OSHA Inspection: EAST MOLINE CARE CENTER

Issued

Oct 29, 1992

Abate by

Dec 31, 1993

Penalty

Initial $2,275 · Current $1,138 Reduced

General-duty citation text

Section 5(a)(1) of the Occupational Safety and Health Act of 1970:
The employer did not furnish employment and a place of employment
which were free from recognized hazards that were causing or likely
to cause permanent crippling, loss of function and serious injury
to employees in that the following employees were exposed to work
conditions which increased the possibility of back injuries.  This
exposure caused, aggravated, or precipitated employee injuries to
the trunk, back, and upper extremities:
a.   Certified Nursing Assistants responsible for most of the
handling, lifting and transfer of the residents were subject
to severe stress and strains of the body including backs,
shoulders, arms and hands.
b.   The ergonomic stressing resulting in back and lifting muscle
strains can be reduced by a program that includes but is not
limited to the following:
Worker exposures to ergonomic stresses while performing tasks were
shown by a recorded history of worker lost time and symptoms of pain
in the back, neck, and shoulders.  The employer did not perform
ergonomic evaluations to identify dangerous work situations and
work practices.
1.   Job Stress Analysis
Using an ergonomic consultant who is qualified by education,
training, and experience in the field of ergonomics, conduct an
ergonomic analysis of all the resident handling and transferring
tasks addressed by OSHA or brought to the attention of the employer
by the employees or the consultant.  The ergonomic analysis shall
include an evaluation of the ergonomic stressors for the occupations,
including anthropometry, posture force and the frequency of actions,
as well as time between actions, and shall utilize survey tools,
including videotaping of simulated tasks and input from the employees
whose jobs are being evaluated and videotaped.  Testing and evaluation
of modifications designed to reduce the ergonomic stressors identified
through the ergonomic analysis should be performed.  During the
testing and evaluation, input from the first line supervisor and
employees who perform the jobs being studied should be obtained and
considered.
Following the completion of the ergonomic analysis the employer shall
submit to the Area Director of the Peoria, Illinois Office of OSHA a
written, detailed plan of abatement.  The plan should include:
a.   Ergonomic analysis report.
b.   Feasible engineering controls and/or work practice controls
which are identified by the Consultant as effective and
feasible in reducing ergonomic stressors through the testing
and evaluation of the recommendations.
c.   A medical management program.
d.   A training and education program.
e.   The lifting stress on CNA workers assisting residents can
be reduced if the height of toilet seats and shower seats
were higher.  Evaluate the effect of raising the seats in
2 inch increments.  Ensure timely maintenance and wheel locks
on shower chairs.
f.   The time needed to put gait belts on residents could be
reduced by putting a removable carrier on the CNA workers
wheelchair, and providing three different length gait belts
for small, medium, and large residents.
g.   Investigate gait belts, stressing to residents' skin damage
might be reduced by using broader belts.  The effective
handling of the resident would be ergonomically more
efficient if there were swivel handles on the belt.  Rather
than use a metal buckle, gait belts closure might be made
more quickly if velcro type closures could be used.
h.   In addition to the resident's weight, as a guide in
determining which residents and processes shall be performed
by a single, by two, and possibly by CNA workers using
mechanical lifting assistance, evaluate the residents based
upon impairment of lower limbs, alertness, cooperativeness,
Parkinson and/or Alzheimer diseases, and possible antisocial
actions such as grabbing, hitting, and pinching.  Share
the information with the ergonomist.  Develop a resident
door coded sign so that CNA workers are aware of special
resident needs and concerns when they enter the room.
i.   Investigate replacement of resident beds with automatic
(motorized) adjustable beds with consideration of the
economics of potential compensation cost and reduction
of employee absenteeism for back injuries.
2.   Education
Implement a comprehensive education program for the nursing personnel
and their managers and supervisors and other employees identified
in the ergonomic program on the range and causes of ergonomic hazards
and means of prevention of back injuries.  Emphasis must be placed
on the recognition of any early symptoms of back injuries and other
musculoskeletal disorders.  The training should include the following
additional elements:
a.   Postures and work methods appropriate for the type of
transfer;
b.   Single lifts and assisted lift needs and requirements;
c.   Procedures to obtain assistance;
d.   Uses and limitations of lifting devices, including patient
assisting devices;
e.   Identification of patients requiring special assistance;
f.   Procedures for non-routine transfers;
g.   Reporting procedures; and
h.   Instructions on the proper use of equipment.
The education program should be repeated on an annual basis, and
the program should include periodic unannounced job site evaluation
to assure that proper transferring techniques by the employees have
been learned and are being used.  An evaluation of the program should
be conducted at least annually and should include suggestions of
proposed changes to the training program.
The use of locally made resident handling videotapes that show the
ideas and suggestions of the CNAs should be supported.  The CNA worker
could give brief discussion of the process, and videotape used to
record the process.  It is suggested that new concepts be demonstrated
by CNA workers using fellow CNA workers to represent the resident.
The techniques could be reviewed by the safety committee and promising
concepts passed onto other care centers.
If CNA workers are expected to provide physical therapy to residents,
the video training program should be expanded to give information
concerning the physical therapy services.  Because much of the
effectiveness of physical therapy is "hands on," a trained physical
therapist should be used along with the video training.
3.   Medical Management
Implementation of a medical surveillance and treatment program for
employees exposed to lifting hazards, which includes the following:
a.   Physical examinations with special attention to medial nerve
distribution, muscular aberrations, and flexibility (including
both strength and stamina testing and nerve pace testing, along
with a review of employee work histories relative to back trauma
disorders).
b.   Medical examinations and counseling of employees as soon
as symptoms generally associated with back strain disorders
are reported.  Detailed examinations of each employee's
specific work history should be performed, and medical
treatment (including ice therapy and exercise therapy)
should be considered where appropriate.  Employees should
be alerted to the minimal effectiveness of surgical
interventions, especially when returning to a job with high
risk factors, and to the use and limitations of posture
or lifting assistance appliances.
c.   Medical records should include a descriptive diagnosis,
specifying which muscles, tendons, and nerves are affected,
as well as treatments prescribed.
d.   Employees should be prohibited from returning to their former
jobs following surgery until the work environment has been
evaluated and modified to the extent possible to reduce the
risk of recurrent injury.
e.   Follow-up of mild cases of impairment to ensure that medical
treatment and job changes have been effective.
f.   Establish the principle that workers who have ergonomic injuries,
and that are not able to perform their assigned work, have the
job of restoring themselves to health.  Enroll all ergonomic
injured workers in a medically supervised physical therapy
program.  The program goal is to return the worker to health
in a minimum of time, and will demonstrate when the worker can
safely resume normal job activities.
g.   Promote openness between the workers and the company.  Workers
should be encouraged to communicate their health concerns.  Early
recognition of ergonomic disease and injury symptoms can allow
the use of the problem correction using low risk conservative
treatment, job retraining and modifications.
Disclaimers:
a.   The employer is not limited to the abatement methods
suggested by OSHA.
b.   The methods explained are general and may not be effective
in all cases.
c.   The employer is responsible for selecting and carrying out
an effective abatement method.

Issued

Oct 29, 1992

Abate by

Nov 10, 1992

Issued

Oct 29, 1992

Abate by

Nov 30, 1992

Issued

Oct 29, 1992

Abate by

Nov 30, 1992

Issued

Oct 29, 1992

Abate by

Nov 30, 1992