The Occupational Safety and Health Administration (OSHA) has historically shown a low profile in most healthcare institutions. Employee bulletin boards carry required health safety regulations in employee break rooms about worker rights, but most healthcare workers have never been through an inspection conducted by an OSHA official. This may change because healthcare is associated with more work-related injuries than many other industries, including construction.
Many OSHA requirements are included in the various inspection programs conducted by organizations that certify compliance. These requirements include mitigation of chemical and radiation hazards, ergonomics, personal protective equipment (PPE) and fall prevention. So OSHA’s influence has been present, but somewhat masked. It is possible that OSHA may take a more direct and active role.
A number of issues need to be kept in mind with OSHA. First, OSHA rules applies to employees, not patients or visitors, when the number of workers exceeds a specific threshold. Second, OSHA may not inspect some state and federal organizations that are inspected by other means. Third, OSHA inspectors are spread fairly thin, so they tend to inspect only if there is a complaint, news event or another specific trigger. If a hospital is unionized then this may impact the chances of a complaint. Fourth, just because you have never seen an OSHA inspector does not mean that one may not show up tomorrow.
The OSHA website (OSHA.gov) provides a broad range of resources addressing worker safety and the federal health safety regulations involved. A particularly helpful interactive tool for healthcare is the Hospital eTool which outlines specific issues relevant to the various hospital departments.
In dealing with OSHA you need to pay attention to three broad topics:
- Engineering and administrative controls to reduce worker risk in general
- Worker protection
- Specific hazards
Medical scores and calculators with a health safety focus can play a role by helping to identify risks and provide evidence-based protocols for addressing those risks. A selection of scores and calculators are highlighted throughout the discussion below, and these are just a sampling of the more than 835 scores included in the Patient Safety Medal Pack, which breaks down the topic into main risk areas, including patient-centric concerns, physical and environmental concerns, infection control and hospital acquired infections, and medication-related safety concerns.
Engineering and Administrative Controls
The first line of defense for worker safety are engineering and administrative controls. These are measures that can reduce or eliminate worker risk by making changes to the system and culture. These may include:
- Employee health services and the handling of work-related injuries
- Worker education, especially for temporary and new employees
- Appropriate policies with evidence of compliance
- Respect for whistleblowers
- Evidence of hazard assessments and remediation by supervisors
- Interventions that reduce risk (such as lifts for moving patients and sharps reduction)
- Environmental monitoring
If engineering and administrative controls cannot eliminate risk to a worker, then interventions are needed to protect the worker. This may take the form of personal protective equipment (PPE) such as masks, gowns and gloves, or required vaccinations to reduce the risk of contracting several infectious diseases. These measures were highlighted by recent concerns about Ebola and other lethal arboviruses brought to the United States by travelers.
- Errors in the Donning of an N95 Mask Reported
- Occupational Hand Dermatitis Associated with Hand Hygiene
- Risk Factors for Occupational Infection of a Healthcare Worker with Viral Hepatitis B
Healthcare workers are at increased risk for a number of specific hazards, so these must be specifically addressed. These include:
- Musculoskeletal injuries, especially to back and upper extremities
- Secondary exposure to chemotherapeutic drugs
- Chemical exposures (ethylene oxide, cleaners, etc)
- Fires, tissue vapors, anesthetic gases and other hazards in the operating rooms
- Slips and falls
- Radiation hazards
- Risk from exposure to MRI magnets
- Emergency transport and helicopters
- Office ergonomics, including computer usage
- Diagnostic Algorithm for Occupational Asthma
- Darkroom Disease in Radiographers
- Recommendations for Prevention of Carpal Tunnel and Other Wrist Complaints in an Ultrasonographer
- Techniques for Preventing Low Back Injury When Lifting
- Patient Assessment Criteria for Safe Transfer and Movement
- Fire Risk Score for Avoiding Fires in the Operating Room
- Risk Factors for Workplace Violence Involving Emergency Department Physicians
- Criteria for the Computer Vision Syndrome (CVS)
At some time you may encounter an OSHA official in a healthcare institution. Being prepared and being familiar with OSHA health safety regulations can make the experience a lot less stressful. They can also make a hospital a whole lot safer for its workers.