By: Shane Stuller

July 2015

Although often overlooked, nursing home and residential care is one the most hazardous industries in the nation. So much so, that in 2012, OSHA issued a National Emphasis Program for programmed inspections of nursing and residential care facilities and the program currently remains in effect. Data from the Bureau of Labor Statistics (BLS) suggests that the healthcare industry continues to report injury and illness rates that exceed the national average of all general industry despite the availability of feasible controls. Such hazards include exposures to ergonomic stressors in patient lifting, exposure to tuberculosis, bloodborne pathogens and other potentially infectious materials, workplace violence, and slips, trips, and falls.

The Issues

The 2010 data from the BLS indicates that an overwhelming percentage of the injuries within the industry were attributed to overexertion-related incidents. As an example, 48% of all reported injuries in nursing care facilities in 2010 were due to overexertion. Injuries from slips, trips and falls were also very commonly reported among the nonfatal injury and illness cases reported. Combined, overexertion and slips, trips, and falls accounted for nearly 75% of all reported cases with days away from work.

According to OSHA enforcement data, the most frequently cited standard in nursing and residential care facilities is the Bloodborne Pathogens standard. Additionally, employees working in nursing and residential care facilities have been identified by the Center for Disease Control and Prevention as being among the top occupational groups with the highest risk for exposure to tuberculosis due to the case rate of disease among individuals over the age of 65.

Workplace violence is also a recognized hazard in nursing and residential care facilities. In 2010, BLS data reported approximately 2,130 assaults by persons in nursing and residential care facilities.

Another commonly recognized hazard in nursing and residential care facilities is the exposure to multi-drug resistant organisms (MDROs) such as MRSA. The CDC has identified residents of nursing homes are among those at an increased risk for colonization of MRSA. Among other hazards that are commonly encountered in nursing and residential care facilities are hazardous chemicals, such as sanitizers, disinfectants and hazardous drugs.

Obstacles

Among the largest obstacles in appropriately evaluating a nursing care facility is the respect for the residents’ privacy. In evaluating resident handling or other hazards such as bloodborne pathogens and tuberculosis, it is critical not to review any resident records that may include personally identifiable health information such as diagnoses, laboratory test results, etc., provided by the employer.

Another scenario may include the evaluation workplace health and safety issues that may involve assessment of resident handling. Resident handling activities may take place in resident rooms, restrooms, showers and bathing areas, or other areas where the privacy of residents could be compromised.

Trying to Find Solutions

When it comes to addressing nursing care facility hazards, employers should consider the following:

Resident Handling

  • Ensure a safety management program is in place. There should be a system in place for hazard identification and analysis along with the employees’ ability to provide input in the development of the facilities’ lifting, transporting, or repositioning procedures.
  • Ensure the availability of lifting devices. There may be a need for mechanical devices and slings to assist in lifting, transporting, or repositioning of residents.
  • Perform employee training. Employees must be trained in the recognition of hazards associated with manual resident lifting, transporting and repositioning. They should also be trained in the reporting of injuries and abating hazards.

Slips, Trips and Falls

  • Evaluate all general work environments. All work environments, such as kitchens, dining rooms, hallways, laundry rooms, shower and bathing areas, and point of access and egress should be evaluated. The employer should documents hazards likely to cause slips, trips and falls, including slippery or wet floors, uneven walking surfaces, cluttered, obstructed, or poorly maintained work areas, hallways, and stairs, broken equipment, or inadequate lighting.
  • Utilize engineering controls. Ensuring spills are reported and immediately cleaned up, posting signs or barriers alerting employees to wet floors, keeping hallways and aisles clear of clutter, and using appropriate footwear are all effective engineering controls that can be used to deal with wet surfaces.

Bloodborne Pathogens

  • Implement a written Exposure Control Plan (ECP). All employers having employees with occupational exposure must establish a written ECP designed to eliminate or minimize employee exposure. The ECP should include, but not be limited to:
    • Determination of employee exposure
    • Implementation of various methods of exposure control, including:
      • Universal precautions
      • Engineering and work practice controls
      • Personal protective equipment
      • Housekeeping
    • Hepatitis B vaccination
    • Post-exposure evaluation and follow-up
    • Communication of hazards to employees and training
    • Recordkeeping
    • Procedures for evaluating circumstances surrounding an exposure incident, and
    • The methods of implementation

Tuberculosis

  • Implement an effective control program which minimizes exposures to TB. While not all controls are required by OSHA, employers with employee exposure to TB must comply with certain OSHA requirements including: 29 CFR 1910.134 - Respiratory Protection, 29 CFR 1910.145 - Accident Prevention Signs and Tags, 29 CFR 1904 - Recordkeeping, and General Duty Clause Section 5(a)(1).
  • Other control methods include: early identification of patient/client, medical surveillance, case management of infected employees, worker education and training, and engineering controls.

Workplace Violence

  • Establish and maintain a violence prevention program. The main components that should be included in a facility's Violence Prevention Program are:
    • Management Commitment and Employee Involvement:
      • Demonstrated concern for employee emotional and physical safety and health, incorporated into a written program for safety and security
    • Worksite Analysis: A step by step common sense look at the workplace to find existing or potential hazards for workplace violence
    • Hazard Prevention and Control: Implementation of engineering and work practices to prevent and control identified hazards
    • Safety and Health Training: To make all staff aware of security hazards and how to protect themselves through established policies, procedures and training
    • Recordkeeping and Evaluation of Program: OSHA required recordkeeping, and evaluation

All nursing and residential care workers should be alert and cautious when interacting with patients and visitors. They should actively participate in safety training programs and be familiar with their employers' policies, procedures, and materials on workplace safety. Feasible and useful abatement methods and strategies exist. Unfortunately, no universal strategy exists to prevent the safety challenges associated with nursing and residential care facilities. The risk factors vary from facility to facility and from unit to unit. Facilities should form multidisciplinary committees that include direct-care staff to identify risk factors in specific work scenarios and to develop strategies for reducing them.

Related Topics: Nursing Safety, Home Safety, Monthly Safety Topics, Safety Articles