Addressing Worker Safety and Health Through the Lens of Strategic Enforcement-Part One.

Ensuring the safety and health of workers in this country, who are employed at millions of workplaces that present a dizzying array of hazards, is daunting. Every day, workers are maimed or die from workplace injuries or occupational illnesses. Hence, government agencies must use all available means to ensure the laws intended to keep workers safe and healthy in their workplaces are maximally effective in accomplishing that purpose. This paper addresses this challenge through the lens of strategic enforcement. It examines how federal and state authority are designed to interact to ensure worker protection in this space, and focuses on what tools for deterring violations - many unrecognized or underutilized by worker safety agencies - are available to leverage the limited resources that inevitably constrain the agencies' reach. The forthcoming Part II will, among other things, showcase a number of noteworthy state and local initiatives that exceed the federal standard.

Chapitre 4. L'accident du travail chez soi.

The widespread use of teleworking during the health crisis reduced the flow of occupational accident claims by 20%. This applies to commuting accidents, as well as claims related to « immediate » or “deferred” risks (Rapp. annuel 2020 de l’Assurance maladie - Risques professionnels : Eléments statistiques et financiers, déc. 2021, p. 2 and 113). On the basis of these figures, working at home could be analyzed as a means of preventing occupational risks and improving workers’ health. In reality, however, these figures should not obscure the fact that telecommuting is a major occupational hazard. This is all the more the case given that, while telecommuting was not very widespread before the pandemic, it is now popular with employees and is being developed by many companies as a source of productivity (Rapp. CNP, May 16 2022). We therefore need to keep a close eye on the development of workplace accident legislation in this area, its adaptability to the specific claims experience of teleworkers and its perfectibility, not forgetting the thorny question of the possible recognition of the employer’s inexcusable fault in the event of the accident being covered by professional legislation.

Importance of legal regulations resulting from technical harmonization in the European Union for improvement of work safety of farmers in Poland.

INTRODUCTION AND OBJECTIVE: Accidents exert a negative effect on the quality and standard of living of rural inhabitants, especially when they make it impossible to continue work on a farm, or this work may be performed only to a limited extent. The creation of effective legal mechanisms which would guarantee the safety of operation of machinery is a crucial issue, it is of a preventive character and considerably limits the number of accidents. Approximately 16.1 million people live in the rural areas and around 2.3 million work in the agricultural sector, which represents 14.5% of all labour in Poland in 2019. OBJECTIVE: The aim of the study was to evaluate the legal regulations resulting from the directives of technical harmonization in the European Union for improvement of safety of work with the use of agricultural machinery in Poland. MATERIALS AND METHOD: The method was critical analysis of legal acts in effect, court rulings, and statistical data concerning accidentsoin farms, made available by the Agricultural Social Insurance Fund (KRUS). BRIEF DESCRIPTION OF THE STATE OF KNOWLEDGE: As a result of Poland's membership of the European Union, rural areas were covered by globalization processes and single market rules, within which there function legal mechanisms of safety and quality of products. CONCLUSIONS: Analysis of the 16 years of Poland's membership of the EU, resulted in positive results being observed in the use of the directives of technical harmonization, especially in reducing the number of accidents involving agricultural machinery. However, this improvement may result from using newly-purchased, modern and safer agricultural machinery covered by the conformity assessment, and preventive actions carried out by the Agricultural Social Insurance Fund. An impact of other factors, not analysed in the study, cannot be ruled out.

Occupational health and safety in agriculture - a brief report on organization, legislation and support in selected European countries.

INTRODUCTION AND OBJECTIVE: Agriculture and forestry are among the most dangerous professions in Europe, with a high level of accidents affecting the sustainability and viability of the sector. International conventions, EU directives and national legislation build the fundamental basis for prevention. The aim of the study is to describe and categorize national mechanisms of occupational safety and health (OSH) for agricultural workers in Europe, to assess the extent of implementing safety regulation, the body in charge, and to give examples of health and safety initiatives. MATERIAL AND METHODS: Results of a questionnaire-survey on basic safety regulations on farms sent by e-mail to the representatives of 30 participating European countries in the context of the Sacurima COST action network (CA 16123) are presented. Due to the complexity, only selected countries are described in this study highlighting the regulative bodies, occupational health services or specific training offers, as well as the complexity of the mechanisms. RESULTS: One of the most serious issues and deficits of EU OSH regulation is the exclusion of self-employed farmers who compose nearly 90% of the farming population. This leads to serious under-reporting of accidents, and because one of the most common measures for the performance of health and safety initiatives are the injury and ill health statistics, better registration systems are urgently needed in almost all countries as a basis for preventive efforts. CONCLUSIONS: The results of the study provide a basis for raising awareness about the current OSH systems in Europe, and the importance of developing sector specific OSH strategies. The proposed activities should assist in tackling high accident rates and poor occupational health for self-employed farmers.

