OSHA ergonomics rule will hit hospitals in September
August 1, 1999 5 minutes read
OSHA ergonomics rule will hit hospitals in September
Patient-lifting injuries targeted in second category
After seven years in development, the U.S. Occupational Safety and Health Administra tion’s (OSHA) proposed ergonomics standard is scheduled for release in September, effectively requiring hospitals to implement ergonomics programs to prevent patient-lifting and other musculoskeletal injuries.
The public has had an unusual chance to view a draft proposal of the standard, which was placed on OSHA’s Internet’s Web site (www.osha-slc.gov/ SLTC/ergonomics/ergoreg.html) earlier this year. Under the recent Small Business Regulatory Enforcement and Fairness Act, proposed regulations must first be reviewed for economic impact on small businesses before being published in the Federal Register for public review and comment.
OSHA crafted the proposal — written in plain language in a question-and-answer format — around six basic elements: management leadership and employee participation, hazard identification and information, job hazard analysis and control, employee training, medical management, and program evaluation.
The proposed standard will cover workplaces where work-related musculoskeletal disorders (WMSDs) are most severe. Coverage will focus on three main categories: manufacturing operations, manual-handling operations, and other jobs causing demonstrated WMSDs.
Gary Orr, CPE, PE, an OSHA ergonomist and leader of the ergonomics standard development team, tells Hospital Employee Health that hospital employees definitely will be covered by the proposed standard, mainly in the second category.
"One area we’re clearly trying to get at is movement of patients in the manual-handling category," he says. "Some workers in dietary or accounts payable departments, where they’re using their hands a lot and might develop carpal tunnel syndrome, will be covered in [the third category], but the data show quite a bit of risk among workers who do a lot of patient-handling."
Under the draft proposal, hospitals will have to create ergonomics programs if they have reported an OSHA-recordable musculoskeletal injury. Orr says this provision has drawn the most criticism from small business panel reviewers, who object to only one incident precipitating development of an ergonomics program.
"They think there should be a combination of more incidents or a pattern of incidents, because one incident might be a rare event, so we’ll probably ask some questions about that in the formal proposal," he states.
However, Orr admits that other commenters have taken an opposing view.
"Their issue is, Wait a minute! You’re hurting people before you’ll start an ergonomics program,’" he relates. "We’re trying to address that in a couple of ways. We believe that if workers are encouraged to report early, we can intervene with OSHA-recordables at a very early stage. OSHA’s responsibility is to address serious injuries in the workplace; for example, a first-degree burn would not even show up as an OSHA-recordable. So we’re hoping that when something like tendinitis is at a very early stage, employees will report it, and the employer will start to react by restricting their duty, which automatically makes it an OSHA-recordable."
Also, once a report is filed, it launches a "proactive stage" in that the same work activities implicated in the reported injury would be covered for other workers, Orr adds. Therefore, if one worker reports an injury related to patient-handling, other workers who do patient-handling would automatically be covered in the ergonom ics program that the employer must develop, even though they did not report an injury.
OSHA further defends its use of an incident trigger by stating that many employers already use one in their ergonomics programs. The trigger helps ensure that employers take action when real problems occur, allows employers to limit the number of jobs they must address at one time, and minimizes costs for employers who have only limited or isolated problems. At the same time, the working draft leaves employers free to develop ergonomics programs that use more sensitive triggers. Many employers already initiate action early — before WMSD symptoms progress to recordable injuries — which OSHA encourages. The use of a trigger incident establishes a "minimum threshold" for employer action, OSHA officials state.
Hospitals are among the top five work sites where WMSDs occur most frequently, Orr says. One reason why patient-lifting-related WMSDs are so prevalent in health care is the "caring till it hurts" philosophy of many health care workers and facilities, he notes.
The concern for patient safety has long taken precedence over the safety and even the lives of workers, a consideration not faced by other types of industries subject to OSHA regulation. Orr says a more balanced approach is necessary.
"The life of the worker is as important as the life of the patient," he asserts. "We don’t want to put the health care worker at great risk to save the life of a patient, and people are starting to understand now that worker safety and patient safety go hand-in-hand. If a worker tries to lift a patient and gets back strain in the process, probably both of them will hit the floor, and we’ll have an injured worker and an injured patient."
Through other regulations such as the bloodborne pathogens standard (see related cover story, p. 85), health care employers have developed more awareness in recent years of the need to protect workers. "The health care industry has been very keen on providing good health care for the public, but when it came to their own people, they probably weren’t as good as many other industries were," Orr says.
In terms of lifting injuries, other industries generally are more aware of the need to eliminate manual lifts to protect workers. However, many health care employers still insist that if workers "would just do the lift correctly," they wouldn’t get injured, he notes. "Industry has said there’s really no right way to lift 100 pounds, so it’s probably better to get [mechanical] assistance. Industry has probably recognized the problem more and what can be done about it."
Still, the final standard won’t be prescriptive, Orr says. Instead, it will motivate employers to explore options for preventing injuries.
Development of an ergonomics standard, which was first announced in 1992 by a notice of proposed rulemaking, has been delayed largely by political opposition from Republicans in Congress representing the interests of big business. Attempts to issue a standard were further derailed after a 1995 draft proposal was released, when Congress prohibited OSHA from promulgating a proposed standard before Sept. 30, 1998. Nevertheless, the agency held stakeholder meetings throughout much of last year in preparation for a final rule.
Orr says political opposition remains active, "but, for the time being, we’re going to see it move ahead."
Presently, the biggest "question mark" will be the results of a new National Academy of Scien ces (NAS) study that will review the medical literature in search of data linking musculoskeletal injuries to occupational hazards, he predicts. The new study, commissioned by Congress, will be a longer version of an NAS report released last year, which verified the existence of substantial scientific evidence connecting musculoskeletal disorders to biomechanical stress on the job.1 (See Hospital Employee Health, January 1999, pp. 1-3.)
Bills in the House and Senate require OSHA to wait for the results of the larger study before issuing a final standard. The study is not expected to be complete until spring 2001.
Reference
1. Steering Committee for the Workshop on Work-Related Musculoskeletal Injuries: The Research Base, Committee on Human Factors, National Research Council. Work-Related Musculoskeletal Disorders: A Review of the Evidence. Washington, DC: National Academy Press; 1998.
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