The impact of workplace screening on the occurrence of cumulative trauma disorders and workers' compensation claims

Work-related musculoskeletal pain, commonly referred to more specifically as musculoskeletal disorders or cumulative trauma disorders, has continued to occur despite efforts by employers, employees, health care providers, and the government to eradicate it. The National Institute for Occupational Safety and Health has encouraged employers to establish ergonomic prevention programs; however, many employers are concerned that screening, education, and focused attention on workplace pain will cause an increase in the number of OSHA 200 events and the incidence of workers' compensation claims. This prospective cohort study demonstrated that there was no increase in the number of OSHA 200 events and no increase in the incidence of workers' compensation claims after completion of an individual risk screening program that included education and employee awareness about work-related musculoskeletal pain. Incidence of cumulative trauma disorders has been most effectively reduced by use of individual risk-screening programs. Therefore, employers should be encouraged to develop and implement prevention programs that include individual risk screening.     

Lead use in California industry: its prevalence and health implications

An estimated 230,000 workers were reported to work in lead-using activities as a result of a 1986 statistical survey of employers in California. However, 68% of these workers worked in activities of relatively low hazard. This included 114,000 workers engaged in electronic soldering. Over 1800 workers were reported to work in battery manufacture, a relatively high-hazard activity, but with consistent monitoring and protection. In contrast, over 4300 workers were involved in radiator repair activities, a high-hazard activity with inconsistent monitoring and protection. Over 8% of construction workers were reported to work in lead-using processes. This sector is exempt from federal Occupational Safety and Health Administration (Fed/OSHA) and California Occupational Safety and Health (Cal/OSHA) lead standards, yet some of the most hazardous activities (welding, grinding, and cutting, etc.) occurred here. Comparison of projections from the National Occupational Hazard Survey of potential lead exposure in California with these survey results suggests consistent and reliable assessment of the major sources of potential occupational exposure to lead.     

A survey of private sector respirator use in the United States: an overview of findings

Limitations of previous surveys of respirator use led the National Institute for Occupational Safety and Health (NIOSH) and the Bureau of Labor Statistics to undertake a survey of respirator use and practices among U.S. private sector employers. The survey was mailed to 40,002 private sector establishments in August 2001; the responses were used to develop national estimates. Respirator use was required in 4.5% of establishments and for 3.1% of employees. Of the establishments requiring respirator use, 95% used air-purifying respirators and 17% used air-supplied respirators. Manufacturing; mining (including oil and gas extraction); construction; and agriculture, forestry, and fishing had the highest rates of establishment respirator use. Respirators were used most frequently to protect against dust/mist, paint vapors, and solvents. Large percentages of establishments requiring respirator use had indicators of potentially inadequate respirator programs. Of establishments requiring respirator use, 91% had at least one indicator of a potentially inadequate respiratory protection program, while 54% had at least five indicators. The survey findings suggest that large numbers of employers may not follow NIOSH recommendations and Occupational Safety and Health Administration (OSHA) and Mine Safety and Health Administration (MSHA) requirements for the selection and use of respirators, potentially putting workers at risk. The findings will aid efforts to increase the appropriate use of respirators in the workplace.     

Compliance with the carbon monoxide standard in the workplace.

The carbon monoxide standard which the Department of Labor uses for the protection of workers' health is reviewed. The legislation, origin of the standard, and enforcement in the workplace are summarized. The agencies within the Department of Labor with enforcement responsibilities are the Occupational Safety and Health Administration (OSHA) and the Mine Safety and Health Administration (MSHA). Comparisons are made with the current federal standard of 50 ppm and other existing or proposed standards. An increasing awareness of the effects of carbon monoxide suggests changes in the standard. A standard based on carboxyhemoglobin levels of exposed nonsmokers that overlaps the levels of normal smokers raises difficult questions. The importance of maintenance and monitoring as well as controls in the management of potential carbon monoxide exposure in the workplace is stressed.     

