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OSHA issues new inspection guidelines for field inspectors: How you’re affected

Hospital Safety Insider, September 22, 2016

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Q: Given the topics it covers, do you think the inspection guidance will make a significant impact on reducing work-related injuries?

Marge McFarlane: I hope so, but I think that the focus of the new inspection guidelines is to manage your upstream risk. If we manage our upstream risk by ensuring that people aren't lifting patients when they shouldn't be, and that there's enough staff, training, and equipment, then you reduce the probability that something bad is going to happen to those people.

Some of the OSHA documents said this [guidance] is what we're going to hold people accountable for. But we don't know how that will play out. Will there really be inspections? Will they really publish the results? Will they really hold people accountable? I think once there's been a few inspections, the OSHA reports come out, and people are cited, then others will take notice.

OSHA has been around since 1970 and the threat has always been there. But I don't know if our employers think that an inspection is imminent. They have other priorities and may say, "we'll deal with OSHA when they come." There's a whole generation or two of workers in the field who see it as not that big a deal. I don't know that they understand the real consequences of something like hepatitis C infection or their part in the potential transmission of hepatitis C. Go to all those [Centers for Disease Control and Prevention] investigations where they're sending notices to hundreds or thousands of people who may have been exposed to blood-borne pathogens.

I think that when people aren't wearing their gloves or doing the cleaning or reusing things they shouldn't, that they may not be aware of risk to people's lives down the line. I just think it's an emphasis whose time has come again.

Q: It didn't seem like any of the instructions the guidance referred to were new. Was there anything created especially for this?

MM: No. These are things that are out there. I just don't think they're on people's radar. But when OSHA did that study [for the guidance] they looked at nursing homes, especially at ergonomics from 2012?2014. In that study you saw the incidence of ergonomic injuries to people and it was significantly above the private sector. This is the value of looking at data and saying, "What population is at risk; are they being harmed?"

The OSHA standard is to protect you from physical injury or death. And improper lifting or repeated lifting or not having the proper equipment for lifting can definitely [cause] physical injury. As a safety officer, I've seen career-ending patient handling events; where nurses try to move people, hurt their backs, and are on light duty for the rest of their lives. [Their injury] isn't operable, they can't do what they were hired to do, and aren't nursing at the bedside anymore. It just takes a moment for this to happen and your life is different.

I think that the emphasis on violent patients needs focus; there is no [OSHA] standard. If the culture isn't strong from the top, saying, "we need to protect, we need to report, we need to educate, we need to prevent," [then this will keep happening.] I've seen situations where violence on staff is the cost of doing business; I've seen that mentality from administration.

I've seen people be attacked or hurt. Some needed surgery, some had concussions. Again, if the wrong person hits them, that raises the possibility of hepatitis C as well as violence.

 

Q: Are there specific standards already in place for the various hazards?

MM: There's nothing new. I think that the Blood-borne Pathogens standard is the one that has a [specific OSHA] standard. Workplace violence doesn't have a specific OSHA standard, nor do ergonomics, tuberculosis, and respiratory. Slips, trips, and falls [STF] is a general industry OSHA standard, but I'm not sure it's a hot topic in healthcare. But again, it goes to priority when you can't go look at incidences of people running or people wearing improper shoes. Especially hurrying downstairs if they're reading something or texting and they have shoes without backs on them. Then you see incident reports that they slipped on the last step because they didn't count [the steps.] And because they were doing something else, they fall and hurt their knees, their hands, or their back, and they call it an accident.

It's like, "no, you had risk factors. You were hurrying, you were wearing improper shoes, and you weren't paying attention to the task at hand (i.e., walking down the stairs holding the handrail)."

People go, "I need to multitask or I can't get my day done." And I say, "there's a tradeoff then. You roll the dice that something bad won't happen to you. And when it does you're very sorry and say, 'I played no part in this.' When you really look at all the situations, we take some risky behaviors. We take some unsafe behaviors, and when the bad stuff happens we're surprised.

This is an excerpt from the monthly healthcare safety resource Briefings on Hospital Safety. Subscribers can read the rest of the article here. Non-subscribers can find out more about the journal, its benefits, and how to subscribe by clicking here.
 

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