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EMPLOYMENT: EMPLOYEES: INJURIES AND FATALITIES :

UNITED STATES: GOVERNMENT: STATISTICAL SOURCES:

Occupational Traumatic Injuries Among Workers in Health Care Facilities
United States, 2012 through 2014

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Occupational Traumatic Injuries Among Workers in Health Care Facilities
United States, 2012 through 2014

Ahmed E. Gomaa, MD1, Loren C. Tapp, MD1, Sara E. Luckhaupt, MD1, Kelly 
Vanoli1, Raymond Francis Sarmiento, MD1,2, William M. Raudabaugh1, Susan 
Nowlin1, Susan M. Sprigg, MPH1 (Author affiliations at end of text)

Weekly
April 24, 2015 / 64(15);405-410

Morbidity and Mortality Weekly Report (MMWR)

United States.  Centers for Disease Control and Prevention

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6415a2.htm?s_cid=mm6415a2_w

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In 2013, one in five reported nonfatal occupational injuries occurred 
among workers in the health care and social assistance industry, the 
highest number of such injuries reported for all private industries (1). 
In 2011, U.S. health care personnel experienced seven times the national 
rate of musculoskeletal disorders compared with all other private sector 
workers (2). To reduce the number of preventable injuries among health 
care personnel, CDC's National Institute for Occupational Safety and 
Health (NIOSH), with collaborating partners, created the Occupational 
Health Safety Network (OHSN) to collect detailed injury data to help 
target prevention efforts. OHSN, a free, voluntary surveillance system for 
health care facilities, enables prompt and secure tracking of occupational 
injuries by type, occupation, location, and risk factors. This report 
describes OHSN and reports on current findings for three types of 
injuries. A total of 112 U.S. facilities reported 10,680 OSHA-recordable* 
patient handling and movement (4,674 injuries); slips, trips, and falls 
(3,972 injuries); and workplace violence (2,034 injuries) injuries 
occurring from January 1, 2012September 30, 2014. Incidence rates for 
patient handling; slips, trips, and falls; and workplace violence were 
11.3, 9.6, and 4.9 incidents per 10,000 worker-months, respectively. Nurse 
assistants and nurses had the highest injury rates of all occupations 
examined. Focused interventions could mitigate some injuries. Data 
analyzed through OHSN identify where resources, such as lifting equipment 
and training, can be directed to potentially reduce patient handling 
injuries. Using OHSN can guide institutional and national interventions to 
protect health care personnel from common, disabling, preventable 
injuries.

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OHSN is a web-based data portal that accepts health care facilities' 
existing OSHA-recordable and non-recordable health care personnel injury 
data. De-identified injury data are converted to standard OHSN data 
elements designed to characterize first, the occupation of the injured 
worker; second, the type, severity, cause and location of the injury; and 
finally, information useful in determining how the injury could be 
prevented. Standardization of data across all facilities allows comparison 
within and across facilities; comparison groups can be selected by OHSN 
participants (e.g., hospitals of comparable size or in the same geographic 
region). New data submissions are available to OHSN participants within a 
week, and they can analyze new and historical injury data and produce 
outputs in the form of graphs and tables at any time. The NIOSH OHSN topic 
page provides information on 1) data terminology, transmission, and 
security; 2) examples of output graphs and tables; and 3) intervention 
resources (3).

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OHSN received data on injuries occurring from January 1, 2012September 30, 
2014, from 112 U.S. health care facilities. Pooled mean incidence rates 
and percentiles were calculated for three types of OSHA-recordable 
injuries: 1) falls, including slipping or tripping without a fall; 2) 
patient handling (e.g., handling, pushing, pulling, or lifting patients); 
and 3) workplace violence (i.e., violent acts directed at health care 
personnel). For each of the three injury types, the same denominator was 
used for all sub-analyses within an injury type, because more specific 
denominators were not available.

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The 112 participating facilities were located in 19 states, with 52% 
located in the Midwest. By size, 46% had bed numbers of less than 200 and 
by type, 95% were general medical and surgical facilities. The 
participating facilities had a total of 162,535 full-time employees and 
reported a total of 13,798 slips, trips, and falls; patient handling; and 
workplace violence injuries; of this total, 10,680 (77.4%) were 
OSHA-recordable injuries. Overall incidence rates of OSHA-recordable 
injuries (average worker-months = 125,041) per 10,000 worker-months for 
patient handling; slips, trips and falls; and workplace violence were 
11.3, 9.6, and 4.9, respectively (Table). Most injuries occurred in two 
groups of workers, those aged 3044 years (35%) and those aged 4564 years 
(44%). Nurses (38%) and nursing assistants (19%) accounted for 57% of 
identified OSHA-recordable injuries. Between 70%90% of OSHA-recordable 
patient handling; slips, trips, and falls; and workplace violence injuries 
occurred among female employees.

