Feds set stage to grapple with ergonomics
Feds set stage to grapple with ergonomics
Patient-handling injuries lead health care concerns
Protecting health care workers from musculoskeletal injuries associated with lifting and moving patients was the focus of health care section presenters and attendees at a landmark national conference held recently in Chicago. The event signals renewed interest on the part of the U.S. Occupational Safety and Health Administration (OSHA) in confronting and addressing the controversial issue of ergonomics programs in the nation’s workplaces.
More than 1,000 representatives of business, labor, government, and academia attended the conference, which was co-sponsored by OSHA and the National Institute for Occupational Safety and Health (NIOSH). More than 60 speakers presented case studies at the first major national forum for exchanging information about developing and instituting effective workplace ergonomics programs. Attendees represented a broad range of workplaces plagued by high rates of musculoskeletal injuries, including factories, offices, construction sites, mines, farms, and health care facilities.
Approximately 200 representatives from the health care community, including many hospitals, attended the session on ergonomics in health care. Workers in the health care industry incur a high rate of musculoskeletal injuries, many from patient lifts and transfers. In fact, recent unpublished figures show hospital employees rank highest of all industry workers in incidents of repeated trauma and overexertion due to lifting, says Gary Orr, PE, CPE, an ergonomist and industrial engineer in OSHA’s office of ergonomic support. Orr helped organize the ergonomics conference.
While musculoskeletal and repetitive stress injuries are a significant problem in terms of employee safety and workers’ compensation costs, the issue of developing workplace ergonomic regulations has become a political hot potato. After three years of development, OSHA released an ergonomic standard draft proposal in 1995.1 (See related story in Hospital Employee Health, July 1995, pp. 85-92.)
However, the government budget crisis shutdown as well as congressional action aimed specifically at preventing development of a standard, which was perceived by some influential segments of the business community as being cost-prohibitive stymied any further OSHA action. Now, similar opposition threatens to prevent even the issuance of any federal guidance on preventing worker injuries.
A rider attached to OSHA’s appropriations budget for 1998 specifically prohibits development of a standard or any guidance material on ergonomics, says Orr. It would require OSHA to fund a lengthy National Academy of Sciences study to find out if ergonomics-related problems actually are responsible for worker injuries. By the time such a study is complete and a new standard developed and issued, the next century would be well under way.
Hearings on the budget and rider will be held this summer, and should the rider pass, the agency will have only until Oct. 1, the beginning of its 1998 fiscal year, to issue any guidance on ergonomics issues.
"I would like to put together guidance materials or technical assistance materials, but unfortunately, if the appropriations rider says no standard and no guidance materials, then we’re stuck," Orr says. "The thought is that if we develop guidance material, it is a rule without making a rule. It really hamstrings our organization. We couldn’t even provide good technical assistance material because it might be viewed as guidance. Even a memo on good practices for an industry such as health care could be construed as developing guidelines for that industry."
Nevertheless, OSHA is moving ahead with several ergonomics-related initiatives. An ergonomics coordinator has been named to direct educational, research, enforcement, and rulemaking activities. The agency also plans to release transcripts of the conference no later than this summer, possibly organized by industry category, to all interested parties.
"This is one of the biggest workplace problems we have to deal with," says Orr. "As the agency that protects worker safety and health, we’ve got to say or do something. What I hope would spin off [from the conference] is to develop best practices for the health care industry, something people could use as a kernel of a start, a basis for building something that is successful for [health care employers]."
The premise of the conference was for OSHA and NIOSH to discover whether ergonomics programs are indeed successful, as well as to give participants an unprecedented networking opportunity, he adds.
Some concerns were common to all industry sectors, such as the need to obtain management commitment, but each industry had its own problems, as well. In health care, for example, the main concern was patient- or resident- handling. The consensus was that a piecemeal or fragmented approach to the problem does not work. Just purchasing back belts or several pieces of lifting equipment, for example, does not provide an adequate solution. Instead, a more thorough or integrated approach, such as a total ergonomics program, works best.
Orr says successful programs in the health care setting include the following elements:
• management commitment and support;
• employee involvement, including evaluating equipment and training other employees;
• workplace analysis to identify problem jobs;
• hazard control that goes beyond the "patchwork approach" of buying a few pieces of equipment and expecting them to solve all the problems;
• medical management, which includes identifying injured workers and helping them return to the workplace;
• employee training to raise awareness of ergonomics problems and to teach employees how to lift patients and use equipment properly.
Information to be on Web site
Attendees and speakers also agreed that workers who are hurting can’t do quality work, says Christopher Gjessing, public health advisor for NIOSH’s division of physical sciences and engineering, and a conference coordinator.
"It’s common sense, but it’s a problem. These [ergonomics] programs save employers money, from workers’ comp costs to quality issues," he says. "We know that despite all the debate and the fury about OSHA creating a standard, many companies are developing and running ergonomics programs they feel are effective."
To help disseminate the information shared at the conference, Gjessing says NIOSH will post much of it on the agency’s Web site (http:// www.cdc.gov/niosh/homepage.html), along with other ergonomics information that will be updated regularly.
A 130-page ergonomics primer distributed at the conference also is available by calling (800) 35-NIOSH and asking for Elements of Ergonomics Programs: A Primer Based on Workplace Evaluations of Musculoskeletal Disorders, DHHS NIOSH Pub. No. 97-117. Although it is not based on conference information, the primer represents more than 20 years of NIOSH workplace investigations and contains case studies drawn from those experiences, Gjessing says.
Based on numerous ergonomics-related inquiries NIOSH has received, as well as the overflow crowd at the conference only about 300 attendees were expected, and registration had to be cut off at 1,000 other conferences could follow, he adds.
Guy Fragala, PhD, PE, CSP, arranger and chair of the conference’s health care section, says federal recognition of high rates of musculoskeletal injuries among HCWs is important.
"The conference reaffirmed that people are interested in ergonomics. It’s something that needs to be addressed, and I think we’ll see some activity. OSHA will set some priorities, and it’s clear that they will pursue ergonomics. Enforcement activity will continue," says Fragala, who also is director of environmental health and safety and faculty member at the University of Massachusetts Medical Center’s occupational health program in Worcester.
A national speaker, teacher, and author on ergonomics in health care (see Literature Review in this issue, p. 57), Fragala says the health care industry recognizes "they have a significant problem with workers’ compensation and back injuries. It’s costing the industry money, and it needs to be dealt with." Many health care employers are not waiting for a federal standard to force development of an ergonomics program, he points out.
Reference
1. U.S. Occupational Safety and Health Administration. OSHA’s proposed ergonomics protection standard: Draft. Washington, DC: OSHA; March 13, 1995.
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