June 29, 2015

New Hospital Safety Inspection Emphases Stem From Longtime Pressure From Advocates

OSHA’s newly rolled-out areas of emphasis for compliance officers conducting hospital and nursing home inspections — focused intently on ergonomic issues, bloodborne pathogens, workplace violence, tuberculosis and slips, trips and falls — comes after lengthy and intense pressure by health care worker advocates, particularly the nurses’ lobby, on the agency to increase inspectors’ concentration on inpatient facilities, Washington sources say.

OSHA leaders unveiled the changes last week in an announcement that grabbed the attention of industry representatives and attorneys engaged in OSHA law, as it focuses on several emphases for which the agency lacks specific standards but has increasingly tried to address under the Obama administration.

Worker safety advocates immediately lauded the initiative as going after a wide swath of problems in inpatient health care that they consider largely neglected over the years. Safe patient handling, the issue OSHA seeks to address by adding an ergonomics emphasis to the inspection regime, has especially come to the forefront in recent years.

Bloodborne pathogens are the subject of a longstanding specific rule but experts note that the issue has not always been a focus within inpatient care centers. A union source also points out that data collected under inspections focused on bloodborne pathogens and disease transmission in general under the directive could also be used to help under-gird OSHA’s plans for an infectious diseases rule.

Other issues broached by the policy directive, perhaps most notably musculoskeletal disorders, are not the subject of a standard and have been longstanding sources of controversy. Industry experts believe the agency has become more emboldened to use the OSH Act general duty clause in cases where it believes ergonomic hazards have gone unaddressed, or where employers should have known and taken steps to reduce the dangers of workplace violence.

Experts say what is notable about the new initiative is that even though some standards, including the one covering bloodborne pathogens, have long been in place and employers are expected to comply, OSHA is now specifically targeting inpatient facilities under the policy. One source says organized nursing labor has for years been putting pressure on OSHA to take some kind of formal action to begin tackling the hazards, with nurses typically viewed as the most vulnerable worker population to the identified concerns. Also last year’s Ebola scare in the United States gave nurses a louder voice and put much greater impetus on OSHA to elevate enforcement to prevent infectious disease transmission in hospitals, an attorney observes.

“Many people have asked me why OSHA is doing this now,” says Valerie Butera, an attorney with Epstein Becker Green, in an email. “The Ebola crisis late last year gave nurses and nursing unions a platform with OSHA that enabled them to point out a great many workplace hazards in healthcare, and OSHA listened.”

“I believe this, combined with the liberal use of the general duty clause by OSHA under the Obama administration, combined to cause OSHA to target inpatient healthcare facilities,” she says. “What is remarkable about this is that OSHA is redirecting substantial resources to target enforcement at inpatient care facilities, which have not been subject to much OSHA scrutiny in the past. And OSHA is not just focused on bloodborne pathogens anymore — in fact, I suspect that musculoskeletal injuries will lead to the greatest number of citations in this initiative.”

Developments including OSHA’s successful exercise of the general duty clause in high-profile cases such as the Walmart trampling case have motivated OSHA officials to use the statutory section more aggressively, and they are feeling more confident about it, she argues.

A different lawyer calls the policy with respect to musculoskeletal disorders “ridiculous,” telling Inside OSHA Online in an email that “OSHA is prohibited from issuing an ergonomics rule without Congressional authorization, and yet it openly announces that it will issue citations to employers that do not comply with its guidance.”

OSHA cites labor statistics as reasoning for the new inspection emphases and notes that similar issues were recently targeted under the recently concluded National Emphasis Program for nursing and residential care facilities. “These focus hazards will be addressed in addition to other hazards that may be the subject of the inspection or brought to the attention of the compliance officer during the inspection,” OSHA says. “The goal of this policy is to significantly reduce overexposures to these hazards through a combination of enforcement, compliance assistance, and outreach.”

The agency states that the Bureau of Labor Statistics and OSHA’s inspection history with the emphasis program “have shown that inpatient healthcare settings consistently have exposures to the safety and health hazards” addressed by the new enforcement memo.

OSHA says with regard to musculoskeletal disorders, between April 5, 2012 and April 5, 2015, OSHA conducted 1,100 inspections of nursing and residential care facilities under the emphasis program. “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.”

Union officials characterize OSHA’s involvement in the concerns at inpatient facilities as long overdue — but still not enough. “It’s a step in the right direction,” says an occupational safety and health staffer for one union affected by the issue. However, the staffer notes that despite the hazard emphases, actual numbers of hospital and nursing home inspections may not actually increase, and that resource constraints may make it difficult for field staff to concentrate on the sector. “It doesn’t seem to say they will do any more inspections in health care [but is] just highlighting to their inspectors … hospitals have these major hazard areas that we know from the data.”

Still, “the more pressure on OSHA’s inspection resources, the less of these they’re going to do,” the source says. “It seems like a small step but at least it’s in the right direction.”

Worker advocates praised OSHA’s move, with organized nursing labor at the forefront and emphasizing ergonomic concerns. “Labor statistics have consistently shown that nurses, nursing assistants and other health care workers are at high risk of MSDs from manually lifting, transferring and repositioning patients,” Debbie Dawson Hatmaker, executive director of the American Nurses Association (ANA), said in a June 25 statement. “Manual patient handling is unsafe for patients and often results in painful, career-ending health care worker injuries.”

ANA hopes the enforcement memo will encourage hospitals to proactively address safe patient handling and mobility and create comprehensive programs to protect patients, nurses and other health care workers, she says. “While OSHA’s action is a step in the right direction, ANA believes a federal ergonomic standard is necessary to protect health care workers and is working with Congress to introduce legislation that would establish such a standard.”

Public Citizen has also been highly engaged in safe patient handling and issued a June 25 statement underscoring ergonomics.

“We applaud OSHA for directing agency time and resources toward hospitals. Heightened inspection and enforcement actions likely will reduce injuries and slow the rate of musculoskeletal disorders in the hospitals that OSHA inspects, but it isn’t enough,” said Keith Wrightson, worker safety and health advocate for Public Citizen’s Congress Watch division. “The real answer to addressing these career-ending injuries is to enact a federal law … to protect these workers that would reduce or eliminate heavy manual lifting in hospitals and other health care settings.”

 A model law would incorporate written patient handling policies and require the use of mechanical devices to move patients, and would require institutions to keep accurate counts of musculoskeletal disorders sustained on the job, analyze the causes of such injuries and submit annual reports to regulatory agencies on the number of musculoskeletal disorders experienced by employees, Public Citizen says. — Christopher Cole ()


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