OSHA Expands Enforcement of Health Care Industry Policies

The Occupational Safety and Health Administration (OSHA) announced an enhanced enforcement policy aimed at inpatient health care workplaces and focused on five key areas: musculoskeletal disorders, workplace violence, bloodborne pathogens, tuberculosis, and slips, trips and falls.

The new policy requires that OSHA inspections at hospitals, nursing homes and residential care facilities include these five major hazard areas, regardless of the original reason for the inspection.

The enforcement initiative was outlined in a June 25, 2015, memorandum from Dorothy Dougherty, deputy assistant secretary of labor for occupational safety and health, to OSHA regional administrators and state plans. The memo requires both federal OSHA regional offices and state plans to evaluate the number of work-related injuries and illnesses at inpatient health care and nursing home facilities in their areas and to target those facilities for inspections.

“Workers in hospitals, nursing homes and long-term care facilities have work injury and illness rates that are among the highest in the country, and virtually all of these injuries and illnesses are preventable,” said David Michaels, assistant secretary of labor for occupational safety and health. U.S. hospitals recorded nearly 58,000 work-related injuries and illnesses in 2013, amounting to 6.4 work-related injuries and illnesses for every 100 full-time employees, according to the Bureau of Labor Statistics (BLS). That’s almost twice as high as the overall rate for private industry.

“The most recent statistics tell us that almost half of all reported injuries in the health care industry were attributed to overexertion and related tasks,” Michaels said. “There are feasible solutions for preventing these hazards and now is the time for employers to implement them.”

The agency anticipates seeking access to employee medical records and interviewing employees to confirm what it finds in injury and illness records, said Carla Gunnin, an attorney in the Atlanta, Ga., office of Jackson Lewis. “Since these hazards are common in the industry and the policy broadens the scope of each health care facility inspection—lengthier, broader and more exacting inspections are likely to result, with the possibility that more citations and proposed penalties will be issued to employers in the health care industry,” she said.

Because there are no specifically applicable regulations related to musculoskeletal disorders or workplace violence, OSHA compliance officers are urged to rely upon the general duty clause, which enables OSHA to issue citations whenever it finds that an employer has failed to provide a safe work environment, said Valerie Butera, an attorney in the Washington, D.C., office of Epstein Becker Green. “Strategic planning is essential to successfully navigating any OSHA inspection, and inspections of inpatient care facilities are imminent. Virtually any type of health care or nursing care facility that provides residential or inpatient services is at risk of an OSHA inspection—particularly if the employer has a high rate of work-related injuries and illnesses,” she said.

Safe Patient-Handling

Recent media reports have drawn attention to the hazards nurses face in lifting patients.

OSHA conducted 1,100 inspections between April 5, 2012, and April 5, 2015, as part of its recently concluded National Emphasis Program on Nursing and Residential Care Facilities. Ergonomic stressors were evaluated in 596 of these inspections, which generated 192 ergonomic hazard alert letters to employers and 11 citations of OSHA’s general duty clause for hazardous ergonomic conditions.

The latest memo provides new guidance related to safe patient-handling. “OSHA will examine the sufficiency of a facility’s injury-prevention program relating to ergonomics, paying close attention to when manual lifting will be performed by caregivers, and what lifting and repositioning equipment is available to reduce injuries,” Gunnin said.

Among the factors OSHA will consider are whether there is an “adequate quantity and variety of appropriate lift, transfer or reposition assistive devices available and operational,” OSHA said.

The agency will also consider whether organizations have systems for hazard identification and analysis; whether employees have provided input in the development of lifting, transferring and repositioning procedures; and whether there is a system for monitoring compliance with internal guidelines.

Violence and Additional Hazards

OSHA recently published best-practice guidance on reducing the risk of violence in health care and social service settings.

In 2013, hospitals reported approximately 5,660 assaults, and nursing and residential care facilities reported approximately 8,780 assaults, according to BLS data.

The private sector in 2013 recorded a rate of 4.2 cases of workplace violence per 10,000 full-time workers. That rate jumped up to 16.2 cases per 10,000 full-time workers in health care. Fifteen percent of the days-away-from-work cases for nursing assistants were the result of workplace violence, whereas less than 10 percent of the overall private sector days-away-from-work cases were the result of violence, according to the BLS.

Additionally, employees working in nursing and residential care facilities have been identified by the Centers for Disease Control and Prevention (CDC) as being among the occupational groups with the highest risk for exposure to tuberculosis. Injuries from slips, trips and falls also account for much of the occupational injury and illness cases reported in nursing and residential care facilities. Taken together, overexertion along with slips, trips, and falls accounted for 68.6 percent of all reported cases with days away from work in 2013.

In addition to the focus hazards listed above, OSHA is interested in other hazards that may be encountered in inpatient health care settings such as exposure to multi-drug-resistant organisms, and exposures to hazardous chemicals, such as sanitizers, disinfectants, anesthetic gases, and hazardous drugs.

Be Prepared

Gunnin advised employers to prepare for upcoming focused inspections by:

• Developing or reviewing the company’s workplace violence prevention plan, infectious diseases prevention program, and ergonomics policies and procedures on patient handling and lifting.
• Training key personnel on strategies for handling OSHA inspections.
• Conducting an internal audit of the employer’s bloodborne pathogens exposure control program, including the annual review of safety devices and access to Hepatitis B vaccinations.
• Ensuring that employees are aware of the hazards associated with the chemicals that they work with and that they have access to safety data sheets.
• Ensuring that the company is following the latest guidance from the CDC on tuberculosis prevention.

“Employers operating inpatient care facilities should immediately conduct an internal OSHA compliance audit with the assistance of outside counsel,” Butera said. “This audit is protected from disclosure by the attorney-client privilege. Audit reports prepared without the aid of outside counsel can be subpoenaed by OSHA and used as a guide to potential violations at the worksite.” An added benefit of conducting an attorney-client privileged audit is the potential for a reduction in workers’ compensation claims, she said. “When an employer addresses the gaps identified in a health and safety audit, it also usually experiences an enormous drop in workers’ compensation costs.”

Roy Maurer is an online editor/manager for SHRM.

Follow him @SHRMRoy

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