Improving compliance with Occupational Safety and Health Administration standards

AORN Journal,  Feb, 2008  by Richard G. Cuming,  Tonette S. Rocco,  Adriana G. McEachern

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Although safe conditions in today's workplace are expected, this has not always been the case for American workers. Before the creation of the Occupational Safety and Health Administration (OSHA) in 1971, more than 14,000 American workers died each year in unsafe work environments, and disabling work-related injuries increased year after year. (1) Fortunately, these statistics have improved significantly. Although not free of risk--in 2005, American workers suffered 4.2 million occupational injuries and illnesses, and 5,702 employees died as a result of accidents at work (2)--the American workplace has been made safer through the

* establishment of standards,

* introduction of inspections, and

* levying of fines.

When OSHA was first established, the agency primarily was concerned with agricultural, mining, and construction-related injuries or deaths. Over the years, the nature of workplace injuries and the causes of work-related fatalities have changed. Today, the four most frequent work-related fatal events are highway accidents, homicides, falls, and being struck by falling objects. The most common nonfatal injuries, resulting in days away from work, are sprains, strains, and tears. Health care workers (HCWs) are at high risk for these musculoskeletal injuries. In 2005, RNs reported 20,100 work-related injuries with the majority being strains and overexertion. (2)

Just as the mining, agricultural, and construction environments have changed since OSHA's inception, so has the work world of American HCWs. During the early to mid 1980s, transmissible, potentially fatal diseases became of great concern to HCWs. In response, OSHA developed standards addressing exposures to bloodborne pathogens in addition to other contemporary workplace safety concerns. (1)

This article reviews OSHA's formation and describes its legal authority, duties, and responsibilities specifically as they relate to the health care industry and, in particular, the perioperative setting. In addition, the use of personal protective equipment (PPE) is discussed from a historical perspective, and OSHA requirements for employee education and monitoring are presented. Finally, relevant federal and state case law is discussed relating to OSHA, workers' compensation, educator/ employer responsibilities, and subsequent liabilities when employees choose not to wear appropriate PPE.

THE OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION

In the 1960s, America's attention was focused on the Vietnam War; the assassinations of President John F. Kennedy, Sen Robert Kennedy, and civil rights leader Martin Luther King, Jr, and the safety of the US workplace. Fourteen thousand workers died from work-related injuries each year, and disabling injuries sustained in the workplace had risen 20% from the previous decade. (1) Sen Harrison A. Williams, Jr (D-New Jersey) called for government intervention to improve the safety of America's workplaces. Simultaneously, Rep William A. Steiger (R-Wisconsin) advocated for the passage of a bill to protect America's workers. In December of 1970, the Williams-Steiger Act was signed into law by President Richard M. Nixon. This act is more commonly known as The Occupational Safety and Health Act of 1970 (OSH Act). (1)

The purpose of the OSH Act is "to assure, so far as possible, every working man and woman in the nation safe and healthful working conditions and to preserve our human resources." (3) To achieve this, the Secretary of Labor was authorized by Congress to

* adopt existing consensus and federal standards within two years of the act's enactment,

* promulgate standards via notice and comment rule making, and

* require employers to comply with OSHA standards?

Thus, the Occupational Safety and Health Administration was formed with the mission to develop and implement standards that prevent occupational injury, illness, and death. (4) Through establishment and enforcement of standards via inspections and the levying of monetary fines, OSHA has been able to improve the safety of the American workplace.

ADOPTING STANDARDS. Recognizing that the federal legislature was ill-prepared to pass laws regarding workplace safety, Congress authorized OSHA to establish and enforce occupational safety and health standards. (5) Not wanting to give one agency "carte blanche" with regard to rule formation, however, Congress required that OSHA follow a public-participation process similar to that of other agencies. This public-participation process, known as notice and comment rule making, is both slow and cumbersome and takes time to produce results. (5)

PROMULGATING STANDARDS. Americans were sustaining occupational injuries at alarming rates, and work-related deaths were rising. Under political pressure to act, Congress gave OSHA a two-year period in which they were authorized to establish binding standards without public participation; however, OSHA could only adopt widely recognized federal standards and/or voluntary consensus standards already in place. These rules were developed by agencies such as the National Fire Protection Agency, the American National Standards Institute, and the American Conference of Governmental Industrial Hygienists. (1) To further address their constituent's concerns that OSHA would be too powerful, Congress required that these standards be adopted verbatim. Federal and voluntary consensus standards were created via procedures in which interested parties agreed to substantial portions of the rule, satisfying public concerns of possible abuse of power. (5)