OSHA: Health worker injuries 'unacceptable and intolerable'

Next wave of inspections targets nursing homes

Nurses' aides have more serious work-related musculoskeletal injuries than any other occupation, and registered nurses rank fifth in MSDs — despite years of efforts to promote safe patient handling. Those and other dismal injury statistics spurred the U.S. Occupational Safety and Health Administration to announce new, targeted inspections of nursing homes, an action that could ultimately increase scrutiny of hospitals as well.

"It is unacceptable that the workers who have dedicated their lives to caring for our loved ones when they are sick are the very same workers who face the highest risk of work-related injury and illness," said David Michaels, MD, MPH, assistant secretary of labor for OSHA, in a statement. "These injuries can end up destroying a family's emotional and financial security. While workplace injuries, illnesses and fatalities take an enormous toll on this nation's economy, the toll on injured workers and their families is intolerable."

A new National Emphasis Program for nursing homes will focus on back injuries from resident or patient handling, exposure to bloodborne pathogens and other infectious diseases, workplace violence, and slips, trips and falls. OSHA has guidelines but no standard for two of those areas (lifting and workplace violence), which means the agency would rely on the general duty clause that requires employers to maintain a workplace free of recognized, serious hazards.

Although hospitals are not part of the National Emphasis Program, it's clear that they also are in OSHA's sights.

"The rates of injuries and illnesses among hospital and health care workers underscore OSHA's concern about the safety and health of these workers," Michaels said. "The workers that care for our loved ones deserve a safe workplace and OSHA is diligently working to make this happen."

When the details of the NEP are unveiled, compliance officers will receive a special directive and training. "You're now going to have an army of compliance officers trained to identify all the same hazards that exist in [hospital] workplaces," says Eric J. Conn, an attorney who heads the OSHA group at Epstein Becker and Green in Washington, DC. "You've got a heightened awareness. I think we can expect hospitals will see more citations just like ones that will come out of the NEP."

It is part of a more aggressive enforcement strategy, he says. "The agency used to be reactionary. They're now proactive in identifying a specific hazard or industry they want to focus on, educating their compliance officers and then sending them out to find [violations]," he says.

Most hazardous job in U.S.?

This is not the first time that nursing homes have been a focus for OSHA. In 2002, after wrestling a settlement from nursing home giant Beverly Enterprises of Fort Smith, AR, over resident handling injuries, OSHA launched a National Emphasis Program. The agency conducted 1,000 inspections of nursing homes but issued only seven ergonomic-related citations.

OSHA also has included nursing homes in its targeted inspections of high-hazard workplaces, but its ergonomic enforcement remains low. In 2010, OSHA issued five general duty clause citations of nursing homes, but none involved resident handling, MSD injuries or other ergonomic issues.

Yet nurses' aides have one of the most hazardous jobs in America. They have the third-highest incidence of non-fatal occupational injuries and illnesses, behind bus drivers and police officers, according to the U.S. Bureau of Labor Statistics. State-run nursing homes have the highest injury and illness rates of any industry, including firefighters and ironworkers.

OSHA noted that the rate of MSDs that involve lost work days actually rose by 10% for nurses' aides, orderlies and attendants in 2010. The rate of 249 cases per 10,000 workers is about seven times higher than the rate for general industry.

"We look at these latest BLS statistics as a clarion call for a paradigm shift on how OSHA allocates their inspection and rulemaking resources," says Bill Borwegen, MPH, safety and health director for Service Employees International Union (SEIU), which represents more than a million health care workers.

"OSHA spends over 80% of the inspection resources in manufacturing and construction, which have lower injury and illness rates than hospitals and health care," he says. "It's time for them to apply their limited resources where people are getting hurt."

The focus on nursing homes and health care should not be limited to an emphasis program, Borwegen says. "The agency has a construction directorate at their headquarters. Maybe it's time to have a service sector or a health care sector directorate. They need to figure out how to revamp the way they do their job in light of these alarming BLS statistics."

The American Health Care Association, the Washington, DC-based organization that represents the long-term care industry, responded to a query from HEH with a statement from Greg Crist, vice president of public affairs:

"As a profession that cares for others, we realize that we must also take care of those that dedicate their time in our facilities. AHCA remains committed to providing resources and training opportunities to our members to develop and implement various workplace safety programs. And we are encouraged to see declining injury rates in nursing and residential care facilities over the last few years. But we must continue to advance in this endeavor and we hope to work with OSHA to uphold this commitment to our caregivers."

Managers lack focus on safety

The focus on nursing homes comes as no surprise to Pamela Dembski Hart, BS, MT(ASCP), CHSP, a safety consultant and principal and founder of Healthcare Accreditation Resources in Boston who has provided training, assessment and consulting services to nursing homes.

"The nursing home population has increased, and without proper oversight and education about safe work practices and engineering controls, injury rates obviously will increase too," says Dembski Hart.

Nursing homes have a high turnover of staff and often have employees who have limited English skills, which contributes to the difficulty maintaining trained and skilled employees. Managers and administrators also may fail to understand the importance of OSHA regulations and the methods necessary to implement them, she says.

For example, there's widespread misunderstanding of the Bloodborne Pathogen Standard, she says. Nursing homes must evaluate and provide safer sharps (as required by the Needlestick Safety and Prevention Act) and annual interactive training that is tailored to the employees' work or job description. Instead, employers often provide general training to nurses and housekeepers at the same time, even though they encounter different hazards, she says.

Nursing homes often fail to update their exposure control plans annually, reevaluate new safety devices, or even include frontline workers in the device evaluation, she says.

Chemical hazards are another area of concern. When chemicals such as surface disinfectants or housekeeping cleaners are transferred to a spray bottle or other secondary container, the new container needs a label showing its identity and hazard levels for flammability, reactivity, health effects and protective equipment.

"I'll go in a janitor's closet and there's no protective equipment," says Dembski Hart, noting that latex and vinyl gloves do not provide protection against most chemicals. "If I pulled a chemical off a shelf and said, 'Find me the MSDS [material safety data sheet], they frequently wouldn't know where to find it. Does it contain hazardous ingredients? Ninety percent [of employees] couldn't answer that because they haven't received appropriate training or any training."

This year, the person asking the question may be an OSHA inspector — and the response could be a citation and fine.