Our Insights

Bryan Connors, M.S., C.I.H., H.E.M.

The Occupational Safety and Health Administration (OSHA) released its 2014 inspection plan and hospitals will continue to be targeted for enforcement based on their high rate of employee injury and illness. According to OSHA, hospital workers experienced 250,000 work-related injuries and illnesses in 2012, and workers’ compensation costs total $2 billion every year. This article reviews the most commonly cited hazards in patient care areas and traditional areas and discusses current strategies for ensuring OSHA compliance.

Commonly Cited Traditional Hazards

 Electrical Safety & Lockout/Tagout

These are a high priority by OSHA inspectors due to the seriousness of injury and fatalities.  Compliance requires labeling, training, written lockout/tagout plans and procedures, and use of insulated tools and personal protection equipment (PPE).

Fall Protection

This applies to roof work (including servicing roof top equipment such as security cameras, light, and heating, ventilating and air-conditioning [HVAC] equipment) and window washing.  Compliance requires a fall risk assessment; training; hazard control systems that are properly designed, specified, and installed; and may require personal fall arrest systems.

Confined Space

Defined as those that: 1) are large enough and configured that an employee can bodily enter and perform assigned work, 2) have limited or restricted means for entry or exit (e.g., tanks vessels, storage bins, vaults, and pits) or 3) are not designed for continuous employee occupancy.  Compliance requires an inventory, signage, training, written entry and rescue procedures, and atmospheric testing in some cases.  The hospital is responsible for contractor and vendor entry as well.

Asbestos

Employee exposure to asbestos containing material (ACM) during construction typically constitutes the high fines from OSHA. Asbestos compliance involves an inventory of ACM in the hospital, a written asbestos management plan, a hazard/exposure assessment, labeling, employee training, and may require medical surveillance.

Machine Guarding

Mechanical rooms and maintenance shops are rife with moving parts on carpentry and maintenance equipment, elevator pulleys, HVAC equipment, pumps, and pneumatic equipment. Other departments such as food services, environmental services, and radiology often have guarding issues as well.

Commonly Cited Hazards in Patient Care Areas

Bloodborne Pathogens Standard and Needlestick Safety and Prevention Act

Bloodborne pathogens was the most frequently cited standard in hospitals in 2013. The standard applies to all employees with occupational exposure to blood or other potentially infectious material, including body fluids mixed with blood, pleural fluid, saliva, etc.
Some of the most common violations under the Bloodborne Pathogens Standard include:

Exposure Control Plan

Review and update the written Exposure Control Plan annually.

Hazard Communication and Training

Training must be conducted annually and documented. Review the training program to ensure it is of high quality and incorporates input from staff on hazards and risks. Verify that documentation is complete and readily accessible.

Waste Handling and Storage

This is a more visible area of compliance and violations will be easily spotted by an OSHA inspector. Ensure proper labels / signage, access to waste containers is not blocked, infectious waste bags are inside containers, and containers are not over-flowing.  Also keep in mind that several states have additional regulations pertaining to management and disposal of biological waste and sharps.

Sharps Injuries

Procedures must be in place for implementing and evaluating (product review, trial period) safer medical devices, including a mechanism for gathering employee feedback which is key to minimizing risks.  The Needlestick Safety and Prevention Act also requires that the hospital establish and maintain a sharps injury log for recording percutaneous injuries from contaminated sharps. The Sharps Log must contain, at a minimum, information about the injury, the type and brand of device involved in the injury (if known), the department or work area where the exposure occurred, and an explanation of how the incident occurred. The log must be recorded and maintained in such a manner so as to protect the confidentiality of the injured employee.

When an injury does occur, the proper documentation must be completed in accordance with the Bloodborne Pathogen Standard requirements.   For performance improvement and program development, ensure that enough data is being collected that will allow the hospital to track and trend injuries.

Personal Protective Equipment (PPE)

Hospitals are required to establish clear criteria for the use of PPE and provide staff training on recognizing risks. Additionally, hospitals are required to provide appropriate PPE that is accessible to staff within a reasonable distance.

