The trusted source for
healthcare information and
Thirteen years after the Needlestick Safety and Prevention Act required health care employers to use safer sharps devices, hospitals were more frequently cited for violations of the Bloodborne Pathogens Standard than any other occupational health and safety regulation.
Yet even as the Occupational Safety and Health Administration placed greater emphasis on enforcement nationally, inspections remain a rarity at hospitals, according to a data review by HEH. About 4% of hospitals had an OSHA inspection that resulted in a citation in Fiscal Year 2013. Hospitals received only .2% of all federal OSHA citations and .7% of all state OSHA citations. About one in eight American workers are in the health care industry, including about 4.8 million in hospitals.
Several of the top 10 most cited standards for hospitals were industrial, involving issues such as electrical safety. The "general duty" clause, which requires employers to provide a workplace free of serious hazards, was cited only five times. None of those involved musculoskeletal disorders from patient handling, the single greatest hazard in health care, according to injury statistics. (See related story, p. 64.)
Without a standard, it is much more difficult for inspectors to cite employers, even when there is a known hazard, OSHA officials said in an emailed response to HEH. "OSHA issues fewer General Duty Clause citations because they require that the agency meet a higher burden of proof than when citing standards for specific hazards," they said.
Instead, OSHA has focused on raising awareness of hazards in health care, while using emphasis programs to target specific issues. Currently, OSHA has a National Emphasis Program for nursing homes. In Fiscal Year 2013, 150 nursing homes were issued fines of more than $410,000 for alleged violations of the Bloodborne Pathogen Standard. Overall, health care employers were fined more than $1 million for Bloodborne Pathogen violations.
Hospitals could find themselves facing tougher inspections, as well, says Tressi Cordaro, JD, an occupational safety and health attorney with Jackson Lewis in Washington, DC. The Obama administration has placed a greater emphasis on enforcement than compliance assistance, she says.
OSHA has issued more citations with higher penalty amounts — and it is easier for employees to file complaints, she says. "Employees are much more aware of their ability to file anonymous complaints," she says.
Bloodborne pathogen compliance is a continuing focus for OSHA. In 2014, Missouri began randomly selecting hospitals for inspection in a local emphasis program on bloodborne pathogens.
The Kansas City region is seeking to increase health inspections, those that address hazards that cause illness, says Dee Cantu, assistant regional administrator for enforcement programs in OSHA’s Region 7.
"Our hope and our goal is that all employers who are covered by the [local emphasis program] will take the necessary steps to get out ahead of OSHA and protect their employees," she says.
About one-third of all hospital inspections by federal OSHA resulted in bloodborne pathogen citations in Fiscal Year 2013. The most common problems: Failure to update the exposure control plan each year, including a review of new devices or procedures, and failure to include frontline workers in the evaluation of devices or update of the plan.
The operating room is an area of concern, as surgeons remain reluctant to use blunt suture needles and safety scalpels. The third most commonly cited portion of the Bloodborne Pathogen standard involves the failure to use engineering controls "to eliminate or minimize employee exposure."
Some sharps devices still are not available with safety features, and the development of new sharps safety technology has slowed, says Raylene Ballard, MS, MT(ASCP) senior project officer at ECRI, a non-profit health care research and information organization based in Plymouth Meeting, PA.
"At least annually, you need to review devices that have the potential for a sharps injury and see if there’s anything currently available [to prevent injury]," she says. "If there’s nothing currently available, you need to [document the review]."
OSHA does not have the authority to scrutinize other, non-bloodborne infectious disease risks — and it has no standard related to many hazards that are unique to health care. But hospitals must still comply with safety regulations that include hazard communications (safety information related to hazardous chemicals), recordkeeping and the control of hazards related to servicing equipment.
"Employers should be aware that patient care areas are not the only places within hospitals where safety and health hazards may exist," OSHA officials said. "OSHA encourages hospital employers to take a broad view when looking at safety and health issues to ensure that they are assessing hazards in each and every department of the facility. Areas such as machine shops, pharmacies, waste disposal operations, central supply departments and housekeeping are among those that should be included in the overall assessment of safety hazards."
Meanwhile, OSHA continues to pursue new standards that would impact health care. In January 2014, OSHA stated that an infectious disease standard that would cover pathogens "transmitted through a variety of transmission routes" is in the pre-rule stage.
"OSHA is concerned about the ability of employees to continue to provide health care and other critical services without unreasonably jeopardizing their health. OSHA is considering the need for a standard to ensure that employers establish a comprehensive infection control program and control measures to protect employees from infectious disease exposures to pathogens that can cause significant disease," the agency said in the semi-annual regulatory agenda.
OSHA also plans to issue a proposed Injury and Illness Prevention Program rule by this fall, according to the agenda. That rule would require employers to assess the workplace for hazards and have a program to reduce the hazards.
To become more effective, the agency needs more legislative authority and financial resources, asserts Keith Wrightson, worker safety and health advocate with Public Citizen, an advocacy organization in Washington, DC. Wrightson co-authored a report last year called "Health Care Workers Unprotected," which said that "OSHA has devoted relatively little effort to addressing the safety risks at health care." (For more information, see HEH, September 2013, p. 97.)
A bill that would strengthen OSHA and raise its maximum penalties, called the Protecting America’s Workers Act, has been introduced in each session of Congress since 2007 but has withered on the vine.
With limited resources, OSHA focuses largely on industries that have a greater potential for worker fatalities, says Wrightson. But other high-hazard workplaces, such as health care, should receive attention as well, he says.
"I understand [the focus on fatalities], but it’s equally important to give people good conditions so they can go to work and come home and care for their families," he says. "In 20 years, if these folks can’t go to work, that spells disaster for our health care system."