Uninvestigated fatal workplace injuries in the United States.

BACKGROUND: Approximately 5000 people are killed by an injury at work every year, but the U.S. Occupational Safety and Health Administration (OSHA) only investigates 25%-35% of these deaths. The aim of this study was to identify industry, geographic, and worker demographic disparities in the proportion of fatal workplace injuries that are investigated by OSHA. METHODS: This cross-sectional analysis drew from 2 years of public data (2014-2015) from the Census of Fatal Occupational Injuries and investigation data from OSHA. Differences by worker age and sex, geographic region, industry, and State Plan- versus Federal Plan-state were examined. RESULTS: Nationally, OSHA investigated about one in four (27.5%) of the 9657 fatal workplace injuries that occurred. Higher odds of uninvestigated fatalities were observed for female workers compared to male workers (odds ratio, 2.35; 95% confidence interval, 1.89, 2.93), for workers over age 65 compared to those aged 18-24 (3.05; 2.44, 3.82), for worker deaths occurring in State Plan states compared to Federal Plan states (1.64; 1.49, 1.79), among other differences. CONCLUSIONS: Although some of the disparities could be explained by OSHA jurisdiction restrictions, other areas of potential reform were identified, such as investigating a greater number of workplace violence deaths and increasing focus in industries with a low proportion of investigations but a high number of fatalities, such as transportation and warehousing. Consideration should be given to adapt policies, expand OSHA jurisdiction, and to increase OSHA resources for conducting both fatality investigations and proactive investigations that can identify and abate hazards before a worker is injured.

Work-related injuries and fatalities in the geotechnical site works.

Geotechnical site works are comprehensive, and they constitute the first step of the construction process. This study performs data mining of geotechnical works and analyzes the database for the root causes of accidents. The Occupational Safety and Health Administration (OSHA) was chosen for the 1984-2013 time frame with 247 cases. Descriptive statistical analyses were performed to discuss variables such as the end use of the work, project type and cost, soil type and condition, type and degree of injury, cause and type of accident, unsafe acts, and occupation and union status of the victim. The results showed that these accidents have a high frequency of recurrence and have a high severity level (54.3% fatalities). In addition, a total of 838 violations were recorded with penalties reaching 5 million US dollars. This study emphasizes that project-specific countermeasures should be taken regarding the root causes of accidents, leading to vigorous strategies to develop safety measures.

The Impact of Safety Regulations on the Incidence of Upper-Extremity Power Saw Injuries in the United States.

PURPOSE: Over 50,000 power saw-related injuries occur annually in the United States. Numerous safety measures have been implemented to protect the users of these tools. This study was designed to determine which interventions, if any, have had a positive impact on the safety of the consumer or laborer. METHODS: We queried the National Electronic Injury Surveillance System database for hand and upper-extremity injuries attributed to power saws from 1997 to 2014. Demographic information including age, sex, date of injury, device, location, body part involved, diagnosis, and disposition was recorded. We performed statistical analysis using interrupted time series analysis to evaluate the incidence of injury with respect to specific safety guidelines as well as temporal trends including patients' age. RESULTS: An 18% increase in power saw-related injuries was noted from 1997 (44,877) to 2005 (75,037). From 2006 to 2015 an annual decrease of 5.8% was observed. This was correlated with regulations for power saw use by the Consumer Safety Product Commission (CPSC) and Underwriters Laboratories. Mean age of injured patients increased from 48.8 to 52.9 years whereas the proportion of subjects aged less than 50 years decreased from 52.8% to 41.9%. These trends were most pronounced after the 2006 CPSC regulations. CONCLUSIONS: The incidence of power saw injuries increased from 1997 to 2005, with a subsequent decrease from 2006 to 2015. The guidelines for safer operation and improvements in equipment, mandated by the CPSC and Underwriters Laboratories, appeared to have been successful in precipitating a decrease in the incidence of power saw injuries to the upper extremity, particularly in the younger population. CLINICAL RELEVANCE: The publication of safety regulations has been noted to have an association with a decreased incidence in power saw injuries. Based on this, clinicians should take an active role in their practice as well as in their professional societies to educate and counsel patients to prevent further injury.

Serious injury and fatality investigations involving pneumatic nail guns, 1985-2012.

