Towards the third quarter of the twentieth century, the Congress has recognized that personal injuries and illnesses at work cause substantial losses to the economy and is a “hindrance to interstate commerce” (“OSH Act of 1970”, 2004). This led to the establishment of the Occupational Safety and Health Administration (OSHA) through the Occupational Safety and Health Act of 1970. Basically, OSHA ensures the safety of the working men and women in the United States. This it does by working with both employees and employers to create safe and healthy working environments (OSHA, 2007).
OSHA encompasses workers in almost all industries, with the exception of those who are self-employed or those working in small farms (Veasey et al., 2002). One of the industries that is receiving a lot of attention from different sectors, the OSHA included, is the health care industry. This is for a number of reasons. First, health care is the second fastest-growing sector in the U.S. economy, next to information technology (National Institute for Occupational Safety and Health [NIOSH], 2007; U.S. Department of Labor, 2006). Health care workforce is estimated to be at over 12 million and still increasing. Furthermore, and perhaps the primary reason for OSHA’s interest in the health care industry, occupational injuries among health care workers have increased over the past decade (NIOSH, 2007). On the contrary, injuries and illnesses in construction and agriculture have experienced decline during the same period.
The health care industry itself covers a wide range of facilities and services. Included in this sector are hospitals, clinics, out-patient surgery centers, delivery centers, dental offices and nursing homes (OSHA, 2007). Because of the large number of services offered in this industry, health care workers are exposed to a number of workplace hazards. For one, hazardous chemicals abound in most health care facilities. These include formaldehyde, which is used in preserving specimen for pathology; ethylene oxide, glutaraldehyde and paracetic acid, which are used for sterilization; and a variety of other chemicals used in health care laboratories. In response to such an issue, OSHA has created a safety program to protect health care workers from such hazards. According to OSHA, the hazard posed by these chemicals must be properly communicated to all people concerned. Chemical manufacturers and pharmaceuticals have the primary responsibility of evaluating the hazards of the substances and goods they produce (OSHA, 2008). OSHA further requires that a Materials Safety Data Sheet (MSDS) be prepared to be conveyed to customers. In the workplace, OSHA requires that employers provide labels and MSDS for the exposed workers, and provide appropriate training in handling (including disposal) of hazardous chemicals and drugs.
Health care workers are also exposed to bloodborne pathogens – infectious materials which can cause diseases in humans such as hepatitis B and human immunodeficiency virus or HIV – and are at risk of acquiring the disease caused by these pathogens (OSHA, 2002). OSHA protects workers by requiring employers to use safer medical devices that are commercially available and effective (OSHA, 2008). Employers also have the responsibility of identifying the workers exposed to this hazard and consequently create a program that would eliminate or minimize worker exposure. Furthermore, employees who are occupationally exposed to bloodborne pathogens should receive the necessary training to handle such hazards.
Radiation is another hazard that laboratory staffs are exposed to. Those who are primarily exposed to radiation are x-ray machine operators and other employees who are unprotected and near the machine during its operation (OSHA, 2008). Acute health effects due to the exposure include erythema and dermatitis, while chronic effects include skin cancer, bone marrow suppression and even congenital effects on the offspring of the exposed employee. The degree of exposure depends on the quantity of radiation, the length of exposure and the protection used. In order to protect the workers exposed to this hazard, OSHA requires that employees be properly protected from radiation. X-ray rooms, for example, could be constructed with barrier walls so that the operator can step behind the wall during machine operation and thus avoid radiation exposure. Furthermore, employers are required to provide the necessary monitoring equipment, such as badges, to be worn by workers working with x-ray machines, radioactive patients and radioactive materials.
One of the hazards also frequently cited by OSHA are electrical hazards (OSHA, 2008). Such hazards result from faulty or damaged electrical wiring or equipment, and unsafe work practices. Exposure to these hazards may result to electric shock, electrocution or explosion. As a solution, OSHA issued a standard indicating that electrical equipment must be freed from all recognized hazards. The standard further requires grounding of all electrical service in close proximity to water, using of safeguards for personnel protection and wearing or using of protective equipment, and observance of appropriate work practices.
