2/7/2014 Presented by MIOSHA Consultation Education and Training - - PDF document

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Presented by MIOSHA Consultation Education and Training (517) 322-1809  Identify the most prevalent occupational

injuries and illnesses within nursing and residential care facilities.

 Compare Michigan occupational injury and

illness data with National data.

 Develop strategies to reduce occupational

injuries and illnesses.

“OSHA recently took notice when it came to our attention that that one in every five U.S. workers injured in the private sector is a healthcare worker.” “These workers should not be forced to risk injury while caring for others.” “It is not acceptable for these workers to continue getting hurt at such high rates. “

Remarks by Dr. David Michaels Assistant Secretary of Labor Occupational Safety and Health Administration(OSHA) Seventh EU/US Joint Conference on Occupational Safety and Health Brussels, Belgium July 11, 2012

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2012 National Rates

5,000 10,000 15,000 20,000 25,000 30,000 35,000 Chart 1 Distribution of Total Injury and Illness Cases by Industry Division Michigan, Private Sector 2012 (Total Cases 105,500) 5,000 10,000 15,000 20,000 25,000 30,000 Chart 1 Distribution of Total Injury and Illness Cases by Industry Division Michigan, Private Sector 2011 (Total Cases 97,400)

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Industry ry NAICS Code Recordi ding year Total Recorda dabl ble Cases es with days away from work, job transfer, fer, or restri riction Other r recorda rdabl ble e cases es Total Cases with days away from work Cases with job transfer

• r restriction

Nursing and Residential Care 623 2012 9.6 5.8 2.4 3.4 3.8 2011 8.7 5.1 2.5 2.6 3.6 Industry NAICS S Code Recording Year Total Recordable Cases with days away from

• m work, job transfer, or

restriction

• n

Other recor

• rdable

cases Total Cases with days away from work Cases with job transfer

• r restriction

Nursing and Residential Care 623 2012 7.6 4.7 2.4 2.3 2.9 2011 10.2 7.1 3.8

• 3.1

Michigan Data: National Data:

Rates based on calculation: (# cases/Emp. Hours) X 200,000

2 4 6 8 10 12 14 Manufacturing: Beverage and Tobacco Products Manufacturing: Primary Metal Healthcare: Nursing and Residential Care Facilities 2010 2011 2012 Total Recordable Case Rate (per 100 employees) 2 4 6 8 10 12 Michigan - NAICS 623

• nly

National - NAICS 623

• nly

Michigan - All Industries National - All Industries 2012 2011 2010 Total Recordable Case Rate (per 100 employees)

NAICS 623 = Nursing and Residential Care

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22% 22% 20% 20% 2% 2% 9% 9% 45% 45% 2% 2%

2012 2012 Michiga higan n Cases es

Violence and other injuries by persons or animal (22%) Falls, slips, trips (20%) Exposure to harmful substances or environments (2%) Contact with object, equipment (9%) Overexertion and bodily reaction (45%) All other (2%)

21% 21% 4% 4% 20% 20% 3% 3% 8% 8% 42% 42% 2% 2%

2011 2011 Michiga higan n Cases es

Violence and other injuries by persons or animal (21%) Transportation incidents (4%) Falls, slips, trips (20%) Exposure to harmful substances or environments (3%) Contact with object, equipment (8%) Overexertion and bodily reaction (42%) All other (2%)

Nursing and Residential Care:

 Ergonomic stressors in patient/resident

lifting

 Workplace violence  Slips, trips, and falls  Bloodborne pathogens  Tuberculosis

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 Most prevalent source of employee injury:

• Musculoskeletal/Ergonomic stress
• Workplace violence (assaults by residents or others)
• Slips, trips, falls

 Bloodborne pathogens (most frequently cited standard)  Tuberculosis:

• Per CDC, among facilities at highest risk for exposure.
• Due to case rate among > 65 age group.

 Note - There are no MIOSHA standards that specifically

address:

• Ergonomics
• Workplace Violence
• Tuberculosis

 Material handling

• Laundry
• Kitchen
• Maintenance

 Resident handling

• Mobility and lift assist requirements noted in care plan?

 Failure to use lifts and lift devices

• Lack of training
• Time constraints
• Too few devices
• Employee fails to recognize the need to use

 More information to be covered in separate

program

1.

Healthcare and social services:

• Psychiatric facilities
• Hospital emergency departments
• Community mental health clinics
• Drug abuse treatment clinics
• Pharmacies
• Community-care facilities
• Residential facilities and
• Long-term care facilities.

2.