Key factors for successful implementation of the National Rollover Protection Structure Rebate Program: A correlation analysis using the consolidated framework for implementation research.

Objectives On US farms, tractor overturns are the leading cause of death; however, these fatalities are preventable with the use of a rollover protection structure (ROPS). A ROPS rebate program was established in New York in 2006 to address these fatalities. Due to its success, the program expanded to six additional states before being implemented as the National ROPS Rebate Program (NRRP) in 2017. The aim of this study was to evaluate the success of the NRRP implementation using short- and long-term ROPS outcome measures and identify which components of the consolidated framework for implementation research (CFIR) correlate with these outcomes. Methods Stakeholders involved in the NRRP implementation were surveyed at four time points, beginning at the time of the NRRP launch and then every six months. These surveys measured 14 relevant CFIR constructs. Correlations between CFIR survey items (representing constructs) and three outcome measures (intakes, funding progress, and retrofits) were used to identify CFIR survey items that are predictive of the outcomes. Results Eight CFIR survey items were highly correlated (rho ≥0.50) with at least one of the three outcome measures. These eight CFIR survey items included four constructs: access to knowledge and information, leadership engagement, engaging (in fundraising and funding requests), and reflecting and evaluating. Conclusions The results of this study provide important guidance for continuing the implementation of the NRRP. Similarly, these findings can inform the evaluation of other similarly structured implementation efforts and the application of CFIR in a variety of settings.

Scoping Global Aquaculture Occupational Safety and Health.

Objectives: In 2017 the Food and Agriculture Organization (FAO) Committee on Fisheries committed to prioritize occupational safety and health issues in aquaculture (AOSH). An international team was established to synthesize OSH knowledge concerning more than 19 million, often vulnerable, aquaculture workers found globally.Methods: The study was conducted as a desktop scoping exercise using both peer-reviewed and gray literature and the knowledge and expertize of an international panel. Collated information used a standard proforma. Panel members developed draft national and regional AOSH profiles outlining occupational hazards contributing to occupational injuries, diseases, and known solutions. These were work-shopped and refined after gathering additional information and used to compile the first global scoping review report on AOSH.Results: Synthesized results revealed multiple hazards, significant global knowledge gaps and some successful and unsuccessful global, national and industry-specific AOSH policies, practices and standards along the primary supply chain, in marine and freshwater contexts. Some constructive initiatives by the International Labor Organization (ILO) and FAO, industry, labor and civil society groups in a range of employment and geographical settings and across diverse populations of workers were identified.Conclusion: Global commitment to AOSH should be given the same focus as product quality, biosecurity, food safety and environmental sustainability in the sector. This needs development and implementation of integrated AOSH actions appropriate for diverse settings especially in low and middle-income countries encompassing greater uptake of international codes, better risk assessment and OSH management, adoption of technological innovations, effective OSH regulation and enforcement, adequate resources, training and information.

Occupational safety in the construction industry.

BACKGROUND: The paper is a research review focusing on occupational safety in the construction industry. OBJECTIVE: The purpose is to present research that highlights the areas of occupational safety and risks and to identify areas where research is lacking. METHODS: 146 articles from scientific journals, mainly covering the construction industry in Europe, Canada, USA, Australia and Japan have been studied. The findings are presented under 11 categories: accident statistics; individual factors; legislation and regulations; ethical considerations; risk management; leadership, management, organization; competence; safety design; cost-benefit calculations; programs and models; and technical solutions. RESULTS: The research is dominated by initiatives from researchers and government authorities, while the construction industry only appears as the object for the research. There is a scarcity of research on integrated systems encompassing subcontractors, as well as a lack of research with sociological perspectives on accidents. Furthermore, only a few studies have applied a gender perspective on safety in construction, i.e. there is a need of further research in this particular area. CONCLUSIONS: A range of initiatives have been taken to increase safety in the construction industry and the initiatives are mainly reported to be successful. There are some cultural differences, but basically researchers present similar results regardless of country.

