OSHA maps out a path to prevention

I2P2 white paper ushers in new rule

To usher in one of the most comprehensive rules ever in an anti-regulatory political climate, the U.S. Occupational Safety and Health Administration may need some fire power. The agency lobbed its first volley with a white paper outlining the benefits of an injury and illness prevention program rule.1

Known as I2P2, the rule would require employers to assess their worksites, identify hazards and work to reduce the risks. OSHA points out that 34 states already have laws that "require or encourage" employers to have prevention programs.

"We hope that once employers better understand the issues, they will see how our efforts align with actions that many workplaces are already taking," an OSHA spokesman said in an emailed response to HEH.

But even employers that have sophisticated injury prevention programs may worry that an OSHA rule would require them to make changes, 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.

"Potentially every employer could be affected, which is something you haven't seen since ergonomics," he says. "The potential scope and reach of it, I think, is going to cause it to be quite controversial."

Employers may fear that I2P2 will open the door for OSHA to cite for almost any hazard — because employers would be required to identify the hazard and abate it. For example, hospitals would likely be expected to address patient handling hazards. On the other hand, I2P2 could provide flexibility for employers to address hazards as they see fit, without prescriptive rules.

"There are a lot of people in the safety and health community who say this is the most important thing OSHA has ever done, [that] the best way to protect workers is to require employers to have a program and look for their own hazards and correct their own hazards," says Hammock. "In that sense, it does get to the core of what many safety and health professionals view as the most effective way for OSHA to regulate."

TJC already wants risk assessments

For hospitals, an OSHA rule requiring injury prevention may simply add to the imperative to control hazards. The Joint Commission accrediting body already requires hospitals to conduct risk assessments under the Environment of Care standard.

"Safety is one of the more common RFI's [requirements for improvement] given because of these risk assessments," says Rick Cotter, president of RT Cotter and Associates in Kingston, MA, a consulting firm that helps hospitals prepare for Environment of Care surveys.

For example, The Joint Commission expects a hospital Environment of Care Committee to review worker safety incidents, he says. "That's part of the expectation of the surveyors. They're getting a lot more forceful about the quality of the data [they want to see] and questioning what's being done about it," he says.

Recently, The Joint Commission has focused on workplace violence, he says. Surveyors also may ask about back injuries and needlesticks.

Other OSHA standards, such as Bloodborne Pathogens and Hazard Communications, already require health care employers to identify risks and take action, notes Pamela Dembski Hart, CHSP, BS, MT (ASCP), principal with Healthcare Accreditation Resources in Boston. The general duty clause of the Occupational Safety and Health Act also requires employers to address hazards that could cause serious injury.

With or without I2P2, health care employers should be conducting hazard assessments, says Hart. "You don't just look at a hazard because there's a rule. If you have a hazard, that's a problem," she says.

Correcting hazards and preventing injury "saves you money in the long run, though you do have to make the commitment to invest in resources and adherence to the standards," she says.

Enforcement is key to injury decline

OSHA is touting the cost-saving potential of I2P2, but recent research suggests that the effectiveness may depend on the enforcement.

In eight states that either require an injury and illness prevention program or provide incentives or requirements through workers' compensation, injuries and illnesses declined by 9% to 60%, OSHA said in its white paper.

OSHA estimates that a national I2P2 rule could reduce injuries by 15% to 35% among employers who don't currently have prevention programs. "At the 15% program effectiveness level, this saves $9 billion per year in workers' compensation costs; at the 35% effectiveness level, the savings are $23 billion per year," OSHA says.

OSHA says that injury and illness prevention programs are "highly flexible – the core elements can be implemented at a basic level suitable for the smallest business, as well as at a more advanced, structured level that may be needed in a larger, more complex organization."

Participation of frontline workers and commitment of senior managers are keys to the success of the programs, OSHA says.

In a report released in January, the RAND Corp. of Santa Monica, CA, found that California's Injury and Illness Prevention Program rule wasn't linked to lower injury rates overall.2

Most of the citations under the rule involved the failure of an employer to have a written plan. But when Cal-OSHA inspectors cited an employer for specific violations, injury rates dropped by 26%, RAND said.

"The most consistent finding for the subsections was that a citation for failing to provide appropriate training was linked both to poorer performance prior to the inspection and to improved performance (a 44% reduction) after the inspection," RAND researchers found.

The RAND researchers concluded that OSHA should continue to rely on hazard-specific standards, but that an I2P2 rule would reinforce the need for employers to have safety programs to address the hazards proactively. "Detection of hazards [in an inspection] would lead not only to the removal of hazards but also to the strengthening of safety programs," they said.


1. U.S. Occupational Safety and Health Administration. Injury and Illness Prevention Programs White Paper, January 2012. Available at http://1.usa.gov/zZDCrF.

2. Mendeloff J, Gray WB, Haviland AM, et al. An evaluation of the California Injury and Illness Prevention Program. RAND Corp., Santa Monica, CA, 2012. Available at http://bit.ly/x4yWFe