Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, HETA 2008-0046-3123, 2011 Mar; :1-19
In November 2007, NIOSH received an HHE request from management of an ICF/MR, a center for the developmentally disabled, in Michigan. The request was submitted because of a high number of injuries among staff from resident aggression. On July 8-9, 2008, we visited the center, where we held an opening conference and met with management. We also held employee interviews, reviewed records and procedures, and toured each of the buildings at the center. Residents' apartments appeared crowded with furniture. In some instances, residents would not be in clear sight of the staff when few staff were working. Staff reported that the personal alarms for alerting coworkers to respond to an incident site did not work in all locations. We observed no other alarm systems or communication devices on site. We interviewed 24 direct care workers and nursing staff who reported being injured by a resident, and most reported being injured while physically restraining patients. These employees reported that an inadequate number of staff responded to events. They also reported that managers lacked concern about their safety and that they did not feel managers would heed their suggestions about how to handle resident aggression. In addition, they reported that they were not fully included in the residents' IPP process. Half of the staff expressed a need for more comprehensive training on handling resident aggression. The number of injuries and illnesses reported on the OSHA Form 300 Log of Work-Related Injuries and Illnesses increased from 2004 to 2006. Nonfatal injury and illness incidence rates were approximately three times higher than national rates in nursing and residential care facilities in 2004 and 2005. Most injuries were from assault, and the number of assault injuries increased over time. The incidence rates of assaults were higher than national rates for the nursing and social assistance sector from 2004 to 2008, with the highest rate occurring in 2006. The most common injuries related to resident assaults were strains/sprains, bruises, and bites. Of the workers' compensation claims, 13 (of 35) were filed by staff who assisted in physically restraining aggressive residents. The facility provided no written policies or procedures on workplace violence. Managers reported that during new employee orientation and annually thereafter, direct care staff completed crisis intervention training, which focuses on handling agitated behaviors and applying physical restraint. Our review of the ICF/ MR regulations showed that in several instances, the center did not follow the regulations on staffing ratios, convening a human rights committee, proper use of medication to manage resident behavior, and staff training. The plan for controlling exposure to bloodborne pathogens did not take into account the risk of infectious diseases from resident assaults. Although the center has closed since our evaluation, we feel that the results of this evaluation may benefit any ICF/MR or other similar facility. We encourage such facilities to develop a safety and health program that includes management and employee participation, hazard identification, safety and health training, and hazard prevention, control, and reporting. Employers should evaluate this program periodically. Our recommendations are based on the general violence-prevention strategies outlined in the document OSHA Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers [OSHA 2004].