OSHA Approves New voluntary Rules-The Occupational Safety and Health Administration (OSHA) has approved new voluntary workplace regulations that will help reduce the number and severity of musculoskeletal disorders (MSDs) caused by exposure to risk factors in the workplace.

What kinds of controls must I use to reduce musculoskeletal disorders (MSD) hazards?

(1) For each problem job, you must use feasible engineering, work practice or administrative controls, or any combination of them, to reduce MSD hazards in the job. Where feasible, engineering controls are the preferred method of control.

(2) You may use personal protective equipment (PPE) to supplement engineering, work practice or administrative controls, but you may use PPE alone only where other controls are not feasible. Where you use PPE, you must provide it at no cost to employees.

From the standard: [Page 68360]

This paragraph of the standard is almost identical to the parallel-proposed provision, with one exception. A footnote to this paragraph in the proposal would have prohibited the use of back belts/braces and wrist braces/splints as PPE; this footnote has been deleted from this paragraph of the final rule. As explained below, OSHA believes that evidence in the record suggests that back belts, in some limited applications, may help to reduce MSD hazards. However, back belts, like other PPE, may not be used alone if other controls are feasible. Wrist splints, wrist braces, and back braces, which are post-injury devices used to speed rehabilitation, are not considered PPE for the purposes of this standard.

Paragraph (l)(i)--Feasible Controls

Paragraph (l)(i) of the final standard mandates the use of feasible controls (engineering, work practice, and administrative controls) or any combination of them to control or reduce MSD hazards in problems jobs. This paragraph also states that engineering controls, where feasible, are the preferred method of control. This paragraph of the final rule is essentially unchanged from the proposal. OSHA is allowing employers this flexibility in the choice of controls because the Agency's experience and information in the rulemaking record indicates that these control approaches have been effective in contributing to reductions in the number and severity of workplace MSDs. In addition, OSHA believes that the broad range of jobs to which the standard will apply, and the great variation in workplace conditions covered, make compliance flexibility essential.

The final standard defines engineering controls as controls that physically change the job in a way that controls or reduces MSD hazards. Examples of engineering controls that are used to address ergonomic hazards are workstation modifications, changes to the tools or equipment used to do the job, facility redesigns, altering production processes, and/or changing or modifying the materials used. Engineering controls range from very simple to complex: from putting blocks under a desk to raise the work surface for a taller-than-average worker to providing a lumbar support pillow or rolled-up towel to a video display unit (VDU) operator, to redesigning an entire facility to enhance productivity, reduce product defects, and reduce workplace MSDs.

When choosing an engineering control to address a particular ergonomic problem, employers often have many choices, depending on how much they wish to spend, how permanent a solution they seek, how extensive a production process change they need, and employee acceptance and preference (see the discussion of control approaches in the summary and explanation for paragraph (m)). For example, as MacLeod (Ex. 26-1425) points out, an employer whose VDU operators are experiencing neck and shoulder problems has many options available, including the following: Raising the height of the monitor by putting it on phone books, building a monitor stand, buying an adjustable monitor stand, buying an adjustable wall-mounted monitor stand, or buying an adjustable desk-mounted monitor stand; Putting the desk on blocks; or Providing an adjustable-height desk or workstation.

Work practice controls involve changes in the way an employee does the job. They are defined by the standard as changes in the way an employee performs the physical work activities of a job that reduce exposure to MSD hazards. Work practice controls involve procedures and methods for safe work. Examples of work practices that reduce the potential for exposure to ergonomic risk factors are the use of neutral positions or postures to perform tasks (keeping wrists straight, lifting close to the body), use of two-person lifts when mechanical lifts are not available, and the observance of micro-breaks as necessary to minimize muscle fatigue. In the context of ergonomic programs, work practice controls are essential, both because they reduce ergonomic stressors in their own right and because they are critical if engineering controls are to work effectively. For example, workers need to be trained to use a power grip rather than a trigger grip if a new tool is to be successful, and they need to know how to adjust an ergonomically designed chair properly if it is to substantially reduce the risk of neck disorders, shoulder tendonitis, or another type of MSD. Work practices, like learning to vary job activities during the day (e.g., moving from filing to sorting mail to using the computer and back again) can often reduce the magnitude and duration of exposure to the relevant risk factor sufficiently to make MSDs unlikely. To be effective, the culture at the workplace and supervisory support and reinforcement are necessary to ensure that safe work practices are routinely observed.