Why do farm accidents persist? Normalising danger on the farm within the farm family.

In the western world, farming is the most dangerous occupation with the highest rates of accidents and fatalities. Farming remains largely a family business and most accidents happen to family members. Why do safety campaigns have such limited success and why do farm families bring this terrible grief on themselves? This article argues that farm accidents are a persistent social pattern requiring analysis of how families are socialised to interact with the farming space. Based on qualitative data gathered for a Scottish study, it is argued that within farm families there is a socialisation and normalisation of danger. Accidents are to be expected. Two key arguments are advanced. First, danger is normalised and children are socialised to undertake risky behaviour. Second, it is suggested that when women do take up farming, they consciously undertake dangerous farming activities to prove that they are 'authentic' farmers. No previous research has considered women's approach to danger, and the existing literature suggests women are more safety conscious. This is not supported by our findings. We argue that farm accidents and fatalities are a persistent social problem because family members socialise each other to accept danger as the norm.

Infectious risk for healthcare workers: evaluation and prevention.

Exposure to pathogenic agents is a major occupational risk factor in healthcare facilities. The most common pathogenic agents are human immunodeficiency virus, hepatitis B and C viruses, and Mycobacterium tuberculosis. In Italy, about 70-80% of all cases of exposure to biological agents result from injuries caused by needles or other sharp instruments used during healthcare procedures. These accidents place a high economic burden on healthcare facilities. Indeed, each event is estimated to cost around € 375. Various studies have shown that the adoption of needlestick-prevention devices reduces occupational exposure to biological risk. At regulatory level, Italian Legislative Decrees 81/08 and 19/14 provide for measures to protect healthcare professionals from biological exposure to pathogenic agents.

Circumstances and Structure of Occupational Sharp Injuries among Healthcare Workers of a Selected Hospital in Central Poland.

(1) Background: An analysis of work-related sharp injuries in Healthcare Workers (HCWs) based at a selected hospital in Central Poland by presenting the frequency of accidents, injury rates, and identifying circumstances of Needle Sticks and Sharp Injuries (NSSI) and giving Post-Exposure Procedures (PEP). (2) Methods: A retrospective analysis of medical documentation regarding work-related NSSI at a district hospital located in central Poland; over the period 2010⁻2017. The study group included HCWs who had an accident while on duty. (3) Results: Most injuries were reported by nurses and staff over 40, on the morning shift. The most common injuries were using a needle. The most exposed part of the body were fingers. The average annual injury rates were: 1.22/100 Nurses; 2.02/100 doctors; 1.34/100 hospital beds; and 8.59/100,000 inpatient days. The rates for 3-year periods, after the implementation of legal regulations were higher than before. CONCLUSION: Injuries rates are more reliable for comparison than frequency. Legislation on the need to register injuries seems to be necessary. In the supervision of work safety of personnel, reliable reporting of all injuries by the respective HCWs plays a key role.

Legal Aspects of Sleep Medicine in the 21st Century.

Multiple manifestations of sleep disorders may interact with the law, making it important to increase awareness of such interactions among clinicians. Patients with excessive sleepiness may have civil (and in some states criminal) liability if they fall asleep while driving and cause a motor vehicle accident. Employers may be held vicariously liable because of the actions of sleepy employees. Hence, awareness of causes of excessive sleepiness, such as sleep deprivation and OSA, is increasing among trucking, railroad, and other safety-sensitive occupations. Interestingly, litigation related to perioperative complications because of OSA is more frequent than nonoperative issues such as a failure to diagnose OSA. Parasomnia-associated sleep-related violence represents a challenge to clinicians because they may be asked to consider parasomnia as a possible contributing, mitigating, or exculpatory factor in criminal proceedings. Clinicians should also familiarize themselves with the legal and regulatory aspects of running an independent sleep laboratory. Sleep telemedicine practice using 21st century technology has opened novel and unique challenges to existing laws. In this review, we cover the most common interactions between sleep disorders and the law, including the challenges of excessive sleepiness and driving, other legal issues involving patients with OSA, and the liabilities associated with parasomnia disorder. We will also cover some practical legal aspects involving independent sleep laboratories and the field of sleep telemedicine.