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Nurse assistants were more likely to sustain injuries than workers in 
other job categories; this occupation had more than twice the injury rate 
of nurses for patient handling and workplace violence injuries (Figure 1). 
Injury rates for slips, trips, and falls were highest among nonpatient 
care staff (e.g., maintenance and security staff), nursing assistants, and 
nurses. Between 2012 and 2014, workplace violence injury rates increased 
for all job classifications and nearly doubled for nurse assistants and 
nurses (Figure 2). Patient handling and workplace violence injury rates 
were highest in inpatient adult wards; these rates were also elevated in 
outpatient emergency departments, urgent care, and acute care centers and 
adult critical care departments. Rates of falls were highest in inpatient 
adult wards, nonpatient care maintenance areas, and operating rooms 
(Table).

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Of all patient handling injury reports, 62% included data on the use of 
lifting equipment; 82% of the injuries occurred when lifting equipment was 
not used (Table). Of all slips, trips and falls injury reports, 65% had 
data on fall type; 89% were falls on the same level, 9% were falls to a 
lower level (e.g., down stairs, ramps, etc.) and 2% were slips and trips 
without falling. Of all workplace violence injury reports, 49% specified 
type of assault (physical, verbal, or destruction of property); 99% were 
physical assaults. Descriptions of who perpetrated the assaults were 
included in 13% of workplace violence injury reports; 95% were committed 
by patients which is in agreement with previous study findings (4).
Discussion

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This report examines patient handling; slips, trips, and falls; and 
workplace violence injuries, which make up a substantial portion of all 
occupational injuries in the health care sector, as reported by the 
national Bureau of Labor Statistics findings for workers in all sectors 
(5). Overall, for the 112 OHSN participating facilities, rates of patient 
handling and workplace violence injuries were highest among nurse 
assistants and nurses; rates of slips, trips, and falls were high for 
these jobs and also for nonpatient care staff. In contrast, physicians, 
dentists, interns, and residents have low injury rates. These data 
indicate that interventions should first focus on prevention of injuries 
to nurse assistants and nurses from patient handling; slips, trips, and 
falls; and workplace violence. Patient handling and workplace violence 
injuries reported to OHSN were clustered in locations providing direct 
patient care, while slips, trips, and fall injuries occurred in both 
patient and non-patient areas. Analysis of detailed, facility-level data 
could identify the higher risk occupations and locations of each facility 
and assist in customizing prevention measures.

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Other studies found that musculoskeletal disorders are increasing among 
health care personnel (2). Nursing staff are exposed to several 
musculoskeletal disorder risk factors: 1) caring for overweight/obese and 
acutely ill patients; 2) high patient-to-nurse ratios; 3) long shifts; and 
4) current efforts to mobilize patients almost immediately after medical 
interventions (6). Prevention measures might concentrate on mitigating the 
high-risk aspects of these jobs. Similar to findings from other studies, 
OHSN data indicate that interventions (e.g., the use of lifting equipment) 
could potentially reduce patient-handling injuries, particularly for 
activities involving positioning, transferring, or lifting a patient (7). 
Additionally, to prevent patient-handling injuries, health care 
institutions might establish a safety culture emphasizing continuous 
improvement and also provide resources such as training in safe patient 
handling and access to lifting teams and lifting equipment. On the basis 
of OHSN findings, the major causes of slip, trip, and fall injuries are 
floor contaminants and contact with objects; however, the variability in 
types of these injuries indicates that each facility should use 
facility-specific data to guide prevention measures. The OHSN topic page 
provides links to helpful resources on safe patient handling methods and 
prevention of falls among health care personnel, including a comprehensive 
falls hazards checklist (3).

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In 2013, Bureau of Labor Statistics found rates of injuries and illnesses 
resulting from workplace violence increased for the second year in a row 
to 16.2 cases per 10,000 full-time workers in the health care and social 
assistance sector (5). Data reported to OHSN revealed the same trend. The 
OHSN topic page provides links to workplace violence prevention resources, 
including an online course to help hospital staff with identifying 
patients at risk for committing violent acts (those with mental illness, 
behavioral disorders, and cognitive dysfunction) as well as ways to 
moderate and prevent violent patient behavior (3).