BACKGROUND: This article examines serious and fatal pneumatic nail gun (PNG) injury investigations for workplace, tool design, and human factors relevant to causation and resulting OS&H authorities' responses in terms of citations and penalties. METHODS: The U.S. Occupational Safety and Health Administration (OSHA) database of Fatality and Catastrophe Investigation Summaries (F&CIS) were reviewed (1985-2012) to identify n = 258 PNG accidents. RESULTS: 79.8% of investigations, and 100% of fatalities, occurred in the construction industry. Between 53-71% of injuries appear to have been preventable had a safer sequential trigger tool been used. Citations and monetary penalties were related to injury severity, body part injured, disabling of safety devices, and insufficient personal protective equipment (PPE). CONCLUSIONS: Differences may exist between construction and other industries in investigators interpretations of PNG injury causation and resulting citations/penalties. Violations of PPE standards were penalized most severely, yet the preventive effect of PPE would likely have been less than that of a safer sequential trigger.

Unreported workers' compensation claims to the BLS Survey of Occupational Injuries and Illnesses: Establishment factors.

BACKGROUND: Studies suggest employers underreport injuries to the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses (SOII); less is known about reporting differences by establishment characteristics. METHODS: We linked SOII data to Washington State workers' compensation claims data, using unemployment insurance data to improve linking accuracy. We used multivariable regression models to estimate incidence ratios (IR) of unreported workers' compensation claims for establishment characteristics. RESULTS: An estimated 70% of workers' compensation claims were reported in SOII. Claims among state and local government establishments were most likely to be reported. Compared to large manufacturing establishments, unreported claims were most common among small educational services establishments (IR = 2.47, 95%CI: 1.52-4.01) and large construction establishments (IR = 2.05, 95%CI: 1.77-2.37). CONCLUSIONS: Underreporting of workers' compensation claims to SOII varies by establishment characteristics, obscuring true differences in work injury incidence. Findings may differ from previous research due to differences in study methods.

Trends in OSHA Compliance Monitoring Data 1979-2011: Statistical Modeling of Ancillary Information across 77 Chemicals.

OBJECTIVES: The Integrated Management Information System (IMIS) is the largest multi-industry source of exposure measurements available in North America. However, many have suspected that the criteria through which worksites are selected for inspection are related to exposure levels. We investigated associations between exposure levels and ancillary variables in IMIS in order to understand the predictors of high exposure within an enforcement context. METHODS: We analyzed the association between nine variables (reason for inspection, establishment size, total amount of penalty, Occupational Safety and Health Administration (OSHA) plan, OSHA region, union status, inspection scope, year, and industry) and exposure levels in IMIS using multimodel inference for 77 agents. For each agent, we used two different types of models: (i) logistic models were used for the odds ratio (OR) of exposure being above the threshold limit value (TLV) and (ii) linear models were used for exposure concentrations restricted to detected results to estimate percent increase in exposure level, i.e. relative index of exposure (RIE). Meta-analytic methods were used to combine results for each variable across agents. RESULTS: A total of 511,047 exposure measurements were modeled for logistic models and 299,791 for linear models. Higher exposures were measured during follow-up inspections than planned inspections [meta-OR = 1.61, 95% confidence interval (CI): 1.44-1.81; meta-RIE = 1.06, 95% CI: 1.03-1.09]. Lower exposures were observed for measurements collected under state OSHA plans compared to measurements collected under federal OSHA (meta-OR = 0.82, 95% CI: 0.73-0.92; meta-RIE = 0.86, 95% CI: 0.81-0.91). A 'high' total historical amount of penalty relative to none was associated with higher exposures (meta-OR = 1.54, 95% CI: 1.40-1.71; meta-RIE = 1.18, 95% CI: 1.13-1.23). CONCLUSIONS: The relationships observed between exposure levels and ancillary variables across a vast majority of agents suggest that certain elements of OSHA's process of selecting worksites for inspection influence the exposure levels that OSHA inspectors encounter. Nonetheless, given the paucity of other sources of exposure data and the lack of a more demonstrably representative data source, our study considers the use of IMIS data for the estimation of exposures in the broader universe of worksites in the USA.

Client Perceptions of Occupational Health and Safety Management System Assistance Provided by OSHA On-Site Consultation: Results of a Survey of Colorado Small Business Consultation Clients.

