An April, 2015 Centers for Disease Prevention and Control report states that in 2013, the health care and social assistance sector accounted for the greatest proportion (20.7%) of private industry nonfatal occupational injuries among all sectors. The most common injuries were due to patient handling; slips, trips, and falls; and workplace violence. In 2011, U.S. health care personnel experienced seven times the national rate of musculoskeletal disorders compared with all other private sector workers.
To reduce the number of preventable injuries among health care personnel, the CDC's National Institute for Occupational Safety and Health (NIOSH), with collaborating partners, created the Occupational Health Safety Network (OHSN) to collect detailed injury data to help target prevention efforts. OHSN, a free, voluntary surveillance system for health care facilities, enables prompt and secure tracking of occupational injuries by type, occupation, location, and risk factors.
OHSN is a web-based data portal that accepts health care facilities' existing OSHA-recordable and non-recordable health care personnel injury data. De-identified injury data are converted to standard OHSN data elements designed to characterize (1) the occupation of the injured worker; (2) the type, severity, cause, and location of the injury; and (3) information useful in determining how the injury could be prevented. Standardization of data across all facilities allows comparison within and across facilities; comparison groups can be selected by OHSN participants (e.g., hospitals of comparable size or in the same geographic region).
New data submissions are available to OHSN participants within a week, and they can analyze new and historical injury data and produce outputs in the form of graphs and tables at any time. The NIOSH OHSN topic page provides information on (1) data terminology, transmission, and security; (2) examples of output graphs and tables; and (3) intervention resources.
A recently published report described OHSN and reported on current findings for three types of injuries. OHSN received data on injuries occurring from January 1, 2012 to September 30, 2014, from 112 U.S. health care facilities. Pooled mean incidence rates and percentiles were calculated for three types of OSHA-recordable injuries: (1) falls, including slipping or tripping without a fall; (2) patient handling (e.g., handling, pushing, pulling, or lifting patients); and (3) workplace violence (i.e., violent acts directed at health care personnel). For each of the three injury types, the same denominator was used for all sub-analyses within an injury type, because more specific denominators were not available.
The 112 participating facilities were located in 19 states, with 52% located in the Midwest. By size, 46% had bed numbers of less than 200 and by type, 95% were general medical and surgical facilities. The participating facilities had a total of 162,535 full-time employees and reported a total of 13,798 slips, trips, and falls; patient handling injury; and workplace violence injuries. Of this total, 10,680 (77.4%) were OSHA-recordable injuries. Overall incidence rates of OSHA-recordable injuries (average worker-months = 125,041) per 10,000 worker-months for patient handling; slips, trips and falls; and workplace violence were 11.3, 9.6, and 4.9, respectively.
Nurse assistants and nurses had the highest injury rates of all occupations examined. Most injuries occurred in two groups of workers, those aged 30 to 44 years (35%) and those aged 45 to 64 years (44%). Nurses (38%) and nursing assistants (19%) accounted for 57% of identified OSHA-recordable injuries. Between 70%–90% of OSHA-recordable patient handling; slips, trips, and falls; and workplace violence injuries occurred among female employees.
Nurse assistants were more likely to sustain injuries than workers in other job categories. This occupation had more than twice the injury rate of nurses for patient handling and workplace violence injuries. Injury rates for slips, trips, and falls were highest among non-patient care staff (e.g., maintenance and security staff), nursing assistants, and nurses.
Between 2012 and 2014, workplace violence injury rates increased for all job classifications and nearly doubled for nurse assistants and nurses. Patient handling and workplace violence injury rates were highest in inpatient adult wards. These rates were also elevated in outpatient emergency departments, urgent care, and acute care centers and adult critical care departments. Rates of falls were highest in inpatient adult wards, non-patient care maintenance areas, and operating rooms.
Of all patient handling injury reports, 62% included data on the use of lifting equipment; 82% of the injuries occurred when lifting equipment was not used. Of all slips, trips and falls injury reports, 65% had data on fall type; 89% were falls on the same level, 9% were falls to a lower level (e.g., down stairs, ramps, etc.) and 2% were slips and trips without falling. Of all workplace violence injury reports, 49% specified type of assault (physical, verbal, or destruction of property); 99% were physical assaults. Descriptions of who perpetrated the assaults were included in 13% of workplace violence injury reports; 95% were committed by patients, which is in agreement with previous study findings.
