Backed by new evidence, OSHA pledges ergonomics law by summer
Facilities that already address MSDs will fare best
Armed with a new report verifying that substantial scientific evidence exists linking musculoskeletal disorders (MSDs) to biomechanical stress on the job, officials of the U.S. Occupational Safety and Health Administration are determined to develop a federal ergono mics standard proposal by summer 1999.
The report, issued by the National Academy of Sciences (NAS) in Washington, DC, reviews scientific research into such occupational MSDs as back injuries and carpal tunnel syndrome and concludes that reducing ergonomic hazards with workplace interventions decreases the risk of those injuries.1
Scientific literature demonstrates that workers who face high biomechanical stress, such as heavy lifting and repetitive motion, have high MSD rates, according to the report. It also notes that most people’s main exposure to biomechanical stresses is on the job.
In a statement issued the same day the NAS report was released to Congress, U.S. Secretary of Labor Alexis M. Herman announced that it "puts to rest any questions about whether OSHA’s efforts to reduce musculoskeletal disorders are supported by sound science. In light of these strong findings . . . I hope Congress will reject any further attempts to delay the development of a protective standard."
In workplaces where ergonomics programs have been implemented — including health care facilities — injuries and workers’ compensation costs have dropped, while productivity and employee morale have increased, Herman adds.
Development of an OSHA ergonomics standard has had a rocky history in recent years, largely due to political opposition from lawmakers representing the interests of big business. Proposed rulemaking was announced in 1992, with a draft slated for release by September 1994. However, congressional attempts to weaken OSHA’s regulatory authority dashed those plans. A draft proposal was released in 1995 (see Hospital Employee Health, July 1995, pp. 85-89), but that document, along with any other plans to issue a standard, again was squelched by Congress when it adopted a federal appropriations bill that prohibited OSHA from promulgating a proposed standard before Sept. 30, 1998.
The previous draft is dead’
Nevertheless, OSHA officials vowed to continue initiatives toward developing a federal ergonomics program management standard. For much of 1998, the agency held stakeholder meetings, regional conferences, and town hall gatherings in various U.S. cities in preparation for a federal rule.
Now, an entirely new proposal is under way. "The previous draft is dead," says David Cochran, PhD, PE, CPE, special assistant for ergonomics at OSHA and a lead author of the standard.
"Much of the opposition was because it was too prescriptive, but the current draft is a more programmatic, flexible standard," he explains.
Political disapproval is still active, but Cochran says OSHA is free to publish a draft proposal because the rider on the federal appropriations bill is no longer in effect. In addition, employer and labor groups that attended recent stakeholder meetings seemed to be reaching a consensus.
"It was surprising how much agreement there was," he remarks. "They agreed that a good [ergonomics] program is necessary to deal with these problems, and they agreed on the components of a good program. If you want a programmatic standard, you give people the leeway to do what’s right, but you need to give them enough guidance so they know what’s right. The key is trying to get the right amount of information [in a standard] without overdoing it."
Cochran says the standard will be built around certain elements that OSHA has found are essential for ergonomics programs. (See box, p. 3.) Health care and other employers would be asked to develop "systematic, logical, programmatic ways" to address the problem of MSDs in the workplace. Many hospitals have acted on ergonomics issues without waiting for a standard, he notes.
"If [MSD] problems are minimal, employers will have to expend minimal energy. They will have to inform employees of the risks and what can be done about them, and set up reporting systems. Quite a few hospitals already have addressed this and are doing fine," Cochran says.
Performance-based standard anticipated
Health care ergonomics expert Guy Fragala, PhD, PE, CSP, director of environmental health and safety at the University of Massachusetts Medical Center in Worcester, says the direction OSHA is taking now toward developing a standard "makes more sense" than previous draft attempts.
"OSHA initially was recommending a very prescriptive type standard, looking at how much weight could be lifted and how many repetitions were too many. It’s very difficult to say because a number of variables are involved," says Fragala, who was appointed to an OSHA committee for standard development related to health care.
A more performance-based standard will call for health care facilities to have some type of management program in place for occupational injuries related to MSDs in general and back injuries in particular, he predicts.
"They’ll be looking at what type of program you have in place at your facility to try and control this and what results you’re achieving. Is your program identifying high-risk activities, making changes where they need to be made, and then measuring the impact of those changes to see if they’re successful? That’s a simple way of stating it, but if someone were accomplishing that, they would be meeting the intent of the standard. A performance-based standard doesn’t tell you exactly how to do it; it just gives you an idea of what you have to do and wants to see how successful you are in achieving it," Fragala says.
NIOSH studies lifting devices
The success of ergonomics programs in hospitals may get a boost from the National Institute for Occupational Safety and Health (NIOSH) when the results of a six-year study are published. The study focuses on nursing homes, but much of the data derived will have direct application in hospitals as well, says Jim Collins, PhD, an epidemiologist in safety research for NIOSH in Morgantown, WV.
Collins notes that a major difference between ergonomics hazards for health care workers and those in other industries is the weight of the loads they are called upon to lift.
"What gets health care workers in trouble is that they’re inevitably called upon to lift people who are 300 pounds and up," he says. "In other industries, such as auto work, employees are mostly male and macho, yet they draw the weight limit at 20 pounds. In the health care industry, mostly females are doing the lifting, and it’s lifting of excessively heavy weight. Patients are unpredictable loads to lift, too, not a well-defined load like a box."
Collins recently tested mechanical lifting equipment in nursing homes, evaluating 11 commercial devices designed for lifting residents/ patients with either no ability or partial ability to bear their own weight. Two main types of devices were evaluated for their effect on biomechanical stresses to the nursing personnel performing the tasks and to identify resident-transferring methods that can reduce biomechanical stresses to personnel. Those devices were mechanical lifts with slings for full-body lifts and standing pivot transfer lifts for partially dependent patients. The latter are used mainly for bed-to-chair lifts and toileting.
By measuring biomechanical loads, the study found transferring methods and resident weight affect low back loading for nursing personnel. It also showed that the lifting devices significantly reduced back compressive forces, removing about two-thirds of low back stresses for each lift when compared to manual lifting methods. The study, which will be published in an ergonomics journal later this year, shows that lifting devices potentially can decrease low back pain for nursing personnel, Collins says.
However, those results are merely preliminary findings, he adds. NIOSH plans to expand the data into a field study that ultimately will redesign the way patients are lifted and examine reductions in back pain, injuries, lost work days, and workers’ compensation costs relative to the cost of lifting equipment, he explains. Three years of pre-intervention data already have been collected, and the agency will gather post-intervention data through the year 2000.
"That’s when we’ll know what we found in that study," Collins says. "We’re trying to minimize manual lifting, and we hope to develop a package describing a best-practices program for hospitals and nursing homes. Our aim is to document the cost-effectiveness of lifting equipment to show a return on investment, with a savings in workers’ comp expenditures and employee pain and suffering. We want to disseminate this information far and wide through the hospital and nursing home community."
1. Steering Committee for the Workshop on Work-Related Musculoskeletal Injuries: The Research Base, Committee on Human Factors, National Research Council. Work-Related Musculoskeletal Disorders: A Review of the Evidence. Washington, DC: National Academy Press; 1998.