Notificação compulsória de acidentes de trabalho: dificuldades e sugestões dos profissionais de saúde em Fortaleza, Ceará / Mandatory reporting of work accidents: difficulties and suggestions by healthcare professionals in Fortaleza, Ceará, Brazil

Introdução: A notificação de acidente de trabalho (AT) é hoje um importante instrumento para a saúde pública, pois a partir dela se tem real conhecimento sobre a situação dos trabalhadores atendidos pelo Sistema Único de Saúde (SUS). Objetivo: Analisar dificuldades e sugestões dos profissionais de saúde sobre a notificação compulsória de AT em unidades sentinela em saúde do trabalhador, no município de Fortaleza, Ceará. Métodos: Estudo quantitativo de cunho descritivo, realizado em unidades sentinela em saúde do trabalhador, no município de Fortaleza, Ceará, no período de fevereiro de 2013 a junho de 2014. Foram aplicados 78 questionários não estruturados aos profissionais responsáveis pela notificação de AT. A exploração dos dados obtidos foi pautada na Análise de Conteúdo. Resultados: As dificuldades encontradas pelos profissionais como impedimento para a não notificação foram: falta de conhecimento quanto ao manejo de medidas a serem tomadas, omissão e sobrecarga de trabalho. Foram citadas como sugestões: educação permanente em saúde (EPS) e divulgação de protocolos. Conclusão: Com os resultados obtidos pelo presente artigo, fica evidente a importância da capacitação dos profissionais de saúde, incentivando a realização das notificações e orientando tais profissionais para o correto preenchimento da ficha de notificação, a fim de diminuir a subnotificação do agravo

Background: Work accident (WA) reports are a relevant public health tool as they afford effective knowledge on the actual situation of workers cared within the Unified Health System (Sistema Único de Saúde ­ SUS). Objective: To analyze the difficulties posed by mandatory WA reporting and suggestions for improvement made by healthcare professionals at sentinel workers' health units in Fortaleza, Ceará, Brazil. Methods: Quantitative and descriptive study conducted at sentinel workers' health units in Fortaleza, Ceará, from February 2013 through June 2014. An unstructured questionnaire was applied to 78 professionals charged of reporting WA. The collected data were subjected to content analysis. Results: As difficulties for reporting WA the participants mentioned: lack of knowledge on how to manage required measures, omission and work overload. Suggestions to improve reporting included health continuing education and divulgation of protocols. Conclusion: The results of the present study point to the relevance of training as a means to enhance reporting and to orient professionals on how to fill report forms in order to reduce underreporting

Employer knowledge of federal requirements for recording work-related injuries and illnesses: Implications for occupational injury surveillance data.

BACKGROUND: Accuracy of the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses (SOII) data is dependent on employer compliance with workplace injury and illness recordkeeping requirements. Characterization of employer recordkeeping can inform efforts to improve the data. METHODS: We interviewed representative samples of SOII respondents from four states to identify common recordkeeping errors and to assess employer characteristics associated with limited knowledge of the recordkeeping requirements and non compliant practices. RESULTS: Less than half of the establishments required to maintain OSHA injury and illness records reported doing so. Few establishments knew to omit cases limited to diagnostic services (22%) and to count unscheduled weekend days as missed work (27%). No single state or establishment characteristic was consistently associated with better or worse record-keeping. CONCLUSION: Many employers possess a limited understanding of workplace injury recordkeeping requirements, potentially leading them to over-report minor incidents, and under-report missed work cases.

[The inadequacy of official classification of work accidents in Brazil]. / A inadequação da classificação oficial dos acidentes de trabalho no Brasil.

Traditionally, work accidents in Brazil have been categorized in government documents and legal and academic texts as typical work accidents and commuting accidents. Given the increase in urban violence and the increasingly precarious work conditions in recent decades, this article addresses the conceptual inadequacy of this classification and its implications for the underestimation of work accidents in the country. An alternative classification is presented as an example and a contribution to the discussion on the improvement of statistics on work-related injuries in Brazil.

