standard — the selection, use, and training related to safer needle devices. The most common lost-time injury in hospitals is back injury.

New Britain (CT) General Hospital, which also received a letter, already had begun reviewing its ergonomic interventions, says Angelina Jacobs, MD, medical director of employee health. "I’m looking at how [the lifts] are actually being utilized," she says. "You can have them in place, but if the staff don’t spend the time to use them, they’re not going to do any good."

New Britain also uses benchmarks from the EpiNet system of the International Health Care Worker Safety Center at the University of Virginia in Charlottesville. The hospital’s needlestick rates have been below the EpiNet benchmarks, she says.

Still, New Britain is taking the OSHA notice to heart. "We’re planning to have a consultant come in also and see what we can do and where we can improve further," she says.

Hospital reporting of all injuries rose last year as needlesticks became reportable under new record-keeping requirements. Although improved reporting can make a hospital’s rates higher, the reporting is an important aspect of an effective health and safety program, say Evanoff and Jacobs.

"There’s a paradoxical effect, which is that hospitals that put more effort into collecting information and reporting it can actually get penalized for doing that," says Evanoff.