Aside from electrocution and electric shock, improper use of electric equipment and faulty wiring also has adverse effects on workers that operate or are exposed to machines such as the hydroculator and ultrasound devices. Ultrasound, although of high frequency and inaudible to the ear may affect hearing and produce other health effects (OSHA, 2008). It is generally believed, however, that ultrasound has relatively little effect on general health unless there is direct contact with the source of the ultrasonic noise (OSHA, 2008). Hearing loss is most probably caused by loud audible noise from source subharmonics rather than the ultrasound itself. Nevertheless, to avoid such incidences, the American Conference of Governmental Industrial Hygienists (ACGIH), using OSHA’s Noise Standard as a basis, has come up with permissible ultrasound exposure levels. The Threshold Limit Values (TLVs) are meant to protect employees from repeated exposure to ultrasound without any adverse effects on hearing and the ability to understand normal speech. For frequencies between 10 to 20 kHz, ceiling values are placed at 105 decibels (dB) when measured in air and 167 dB when measured in water (OSHA, 2008). For frequencies between 30and 100 kHz, the maximum values are 115 and 177 dB when measured in air and water, respectively. It is worth noting, however, that these values prevent hearing loss caused by the subharmonic frequencies, rather than the ultrasound itself.
As part of OSHA’s Noise Standards, controls for high-frequency sound, such as ultrasound, are required. Barriers to this sound can be easily constructed and in many cases, machines and surfaces in the workplace act as barriers themselves (OSHA, 2008).
National Institute for Occupational Safety and Health (2007). Health care workers. Center for Disease Control and Prevention. Retrieved January 28, 2008 from http://www.cdc.gov/niosh/topics/healthcare/.
OSHA (2002). Bloodborne pathogens: OSHA fact sheet. OSHA. Retrieved January 28, 2009 from http://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdf.
OSHA (2008). Compliance assistance quick start: Step 1. OSHA. Retrieved January 28, 2008 from http://www.osha.gov/dcsp/compliance_assistance/quickstarts/health_care/ hc_step1.html.
OSHA (2006). Hazard communication: Foundation of workplace chemical safety programs. OSHA. Retrieved January 28, 2008 from http://www.osha.gov/SLTC/hazardcommunications/index.html.
OSHA (2008). Hospital etool: Bloodborne pathogens. OSHA. Retrieved January 28, 2008 from http://www.osha.gov/SLTC/etools/hospital/hazards/bbp/bbp.html.
OSHA (2008). Hospital etool: Electrical hazards. OSHA. Retrieved January 28, 2008 from http://www.osha.gov/SLTC/etools/hospital/hazards/electrical/electrical.html.
OSHA (2008). Hospital etool: Radiology module. OSHA. Retrieved January 28, 2008 from http://www.osha.gov/SLTC/etools/hospital/clinical/radiology/Radiation.
OSHA (2008). Noise and hearing technical manual chapter: noise and health effects. OSHA. Retrieved January 28, 2008 from http://www.osha.gov/dts/osta/otm/noise/health_effects/index.html.
OSHA (2004). OSH Act of 1970. OSHA. Retrieved January 28, 2008 from http://osha.gov/pls/oshaweb/owadisp.show_document?p_table=OSHACT&p_id=2743.
OSHA and the Health Care Industry 7
OSHA (2007). OSHA facts – August 2007. OSHA. Retrieved January 28, 2008 from http://osha.gov/as/opa/oshafacts.html.
U.S. Department of Labor (2006). High growth industry profile. U.S. Department of Labor. Retrieved January 28, 2009 from http://www.doleta.gov/BRG/Indprof/IT_profile.cfm.
Veasey, D.A., McCormick, L.C., Hilyer, B.M., Oldfield, K.W. & Hansen, S. (2002). Confined space entry and emergency response. New York: McGraw-Hill Companies.