The U.S. Occupational Safety and Health Administration (OSHA) announced a campaign July 16, 2013, to prevent musculoskeletal disorders (MSDs)—including sprains, strains, and soft-tissue and back injuries—among health care workers responsible for patient care.
“The best control for MSDs is an effective prevention program,” the agency emphasized in a press release. “Our goal is to assist nursing homes and long-term-care facilities in promoting effective processes to prevent injuries.”
OSHA is providing 2,500 employers, unions and associations in the health care industry in Delaware, Pennsylvania, West Virginia and the District of Columbia with information about how to prevent hazards such as lifting excessive weight during patient transfers and handling. It’s also informing employers of how they can initiate a zero-lift program, by which workers can minimize direct patient lifting by using special lifting equipment and transfer tools.
According to OSHA, in 2010 there were 40,030 occupational MSD cases in private industry nationwide where the source of injury or illness was a health care patient or resident of a health care facility. In MSD cases involving patient handling, 99 percent were the result of overexertion, resulting in sprain, strain or tear injuries. Nursing aides, orderlies and attendants incurred occupational injuries or illnesses in 49 percent of the MSD cases involving health care patients. Registered nurses accounted for 17 percent, and home health aides another 6 percent.
Report: Inspections, Ergonomic Standard Needed
In a recently published report, the consumer-advocacy group Public Citizen charged that OSHA’s insufficient inspections at health care facilities and lack of an ergonomic safety standard are failing health care workers, who suffer more injuries than workers in any other occupational sector.
In 2010, for instance, health care employers reported 653,900 workplace injuries and illnesses—that’s over 152,000 more than the next-most-afflicted industry, manufacturing.
“But OSHA has devoted relatively little effort to addressing the safety risks at health care facilities, compared to its work in other highly afflicted industries,” the report points out. “For example, health care workers outnumber construction workers more than two-to-one, but OSHA conducts only about one-twentieth as many inspections of health care facilities as construction sites.”
Public Citizen also noted that the occupational-safety watchdog lacks standards that are applicable to the health care setting, specifically an ergonomic standard. Musculoskeletal disorders are the leading source of health care worker injuries and should be addressed through focused regulation, the report said.
“In fairness to OSHA, the adversity it faces goes well beyond a shortage of resources. The process for creating standards has become so cumbersome and subject to interference that the agency could not possibly fulfill its mandate.”
The agency published ergonomic regulations in 2000, to protect workers in all industries from ergonomic hazards, but Congress repealed them before they took effect. In 2010, OSHA proposed a rule that would have added a column to reporting logs for employers to indicate whether an injury was a musculoskeletal disorder, but that proposal was first delayed by the administration, then blocked by Congress, and is still on the agency’s long-term agenda.
Public Citizen recommended that OSHA put forth a safe-patient-handling standard to address ergonomic stressors and musculoskeletal disorders that includes the following:
- Requiring the use of engineering controls, lifting and transfer aides to perform acts of lifting, transferring and repositioning health care patients and residents.
- Requiring the use of mechanical lifting devices even in cases in which teams do the lifting.
- Covering all shifts and units in all areas of health care, including hospitals and nursing-home facilities.
“Until such standards can be implemented, OSHA should vastly expand its use of the general duty clause to cite health care facilities for hazards that are not documented in existing rules,” the report advised.
In a written response included in the report, the agency said that, in the absence of an ergonomic standard, inspectors must meet a high evidentiary threshold when issuing a citation under the general-duty clause.
“In addition, citations are not the only tools OSHA has at its disposal,” the agency explained. In cases where ergonomic hazards do not meet the evidentiary threshold required to cite companies under the general-duty clause, OSHA said, it has issued hazard-alert letters to those employers.
Since the start of the 2012 National Emphasis Program (NEP), which focuses on risks at nursing homes and long-term-care facilities, the agency said, “we have issued more than 55 such [letters] outlining ergonomic hazards and providing employers examples of feasible abatement methods they can implement to help prevent ergonomic-related injuries to workers in nursing and residential care settings.”
OSHA confirmed that it is currently not pursuing a rule on safe patient handling for health care workers.
“We continue to be concerned about this serious issue and promote sensible solutions through the NEP, guidance and outreach activities; however, OSHA does not have resources to move forward on all rulemaking necessary to address all the pressing workplace health and safety hazards.”
Information on safe patient handling, including how to identify hazards, how to start a safe patient handling program, training resources and state legislation can be found here.
Roy Maurer is an online editor/manager for SHRM.
Follow him on Twitter @SHRMRoy.
Identify, Treat and Prevent MSDs, SHRM Online Safety & Security, August 2011
OSHA Withdraws Proposal for Musculoskeletal Disorder Reporting, SHRM Online Safety & Security, January 2011
OSHA: Expect Ergo Citations Under General Duty Clause, SHRM Online Safety & Security, April 2010
Labor, Business Disagree on Change to Illness/Injury Log, SHRM Online Safety & Security, March 2010
OSHA Proposes Tracking Musculoskeletal Injuries, SHRM Online Safety & Security, January 2010
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