OSHA cracks down on ergo hazards in health care
OSHA cracks down on ergo hazards in health care
Nursing homes face targeted inspections
Eleven years after Congress rescinded the ergonomics standard, the U.S. Occupational Safety and Health Administration is preparing to wield its "general duty clause" powers to identify ergonomic hazards in health care.
OSHA compliance officers will evaluate how nursing homes are addressing the hazards of resident handling as part of a three-year National Emphasis Program on long-term care. Inspectors will ask about specific program elements, including hazard assessment, adequacy of lift equipment, training and monitoring of compliance. Employers could receive a hazard alert letter or citation based on injury rates, severity of injuries, and the scope of the resident handling program.
Although the enforcement action doesn't include hospitals, inspectors around the country will receive training on recognizing hazards in health care.
"I think every health care employer would benefit from reviewing the NEP and seeing where their own programs match up or stack up against those things the compliance officers will look at," says Brad Hammock, an attorney with Jackson Lewis in Reston, VA, who specializes in occupational health law and was counsel for safety standards at OSHA from 2005 to 2008.
The increased scrutiny of nursing homes comes in response to high rates of musculoskeletal disorders and other injuries. "One in every five workers injured in the private sector is a health care worker, and for some groups of these health care workers, the annual injury rate is rising," an OSHA spokesman told HEH in a written response to questions. "This new NEP increases our effort to address the high injury rates in Nursing Home (NH) settings."
OSHA also directed its inspectors to evaluate the hazards of bloodborne pathogens, tuberculosis, workplace violence and slips, trips and falls at nursing homes. The inspectors also can cite for other hazards, such as methicillin-resistant Staphylococcus aureus (MRSA) infection or hazard communication, the compliance directive said. But it is the ergonomics section that has drawn the most attention.
"They're really grappling with this epidemic of injuries and illnesses in the health care sector," says Bill Borwegen, MPH, occupational health and safety director of the Service Employees International Union (SEIU) in Washington, DC, who notes that OSHA has had previous NEPs that included ergonomics in nursing homes.
"These are recognized hazards, and under the general duty clause [of the Occupational Safety and Health Act] you need to address recognized hazards," he says.
OSHA states that it will not enforce voluntary guidance as part of the NEP. But the compliance document lists questions about program components that mirror the guidance, says Eric J. Conn, an attorney who heads the OSHA group at Epstein Becker and Green in Washington, DC. OSHA issued voluntary ergonomics guidelines for nursing homes in 2003. (http://1.usa.gov/1nbakv)
"The real heart of this NEP is ergonomics," says Conn. "I really think OSHA was wandering around in the woods for years since their ergonomics standard was struck down, searching for a coherent enforcement policy. I think this NEP reflects what they think their [strategy] is going to be. And this is a test case."
High rate of MSDs, few citations
Patient and resident handling has been the single greatest hazard for work-related injury in hospitals and nursing homes. Nursing aides and orderlies have the highest rate of work-related MSDs of all occupations, seven times higher than for injuries in all industries.
Yet in the past 11 years, OSHA has issued only 13 ergonomics-related citations in nursing homes and intermediate care facilities, which amounts to 30% of ergonomics-related citations in all industries. (There were no ergonomics-related citations in hospitals.)
Most of those nursing home citations occurred in 2002-2003 during the last nursing home NEP.
OSHA may cite a greater number of employers through this NEP, says Hammock. OSHA is targeting nursing homes with injuries resulting in a DART rate (days away from work or restricted duty) of 10 or more. Currently, a rate of 16 or higher triggers comprehensive inspections of nursing homes under site-specific targeting.
At least 700 nursing homes have injury rates high enough to make them eligible for an NEP inspection, OSHA says. The NEP requires each OSHA area office to conduct at least three NEP inspections per year.
The enforcement action also may give OSHA detailed information on ergonomic hazards in health care, notes Conn. "It's very possible OSHA intends to use the results and the data from this national emphasis program to support a new, more tailored ergonomics rule," he says.
Take a closer look at safety
While OSHA trains its inspectors how to look for health care hazards, employers should take the time to review their own practices, says Pamela Dembski Hart, CHSP, BS, MT (ASCP), principal with Healthcare Accreditation Resources in Boston.
A program of unannounced inspections has a way of getting employers' attention. "It's like troopers patrolling the roads are [enforcing] the speed limit. All of the sudden people pull back on the accelerator."
Health and safety training is often a weak spot and an area targeted by OSHA, says Hart. The training should occur at hire and annually, and it should be conducted by someone knowledgeable in the safety and health issues, she says. Your employees' compliance will depend upon the quality of the training, she says.
Documentation is another potential problem area. Your manuals and policies need to be up to date and accessible, Hart says. Your hazardous materials should be properly labeled and safety data sheets should be readily available. Employees also should know how to report an incident or exposure, she says.
If employers don't have the resources to do their own self-evaluation, Hart suggests hiring a consultant who can assess your program and make recommendations. This isn't just an exercise to impress an OSHA inspector. Self-audits and even the inspections help employers reduce workplace hazards and avoid injuries, Hart says.
"Employers often look at compliance as costing them money. Well, injuries and accidents cost a lot more," she says.
Employers should read the NEP and use it as a framework to review their program, says Conn. But it is also important for employers to be prepared to respond to an OSHA inspection, he says. He provides a checklist that guides employers on their rights and obligations.
Eleven years after Congress rescinded the ergonomics standard, the U.S. Occupational Safety and Health Administration is preparing to wield its "general duty clause" powers to identify ergonomic hazards in health care.Subscribe Now for Access
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