November 30, 2018
Division of Regulations, Legislation, and Interpretation Wage and Hour Division
US Department of Labor. Room S-3502
200 Constitution Avenue, N.W.
Washington, DC 20210
Re: RIN 1235–AA22
To Whom It May Concern:
The American College of Occupational and Environmental Medicine (ACOEM) appreciates the opportunity to provide comments on the proposed rule removing restrictions on 16- and 17-year- olds’ use of power-driven patient lifts in health care settings. ACOEM is a national medical society representing more than 4,000 occupational medicine physicians and other health care professionals devoted to preventing and managing occupational injuries. Occupational injuries are common, expensive, and often disabling in the health care industry. Patient handling, or lifting, is a frequent cause of injury among health care personnel (HCP), and safe patient handling can clearly decrease injuries and improve safety for both patients and HCP. Therefore, ACOEM is particularly qualified and interested in proposed changes to Hazardous Occupational Order 7 as they relate to injury risk for younger HCP.
ACOEM agrees with many points in the DOL justification for the rule change. Specifically:
- Mechanical patient hoists, or lifts, are used only in health care settings and as such are categorically different from the other mechanical lifts in the rule (which are mostly used in the construction industry).
- The 2011 non-enforcement policy appropriately recognized the difference in risk between these industry settings and made provision for younger HCP, often in apprentice positions, to use these hoists after substantive training and with supervision.
- Evidence from many studies demonstrates that mechanical lifts are generally safer for staff, and potentially safer for patients, than manual lifting.
- Restrictions on younger HCP using mechanical lifts may lead to the unintended consequence of those HCP performing more manual lifting with concomitantly greater injury risk.
- Following established “Best Practices” for systematic comprehensive safe patient handling (as developed by OSHA, NIOSH and professional organizations), may have a greater impact on safety and injury cost reduction than blanket restrictions.
- Work and training opportunities, including apprenticeships, can benefit both teenage and adult HCP, as well as the health care industry
However, given that BLS statistics continue to demonstrate high lost-time injury rates and injury costs among low-wage HCP, we are concerned about potential unintended consequences of blanket reductions in regulatory oversight for this group. This is particularly a concern in resource-poor settings where apprentices and teenaged workers may be needed to mitigate systemic staffing shortages – that are often related to low wages, injuries, and high staff turnover. Specific concerns include:
- Patients needing transport and lifting are trending heavier every year. Lifting bariatric patients increases staff injury risks with and without the use of mechanical hoists. Although mechanical hoists are preferable to manual lifts in most cases, experienced lifting teams are necessary to minimize risk to HCP and patients in either case. By falsely believing that mechanical hoists solve all lifting challenges, facilities may be motivated to decrease training and staffing.
- Mechanical lifts may not be usable per manufacturers’ specifications in real-life settings in which patients are over recommended device weight limits, soiled with infectious body fluids, combative, or have certain medical conditions. Patient care is intrinsically unpredictable, and when mechanical lifts are used safe patient handling requires judgment as well as strength and mechanical knowledge.
- Poor judgment, low experience, under-estimation of hazards, and distractibility are recognized vulnerabilities in teen-aged drivers and workers. In the healthcare setting, these qualities may pose risks to young HCP (and potentially patients) when using mechanical equipment without supervision.
- Cited studies on the adverse impact of the 2011 rule include survey data with very little data (reference 34/35) which may not be generalizable.
- Ongoing monitoring by OHS staff should be implemented to ensure appropriate use of mechanical lifts in this population of workers.
In summary, ACOEM strongly supports wide use of mechanical hoists in health care to reduce injuries to HCP (when utilized with appropriate training and lift teams). We recognize that HO7, as currently enforced, presents some unnecessary barriers and costs to potential teenaged HCP and health care facilities. However, we believe that these young workers have special risks that should be explicitly addressed with appropriate required safe patient handling training, competency assessments, and supervision. Regardless of whether mechanical hoists are appropriate to a patient’s situation, teen-aged HCP should not lift patients unassisted and unsupervised. We support extending the comment period and further study of this issue.
Thank you for your consideration of our comments. Please do not hesitate to contact Patrick O’Connor, ACOEM’s Director of Government Affairs at 703-351-6222 with any questions.
William G. Buchta, MD, MPH, FACOEM