Tradicionalmente, os acidentes do trabalho no Brasil vêm sendo categorizados em documentos governamentais, bem como em textos jurídicos e acadêmicos, como típicos e de trajeto. Face ao aumento da violência urbana e à precarização do trabalho em décadas recentes, discute-se a inadequação conceitual dessa classificação e sua implicação no subdimensionamento dos acidentes do trabalho no país. É apresentada uma classificação alternativa, como ilustração e contribuição à discussão sobre o aprimoramento das estatísticas das lesões associadas ao trabalho no país.

Tradicionalmente, los accidentes de trabajo en Brasil están siendo categorizados en documentos gubernamentales, así como en textos jurídicos y académicos, como típicos y de desplazamiento. Ante el aumento de la violencia urbana y la precarización del trabajo en las décadas recientes, se discute la inadecuación conceptual de esa clasificación y su implicación en el subdimensionamiento de los accidentes de trabajo en el país. Se presenta una clasificación alternativa, como ilustración y contribución a la discusión sobre el perfeccionamiento de las estadísticas de las lesiones asociadas al trabajo en el país.

Mine Safety and Health Administration's Part 50 program does not fully capture chronic disease and injury in the Illinois mining industry.

BACKGROUND: The Mine Safety and Health Administration (MSHA) requires reporting of injuries and illnesses to their Part 50 program. A 2011 study indicated that the Part 50 program did not capture many cases of injury in Kentucky, causing concern about underreporting in other states. METHODS: MSHA Part 50 reports from Illinois for 2001-2013 were linked to Illinois Workers' Compensation Commission (IWCC) data. IWCC cases not found in the Part 50 data were considered unreported. RESULTS: Overall, the Part 50 Program did not capture 66% of IWCC cases from 2001 to 2013. Chronic injuries or illnesses were more likely to be unreported to MSHA. CONCLUSIONS: The majority of occupational injuries and illnesses found in the IWCC from this time period, were not captured by Part 50. Inaccurate reporting of injuries and illnesses to the Part 50 program hinders MSHA's ability to enforce safety and health standards in the mining industry.

Interventions to prevent injuries in construction workers.

