Elective Surgeries, Hidden Responsibilities and Safety Program Management

An unforeseen risk factor for injury was brought to light recently in Ohio, where two employees in a span of two weeks fell while at work and broke a bone. One employee, a nurse, was hospitalized and required surgery to repair her fractured hip.

Immersed in the process of seeking to reduce hazards in the workplace, a staff development coordinator, who also was the safety specialist, reported what seemed to an unrelated commonality: Both injured employees had undergone gastric bypass procedures. Could the surgery and its aftereffects link these two OSHA recordable injuries?

As safety professionals, we try to recognize (even predict) hazards so employers can apply the recommended protection measure or redesign the workplace to eliminate incidents. Often, we find ourselves reviewing accident reports and evaluating contributing factors, focusing on the behavioral aspects and physical conditions observed and reported right before the incident occurred. Similar incidents may share common elements; we seek to understand these trends in order to mitigate their reoccurrence.

The Link to Bariatric Surgery

Bariatric surgery is an operation on the stomach or intestines that helps patients with extreme obesity to lose weight. This surgery is an option for people who cannot lose weight by other means or who suffer from serious health problems related to obesity. Between 2011 and 2013, the number of bariatric surgeries performed in the United States grew by nearly 15 percent, according to new estimates from the American Society for Metabolic and Bariatric Surgery (ASMBS).

According to recent studies performed by researchers at the Division of Endocrinology of the Columbia University College of Physicians and Surgeons' Department of Medicine, bariatric patients had an increased incidence of all fracture, fractures due to minimal or moderate trauma and fractures of the hip, spine, wrist and humerus. Risk was greatest for appendicular fractures; half of all fractures occurred in the foot, leg or hand.

According to researchers, Vitamin D deficiency and lower preoperative activity were predictors of fracture. The researchers noted that one of the side effects of these procedures was a detrimental effect on bone and mineral metabolism. They also noted a trend toward increased fracture risk in bariatric patients after 3-5 years and in those with the greatest decline in BMI.

While it was explained in the study that,"Bariatric surgery is an effective and increasingly common treatment for severe obesity and its many co-morbidities," nurses and nursing aides fall within a population that may elect (and can afford) a bariatric surgery such as gastric bypass as a viable option in reducing weight and ensuring healthier years ahead.

Already at Risk for Falls

While slip, trip and fall hazards can occur in any work environment, they are prevalent in healthcare settings. Historically, the injury rate for workers in these facilities is double the injury rate for all full-time workers in other occupations.

In an effort to reduce the high injury rates in the healthcare industry, OSHA has reissued its National Emphasis Program to use both enforcement and collaborative efforts to address hazards such as musculoskeletal disorders from lifting patients or residents, exposures to tuberculosis and bloodborne pathogens, workplace violence and slips, trips and falls.

Today, nursing homes and residential care facilities employ approximately 2.8 million workers at 21,000 work sites. Many nursing home tasks require considerable lifting and other strenuous physical labor. OSHA has focused attention on the industry, due in part to the consistently high number of recordable injuries suffered by nurses and nurses' aides when assisting residents in and out of beds, showers and wheelchairs.

When there is a mismatch between the physical requirements of the job and the physical capacity of the worker, work-related musculoskeletal disorders (MSDs) can result. OSHA has recommended a zero-lift policy for all continuing care facilities.

Avoiding Slips and Falls

OSHA specifically focuses on making sure aisles and work floors remain clear and dry to enable stability of the worker. Training and routine inspection by first-line supervisors should catch many slip and trip hazards. But is a fall the only way a bone could break? Or could physical exertion (like lifting a box of files, carrying a crate or providing an assisted lift of a resident) add enough pressure to a calcium-deprived bone to cause it to fracture simply from the added weight or pressure?

A fragility fracture (a fracture from a minor injury) often is an indicator of problem with bone density. When the unintended consequences of an elective surgery like bariatric bypass and its associated bone loss could have contributed to an employee's injury and in turn impact the employer injury rates, what reasonable action should or could the employer take?

What Can the Employer Do?

Legally, it is the employer's responsibility to keep a workplace free from recognized hazards, but recognizing hazards takes a lot of effort and an understanding of safe work practice. Employers now may need to include employees' elective surgeries as part of the equation when determining risk factors.

How can an employer monitor when there's an occupational risk that injury can occur in apart as a result of elective surgery? Unless the employee voluntarily reports the surgery, there's nothing an employer can do. Many employers are not even aware when employees take medications that have side effects warning them not to operate heavy equipment or machinery, so asking employees to self-report elective surgery might be asking a lot.

But do employees have an obligation to the people around them who may be impacted by their actions? Taking personal responsibility for safety or having your employer monitor your treatments and medical procedures may require a team approach.