"This document was published prior to the publication of OSHA's final rule on Ergonomics
Program (29 CFR 1910.900, November 14, 2000), and therefore does not necessarily
address or reflect the provisions set forth in the final standard."
Charles N. Jeffress
Frontline Healthcare Workers
August 7, 2000
- Have you ever thought of yourself as a warrior? Perhaps that's not a picture that comes readily to mind. As healthcare professionals, you've dedicated your career to preserving lives, promoting health and offering comfort.
- Still, the warrior image may be apt. You face a battle against a myriad of hazards. Some of those hazards are fatal. In caring for your patients, you may place your own health at risk.
- Your mission, as defined by Hippocrates nearly 2500 years ago, is "to help, or at least to do no harm." While Hippocrates focused on preventing harm to the patient, it's equally important to avoid harm to the healthcare provider.
- People have always been the most important element in healthcare. Whether it's someone using the computer for a more accurate diagnosis or someone holding a fragile newborn, people make the difference. Our healthcare system depends on healthy, skilled workers who have a special gift for caring for others.
- So before you go into battle, be sure you're prepared. Use the most effective weapons. For example, you need needles with safer designs, ergonomics programs to reduce your risk of back injury, scavenging systems to eliminate waste anesthesia gases.
- OSHA is on your side in this effort. Preserving frontline workers' health is not at odds with good patient care. On the contrary, it's part and parcel of good patient care. We can and must accomplish both goals together. I believe good healthcare and good occupational protection go hand in hand. It's not either/or. It's both/and.
- OSHA takes your health as seriously as you take the health of your patients. We'll be discussing the nexus between patient care and healthcare employee health at a best practices conference we're co-sponsoring in October in Pennsylvania. I hope many of you will be able to come to that event.
- You'll be talking more today and tomorrow about specific ways to prevent needlesticks and protect against bloodborne pathogens. Since 80 percent of the occupational exposures to blood occur through needlesticks, these injuries are of grave concern.
- Let me put it a little more personally. Each of you sitting here today faces a one-in-seven chance of experiencing a needlestick this year. That's because in 2000, we estimate 600,000 to 800,000 needlesticks will occur among the 5.6 million healthcare workers in the U.S.
- Over and above needlesticks, in 1998, nearly 490,000 recordable injuries occurred in U.S. hospitals and nursing homes-about eight percent of all workplace injuries and illnesses in the private sector. While injuries have declined, that number is still far too high.
- One of the ways we are seeking to address that problem is by focusing our resources on the workplaces with high injury and illness rates. This year, OSHA identified 13,000 specific worksites, including 2,600 healthcare facilities, with higher than average injury and illness rates. Our inspections are focused on these high risk sites.
- In the spring, I wrote to each of the 13,000 sites, alerting employers to their high rates and encouraging them to improve their safety and health programs. For hospitals, we even offer a special web page on our Internet site filled with useful information and links to other helpful sites.
- We will continue our efforts, through both enforcement and education, to work with healthcare employers, unions and associations to make your workplaces safer.
- Many of you were here two years ago for the last Frontline conference. I want to talk for a few minutes about some of the developments that grew out of that session.
- At the last conference, I announced that OSHA would be requesting information on preventing needlesticks. In September 1998, we asked the public for details on engineering and work practice controls used to prevent needlesticks. We received nearly 400 responses, and the healthcare community sent us a great deal of valuable information.
- We learned that a variety of safer devices exist. But they aren't in widespread use. So there are still many, many needlesticks occurring that could be prevented. Comments also made clear that training and education are critical. Just buying safer devices isn't enough. Involving frontline workers in evaluating new devices is especially important in selecting the equipment best suited to each facility.
- Based on the information we received, OSHA updated its bloodborne pathogens compliance directive, as I promised we would. The directive we issued last fall does not change the standard or create new legal duties, but is a restatement, clarification and further explanation of the standard's requirements.
- For one thing, it emphasizes the importance of reviewing a facility's exposure control plan at least once a year. A key part of that plan is identifying and implementing the engineering controls that form the first line of defense against exposure to bloodborne pathogens. The directive makes plain that every year workplaces covered by the standard should consider whether more effective devices are available to protect workers against needlesticks. If better devices
exist, the facility needs to consider which ones would be the most appropriate to use. It's also important to review basic work practices, personal protective equipment and administrative controls.
- Further, we've expanded the sections in the directive that focus on coverage of multi-employer worksites such as home health services, employment agencies, personnel services and independent contractors.