Late-night Retail Settings

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 1. Type 1—Criminal Intent

Violent acts by people who enter the workplace to commit a robbery

• r other crime—or current or former employees who enter the

workplace with the intent to commit a crime.

 2. Type 2—Customer/Client/Patients

Violence directed at employees by customers, clients, patients, students, inmates or any others to whom the employer provides a service.

 3. Type 3—Co-worker

Violence against co-workers, supervisors, or managers by a current

• r former employee, supervisor, or manager.

 4. Type 4—Personal

Violence in the workplace by someone who does not work there, but who is known to, or has a personal relationship with, an employee.  Management commitment  Employee involvement  Worksite analysis  Hazard prevention and control  Safety and health training  Recordkeeping and program evaluation

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 Equal concern and commitment for

safety and health of residents and employees.

 Allocation of resources and

authority to those responsible to violence prevention program.

 Establish comprehensive program

for medical and psychological counseling with debriefing for employees experiencing or witnessing an assault or other violent incidents.

 Understand and comply with violence

prevention program.

 Actively participate on safety committee.  Report all instances promptly and accurately.  Participate in training programs.  Threat assessment team

• Management, employees, security, maintenance, human

resources

 Evaluate existing or potential hazards for

workplace violence

• Procedures and operations
• Specific vulnerable locations

(reception, parking lot, resident room, shower room)

 Review of injury data  Implement screening survey to document

experiences of employees

 Evaluate effectiveness of existing security and

protective measures

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Engineering controls remove or reduce the hazard:

 Physical barriers between the hazard and the

employee

• Locked doors
• Safe rooms and enclosures
• Deep counters and shatter-proof glass

 Alarms or panic buttons  Mirrors to see end of hallway  Video surveillance in high risk areas (i.e.

reception)

 Policies and procedures for employees, residents,

visitors and delivery personnel

 Local law enforcement involvement  Reporting and documenting all incidents  Trained response team  Control access:

• Facility
• Medication storage

 Determine behavioral history for transfers  Include information related to assaultive and

abusive behavior in resident care plan

 Employee dress code (i.e. no necklaces/lanyards)  Remove loose (easily thrown objects) from

environment

 Train employees:

• Policies, procedures and elements of the plan
• When/what/how to report
• Ways to protect themselves
• Location and operation of protective devices

 Recordkeeping:

• MIOSHA/OSHA Log of Work-related Injuries and

Illnesses (300 and 301)

• Employee medical records
• Incident including near-miss documents/reports
• Resident abusive or assaultive behavior

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 Resistive Behaviors:

• Pulling away from

the caregiver

• Fleeing

 Vocal agitation

• Crying
• Yelling or other loud

exclamations

 Verbal and Physical

Aggression

• Cursing and name-

calling

• Inflicting pain on

caregiver or self: Biting, hitting, scratching, pinching

• Pushing away
• Destruction of property

 Resident to self  Resident to resident  Resident to care giver  Resident to guest  Guest to resident or care giver 

Physical comfort and pain



Emotional well-being



Sense of competency



Need for socialization



Ability to find one’s way



Desire to be understood



Desire to communicate effectively

Michigan Dementi tia Coaliti tion, , Knowle wledg dge and Skills Needed d for Dementi tia Care A Guide de for Direct ct Care Workers 2006 2006

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 Leave if threatened  Position for easy exit  Retreat into safe area  Use 2 staff members (avoid more than 2 as

this may escalate fear and aggression)

 Notify supervisor immediately if they are

injured or assaulted at work

 OSHA's "Guidelines for Preventing Workplace

Violence for Health Care & Social Service Workers" resource is available online at http://www.osha.gov/Publications/OSHA314 8/osha3148.html.

 Additional information on workplace violence

is available at http://www.osha.gov/SLTC/workplaceviolenc e/index.html. Kitchen, dining, hallways, laundry, bathing areas, points of entry/egress:

 Floors (wet, uneven, cluttered, poor lighting)  Floor openings (unguarded)  Damaged or inadequate stairways  Elevated work areas w/o guardrails  Inadequate aisles  Improper use of ladders and/or stepstools

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 What are conditions that could lead to a slip,

trip or fall?

 How do we notify people of a slip, trip or fall

hazard?

 What can we do to prevent

slips, trips and falls?

 Environment  Equipment  Work Practices: processes or procedures  Individual:

inherent characteristics, habits and behavior

Where Do Hazards Lurk

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Photo used with permission of Marsh USA, Inc. Photo used with permission of Marsh USA, Inc. Photo used with permission of Marsh USA, Inc.

