OSHA Expands Use of Enforcement Resources in Healthcare Inspections


On June 25, 2015, OSHA issued a memorandum establishing guidance for inspections of inpatient healthcare facilities hospitals, nursing, and residential care facilities. OSHA has directed its Compliance Safety & Health Officers (CSHOs) to focus on:

  • Musculoskeletal disorders (MSDs) relating to patient or resident handling
  • Workplace violence
  • Blood borne pathogens
  • Tuberculosis
  • Slips, trips, or falls
  • Exposure to multi-drug resistant organisms, such as Methicillin-resistant staphylococcus aureus (MRSA)
  • Exposures to hazardous chemicals, such as sanitizer, disinfectants, anesthetic gases, and hazardous drugs


Of particular note is OSHA‚ heightened focus on MSDs and workplace violence. In citing healthcare facilities under this enforcement guidance, OSHA intends to continue and expand its practice of alleging violations of the General Duty Clause which requires employers to provide workplaces free from recognized hazards that are causing or are likely to cause death or serious physical harm to employees. OSHA uses the General Duty Clause to support citations for hazardous ergonomic conditions as well as potential workplace violence hazards.

Recently, OSHA has been aggressive in pursuing citations related to MSDs in other industries such as poultry processing, and with this new memorandum OSHA signals its intent to expand this aggressive approach to healthcare as well.

MSD Inspections

At the beginning of the inspection, CSHOs will ask for the maximum census of patients/residents and the existing census at the time of inspection. CSHOs also will ask about the degree of ambulation of the patients/residents, to assist in evaluation of the degree of ergonomic (MSD) hazards that may be present. The CSHO also will assess whether the establishment has implemented a process to address ergonomic hazards. If so, the CSHO will examine that program to determine whether it is appropriately managed and implemented and that employees have been properly trained in recognition of ergonomic hazards, and proper work technologies to avoid MSDs.

Workplace Violence

The CSHOs are directed to investigate for the potential or existence of violence hazards. Among other things, CSHOs will want to see hazard assessments, whether a workplace violence prevention program is in place, the identity of all employees in charge of security, and information regarding employee training programs and methods used to inform workers of the potential for, and prevention of, workplace violence.

Although some of these focus hazards were a part of OSHA‚ National Emphasis Program Nursing and Residential Care Facilities, there can be little doubt that this newly issued enforcement guidance signals a likely expansion of OSHA‚ inspections of healthcare facilities, particularly given OSHA‚ assertion that inpatient healthcare settings have some of the highest rates of injury and illness in the nation, and have high incidences of workplace violence.

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