Should MSDs have more than one definition?
Separate reporting of work-related musculoskeletal disorders (MSDs) has been delayed at least another year while the U.S. Occupational Safety and Health Administration decides how those injuries should be defined — and whether the record keeping should be changed at all.
In a question debated in numerous ergonomics hearings and forums, OSHA once again is asking, "What is an MSD?" Is it an injury caused by a single trauma, such as a back injury that occurs when lifting a patient? Is it extremity pain that develops over time after cumulative trauma? Can one definition cover both?
OSHA’s statements in the Federal Register notice hint that the agency may reject a single definition of MSDs and drop the idea for a special column to track them. In fact, that position corresponds with OSHA’s "comprehensive approach" to ergonomics, which avoids broad definitions and focuses on industry-specific, voluntary guidelines.
"OSHA found that no single definition of ergonomic injury’ was appropriate for all contexts," the agency said in the notice.1 "The agency stated that it would work closely with stakeholders to develop definitions for MSDs as part of its overall effort to develop industry-or-task specific guidance materials."
Worker advocates accused OSHA of trying to minimize the problem of MSDs by changing the definition. "Labor Secretary [Elaine] Chao is going to have the most effective MSD program the country has ever seen by redefining the problem away," says Bill Borwegen, MPH, occupational health and safety director of the Service Employees International Union (SEIU). "It’s tragic, really. Now we’re not going to have the information and ammunition to spend the resources to make the problem really go away rather than to make it go away artificially."
"We’ve been dismayed by that move to not count MSDs in a straightforward way," says Karen Worthington, MS, RN, COHN-S, occupational safety and health specialist for the American Nurses Association in Washington, DC. "It continues to feel like delay tactics and tactics that will undermine finding the problem."
In the same Federal Register notice, OSHA released a new rule for the recording of hearing loss that focuses on overall hearing deficiency. The MSD and hearing-loss provisions were delayed when OSHA released its final record-keeping standard that became effective this year. The new record-keeping rule clarified what is meant by "first aid only" and require the reporting of all needlesticks.
The record-keeping rule provided for separate columns to collect information on MSDs and work-related hearing loss to make those injuries easier to track. OSHA still is unsure if those additional columns are necessary and is asking for comment. Employers would be required to report the injuries but would not need to identify them separately as MSDs and hearing loss cases. "If the agency decides there’s no need for a column, we don’t need a definition [of MSDs]," explains Jim Maddux, a statistician with OSHA’s directorate of safety standards. "If we decide the column is useful, we’ll use the old definition or adopt a new one."
Tracking could help employers
Every year, the Bureau of Labor Statistics (BLS) releases data on MSDs that involve time away from work, including details about body part affected (back, upper extremity, etc.) and industry-specific data. BLS compiles that data from surveys of about 200,000 employers.
With the record-keeping change, BLS would have additional information on reportable injuries that do not involve time away from work, says William Weber, MS, BLS assistant commissioner for safety health and working conditions. "It would give a more complete picture of the total problem of MSDs." At the same time, employers would have to decide whether to check the MSD box, he notes. "That does depend on the employers’ understanding of the definition of MSDs and their ability to apply that definition consistently," he says.
In the long run, employers are the ones who would actually benefit from the new record-keeping requirement, asserts Guy Fragala, PhD, PE, CSP, director of environmental health and safety at the University of Massachusetts Medical Center in Worcester. BLS data (available at www.bls.gov/iif/osheval.htm) provide national benchmarks, but a separate reporting of MSDs on the OSHA 300 would make it easier for employers to track their own injuries and monitor the effectiveness of interventions, he says.
"Musculoskeletal disorders are an important occupational injury problem. So if we can develop record-keeping systems that will help us better understand where problems are occurring, I think that will be useful," Fragala says. "It’s worth the effort to review the system and come up with a mechanism which will allow us to track our experience in this area."
For more information, visit the OSHA web site at www.osha.gov.
1. 67 Fed Reg 44,037 (2002).