Workplace Safety and Accident Prevention

History of Workplace Safety

  • Environmental safety is a necessary component of workplace safety.
  • Regulations and standards govern environmental safety in the workplace, covering:
    • Fire safety
    • Toxicology
    • Communication of safety data
    • Biohazardous waste
    • Terrorism
    • Extreme weather
  • These standards are overseen by OSHA or other regulatory bodies and are often required by national or state law.
  • OSHA:
    • Agency within the Labor Department, effective on 04/28/1971.
    • Mission: assure safe and healthful conditions for working men and women by setting and enforcing standards and providing training, outreach, education, and compliance.
  • OSHA's effectiveness (data from Bureau of Labor Statistics, 2010):
    • Workforce doubled from 1970 to 2010.
    • Workers killed on the job decreased by 68%.
      • From 38 people every day in 1970 to 12 people every day in 2010.
      • Annual job-related deaths decreased from 14,000 in 1970 to about 4,500 in 2010.
    • Rate of reported serious workplace illnesses and injuries decreased.
      • From 11 per 100 workers in 1972 to 3.5 per 100 workers in 2010.
  • As of October 2013, 22 states or territories had OSHA-approved state programs.
  • State plans may exclude certain workers (e.g., those on military bases).
  • Federal agency does not cover workers in local and state government jobs unless the state has an OSHA-approved state plan.
  • Only New York, New Jersey, Connecticut, Illinois, and The Virgin Islands have plans covering only state and local government workers.
  • Workers of all federal agencies, including the US Postal Service, are protected under OSHA.
  • Work situations not covered under the OSH Act:
    • Self-employment.
    • Farmers' employment of immediate family members.
    • Workplaces where hazards are regulated by other federal agencies (e.g., the military).

Safety in Healthcare Facilities

  • Create a culture of safety.
  • Management must set an example by committing to and enforcing safe practices and policies.
  • Employees should be part of the process and feel safe contributing.
  • Follow facility-specific protocol for reporting adverse events.
  • Keeping accurate records and analyzing incident reports will help identify causes and prevent future events.
  • National Safety Council definition of an incident: an unplanned, undesired event that adversely affects completion of a task.
  • Incidents are made up of both accidents and near misses.
  • Accident: undesired event that results in personal injury or property damage.
  • Near miss: incidents where no property was damaged and no personal injury was sustained, but damage and/or injury easily could have occurred with a slight shift in time or position.
  • OSHA requires companies with 11 or more employees to maintain accurate records of job-related injury and illness.
  • Employers must maintain records on three OSHA forms: OSHA 300, OSHA 300A, and OSHA 301.
  • A separate insurance form can be used instead of the OSHA 301 form if it includes all required information.
  • OSHA has no specific standards for accident investigation but recommends investigation to help prevent future incidents.

Risky Features of Medical Environments

  • Medical environments are not necessarily designed with the patient in mind and do not enhance patient mobility or help prevent falls.
  • Hospitals are designed to enhance the ease of moving equipment.
  • Building features that can increase the risk of falls:
    • Slick or wet surfaces.
    • Transitions in flooring.
    • Shiny finish on floors.
    • Thick or loose carpet and rugs.
  • Clinics might lack certain items that can prevent falls:
    • Handrails on walls, especially in stairways.
    • Grab bars in restrooms.
    • Supportive structures in open areas for patients to grab onto.
    • Absence of adequate lighting, especially for visually impaired patients, and stairs without reflective indicators or labels for the first and last steps.
  • A safe clinical environment is vital to reducing the likelihood, frequency, and severity of fall episodes.

Safety and Health Management System

  • Workplace injuries and illnesses cost American businesses an estimated 170,000,000,000170,000,000,000 annually, and many are preventable.
  • OSHA recommends that employers institute a safety and health management system.
  • Important elements in an effective system:
    • Training for all staff.
    • Employee involvement.
    • Management commitment.
    • Worksite analysis.
    • Hazard control and prevention.
  • OSHA hypothesizes that the cost of initiating an effective system will be offset by savings from reducing workplace injury costs and provides a detailed checklist.