Overall, for the 112 OHSN participating facilities, rates of patient handling and workplace violence injuries were highest among nurse assistants and nurses; rates of slips, trips, and falls were high for these jobs and also for non-patient care staff. In contrast, physicians, dentists, interns, and residents have low injury rates.
These data indicate that interventions should first focus on prevention of injuries to nurse assistants and nurses from patient handling; slips, trips, and falls; and workplace violence. Patient handling and workplace violence injuries reported to OHSN were clustered in locations providing direct patient care, while slips, trips, and fall injuries occurred in both patient and non-patient areas. Analysis of detailed, facility-level data could identify the higher risk occupations and locations of each facility and assist in customizing prevention measures.
Other studies found that musculoskeletal disorders are increasing among health care personnel. Nursing staff are exposed to several musculoskeletal disorder risk factors: (1) caring for overweight/obese and acutely ill patients; (2) high patient-to-nurse ratios; (3) long shifts; and (4) current efforts to mobilize patients almost immediately after medical interventions. Prevention measures might concentrate on mitigating the high-risk aspects of these jobs.
Similar to findings from other studies, OHSN data indicate that interventions (e.g., the use of lifting equipment) could potentially reduce patient-handling injuries, particularly for activities involving positioning, transferring, or lifting a patient. In over half of patient handling injuries, lifting equipment was not used (51%). Additionally, to prevent patient-handling injuries, health care institutions might establish a safety culture emphasizing continuous improvement and also provide resources such as training in safe patient handling and access to lifting teams and lifting equipment.
On the basis of OHSN findings, the major causes of slip, trip, and fall injuries are floor contaminants and contact with objects. However, the variability in types of these injuries indicates that each facility should use facility-specific data to guide prevention measures.
In 2013, the Bureau of Labor Statistics found rates of injuries and illnesses resulting from workplace violence increased for the second year in a row to 16.2 cases per 10,000 full-time workers in the health care and social assistance sector. Data reported to OHSN revealed the same trend. The OHSN topic page provides links to workplace violence prevention resources, including an online course to help hospital staff with identifying patients at risk for committing violent acts (those with mental illness, behavioral disorders, and cognitive dysfunction) as well as ways to moderate and prevent violent patient behavior.
The findings in this report are subject to at least four limitations. First, in 2012 to 2014, only 112 U.S. health care facilities from 19 states participated, and the data in this report might not be representative of the thousands of health care facilities in the United States. Second, a considerable proportion of OHSN injury data regarding risk factors are categorized as unspecified, which could limit OHSN's ability to identify causality and prevention needs. Third, possible participation, reporting, and recording biases might exist. Voluntary participation might skew participation to best-practice facilities and some facilities might not report all injury data, leading to underestimation of injury rates. Not all facilities collect detailed data requested by OHSN, such as specific activities which lead to patient-handling injuries or why a patient or coworker commits violence against health care personnel. Thus, missing data might bias the results.
OHSN offers a variety of tools for NIOSH and health care institutions to work toward a common goal of employee safety and health by reducing all types of injuries among health care personnel. OHSN enables health care facilities to track injuries; collect and analyze detailed standard injury data to direct resources toward employees, departments, and situations most at risk; compare their own injury rates with groups of their choosing; access prevention resources; facilitate implementation of timely prevention measures; and monitor intervention impact.
Emphasizing worker safety promotes and strengthens patient safety, which contributes to improved patient care and reduced costs. Future improvements to OHSN include plans to develop a module to systematically collect detailed information on occupational injuries from needles, scalpels, and other sharp objects, and blood and body fluid exposures among health care personnel to assist in creating prevention strategies for those hazards. Targeting prevention strategies can protect health care personnel from prevalent, disabling injuries and help in managing resources.
See the CDC Report
See also Medical Law Perspectives, October 2014 Report: Backaches and Court Battles: When Chronic Back Pain Leads to Litigation
See the Medical Law Perspectives September 23, 2014, Blog: Heat Stress Kills Workers