Administrative controls are work practices and policies implemented by the employer that are designed to reduce the magnitude, duration, and/or frequency of employee exposure to risk factors by changing the way work is assigned or scheduled. Examples of administrative controls that are used in the ergonomics context are employee rotation, job enlargement, and employer-initiated changes in the pace of work.

Administrative controls have been effective in addressing MSD hazards in a number of cases. For example, one case study cited in the Benefits chapter (Chapter IV of the Final Economic Analysis) describes a lift team approach that has been effective in reducing work-related back injuries among nursing personnel in a long-term care facility for the elderly (Ex. 26-1091). The table of ergonomic program and intervention case studies in Section VI shows dozens of examples of the successful use of administrative controls, either alone or in combination with other controls.

However, administrative controls must be used carefully if they are to provide effective protection to employees. A well-known ergonomics book, MacLeod's ``The Ergonomic Edge,'' cautions:* * * job rotation is only beneficial if the tasks involve different muscle-tendon groups or if the workers are rotated to a rest cycle * * *. Furthermore, job rotation alone does not change the risk factors present in a facility. Although job rotation may have beneficial effects, engineering changes should remain the goal of the ergonomics program (Ex. 26-1425).

OSHA agrees, and paragraph (l)(1) notes, that engineering controls are the preferred method of controlling MSD hazards in cases where these controls are feasible. In contrast to administrative and work practice controls or personal protective equipment (PPE), which traditionally have occupied lower tiers of the hierarchy, engineering controls fix the problem once and for all.

Many commenters agreed that engineering controls are generally superior to other controls, i.e., administrative controls, work practices, or personal protective equipment (see, e.g., Exs. 26-1487, 26-1428, 26-1424, 26-2; 26-1426, 26-1425, 26-1408; and 26-3). For example, a recent ergonomics text states: Ergonomic hazards can be effectively eliminated by introducing engineering [Page 68361] controls and applying ergonomic principles when developing workstations, tools, or jobs * * * only engineering controls eliminate the workplace hazards. Other strategies [work practices, administrative controls] only minimize the risk of injury (Ex. 26- 1408).

However, a number of commenters mistakenly understood OSHA's statement in the proposal about the preferred status of engineering controls. These commenters understood this statement to mean that administrative or work practice controls could not be used in lieu of engineering controls. This was not OSHA's intent, nor is the inclusion of this statement in the final rule to be interpreted that way. In the final rule, as in the proposal, OSHA is permitting any combination of controls (except PPE) to be used to control MSDs, either alone or in combination. OSHA agrees, as these parties (see, e.g., Exs. 30-3344, 30-4628) argued, that in many cases, the use of administrative or work practice controls alone may eliminate the hazard and thus obviate the need for more expensive engineering controls. For example, the Milliken Company stated:

The authorization in [proposed] section 1910.920(a) for employers to use any combination of engineering, administrative, and work practice controls is effectively rendered meaningless with the statement that follows, which specifies that engineering controls are the preferred method for eliminating or materially reducing MSD hazards. This provides too much latitude for OSHA area directors to issue citations when an employer has used administrative and work practice controls rather than engineering controls (Ex. 30-3344).