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Flooring 50% Footwear 24% Failure to warn 9% Training 7% Fraud 10%

• Floor material
• Floor finish
• Floor texture and pattern
• Floor slope
• Floor contaminants
• Floor condition
• Environmental conditions
• Footwear of person
• Footstep of person

Apply floor skid strips to steps and ramps

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General Lighting: A slip, trip or fall may occur if a walking surface is poorly lit and it causes a person not to see an obstacle. Emergency Lighting: A slip, trip or fall may occur if an

• rganization’s electricity fails in an emergency

and employees can’t see their way out.

• Engineering
• Administrative
• Personal Protective Equipment
• Redesign of equipment
• Substitution of a material or equipment
• Use of barriers to isolate a hazard
• Use of barriers to isolate a person

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• Education and training
• Signage
• Maintenance
• Good housekeeping
• Contracting specialized

services (i.e. snow and ice removal).

• Slip-resistant shoes
• Fall arrest equipment
• Safety platforms

 Wet floors

• Fresh mopped areas
• Outside entrances
• Kitchen and laundry areas
• Bathing area
• Maintenance areas: Chillers, boilers, steam

 Ladders  Equipment: Resident assistive equipment  Office area: drawers and cords

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 Inspect ladder before each use.  Use only ladders in good condition and

appropriate for the job.

 Use the ladder properly.  Check ladder weight restrictions.  Information was covered in the Top 25

Presentation.

 MIOSHA Compliance Directive: GISHD-COM-

05-2R2, Enforcement Policy and Procedures for Evaluating Occupational Exposure to Tuberculosis (TB)

 Citations would be written under Act 154,

General Duty Clause.

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 170 cases reported → rate of 1.7/100,000

decrease from 2010 (rate=1.9/100,000)

 Foreign-born cases decreased to 50% from

58.3% in 2010

 76.5% of cases are located in Metro Detroit

• Wayne (including Detroit), Oakland and

Macomb

 1 case of MDR TB  10% were homeless within the last year  22.4% abused alcohol, injection or non-

injection drugs within the last year

Source: Noreen Mollon, MS TB Epidemiologist, Michigan Department of Community Health (MDCH)

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 Long Term Elderly Care  Health Care Settings

Does not apply to certain non-hospital settings unless perfor formi ming high hazar ardous

• us proc
• cedures on

TB or suspected TB.

• Doctors & Dental Offices
• Clinics
• Home Health Care
• Local Public Health Facilities

 EMT’s.  Correctional Institutions

• Includes police working in jails

 Drug Treatment Centers  Homeless shelters

Reasonably anticipated contact with confirmed infectious or suspected during performance

• f job duties

 An internal protocol must be established  Aware of general signs & symptoms

• Persistent productive cough (blood)
• Fatigue
• Fever
• Weight loss
• Night sweats

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 Mantoux skin test : those with direct

contact, annually.

• New employees - “2-step” within 2 weeks
• No cost to employee
• Repeat 6 months for high exposure

 Positive skin tests: evaluated and

managed

• Converts and those with a history

Note: Current shortage (April, 2013-Present) of TB antigen for skin tests may defer testing for low-risk. CDC recommends blood testing program for high- risk until supply returns to normal levels. Follow CDC recommendations.

 Isolation Rooms  Increased TB testing for staff providing care  Respiratory Protection: Must comply with the

MIOSHA Part 451Respiratory Protection Standard

• NIOSH approved N-95 (minimum)
• Written program
• Medical evaluation -medically fit to wear respirator
• Fit-testing
• Respirator use, limitations, availability, maintenance

and disposal.

• Employee training

 Entering rooms of known or suspected TB

resident even after discharge until room purged

 Performing high hazardous procedures on

known or suspected

 Transporting known or suspected in

closed vehicle by emergency response employees or others

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Michigan Department of Community Health: www.michigan.gov/tb Centers for Disease Control and Prevention (CDC) Self-Study Modules: www.cdc.gov/tb/education/ssmodules/defau lt.htm

 Industrial Hygienist

MIOSHA-Consultation Education and Training (517) 322-1809

 Matt Macomber, CIH

Infectious Diseases and TB Specialist MIOSHA-General Industry safety & Health Division (989) 758-1515

 Michigan Department of Community Health –

Communicable Diseases, Epidemiology Section (517) 335-8165

 Identify the most prevalent occupational

injuries and illnesses within nursing and residential care facilities.

 Compare Michigan occupational injury and

illness data with National data.

 Develop strategies to reduce occupational

injuries and illnesses.

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