Where do most workplace injuries happen? Oil drilling, you might think, or construction, or truck driving. But in an ironic twist, the workers in the most dangerous industry don't have to go very far if they get injured; they work in the health care sector.
According to a new report by Public Citizen's Congress Watch, a consumer advocacy group, nearly half -- 45 percent -- of all incidents of workplace violence that result in lost workdays occur in the health care industry. Nursing aides, orderlies and attendants are seven times more likely than the average worker to suffer musculoskeletal disorders (requiring days off work), according to the latest data, and also seven times more likely to be injured in an assault on the job.
"I think a lot of the reasons may have to do with people being on medication, and being off medication," explains Keith Wreightson, the work safety and health advocate at Public Citizen's Congress Watch, and a co-author of the report. He believes many of the violent incidents occur in psychiatric facilities, and in general, "a lot of people are not particularly happy to be in a health care facility. They're angry."
Workplace Not Monitored: The Occupational Safety and Health Administration, the federal body tasked with ensuring workplace safety, devotes only a fraction of its attention to the health care industry compared to other high-risk occupations, according to the Congress Watch report, which was created with assistance from the Service Employees International Union. Part of the reason is that there are only a tiny number of regulations on the books that affect the sector.
"If they show up in a health care facility, there's nothing to cite them on, fine them on, write them up on, or say anything about it," says Wreightson. "... Employers in the health care industry are more likely to be cited for frayed electrical cords over physical harm or ergonomic harm to an employee."
And while injury rates are falling in other risky professions, in the health care industry, injuries and illnesses are rising. Workplace violence alone, which OSHA calls "a recognized hazard" in the industry, jumped 13 percent between 2009 and 2010.
Enormous Number of Cases: The private health care industry doesn't have the highest rate for all injuries and illnesses, but with such a enormous workforce, it has the highest number. In 2010, there were almost 654,000 cases in the health and social assistance sector, 152,000 more cases than the next highest -- manufacturing. And when it comes to back injuries, disease, and workplace violence, health care workers are particularly vulnerable, the report states, with rates far exceeding the national average. Health care workers experience percutaneous injuries -- punctures of the skin with sharp instruments or needles -- 400,000 times a year, which can pose a high risk of exposure to HIV and hepatitis.
Despite the staggering number of injuries among health care workers, the report documents how OSHA conducts very few inspections of health care workplaces. Employers in the health care and social assistance sector reported more than twice the number of injuries than employers in construction, yet OSHA conducted more than 52,000 inspections of construction sites in 2010, compared to 2,500 inspections of health care facilities. At the same time, the report adds, construction workers are far more likely to die on the job than anyone working in health care.
"Thirty years ago we had an economy that was based on industry and manufacturing and we've drastically stepped away from that in a matter of years," says Wreightson. "OSHA has not been able to kept up with that pace increase. ... It's completely blinded them essentially that health care is now the biggest industry in the United States."
The Public Citizen's Congress Watch recommends more standards in the industry, such as one concerning ergononomic stressors to reduce back injuries and a zero-tolerance approach to verbal and physical abuse. When OSHA issued a new rule in 1991 requiring health care facilities to offer free hepatitis B vaccinations, the report points out, infections declined from 17,000 cases in 1983 to 400 in 1995.
But new regulations are always tricky to pass, particularly in recent years. OSHA actually issued an ergonomics standard in 2000, but in 2001, the House and Senate repealed it before it took effect.