From workplace violence to bloodborne pathogen exposure, OSHA and other organizations are paying more attention to hospital safety protocols that go beyond awareness for patients.

Dangers that exist in healthcare settings are typically thought of as hospital-acquired infections, biohazard exposure, incidence of medical errors and fall risks. These quagmires remain worthy of attention and protocols that promote safety, yet are primarily focused on patients. But these can also affect nurses and other providers who are tasked with protecting patients. The jeopardy that healthcare staff is exposed to daily is serious, and these issues are not going unnoticed. In 2013, one in five reported nonfatal occupational injuries occurred among workers in the healthcare and social-assistance industry, the highest number of such injuries reported for all private industries, according to the U.S. Bureau of Labor Statistics.

Furthermore, the Occupational Safety and Health Administration (OSHA) found that healthcare personnel in the United States experienced seven times the national rate of musculoskeletal disorders compared with all other private sector workers in 2011.

“According to OSHA, working in a hospital is the most dangerous place in the United States,” said Allan F. Brack, a training and education consultant with Qlicksmart, a company that develops safety products and provides education on the prevention of sharps injuries. “There’s no question that this is becoming a big deal. The vast majority of hospitals do not meet OSHA requirements.”

These requirements cover a landscape of risks, such as bloodborne pathogen exposure, workplace violence, and the providing of protective equipment and respiratory safety. OSHA requirements related to pathogens include the drafting of written control plans designed to eliminate or minimize exposure while ensuring the plan is accessible to employees and updated annually. As part of that updating, management should also consider implementation of available and effective medical devices designed to eliminate or minimize occupational exposure. Employers are also expected to solicit input from non-managerial employees who are responsible for patient care and who are potentially exposed to injuries from contaminated sharps in the identification, evaluation and selection of effective practice controls as part of said plans.

“One of the biggest areas of concern, and not all hospitals are aware, is OSHA’s enforcement of bloodborne pathogen issues, along with back injuries and workplace violence,” Brack said.

Pertaining to protective equipment, OSHA requires the provision of materials that protect the eyes, face, head and extremities, as well as protective clothing, respiratory devices, and protective shields and barriers. All items must be maintained in a sanitary and reliable condition by reason of exposure to hazards of processes or environment, chemical hazards, radiological hazards or mechanical irritants that could cause injury or impairment through absorption, inhalation or physical contact. From the respiratory perspective, employers should make respirators available for times when the air may be contaminated by dusts, fogs, fumes, mists, gases, smokes, sprays or vapors. While the primary goal is prevention of atmospheric contamination, the establishment and maintenance of a respiratory program is also part of the regulations set by OSHA. According to Brack, there is disconnect between OSHA standards and the recognition of such standards by hospital administration.

“Many hospitals are working under the assumption that the Joint Commission is the one responsible [for all safety protocol], and they’re wrong,” he said. “In June 2015, OSHA sent out a directive to all regional offices that they should be inspecting hospitals, nursing homes and other facilities independent of the Joint Commission. Meaning, they’re seeing a lot of injuries.”

And as OSHA has intensified inspections, fines that have been levied for various unsafe practices have been delivered at an immense level, Brack said “Fines are ranging from tens of thousands to hundreds of thousands of dollars,” he continued.”

Another area of concern has been workplace violence. OSHA’s statistics show that nearly two million American workers report workplace violence annually while many more are said to go unreported. The National Institute for Occupational Safety and Health (NIOSH), an agency governed by the Centers for Disease Control and Prevention, defines workplace violence as acts (including physical assaults and threats of assaults) directed toward people at work or on duty ranging from incidents including offensive or threatening language to homicide. Nurses working in psychiatric wards, emergency departments, waiting rooms and geriatric units remain most at risk, as are those who work alone, lack appropriate security onsite, lack training and policies for preventing and managing crises, and are transporting patients. Risks increase if patients are exposed to long waiting times and/or staff members find themselves in poorly lit corridors, rooms, parking lots and other areas. NIOSH officials suggest employers take steps to prevent violent acts, such as developing safety and health programs that involve management and employees, and cover topics such as hazard identification and prevention, safety and health training, and appropriate reporting measures in the event of violence. Brack also warns of the “job pressures” that can also contribute to unsafe situations, not necessarily connected to violence specifically but more in the sense of employees being generally at risk.

“We live in a world where you have to react quickly in order to meet the efficiencies of the hospital’s plan,” he said. “You get many injuries that could be avoided if the basic rules of compliance were being followed. There’s got to be correlation between cutting corners due to [job] pressures and being injured. You either are safe, or you are not safe.”

According to OSHA, having safety and health management systems has helped reduce “personal, financial and societal costs that injuries, illnesses and fatalities impose.” Research also reportedly demonstrates that such systems are effective in transforming workplace culture; reducing injuries, illnesses and fatalities; lowering workers’ compensation and other costs; improving morale and communication; and improving processes, products and services. Characteristics that make safety programs effective include management commitment, employee participation, integration of health and safety with business planning, and continuous system evaluation. OSHA’s research has also found that organizational factors are the most significant predictors of safe behaviors, citing studies that show compliance with standard precautions increases when workers believe there is a commitment to safety and when institutions place an emphasis on interventions that are intended to improve organizational support for employee health and safety.