What you should know about OSHA's safety initiative.

On August 8, the U.S. Department of Labor launched a seven-state initiative to protect workers in nursing homes. Just three days earlier, an agreement was reached between OSHA and the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) to form a three-year partnership to promote health and safety for health care workers. Whether this news reached you from one of several newsletters (e.g., "OSHA Week" or "Ergonomics Intelligence Report") or you picked it up off the Internet (www.osha.gov), much is happening that can impact your nursing home operations. This article will briefly describe the OSHA initiative and add some details about its implementation.

Why is this all happening now? Certainly the nursing home industry has been aware for years of the abundance of nonfatal occupational injuries and illnesses to their personnel. The Bureau of Labor Statistics found in 1994 that nursing homes had the third highest incidence rate (16.8 per 100 fuIItime workers) among industries with 100,000 or more nonfatal injury or illness cases. Nursing home workers experience most injuries when handling residents (51.2% of reported injuries). Back injuries account for 42% of all injuries in nursing homes, compared to 27% in the private sector. Statistics like these have led OSHA to cite many nursing homes under the General Duty Clause (5.A.1), but whether unsafe lifting can be established as the cause of these back injuries is still being argued (Department of Labor v. Beverly Enterprises, now being appealed).

There is no standard for ergonomics in the U.S. at this time -- and the debate among scientists, politicians, labor unions and business consortiums continues to rage. In the meantime, OSHA has gained experience with the Maine 200 Program for the past three years, with many successes to report. In fact, three of the four nursing home case studies presented by OSHA on the Internet are from Maine. Now, instead of concentrating on enforcement efforts, with this initiative OSHA has signaled an interest in helping those nursing homes that want to help themselves.

What does the initiative entail? Stressing a comprehensive safety and health program approach, seven states been selected for the pilot program, based on having at least 500 nursing homes (Florida, Illinois, Massachusetts, Missouri, New York, Ohio and Pennsylvania). Keith Motley is the overall coordinator for the program (reachable at OSHA's Health Response Team at 801-487-0521). I also spoke with Graciela Perez, who is coordinating the initiative for the Northeast Region (617-565-9833).

Based on our discussions, I learned that OSHA compliance officers received three days of training in August on the characteristics of nursing homes and regulations that apply to them. Their training also included setting up safety and health programs, hazard recognition and control procedures, and techniques to handle residents safely. The outreach segment of the initiative began last month and continues through October, with free training and education seminars offered to nursing home industry representatives in the seven states. After the training sessions, OSHA will target worksites with the greatest documented safety and health problems for enforcement -- an approach they took with Maine 200.

The free training sessions, scheduled to last one day, will introduce attendees to OSHA, and will cover issues and solutions from OSHA's experience (involving hundreds of nursing homes over the past several years). The training will not be "indepth" -- rather, it will provide broad exposure to important topics to guide nursing homes, subsequent efforts. Within the framework of a comprehensive safety and health program, the following topics will be covered@ tuberculosis, bloodborne pathogens, workplace violence (including combative residents), resident handling, slips, trips and falls, hazard communications, machine guarding, and electrical hazards. A document detailing how to develop a safety and health program appropriate for a nursing home will be distributed at each training session.

Given the many topics to be covered in a single day, how much information about the ergonomics of resident handling can be presented? About one hour of each session will be spent looking at the statistics describing handling of residents, comparing the stresses of manual transfers to those of device-assisted transfers, and exposing the attendees to the wide variety of devices that are available. The importance of medical management for injured workers will also be stressed. From my own perspective, each of these subtopics could easily require at least a full day of training before nursing home staff would understand the implementation of appropriate control strategies in their own environments. (Incidentally, the components of a comprehensive safety and health program and a comprehensive ergonomics program are the same: worksite analysis, hazard prevention and control, medical management, and training and education.)

OSHA also points out that it is offering free consultation services to small nursing home employers in these states. However, the "how to" specifics should be obtained from trained experts who can help employers identify and correct specific hazards and set up comprehensive safety and health programs.

To contact OSHA's nursing home coordinators in specific regions, call:

CT, MA, NH, RI, ME, VT: 617-565-9860 NJ, NY, Puerto Rico, Virgin Islands: 212-337-2378 D.C., DE, MD, PA, VA, WV: 215-596-1201 AL, FL, GA, KY, MS, NC, SC, TN: 954-424-0242 IL, IN, MI, MN, OH, WI: 312-353-2220 AR, LA, NM, OK, TX: 214-320-2400 IA, KD, MO, NE: 816-426-5861 CO, MT, ND, SD, UT, WY: 303-391-5858 AZ, CA, NV, HI, Guam, American Samoa: 808-541-2685 AK, ID, OR, WA: 206-553-5930

Finally, there is no guarantee that nursing homes that attend the free training sessions will escape OSHA enforcement. They will, however, learn the extent of OSHA's concern for the nursing home as a workplace and should be able to proceed with developing their own comprehensive safety and health programs.

Robert O. Andres, PhD, CPE, is President of Ergonomic Engineering, a safety consulting firm based in Pelham, MA. For further information, [phone].