Categories: OSHA

By Eric J. Conn, Head of Epstein Becker & Green’s OSHA Practice Group

OSHA recently announced a campaign to raise awareness about the hazards likely to cause musculoskeletal disorders (MSDs) among health care workers responsible for patient care.  Common MSDs suffered in the patient care industry include sprains, strains, soft tissue and back injuries.  These injuries are due in large part to over exertion related to manual patient handling activities, often involving heavy lifting associated with transferring and repositioning patients and working in awkward positions.

“The best control for MSDs is an effective prevention program,” said MaryAnn Garrahan, OSHA’s Regional Administrator in Philadelphia. “[OSHA’s] goal is to assist nursing homes and long-term care facilities in promoting effective processes to prevent injuries.”

As part of the campaign, OSHA will provide 2,500 employers, unions and associations in the patient care industry in Delaware, Pennsylvania, West Virginia and the District of Columbia with information about methods used to control hazards, such as lifting excessive weight during patient transfers and handling.  OSHA will also provide information about how employers can include a zero-lift program, which minimizes direct patient lifting by using specialized lifting equipment and transfer tools.  Here is a resource regarding Safe Patient Handling from OSHA's website.

Employers in the healthcare industries should be on high alert, because whenever OSHA provides information about hazards it believes are present, a focus on enforcement is soon to follow.  This is particularly true when it comes to hazards for which OSHA has no specific standards or regulations, like ergonomics.  In these circumstances, OSHA is limited in its enforcement to use of Sec. 5(a)(1) of the OSH Act – the General Duty Clause.  The General Duty Clause is used by OSHA to issue citations in the absence of a specific standard, in situations where employers have not taken steps to address “recognized serious hazards.”  Efforts like OSHA’s present campaign to advise healthcare employers about hazards in their workplaces, is OSHA’s way of making you “recognize” the hazard, so the Agency can more easily prove General Duty Clause violations.

Of course, there are plenty of other reasons that healthcare employers should take note of the rate of MSD cases in patient care work.  First, MSD injuries carry with them significant costs, from medical expenses, to disability compensation, and litigation.  Direct and indirect costs associated with back injuries alone in patient care are estimated at $20 billion annually.  Second, MSD injuries are particularly costly because they are generally accompanied by chronic pain, which leads to frequent absenteeism and employee turnover.  As many as 20% of nurses who leave direct patient care, do so reportedly because of MSD injuries on the job.  Finally, healthcare employees who experience pain and fatigue may be less productive, less attentive, more susceptible to other injuries, and may be more likely to affect the health and safety of others, including co-workers and patients.

OSHA’s campaign is fueled by the growing number of MSD cases in the patient care industry over the past few years.  OSHA reported 40,030 occupational MSD cases in private industry nationwide in 2010, where the source of injury or illness was a patient or resident of a health care facility.  Nurse aides, orderlies, and attendants reportedly have the highest rate of MSDs, with an incident rate of 249 per 10,000 workers.  This is nearly seven times the national average for all other industries (34 per 10,000 workers).

This ergonomics campaign comes in the wake of several other OSHA initiatives targeting the patient care industry.  For example, in 2012, OSHA launched a National Emphasis Program (NEP) for Nursing and Residential Care Facilities to address safety and health hazards common in nursing homes.   The NEP, expected to last at least three years, directs OSHA’s enforcement resources at evaluating, among other hazards, employers’ efforts to address the risks of resident handling.   Employers are evaluated on:

  • how residents are assessed for their mobility needs and who does the assessment;
  • the adequate number and variety of mechanical devices, along with a variety of slings and sling sizes;
  • the use of additional devices such as friction-reducing, transfer, and repositioning devices; and,
  • employee training and demonstration of competency in doing transfers and using equipment.

Read more about the Nursing Home NEP here on the OSHA Law Update Blog.

This healthcare ergonomics campaign also fits in with OSHA’s other efforts to regulate ergonomic hazards across all industries.  For example, in 2011, OSHA proposed to revise its Injury and Illness Recording and Reporting regulation to require employers to check a box in a new column labeled “MSD” on the OSHA 300 log.  In other Rulemaking activity, we expect OSHA to use its proposed Injury and Illness Prevention Program (IIPP) rule, which has been under development for almost three years, to lead to an enormous increase in enforcement related to ergonomic issues and MSDs.  Read more about OSHA’s efforts to develop the I2P2 Rule here.


Daniel C. Deacon, a Summer Associate (not admitted to the practice of law) in Epstein Becker Green’s Washington, DC office, contributed to the preparation of this post.

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