The Occupational Safety and Health Administration (OSHA) On-Site Consultation Service provides assistance establishing occupational health and safety management systems (OHSMS) to small businesses. The Safety and Health Program Assessment Worksheet (Revised OSHA Form 33) is the instrument used by consultants to assess an organization's OHSMS and provide feedback on how to improve a system. A survey was developed to determine the usefulness of the Revised OSHA Form 33 from the perspective of Colorado OSHA consultation clients. One hundred and seven clients who had received consultation services within a six-year period responded to the survey. The vast majority of respondents indicated that the Revised OSHA Form 33 accurately reflected their OHSMS and that information provided on the Revised OSHA Form 33 was helpful for improving their systems. Specific outcomes reported by the respondents included increased safety awareness, reduced injuries, and improved morale. The results indicate that the OHSMS assistance provided by OSHA consultation is beneficial for clients and that the Revised OSHA Form 33 can be an effective tool for assessing and communicating OHSMS results to business management. Detailed comments and suggestions provided on the Revised OSHA Form 33 are helpful for clients to improve their OHSMS.

Resident aggression toward staff at a center for the developmentally disabled.

Few studies have examined factors contributing to nonfatal assaults to staff working in residential care facilities. The authors evaluated resident assaults toward direct care/nursing staff at an intermediate Care Facility for Individuals with Mental Retardation (ICF/MR), which included observations of work areas, employee interviews, calculation of injury and assault rates for 2004 to 2007 from Occupational Safety and Health Administration Logs, and review of state ICP/MR guidelines. Most staff interviewed reported having been injured during physical restraint of a resident and the average rate of injury from assault at the center evaluated was higher than the average national rates for the health care and social assistance sector for the same time period. The center lacked policies and developing a post-incident response and evaluation program to assist staff in coping with the consequences of assault and/or occupational injury.

Workplace measurements by the U.S. Occupational Safety and Health Administration since 1979: Descriptive analysis and potential uses for exposure assessment.

This letter summarizes modifications to the results presented in Lavoué et al. (2012): Lavoué, J., Burstyn, I.,Friesen, M. (2012) Workplace Measurements by the US Occupational Safety and Health Administration since1979: Descriptive Analysis and Potential Uses for Exposure Assessment. Annals of occupational hygiene57(1):77­97. Although several results were altered, the conclusions were not affected by the changes.

Analysis of occupational asbestos exposure and lung cancer mortality using the g formula.

We employed the parametric G formula to analyze lung cancer mortality in a cohort of textile manufacturing workers who were occupationally exposed to asbestos in South Carolina. A total of 3,002 adults with a median age of 24 years at enrollment (58% male, 81% Caucasian) were followed for 117,471 person-years between 1940 and 2001, and 195 lung cancer deaths were observed. Chrysotile asbestos exposure was measured in fiber-years per milliliter of air, and annual occupational exposures were estimated on the basis of detailed work histories. Sixteen percent of person-years involved exposure to asbestos, with a median exposure of 3.30 fiber-years/mL among those exposed. Lung cancer mortality by age 90 years under the observed asbestos exposure was 9.44%. In comparison with observed asbestos exposure, if the facility had operated under the current Occupational Safety and Health Administration asbestos exposure standard of <0.1 fibers/mL, we estimate that the cohort would have experienced 24% less lung cancer mortality by age 90 years (mortality ratio = 0.76, 95% confidence interval: 0.62, 0.94). A further reduction in asbestos exposure to a standard of <0.05 fibers/mL was estimated to have resulted in a minimal additional reduction in lung cancer mortality by age 90 years (mortality ratio = 0.75, 95% confidence interval: 0.61, 0.92).

Workplace measurements by the US Occupational Safety and Health Administration since 1979: descriptive analysis and potential uses for exposure assessment.