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The findings in this report are subject to at least four limitations. 
First, in 20122014, only 112 U.S. health care facilities from 19 states 
participated, and the data in this report might not be very representative 
of the thousands of health care facilities in the United States. Second, a 
considerable proportion of OHSN injury data regarding risk factors are 
categorized as unspecified, which could limit OHSN's ability to identify 
causality and prevention needs. Third, possible participation, reporting, 
and recording biases might exist. Voluntary participation might skew 
participation to best-practice facilities and some facilities might not 
report all injury data, leading to underestimation of injury rates. Not 
all facilities collect detailed data requested by OHSN, such as specific 
activities which lead to patient-handling injuries or why a patient or 
coworker commits violence against health care personnel. Thus, missing 
data might bias the results. As participating facilities submit more 
complete information on worker injuries, the large amount of unspecified 
data might likely diminish. NIOSH personnel can assist facilities with 
improving data completeness and quality.

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OHSN offers a variety of tools for NIOSH and health care institutions to 
work toward a common goal of employee safety and health by reducing all 
types of injuries among health care personnel. OHSN enables health care 
facilities to track injuries; collect and analyze detailed standard injury 
data to direct resources toward employees, departments, and situations 
most at risk; compare their own injury rates with groups of their 
choosing; access prevention resources; facilitate implementation of timely 
prevention measures; and monitor intervention impact. Emphasizing worker 
safety promotes and strengthens patient safety (8), which contributes to 
improved patient care and reduced costs (9). Future improvements to OHSN 
include plans to develop a module to systematically collect detailed 
information on occupational injuries from needles, scalpels, and other 
sharp objects, and blood and body fluid exposures among health care 
personnel to assist in creating prevention strategies for those hazards. 
Targeting prevention strategies can protect health care personnel from 
prevalent, disabling injuries and help in managing resources.

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Acknowledgments

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Occupational Health Safety Network health care facilities participants; 
Geoff Calvert; Mary Metz.
1Division of Surveillance, Hazard Evaluations and Field Studies, National 
Institute for Occupational Safety and Health; 2Public Health Informatics 
Fellowship Program, Division of Scientific Education and Professional 
Development, Center for Surveillance, Epidemiology and Laboratory 
Services, CDC (Corresponding author: Ahmed Gomaa, [log in to unmask], 
513-841-4337).

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References

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Bureau of Labor Statistics. 2013 Survey of occupational injuries and 
illnesses: nonfatal (OSHA recordable) injuries, industry incidence rates 
and counts. Washington, DC: US Department of Labor, Bureau of Labor 
Statistics, Safety and Health Statistics Program; 2014. Available at 
www.bls.gov/iif/oshwc/osh/os/osch0052.pdf.

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Occupational Safety and Health Administration. Safety and health topics: 
healthcare. Washington, DC: US Department of Labor, Occupational Safety 
and Health Administration. Available at 
https://www.osha.gov/SLTC/healthcarefacilities/index.htmlExternal Web Site 
Icon.

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CDC. NIOSH Occupational Health Safety Network. Cincinnati, OH: US 
Department of Health and Human Services, CDC, National Institute for 
Occupational Safety and Health; 2015. Available at 
http://www.cdc.gov/niosh/topics/ohsn/.

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Arnetz JE, Hamblin L, Essenmacher L, Upfal MJ, Ager J, Luborsky M. 
Understanding patient-to-worker violence in hospitals: a qualitative 
analysis of documented incident reports. J Adv Nurs 2015;71:33848.
Bureau of Labor Statistics. News release: nonfatal occupational injuries 
and illnesses requiring days away from work, 2013. Washington, DC: US

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Department of Labor, Bureau of Labor Statistics, Safety and Health 
Statistics Program; 2014. Available at 
http://www.bls.gov/news.release/osh2.nr0.htmExternal Web Site Icon.

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Patient Safety Network. Patient safety primer: nursing and patient safety. 
Washington, DC: US Department of Health and Human Services, Agency for 
Healthcare Research and Quality; 2012. Available at 
http://psnet.ahrq.gov/primer.aspx?primerID=22External Web Site Icon.

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Powell-Cope G, Toyinbo P, Patel N, et al. Effects of a national safe 
patient handling program on nursing injury incidence rates. J Nurs Adm 
2014;44:52534.

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Sinnott M, Shaban RZ. Can we have a culture of patient safety without one 
of staff safety? BMJ 2011;342:c6171.

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Sinnott M, Eley R, Winch S. Introducing the safety score audit for staff 
member and patient safety. AORN J 2014;100:915.

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*	OSHA-recordable injuries are defined as work-related injuries and 
illnesses that result in at least one of the following: death, loss of 
consciousness, days away from work, restricted work activity or job 
transfer, medical treatment beyond first aid, or a diagnosis by a 
physician or other licensed health care professional.


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The complete document including statistical data may be read at the URL 
above.


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