Ergonomics

  • Ergonomics: a science that fits the design of devices, systems, and working conditions to the requirements of the worker to improve comfort or safety.
  • Purpose: increase worker safety and productivity by modifying the work environment.
  • Work-related musculoskeletal disorders are one of the top causes of workday injuries and illnesses.
    • Examples: lower back injuries, muscle strains, rotator cuff injuries, and carpal tunnel syndrome.
  • In 2011, the healthcare industry had one of the highest musculoskeletal disorder rates of all industries (Bureau of Labor Statistics).
  • In the same year, musculoskeletal disorders caused 33% of all work-related injuries and illnesses.
  • Employers can greatly reduce the number and severity of work-related musculoskeletal disorders by applying ergonomic principles.
  • A successful ergonomics plan should be ongoing and will require:
    • Management support.
    • Involvement of workers.
    • Provision of training.
    • Identification of problems.
    • Encouragement of early reporting of musculoskeletal symptoms.
    • Implementation of solutions to control hazards.
    • Evaluation of progress.

Accident Causation Theories

  • Investigating the causes of workplace injuries due to accidents can decrease the probability that these accidents will reoccur.
  • Employers should ask what circumstances led to the accident event for the purpose of making changes in processes or equipment.
  • Single Factor Theory:
    • Based on the idea that every accident has a single cause.
    • Limited because it only identifies one cause and fails to take into account other contributing factors.
    • Example: Surgeon cuts hand with scalpel; the single factor theory would only identify the scalpel as the cause.
    • Impractical for accident and loss prevention.
  • Domino Theory:
    • Postulates that accidents are caused by a series of predictable chronological events, like stacked dominoes falling down one by one.
    • One event leads to another in a logical progression until an accident occurs.
    • Three popular domino theories:
      • Heinrich's (1931)
      • Byrd and Loftus's (1976)
      • Markham's (1978)
    • Each theory divided into three phases:
      • Pre-contact: events or conditions leading up to the accident.
      • Contact: the actual occurrence of the accident.
      • Post-contact: the results of the accident (e.g., physical injury or damage).
    • According to domino theories, the sequence of events must be interrupted during the pre-contact phase to prevent the accident.
  • Multiple Causation Theory:
    • Proposed by Vernon L. Gross, spawned from the domino theory concept.
    • Each single accident may have many contributing factors, causes, and sub-causes.
    • Accidents are a result of the combination of factors.
    • Factors can be represented by four Ms: machine, media, man, and management.
      • Machine: tools, vehicles, equipment, or other machinery.
      • Media: Environmental characteristics such as weather conditions (snow, ice, rain) and the temperature of a building.
      • Man: human factors with physiological factors like age or height and psychological or cognitive variables.
      • Management: policies carried out by management staff, such as safety rules, equipment selection, and organizational structure.
  • Systems Theory:
    • Proposed by RJ Forenzi.
    • The probability that an accident will occur is regulated by the interactions of three different elements: the person or worker, the machines, and the environment.
    • The skills, knowledge, and experience of an employee will impact how he handles the machinery in a given work environment, and the combination of these factors will determine the probability that an accident will occur.

Accident, Incident, and Near Miss Definitions

  • Understanding the theories of causation can aid in the investigation and reporting of accidents, incidents, and near misses.
  • OSHA supports the definitions of three terms dealing with adverse workplace events put by the National Safety Council, Inc.
  • Accident: undesired event causing personal injury or property damage.
  • Incident: unplanned, undesired event adversely affecting completion of a task.
  • Near miss: an incident in which no property was damaged and no injury was sustained, but with a slight shift in time position, damage or injury could have occurred.
  • Incidents include both near misses and accidents.
    • All accidents are incidents, but not all incidents are accidents.
  • Accidents always result in injury, loss, or damage, and Near misses result in no injury, loss, or damage.
  • As of October 2013, OSHA had no specific standards for accident investigation.
  • OSHA recommends all incidents should be investigated in order to identify and control hazards before accidents happen.
  • When root causes are identified and corrected, future incidents can be prevented.
  • The purpose of an investigation is not to assign blame but to correct problems.
  • Most incident investigations are done by direct supervisors, and investigations should be carried out with employee involvement.
  • A company might also have a safety department or committee that can aid in the investigation.
  • Anyone conducting an incident investigation should receive appropriate training.