Legislation and regulations addressing workplace violence in the United States and British Columbia

OVERVIEW: For as long as workers have had contact with customers, coworkers, the public, and others, they have faced risk of assault. However, in the 1980s and 1990s, a number of highly publicized incidents occurred that involved multiple fatalities, and reliable statistics showed homicide to be a major cause of worker deaths. As a result, violence in the workplace became a subject of concern among the public and policymakers. This article reviews a number of legislative and regulatory efforts from the past decade that were designed to prevent violence against employees. Some states and localities have enacted legislation to address specific types of violence in the workplace, such as robbery-related violence, and violence against health care workers and taxi drivers. In addition, the U.S. Occupational Safety and Health Administration (OSHA), as well as a number of state OSHA programs, has attempted to reduce the risk of assault to workers through new and existing statutes and administrative regulations. To provide a contrast with developments in the United States, the author will also discuss requirements for prevention of assault in the workplace in the Canadian province of British Columbia.     

Local government workers' health and safety programs

Public sector workers are denied the broad legal protections of the Occupational Safety and Health (OSH) Act of 1970. The OSH Act provides incentives for states to operate a State OSHA Plan, but they must cover private and non-Federal public sector workers. Public sector workers in states not operating a State OSHA Plan are not protected by the OSH Act. A review of enforcement activities by State OSHA Plans suggests preferential treatment for public employers compared to private. Public sector safety and health programs vary widely in the 27 states without State OSHA Plans. The Department of Labor determined that the majority of these states operate unacceptable programs. Regardless of program type, public sector workersí injuries and illnesses frequently exceed those found in the private sector.     

Hydrogen sulfide exposure at a waste treatment facility

Occupational Safety and Health Administration (OSHA) regulations require employers to report workplace-related fatalities.((1)) OSHA inspection policy and procedures require that a workplace fatality or workplace hazards with potential imminent danger receive the highest priority for inspection.((2)) This inspection began on a Saturday when a local fire department advised the OSHA area office of a workplace fatality. The fire department also reported that the death was due to natural causes, based on a county coroner's report that stated the worker had died from a heart attack. Under normal circumstances OSHA begins a workplace fatality investigation within one day of notification. Workplace deaths due to natural causes, as was initially reported in this case, may not receive an OSHA inspection. However, subsequent to the incident, a family member contacted the OSHA area office and reported that the death may have been due to chemical vapor exposures, based on information from co-workers of the deceased. The family had already requested a toxicological screening of the victim and the coroner had agreed. Based on this new information, the local OSHA area office opened a facility inspection.     

Occupational hearing loss

Hearing loss is a significant and unfortunately common occupational malady. Over the past several decades both the Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH) have initiated efforts to better understand and to limit the occurrence of occupational hearing loss, particularly as it relates to excessive noise exposure. This paper briefly addresses the pathophysiology of noise-induced hearing loss and then describes the occupational and non-occupational factors which influence a worker's risk of hearing loss. The primary foci of this discussion are the clinical evaluation, diagnosis, and management of occupational hearing loss. Issues of prevention, OSHA-mandated hearing conservation efforts and compensation are reviewed.     

Occupational health surveillance: a means to identify work-related risks.

The lack of successful disease surveillance methods has resulted in few reliable estimates of workplace-related disease. Hazard surveillance--the ongoing assessment of chemical use and worker exposure to the chemicals--is presented as a way to supplement occupational disease surveillance. Existing OSHA (Occupational Safety and Health Administration) and NIOSH (National Institute for Occupational Health) data systems are adapted to this function to characterize the distribution and type of hazardous industry in Los Angeles County. A new method is developed for ranking potentially hazardous industries in the county using actual exposure measurements from federal OSHA compliance inspections. The strengths of the different systems are presented along with considerations of industrial employment and types of specific chemical exposures. Applications for information from hazard surveillance are discussed in terms of intervention, monitoring exposure control, planning, research, and as a complement to disease surveillance.     

Increasing worker and community awareness of toxic hazards in the workplace

In November 1984, the Governing Council of the American Public Health Association (APHA) released this position paper on disclosure of occupational health hazards. The Council's action was prompted by the Occupational Health and Safety Administration's (OSHA's) promulgation of a national right-to-know standard that would pre-empt stronger state and local laws protecting an employee's right to be told about hazardous materials in the workplace. The APHA document outlines the dimensions of the toxic substances problem in the United States; argues the need for right-to-know laws; defines the roles of OSHA, unions, and local coalitions for workplace safety; and criticizes the Federal Hazard Communication Standard. Lists of ten essential components of a national right-to-know policy and of four actions the APHA will take to further the worker's right-to-know conclude the paper.     

