When you think of the industry with the highest number of workplace injuries, you may be picturing oil fields, manufacturing plants, or farmlands. You might be surprised to learn that, in fact, health care workers suffer more injuries on the job than workers in any other sector.

A report released today by Public Citizen found that the rates of injury for nursing aides, orderlies and attendants are off the charts – seven times the national rate of all employees! The most common injuries for these workers are musculoskeletal disorders, which often result from moving patients, and come with a price tag of more than $7 billion annually, the report said.

But the ergonomic issues only tell part of the story.

OSHA’s presence is not as prevalent in health care sites as is felt in other industries. Though the number of health care workers is more than double the number of construction workers, OSHA conducts only one-twentieth the number of inspections at health care sites than construction sites, Public Citizen reported.

That potentially could be because of the severity of injuries endured. In 2010, fatalities claimed the lives of 774 U.S. construction workers and 329 manufacturing workers, compared to 141 workers in the health care and social assistance sector, according to data from the U.S. Bureau of Labor Statistics.

“OSHA is not fulfilling [its] obligation for health care workers,” the report alleged. “To comply with the law that authorizes its existence, OSHA needs to dramatically increase the number of inspections of health care facilities and issue binding standards to ensure that workers are protected from widely acknowledged hazards. Doing so will require significantly more funding, as well as more cooperation from both Congress and the executive branch in developing needed safety rules.”

Health care workers also experience an undue rate of workplace violence. Of all workplace violence incidents in the United States that result in lost workdays, 45 percent are in the health care sector, Public Citizen reported.

OSHA has no specific rules to address either workplace violence or ergonomic hazards, but the agency has taken other steps, such as through advisory publications and a program focusing on risks in nursing homes. The latter excludes workers in hospitals and other health care settings, where high injury rates also are reported.

“Enforcement efforts also are frustrated by a dearth of safety rules relating to the types of risks facing health care workers. This gives inspectors a limited menu of choices to cite facilities for safety violations,” the report said. “A last resort for the agency is to rely on its catch-all ‘general duty’ clause, which requires employers to provide conditions that are ‘free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employee.’ But the evidentiary standard for the general duty clause is so high that few cases are brought pursuant to it.”

Ten states have enacted safe patient handling laws, which require that health care providers furnish mechanical lifting and transfer devices so that employees do not have to lift and move patients manually. After these measures have been passed, health care workers’ injury rates have been reduced in these states.