While the inspection reports don't specify the cause, COVID-19 is likely the culprit, said Karen Tynan, of counsel at the labor and employment law firm Ogletree Deakins, who has been studying the data.
The staggering increase in workplace fatalities and catastrophes signals that providers need to prioritize personal protective equipment, she said. They also need to use Plexiglas barriers and reconfigure their pathways, among other engineering tweaks, as well as implement administrative protocols such as how to take on and off PPE and staggering break times, Tynan said.
"This is not just a one-off fix related to N95 mask inventories—it goes far beyond this pandemic," she said. "I don't know if this will prompt new regulations around healthcare, but stepping up OSHA investigations will put pressure on providers to improve processes like engineering and administrative controls."
There was an average of 20 safety inspections at healthcare facilities per week in April, significantly outpacing the average of three per week prior to the COVID-19 pandemic, Tynan noted. Those stemmed from complaints regarding a lack of PPE and inadequate training about COVID-19 illnesses in the workplace, among others, according to OSHA.
Investigations expose providers to hefty financial penalties, harmful impacts on an organization's accreditation, insurance premiums and contracting as well as its reputation and community standing, Tynan said.
"These healthcare facilities who are in the process of being inspected by OSHA are going to have to provide documentation of their safety processes, workplace training, how they dealt with the hazard of COVID-19 and attempts to try to get PPE," she said.
While many of the OSHA investigations were linked to healthcare workers who contracted COVID-19, the pandemic has also likely caused more accidents. More maintenance workers have likely gotten injured as they repaired ventilation systems and other equipment on the roof, said Tracey Riepenhoff, a senior project manager at LJB, a consulting firm that specializes in structural engineering.
Falls from a roof constitute about 20% of workplace fatalities and is the No. 1 cited OSHA violation fall hazard over the last nine years, she said.
"I'm sure there were a lot of facilities that had to rework their ventilation systems, leading to more people getting up on the roof," Riepenhoff said.
Bon Secours Mercy Health started to revamp its workplace safety precautions well prior to the pandemic, triggered by a maintenance worker's fall from a roof.
The Cincinnati-based health system has since worked with LJB to analyze its safety risks, revealing 1,800 fall hazards. But it wasn't as daunting as it seemed, said Steven Bodily, chief operating officer of supply chain at Bon Secours Mercy, adding that LJB's risk assessment methodology transformed an overwhelming list of hazards into a manageable plan.
Bon Secours Mercy will be able to remediate 41% of the risk this year, measured by severity and probability, by addressing just 18 specific hazards. Around 180 fall hazards accounted for about 81% of the risk, which will be addressed from 2021 through 2023.
Fixes included warning line systems for work near a roof edge, guardrails, modified ladders and stairs, and fall-protection systems like harnesses. Most are solutions that can be purchased from a retailer and require a modest investment, said Bodily, noting that some require customization.
"It was incredibly eye-opening to our team," he said. "We could have a hospital that was built seven months ago that passes the building code but is non-compliant with OSHA on day one."
Many health systems leave deferred maintenance on the back burner as patient care, among other priorities, takes precedent.
"Too many times it gets lost among the priorities unless there is a fatality," Riepenhoff said. "There is a lot of equipment on the roof and a lot of reasons maintenance workers have to get up there."
OSHA updated some of its standards for fall protection and walking-working surfaces in 2017, which were some of the first significant changes in the last 40 years. They provide new guidelines on safe distance to a roof edge, visual warnings and appropriate fall-protection gear.
Hopefully the pandemic brings long-term change to the healthcare industry with a renewed focus on workplace safety, Tynan said.
"What this has shown is that the janitor or custodian doing a lot of sanitation work is incredibly important," she said. "Just as our society has seen grocery workers as essential, I think this pandemic has shown that workers who haven't received a lot of glory or recognition are incredibly important."