BACKGROUND: Inspectors from the US Occupational Safety and Health Administration (OSHA) have been collecting industrial hygiene samples since 1972 to verify compliance with Permissible Exposure Limits. Starting in 1979, these measurements were computerized into the Integrated Management Information System (IMIS). In 2010, a dataset of over 1 million personal sample results analysed at OSHA's central laboratory in Salt Lake City [Chemical Exposure Health Data (CEHD)], only partially overlapping the IMIS database, was placed into public domain via the internet. We undertook this study to inform potential users about the relationship between this newly available OSHA data and IMIS and to offer insight about the opportunities and challenges associated with the use of OSHA measurement data for occupational exposure assessment. METHODS: We conducted a literature review of previous uses of IMIS in occupational health research and performed a descriptive analysis of the data recently made available and compared them to the IMIS database for lead, the most frequently sampled agent. RESULTS: The literature review yielded 29 studies reporting use of IMIS data, but none using the CEHD data. Most studies focused on a single contaminant, with silica and lead being most frequently analysed. Sixteen studies addressed potential bias in IMIS, mostly by examining the association between exposure levels and ancillary information. Although no biases of appreciable magnitude were consistently reported across studies and agents, these assessments may have been obscured by selective under-reporting of non-detectable measurements. The CEHD data comprised 1 450 836 records from 1984 to 2009, not counting analytical blanks and erroneous records. Seventy eight agents with >1000 personal samples yielded 1 037 367 records. Unlike IMIS, which contain administrative information (company size, job description), ancillary information in the CEHD data is mostly analytical. When the IMIS and CEHD measurements of lead were merged, 23 033 (39.2%) records were in common to both IMIS and CEHD datasets, 10 681 (18.2%) records were only in IMIS, and 25 012 (42.6%) records were only in the CEHD database. While IMIS-only records represent data analysed in other laboratories, CEHD-only records suggest partial reporting of sampling results by OSHA inspectors into IMIS. For lead, the percentage of non-detects in the CEHD-only data was 71% compared to 42% and 46% in the both-IMIS-CEHD and IMIS-only datasets, respectively, suggesting differential under-reporting of non-detects in IMIS. CONCLUSIONS: IMIS and the CEHD datasets represent the biggest source of multi-industry exposure data in the USA and should be considered as a valuable source of information for occupational exposure assessment. The lack of empirical data on biases, adequate interpretation of non-detects in OSHA data, complicated by suspected differential under-reporting, remain the principal challenges to the valid estimation of average exposure conditions. We advocate additional comparisons between IMIS and CEHD data and discuss analytical strategies that may play a key role in meeting these challenges.

The value of HAZWOPER medical surveillance.

Medical surveillance is mandated for workers with potential exposure to hazardous materials. However, little guidance is provided regarding the components of a medical surveillance testing program for these individuals. This article describes the medical surveillance program for a group of 72 employees who respond to hazardous material releases throughout the United States. Conditions related to chemical exposures were not identified in this group. However, several non-occupational health conditions were identified, including a relatively high prevalence of one or more signs of metabolic syndrome. Medical surveillance may provide valuable information regarding an individual's underlying health status and non-occupational health conditions to be addressed at an early stage.

Occupational injuries and illnesses in the solid waste industry: a call for action.

Work-related injuries and illnesses are multi-factorial and remain major problems of public health magnitude requiring the attention of all stakeholders in the solid waste industry. The objective of this article was to describe the patterns of occupational injury and illness (OII) reporting incidence among workers in a major private U. S. solid waste management company. A five-year (2003-2007) retrospective review of the corporate Occupational Safety and Health Administration (OSHA) logs 300/300A/301 was conducted and employee OII reports (n = 1895) were analyzed from 37 establishments across 11 different states. The OII reporting rates were compared to industry average.

Evaluating the Michigan SENSOR Surveillance Program for work-related asthma.

BACKGROUND: Most Occupational Safety and Health Administration (OSHA) inspections are based on employee complaints or targeting of industry groupings. Limited use has been made of illness data to target inspections and evaluation of such targeting is even more limited. METHODS: This study compared 545 Michigan OSHA (MIOSHA) inspections performed as follow up to reports of work-related asthma (WRA) with 12,268 non-disease initiated OSHA inspections performed during the same time period (1989-2002). RESULTS: SENSOR asthma inspections were more likely to be conducted in larger, unionized employers. Although the likelihood of citations ( approximately 50%), type of citation, and monetary penalties ( approximately 30%) were not different between disease and non-disease initiated inspections, the number of citations and amount of monetary penalties were less in disease initiated inspections. Citations and penalties were more likely for small as compared to large employers, and were less likely at unionized worksites. CONCLUSIONS: Even without the availability of specific standards for agents that cause WRA, inspections triggered by a WRA index case are very much like other inspected worksites in terms of the prevalence of violations observed at the worksite. The advisability of making referrals to OSHA and additional ways to evaluate the effectiveness of this type of intervention model are discussed.

"Cooking the books"--behavior-based safety at the San Francisco Bay Bridge.