Work-related deaths in construction painting.

Analysis of investigation records of the United States Occupational Safety and Health Administration (OSHA) concerning work-related deaths in Standard Industrial Classification (SIC) 1721, construction painting, showed a higher risk of fatal injury than expected from cohort studies including injuries on and off the job. Work-related death rates were 2.3 x 10(-4)/year (ie, three to five times that of general industry). Of the 129 deaths investigated, the largest category was falls (N = 65), followed by electrocution (N = 40) and asphyxiation from solvents or oxygen deficiency (N = 6). Eighteen deaths had other causes. The average OSHA fine for the employer was USD 607.00/fatality. Only 31% of the deaths occurred at firms covered by a union contract. Risk of fatal injury was the highest for small firms with fewer than 10 employees. Cohort mortality studies based on records from unions or large employers probably exclude many small firms and so underestimate the risk of fatal injury to painters.     

Occupational health priorities for health standards: the current NIOSH approach.

Government agencies responsible for protecting the public from the adverse effects of toxic chemicals must set priorities for research, regulatory action, protocol testing, and monitoring due to the vast number of toxic chemicals and the limited resources available to these agencies. The National Institute for Occupational Safety and Health (NIOSH) must set priorities for research on hazards encountered in the workplace. Priorities are also utilized by NIOSH in preparing criteria for recommended occupational standards which are forwarded to the Occupational Safety and Health Administration (OSHA), U.S. Department of Labor, for possible promulgation. For various reasons, including rapidly changing conditions in the American workplace, NIOSH has instituted a revised priorities program. In the future, NIOSH research and recommended standards activities will focus not only on individual chemicals, but also on industries, occupations, chemical classes, and general industrial processes. NIOSH has also implemented a new program which will allow recommended control procedures for certain chemicals to be forwarded to OSHA in a shorter time period than has been experienced previously.     

Now is the time for us to become the leaders we have been waiting for

The budget crisis in California threatens to cut even more resources from the state workplace health and safety agency, Cal/OSHA. This crisis is completely artificial as there are tremendous resources in the state-if the corporations, and the rich who own them, paid taxes. But even with adequate funding, the goal of reducing worker injuries, illnesses, and fatalities can be achieved only by a grassroots occupational safety and health movement that empowers informed workers to be active in protecting their own health at work, and ensures that employers and government mobilize the resources required for safe and healthy workplaces. This is the text of a speech given at the Worksafe Mini-Summit for a Revitalized State Occupational Safety and Health Program, Emeryville, CA, March 25, 2011.     

Protecting workers from pathogens. Employers must act now to comply with OSHA's new standard on bloodborne pathogens

A new standard set forth by the Occupational Safety and Health Administration (OSHA) requires healthcare employers to implement sweeping new controls in areas such as record keeping, engineering, hazard prevention, and work practice. Through the bloodborne pathogen standard, which went into effect on March 6, OSHA acknowledges that healthcare workers face significant health risks as a result of occupational exposure to blood and other infectious materials. Although most prudent healthcare providers already adhere to the Centers for Disease Control's universal precautions, the OSHA regulations include several additional mandatory measures that are more specific and stringent. The additional measures include the development of an exposure control plan, procedures for responding to an employee's exposure to bloodborne pathogens, the implementation of certain engineering and work practice controls to eliminate or minimize on-the-job exposure risks, and the provision of personal protective equipment and information and training programs. OSHA estimates that the greatest cost component of implementing procedures to bring a facility into compliance is attributable to the purchase of personal protective equipment. Although the costs of compliance are substantial, OSHA has estimated that these costs represent less than 1 percent of the healthcare industry's annual revenues. Violation of the bloodborne pathogen standard may result in penalties of up to $70,000, depending on the severity of the infraction. Criminal penalties are also possible for willful violations that result in worker death.     