Managers should conduct inspections to verify that appropriate types and sizes of PPE are being stored and are accessible.  Interview staff to ensure they can locate PPE.

Ergonomics and Safe Patient Handling

Ergonomics issues can be cited under the General Duty Clause. Before issuing a citation, OSHA will consider:

• Whether an ergonomic hazard exists.
• Whether that hazard is recognized.
• Whether the hazard is causing, or is likely to cause, serious physical harm to employees.
• Whether a feasible means exists to reduce the hazard.

An effective ergonomics program includes:

• Leadership support is essential to success.
• Facility equipment and design.
• Patient assessment to identify risks and when to use equipment.
• Staff training on how to identify risks and how to use equipment.
• Clear criteria for “no lift” policies.
• A process for tracking injuries and responding to them.

Common Hazards in the Clinical Laboratory Environment

 Formaldehyde

OSHA has prescriptive requirements for labeling and this is a common vulnerability for many hospitals. Labels must include the chemical name, hazard warning, and must state “Caution: Cancer Causing Agent”. Labeling the outside of a storage cabinet is not sufficient; the container itself must be labeled.

Hospitals are required to conduct monitoring for employee exposure to formaldehyde for specific exposure limits (permissible exposure limit and short-term exposure limit). This includes employees in clinical and pathology laboratories. Often, employers will not monitor all of the procedures required by OSHA. Specifically, ensure that “waste dumping procedures” have appropriate exposure determination and monitoring data.

Training is required annually for anyone working with a certain concentration of formaldehyde or with a certain exposure to formaldehyde.

Hazardous Spill Response

Any employee responsible for responding to a hazardous spill must have specialized training. Hospitals must provide spill kits and appropriate PPE including respirators. Often, hospitals are vulnerable in training requirements and written procedures for chemical spill response.

Medical and First Aid – Eye Washes

Inspections should be conducted routinely to verify that eye washes are available and accessible (not blocked or covered).  Also ensure that eyewashes are in close proximity (e.g., within about 10 seconds) from where injurious chemicals are stored and used.

Compliance Strategies

A hazard and risk assessment is the first step toward ensuring OSHA compliance for hazards in patient care areas and traditional hazards. Don’t assume that Environmental Rounds (Hazard Surveillance) will spot these types of issues – dedicate a separate survey that involves hospital personnel who perform both typical and high hazard tasks.  Based on our experience conducting OSHA compliance gap analyses for hospitals, we recommend the following to ensure OSHA compliance:

• Review training programs carefully.  They should be of high quality and contain input from staff on site-specific conditions and hazards.  Ensure training records are complete and current – this is the first thing an OSHA inspector will review.
• Many standards have very prescriptive requirements for written policies. Ensure the necessary policies are in place and current.
  Ensure there is a system of defined responsibilities in place to maintain compliance.  Almost invariably, when programs do not have “program owners” there are lapses in safety and/or compliance.
• Don’t depend on occasional hazard assessments to point out deficiencies, but rather put this responsibility in the hands of several people who have operational responsibilities. Request regular reports from these people (with metrics if applicable).
• Assure topical experts are used when developing safety procedures.

OSHA compliance can often be a problem in hospitals because of the wide range of activities taking place (including those of outside contractors) across many departments.  A dedicated effort is necessary to ensure continuous compliance and can help prevent a serious injury, reduce workers’ compensation costs, and reduce risk to brand name.  Fortunately, many of the review and improvement mechanisms already exist in hospitals to ensure Joint Commission compliance, and with a little additional effort and a trained eye they can be applied to ensuring OSHA compliance as well.

Achieving a safer workplace and OSHA compliance may seem like a formidable task, but if tackled methodically using the results of the hazard and risk assessment it is very doable. The high cost of employee injury and illness, non-compliance, and risk to staff and patient well being is more than worth the effort to improve safety performance.

Bryan Connors, M.S., C.I.H., H.E.M., is Practice Director, Healthcare, at EH&E.  He has extensive program management experience in environmental health and safety and facilities compliance programs in the healthcare and biotechnology sectors, including 10 years of direct program management responsibilities in several tertiary care hospitals.  For more information, contact Bryan at bconnors@eheinc.com.