Practitioners of Behavior-Based Safety (BBS) claim dramatic reductions in worker injuries and illnesses through modifying workers' "unsafe behaviors." This case study of a BBS program implemented by KFM, a giant construction consortium rebuilding the eastern span of the San Francisco Bay Bridge in California, documents how BBS was used to suppress reporting of worker injuries and illnesses on site. The key elements of KFM's BBS "injury prevention" strategy included: 1) cash incentives to workers and supervisors who do not report injuries; 2) reprisals and threats of reprisals against those employees who do report injuries; 3) selection and use of employer friendly occupational health clinics and workers compensation insurance administrators; 4) strict limits on the activities of contract industrial hygiene consultants; and 5) a secretive management committee that decides whether reported injuries and illnesses are legitimate and recordable. KFM reported injury and illness rates 55% to 72% lower than other bridge builders in the Bay Area, but the California Division of Occupational Safety and Health (Cal/OSHA) issued Willful citations to the consortium in June 2006 for failing to record 13 worker injuries on its "OSHA Log 300," as required by law.

Fatal injuries to teenage construction workers in the US.

BACKGROUND: The construction industry is second only to agriculture in the annual number of fatal injuries in workers less than 18 years of age. We examined fatal injury reports for youth and adult workers to determine risk factors for injury and applicability of existing child labor regulations. METHODS: The US Occupational Safety & Health Administration (OSHA) investigation data for fatal work injuries from 1984 through 1998 were reviewed with respect to type of event, employer characteristics, and apparent violations of existing child labor laws under the Fair Labor Standards Act (FLSA). We also examined whether the employer met exemption criteria for federal enforcement of child labor or OSHA regulations. RESULTS: The fatality rate for teenage construction workers age 19 and younger was 12.1 per 100,000 per year, slightly less than for adult workers. Teenage workers who were fatally injured were more likely than adults to have been employed at non-union construction firms (odds ratio (OR) = 4.96, P < 0.05), firms with fewer than 11 employees (OR = 1.72, P < 0.05), and their employers were more likely to have been cited by OSHA for safety violations (OR = 1.66, P < 0.05) than for firms which were investigated because of a fatality in an adult worker. Fatalities in teenagers were more likely to occur in special construction trades such as roofing. Among fatalities in workers less than 18 years of age, approximately one-half (49%) of the 76 fatal injuries were in apparent violation of existing child labor regulations. We estimated that in 41 of the 76 cases (54%) the employer's gross annual income exceeded the $500,000 threshold for federal enforcement of child labor laws. Only 28 of 76 cases (37%) were at construction firms with 11 or more employees, which are subject to routine OSHA inspections. CONCLUSIONS: Fatal injuries in teenage construction workers differed from those in adults in that they were more likely to be at small, non-union firms of which a substantial proportion were exempt from federal enforcement of child labor laws and from routine OSHA inspections. Safety programs for young construction workers should include small, non-union construction firms and those in special construction trades such as roofing. We did not identify specific areas for new regulation but the number of fatalities reviewed was small.

Work-related amputations in Michigan, 1997.

BACKGROUND: Work-related amputations are of concern in Michigan and nationally. This study reports on 1 year of data on work-related amputations, which were treated in Michigan hospital emergency departments (ED) or as in-patients in Michigan. METHODS: Michigan hospitals provided face sheets and discharge summaries of in-patient and ED visits for work-related amputations that occurred in 1997. Information was also obtained about worksite inspections associated with reported amputations from the Michigan Occupational Safety and Health Act (MIOSHA) program. Data from this study and from Michigan workers compensation were used to generate an estimate of the true numbers of work-related amputations in Michigan in 1997. RESULTS: Three hundred thirty-nine work-related amputations were identified by hospitals. Powered saws and power presses were the leading sources of injury. MIOSHA completed 30 enforcement inspections related to these amputations. Our best estimate of the total numbers of work-related amputations in 1997 for Michigan was 693, of which 562 resulted in hospitalization or ED treatment. CONCLUSIONS: In-patient and ED records provided information for identifying high risk groups and problem worksites in Michigan. Estimates generated from these data underscore that data on work-related amputations released by the Bureau of Labor Statistics (BLS), which reported 440 amputations in 1997, are a significant undercount--only 64%--of the true number of cases. Better integration of public health data into OSHA enforcement activity is needed.