Fatal injuries to teenage construction workers in the US

BACKGROUND: The construction industry is second only to agriculture in the annual number of fatal injuries in workers less than 18 years of age. We examined fatal injury reports for youth and adult workers to determine risk factors for injury and applicability of existing child labor regulations. METHODS: The US Occupational Safety & Health Administration (OSHA) investigation data for fatal work injuries from 1984 through 1998 were reviewed with respect to type of event, employer characteristics, and apparent violations of existing child labor laws under the Fair Labor Standards Act (FLSA). We also examined whether the employer met exemption criteria for federal enforcement of child labor or OSHA regulations. RESULTS: The fatality rate for teenage construction workers age 19 and younger was 12.1 per 100,000 per year, slightly less than for adult workers. Teenage workers who were fatally injured were more likely than adults to have been employed at non-union construction firms (odds ratio (OR) = 4.96, P < 0.05), firms with fewer than 11 employees (OR = 1.72, P < 0.05), and their employers were more likely to have been cited by OSHA for safety violations (OR = 1.66, P < 0.05) than for firms which were investigated because of a fatality in an adult worker. Fatalities in teenagers were more likely to occur in special construction trades such as roofing. Among fatalities in workers less than 18 years of age, approximately one-half (49%) of the 76 fatal injuries were in apparent violation of existing child labor regulations. We estimated that in 41 of the 76 cases (54%) the employer's gross annual income exceeded the $500,000 threshold for federal enforcement of child labor laws. Only 28 of 76 cases (37%) were at construction firms with 11 or more employees, which are subject to routine OSHA inspections. CONCLUSIONS: Fatal injuries in teenage construction workers differed from those in adults in that they were more likely to be at small, non-union firms of which a substantial proportion were exempt from federal enforcement of child labor laws and from routine OSHA inspections. Safety programs for young construction workers should include small, non-union construction firms and those in special construction trades such as roofing. We did not identify specific areas for new regulation but the number of fatalities reviewed was small.     

Occupational health training of local health department personnel: a curriculum model and implications of training

The Occupational Safety and Health Act of 1970 assigns to the federal government specific responsibilities for regulating safety and health in industry. At the same time, occupational health programs have traditionally been, and continue to be, one responsibility of local and state health agencies. In California, local health agencies are required to provide occupational health services in larger jurisdictions. Professional level positions which may be required include: Occupational health physician, occupational health nursing consultant, industrial hygienist or occupational health sanitarians, industrial hygiene engineer, and industrial hygiene chemist. Frequently a local health agency may satisfy its occupational health requirements by training a registered sanitarian to become an occupational health sanitarian.     

The right to know and the duty to disclose hazard information

In late 1983, the Occupational Safety and Health Administration (OSHA) promulgated its final rule on "hazard communication," establishing the right of workers in manufacturing industries to information about chemical hazards, and the duty of importers and manufacturers to disclose such information. Baram reviews areas where the new, limited OSHA regulation conflicts with existing local, state, and federal laws, many of which are more stringent and more protective of worker and community health. He suggests steps that could be taken to avoid the extensive litigation that might result from the potential preemptive effect of the new OSHA rule.     

Compliance with OSHA record-keeping requirements.

The Occupational Safety and Health Act of 1970 requires employers to maintain records of workplace injuries and illnesses. To assess compliance with the law, data from the National Occupational Exposure Survey (NOES) were examined. Of the 4,185 companies with 11 or more employees, 75 per cent maintained OSHA Form 200 designed for recording illnesses and injuries. The number of employees and the presence of a union were positive determinants in the record maintenance. Of companies with 500 or more employees, 95 per cent kept records compared with 60 per cent of companies with between 11 and 99 employees.     

Where occupational health reporting systems go wrong

Reporting of occupational illness occurs in two statistical systems maintained by the Bureau of Labor Statistics. The first system, the core program established under the Occupational Safety and Health Act of 1970, provides national data by industry from direct reporting of employers in annual (mail) surveys. The second system, based on worker's compensation records, provides data on the characteristics of injuries and illnesses and the workers involved. Although skin diseases are reported separately in both systems, there is usually insufficient detail to establish etiology precisely. Conceptual and practical problems hamper the building of a substantive occupational illness data base.