No OSHA citations for hospitals on ergo

You’re OK if you’re making progress

Enforcement related to ergonomic hazards remains light more than two years after the U.S. Occupational Safety and Health Administration (OSHA) trained inspectors to recognize and document those hazards. More than 1,000 inspections of nursing homes generated only 10 citations related to ergonomics. They were among only 16 employers nationwide who received such citations.

No hospitals have been cited for ergonomic hazards, although overexertion in lifting is the leading cause of injury in the industry.

"The burden of proof is much higher than if we had a standard," says Richard Fairfax, OSHA director of enforcement programs. "We have to establish a number of elements [for a general duty clause violation]. If the employer is working toward abating, that takes them out of [range] of the general duty clause."

The general duty clause of the Occupational Safety and Health Act requires employers to keep workplaces free of hazards that could cause serious injury. To cite employers based on the clause, inspectors must show "the employer failed to keep the workplace free of a hazard to which employees were exposed, the hazard was causing or likely to cause death or serious physical harm, the hazard was recognized, and a feasible means of abatement for that hazard exists," OSHA has stated.

When OSHA inspectors identified hazards that didn’t meet the general duty clause criteria, they sent hazard alert letters suggesting safety improvements. Of 376 hazard alert letters sent to employers, 181 were to nursing homes. None were sent to hospitals.

"When [Labor Secretary Elaine] Chao told us they were going to kill the ergonomics standard, OSHA told everyone that they were going to unleash a much more aggressive general duty clause campaign on ergonomics," notes Bill Borwegen, MPH, health and safety director of the Service Employees International Union (SEIU).

"Clearly, that has not happened. Clearly, it was simply a ruse to deflect criticism that OSHA was eliminating the standard that would have addressed the leading cause of workplace illness and injuries," he explains.

State legislators and regulators and workers’ compensation insurers ultimately may take greater action on ergonomics, Borwegen says.

Fairfax contends the nursing home ergonomics guidelines, outreach and education programs, and hazard alerts have led to safer working conditions. "We’re seeing more and more nursing home establishments that are doing something [about ergonomic hazards]," he notes.

OSHA asserts that by targeting its enforcement activities to high-hazard industries and the most egregious employers, it is making significant progress in improving worker safety.

In November, John L. Henshaw, CIH, OSHA administrator, touted the agency’s "strong, fair, and effective" enforcement program, which focuses on high-hazard workplaces.

"OSHA’s balanced approach in worker safety and health, in our mind, is succeeding; and it’s validated by the workplace injury and illness rate, which is decreasing, even as our work force continues to expand," he said at a news conference.

The targeting of certain industries is an important part of that, says Henshaw. "It’s an effort to focus our energies where they are needed most," Henshaw notes.

Both hospitals and nursing homes have an injury and illness incident rate that’s significantly higher than the general industry average: 9.7 per 100 full-time workers at hospitals, 12.6 at nursing homes, and 5.3 for general industry.

The bloodborne pathogen standard continued to be the No. 1 standard cited by OSHA inspectors in hospitals. From October 2003 to September 2004, OSHA issued 115 citations at 37 hospitals, with fines totaling about $100,000. The nature of those citations has changed since the passage of the Needlestick Safety and Prevention Act, says Fairfax.

"Ten years ago, most of our violations were for not having a bloodborne pathogen program at all," he says. "Now our citations are for deficiencies."

The respiratory protection standard was the fifth most frequently cited, although OSHA has not cited any hospitals for failing to conduct annual fit-testing, Fairfax says.