- Discussions at the last Frontline conference also called our attention to safety hazards posed by glass capillary tubes used for blood samples, a subject that Diane Mawyer will talk about later this morning. OSHA, NIOSH and the FDA published a joint safety advisory in February 1999 to warn about the dangers associated with accidental breakage of the tubes. When tubes break, blood may splatter on healthcare workers or glass fragments may cut you. About 2,800 injuries occur every year from broken tubes.
- The advisory got widespread distribution, both through the agencies and through professional journals. Purchasers and manufacturers took notice. Some suppliers are no longer offering glass tubes, and some manufacturers have switched to other materials for the tubes they make.
- We believe that this effort has made the healthcare setting safer for thousands of workers. It's an example of how government, employers, researchers, employees and the media can work together towards a common goal.
- Another concern for healthcare workers discussed at the last Frontline conference was latex allergies. In April 1999, OSHA issued guidance to field personnel that was widely circulated in the healthcare community alerting people to the potential for allergic reactions among workers using latex gloves. We estimate 8-12 percent of healthcare workers are latex sensitive.
- OSHA's technical information bulletin provides a detailed discussion of the latest research on latex allergy. It covers the types of allergic reactions that can develop once workers become sensitized to latex. Perhaps more importantly, the bulletin lists strategies healthcare facilities can use to minimize the risk of allergic reaction. Recent studies verify that reducing the risk of latex allergy is sound business practice because it reduces disability among essential healthcare workers.
- In addition to the materials we've developed to help healthcare employers and workers address health concerns, OSHA is looking at other ways to promote workplace safety in healthcare facilities. Partnership is one of those ways. We've encouraged healthcare facilities to join our Voluntary Protection Programs, which recognize outstanding safety and health programs. Two nursing homes in Missouri and two hospitals in Ohio are currently participating.
- Also, in early June, we renewed our partnership with the Joint Commission on Accreditation of Healthcare Organizations. We've worked with the Joint Commission since 1996 to develop training materials and publications for healthcare facilities. And the Joint Commission's accreditation manuals now include specific examples to illustrate how compliance with OSHA standards also
satisfies Joint Commission standards.
- OSHA is also developing a course for our inspectors that focuses on the healthcare industry with special emphasis on hospitals. We've had help from many stakeholders, and the first session will run this November.
- As many of you know, OSHA is revising its recordkeeping standard. One of the issues we're looking at is whether all exposure incidents resulting from contaminated needles and other sharps should be reported. Now, only those that lead to illness or require medical care beyond first aid must be entered on the OSHA log.
- Of course, any new rule would include strong privacy and security safeguards. Our recordkeeping rule should be published before the end of the year.
- Ergonomics is OSHA's top priority for standard setting. The reason is very simple. That's where the injuries are. Back injuries, carpal tunnel syndrome and other MSDs total more than one-third of the most serious work-related injuries each year. About 1.8 million workers experience these injuries each year. This includes 600,000 injuries serious enough to cause workers to miss work. More than 65,000 of those injuries involve healthcare workers.
- OSHA's proposal focuses on high risk jobs such as lifting patients. The proposal requires employers to fix jobs where there are problems. Employers would also provide medical treatment if needed and pay for lost time.
- It's a sensible, flexible proposal. It would eliminate an average of 300,000 serious injuries each year and save $10 billion in medical treatment, workers' compensation, and related costs.
- To hear our critics talk, you'd think that you all are suffering these back injuries and MSDs from playing tennis on weekends, not from lifting patients. You'd also think that investing in your health will bankrupt your employer. Make not mistake about it, the fight over ergonomics is a fight over your health. You and your employers will win by implementing effective ergonomics programs, and we cannot let the partisan attacks prevent us from accomplishing our goals.
- One thing I want to make very clear: We will complete an ergonomics standard this year. Our ergonomics team is committed to doing that. I am committed to doing that. The Secretary of Labor is committed to doing that. And the President and Vice President are committed as well.
- One final thank you from me to you: This afternoon you will present the Susan Harwood Memorial Awards for Outstanding Student Research. I appreciate your honoring the memory of this dedicated OSHA employee in such an appropriate manner. Dr. Harwood was a key member of OSHA's staff for 17 years and was instrumental in the development of the BBP standard, which was just one of the multitude of standards to which she contributed. Cotton dust, formaldehyde, lead in construction...were other areas where she worked diligently to protect workers. OSHA now names its training grants The Susan Harwood Grants in her honor. Thank you for helping to honor further a woman who fought hard and won a major victory for workers with publication of the BBP standard.
- Frontline healthcare workers wage war against disease on behalf of all of us. You do your best to see that your patients go home whole and healthy. And we all appreciate that.
- You have a right to go home whole and healthy every day, too. And OSHA has a responsibility to do our best to see that you, too, have a safe and healthful workplace. I look forward to continuing to work with you toward that end.