BACKGROUND: Construction workers are frequently exposed to various types of injury-inducing hazards. There are a number of injury prevention interventions, yet their effectiveness is uncertain. OBJECTIVES: To assess the effects of interventions for preventing injuries in construction workers. SEARCH METHODS: We searched the Cochrane Injuries Group's specialised register, CENTRAL (issue 3), MEDLINE, Embase and PsycINFO up to April 2017. The searches were not restricted by language or publication status. We also handsearched the reference lists of relevant papers and reviews. SELECTION CRITERIA: Randomised controlled trials, controlled before-after (CBA) studies and interrupted time-series (ITS) of all types of interventions for preventing fatal and non-fatal injuries among workers at construction sites. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, extracted data and assessed their risk of bias. For ITS studies, we re-analysed the studies and used an initial effect, measured as the change in injury rate in the year after the intervention, as well as a sustained effect, measured as the change in time trend before and after the intervention. MAIN RESULTS: Seventeen studies (14 ITS and 3 CBA studies) met the inclusion criteria in this updated version of the review. The ITS studies evaluated the effects of: introducing or changing regulations that laid down safety and health requirements for the construction sites (nine studies), a safety campaign (two studies), a drug-free workplace programme (one study), a training programme (one study), and safety inspections (one study) on fatal and non-fatal occupational injuries. One CBA study evaluated the introduction of occupational health services such as risk assessment and health surveillance, one evaluated a training programme and one evaluated the effect of a subsidy for upgrading to safer scaffoldings. The overall risk of bias of most of the included studies was high, as it was uncertain for the ITS studies whether the intervention was independent from other changes and thus could be regarded as the main reason of change in the outcome. Therefore, we rated the quality of the evidence as very low for all comparisons.Compulsory interventionsRegulatory interventions at national or branch level may or may not have an initial effect (effect size (ES) of -0.33; 95% confidence interval (CI) -2.08 to 1.41) and may or may not have a sustained effect (ES -0.03; 95% CI -0.30 to 0.24) on fatal and non-fatal injuries (9 ITS studies) due to highly inconsistent results (I² = 98%). Inspections may or may not have an effect on non-fatal injuries (ES 0.07; 95% CI -2.83 to 2.97; 1 ITS study).Educational interventionsSafety training interventions may result in no significant reduction of non-fatal injuries (1 ITS study and 1 CBA study).Informational interventionsWe found no studies that had evaluated informational interventions alone such as campaigns for risk communication.Persuasive interventionsWe found no studies that had evaluated persuasive interventions alone such as peer feedback on workplace actions to increase acceptance of safe working methods.Facilitative interventionsMonetary subsidies to companies may lead to a greater decrease in non-fatal injuries from falls to a lower level than no subsidies (risk ratio (RR) at follow-up: 0.93; 95% CI 0.30 to 2.91 from RR 3.89 at baseline; 1 CBA study).Multifaceted interventionsA safety campaign intervention may result in an initial (ES -1.82; 95% CI -2.90 to -0.74) and sustained (ES -1.30; 95% CI -1.79 to -0.81) decrease in injuries at the company level (1 ITS study), but not at the regional level (1 ITS study). A multifaceted drug-free workplace programme at the company level may reduce non-fatal injuries in the year following implementation by -7.6 per 100 person-years (95% CI -11.2 to -4.0) and in the years thereafter by -2.0 per 100 person-years (95% CI -3.5 to -0.5) (1 ITS study). Introducing occupational health services may result in no decrease in fatal or non-fatal injuries (one CBA study). AUTHORS' CONCLUSIONS: The vast majority of interventions to adopt safety measures recommended by standard texts on safety, consultants and safety courses have not been adequately evaluated. There is very low-quality evidence that introducing regulations as such may or may not result in a decrease in fatal and non-fatal injuries. There is also very low-quality evidence that regionally oriented safety campaigns, training, inspections or the introduction of occupational health services may not reduce non-fatal injuries in construction companies. There is very low-quality evidence that company-oriented safety interventions such as a multifaceted safety campaign, a multifaceted drug workplace programme and subsidies for replacement of scaffoldings may reduce non-fatal injuries among construction workers. More studies, preferably cluster-randomised controlled trials, are needed to evaluate different strategies to increase the employers' and workers' adherence to the safety measures prescribed by regulation.

[Medical Knowledge in Accident Insurance : Assessing "Pneumatic Tool Damages" at the Bergmannsheil Hospital, 1929-1944]. / Medizinisches Wissen in der Unfallversicherung : Die Begutachtung von "Preßluftschäden" im Krankenhaus Bergmannsheil, 1929­1944.

The article focuses on one central element of medical activity in the context of the German social insurance system: providing expert assessments in accident pension cases. Taking an example from interwar coal mining, it aims to reconstruct how social policy makers first conceived of "pneumatic tool damages" as occupational disease and how trauma surgeons had to deal with this new entity of social law once it had been institutionalized in 1929. Drawing on physicians' publications as well as archival sources from the supreme court in social insurance, the Reichsversicherungsamt, the article examines how the controversial generation of new knowledge took place. It argues that medical knowledge was neither simply applied to administration and law nor was it compromised by the necessity to adjust it to those fields of decision-making. Expert medical opinions should instead be understood as a specific form of medical knowledge.

Occupational health and safety issues in the informal economic segment of Pakistan: a survey of construction sites.

This research covers the current status of occupational health and safety (OHS)-related practices in the informal construction segment of Pakistan. Data were collected, through interviews, from 316 construction sites employing 3577 workers. The results of the study reveal that both employers and workers lack knowledge of OHS laws/standards and no practices of this nature are enacted at these construction sites. Alarmingly, work-related accidents, whenever they happen, are not given due attention and there is no formal injury-report system. The informal construction industry employs a huge portion of the informal workforce, and lack of OHS happens at tremendous human cost. These research findings may thus play their role in strengthening the case for reforms in the sector. This study, if properly utilized, may also enable employers of the sector by increasing their knowledge about OHS practices and, as a result, trying to offer safer environments for their workers.