1. Wallis, Laura


New guidance on inspections in health care settings.


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Health care settings, such as hospitals and long-term care facilities, have some of the highest rates of injury and illness in the country-with a total case rate of 6.4 work-related injuries and illnesses for every 100 full-time employees in calendar year 2013, according to the Bureau of Labor Statistics. Amid growing concern, Occupational Safety and Health Administration (OSHA) deputy assistant secretary Dorothy Dougherty issued a safety memo on June 25 to guide inspections in health care settings.


The memo focuses on five specific areas of danger: musculoskeletal disorders related to patient or resident handling; workplace violence; blood-borne pathogens; tuberculosis; and slips, trips, and falls. Musculoskeletal injuries, also known as overexertion, are areas of particular concern; 44% of all reported injuries within the health care industry were attributed to overexertion.


The memo details inspection procedures, including determining whether a system is in place to prevent ergonomic injuries, whether that system is being implemented, and whether employers are being properly trained in the use of safety equipment, as well as suggested language for issuing citations. The guidance applies to all federal OSHA inspections in hospitals and nursing and residential care facilities. Because these hazards are a nationwide problem, state plans are also expected to follow the guidance.


The move represents an expansion of the National Emphasis Program on Nursing and Residential Care Facilities, which expired in April. At that time the agency announced that given the severity of safety concerns, updated guidance was forthcoming. This comes on the heels of recent media attention on workplace injuries among nurses and the relative lack of attention hospitals and government agencies have paid to the issue-including a multipart series this year on National Public Radio titled Injured Nurses (


Debbie Dawson Hatmaker, executive director of the American Nurses Association (ANA), is encouraged by the OSHA memo, stating, "We hope [it] will encourage hospitals to take seriously setting a comprehensive program for mobility and safety." She isn't convinced, however, that the move goes far enough.


The ANA issued a statement on the same day the OSHA memo was released commending the agency and the Obama administration for the move, calling it a "step in the right direction" but noting that the "ANA believes a federal ergonomic standard is necessary to protect health care workers."


Says Hatmaker, "Nursing assistants and RNs have very high injury rates. And injuries occur not from single incidents but from repeated small injuries over the years, and they can be career ending."


Ultimately, she says, the ANA's position "is that we believe there should be no manual lifting, for the safety of the patient as well as the worker. Creating a culture of safety is very important."


And although the new guidelines, as well as safety resources made available on the OSHA Web site (, can help hospitals tackle safety issues head on, the creation of national ergonomic standards could "make it happen in a much stronger way."


The ANA leadership is optimistic that this will happen and is working with Representative John Conyers (D-MI) to gain Senate support for a bill that would establish safer patient-handling standards nationwide.-Laura Wallis