Other commenters who misinterpreted the proposed statement about the preference for engineering controls were concerned that this preference could greatly increase the costs of compliance if OSHA enforced this provision. For example, the Rubber Manufacturers Association emphasized that `` * * * the hierarchy placing engineering controls over other alternatives * * * restricts employers' discretion to choose less expensive, non-engineered alternatives'' (Ex. 500-95). Other groups, such as Pharmteck (Ex. 30-4122) and Southern States Cooperative Inc. (Ex. 30-394), argued that `` * * * a vast percentage of workplace injuries result not from exposure that might be limited through engineering solutions, but from problematic employee behavior and safety related decisions.'' Issues of feasibility were pointed to by several commenters (see, e.g., Exs. 30-3368, 30-4264) such as the National Soft Drink Association, which stated:

Although the employer is allowed to use any combination of controls, OSHA makes clear that engineering controls are preferred, where feasible. Lacking any definition or guidance of the term ``feasible'' complicates understanding or complying with OSHA's intent in this regard. Such ambiguity will undoubtedly lead to disagreements between employers and OSHA compliance personnel (Ex. 30-3368).

In response, OSHA notes that the hierarchy of controls has been an established industrial hygiene practice since the 1950s and has been a longstanding OSHA policy, as evidenced by many of the Agency's standards (e.g., asbestos, Sec. 1910.1001; benzene, Sec. 1910.1047; cadmium, Sec. 1910.1027; and methylene chloride, Sec. 1910.1052). As was stated in the proposal, ergonomists endorse the hierarchy of controls because they believe that control technologies should be selected based on their reliability and efficacy in controlling or reducing the workplace hazard (exposure to risk factors) giving rise to the MSD. OSHA does not agree that ``problematic employee behavior'' is the cause of occupational injuries and illnesses, nor that feasibility will be a concern with this standard, in large part because the standard allows such flexibility in control approach and requires only that employers implement feasible controls. Many groups (see, e.g., Exs. 32-21-1-2-19, 20-69, 20-22, 30-4538, 30-3683) commenting on the proposal strongly supported the hierarchy of controls. For example, the American Association of Safety Engineers stated:

We agree that engineering controls should be the first option in alleviating MSDs. While this type of approach could be the most expensive from the short-term perspective, our experience is that engineering controls are the most efficient/effective approach in the long-term (Ex. 32-21-1-2-19).

OSHA agrees that the use of engineering controls is the most effective way of controlling the MSD hazards. However, as discussed above, this standard permits employers to use any combination of controls, except PPE alone, to address MSD hazards in their workplace.

Paragraph (l)(2)--Personal Protective Equipment

Paragraph (l)(2) of the final standard permits employers to use personal protective equipment (PPE) to supplement engineering, work practice, and administrative controls. However, personal protective equipment may not be used alone, i.e., as the sole means of employee protection, unless no other controls are feasible. In addition, any PPE that is provided must be made available to employees at no cost. PPE is equipment that is worn by the employee and reduces exposure to risk factors and MSD hazards in the job. Examples are palm pads and knee pads to reduce contact stress, vibration-attenuation gloves, and gloves worn to protect against cold temperatures.

The hierarchy of controls, which, as discussed above, is widely endorsed by ergonomists, occupational safety and health specialists, and health care professionals, accords last place to PPE because:

Its efficacy in practice depends on human behavior (the manager's, supervisor's and worker's),

Studies have shown that the effectiveness of PPE is highly variable and inconsistent from one worker to the next. The protection provided cannot be measured reliably; PPE must be maintained and replaced frequently to maintain its effectiveness,

It is burdensome for employees to wear, because it decreases mobility and is often uncomfortable, It may pose hazards of its own (e.g., the use of vibration-reduction gloves may also force workers to increase their grip strength). One author (Ex. 26-1408) notes that: `` * * * in most cases, the use of PPE focuses attention upon worker responses and not the causes of ergonomic hazards.* * * PPE does not eliminate ergonomic hazards * * * [and] must be considered as the last line of defense against ergonomic hazard exposure.'' Thus, although the final standard permits PPE to be used as a supplemental control, it cannot be relied on as a permanent solution to MSD hazards unless other feasible controls are unavailable. In the proposal, OSHA included a note to the proposed section on the hierarchy of controls that stated that back belts/braces and wrist braces/splints were not to be considered PPE for purposes of the standard. This note was added to alert employers to the fact that back belts and wrist braces, which are widely used in U.S. workplaces, were not to be considered a control to reduce ergonomic hazards under the proposed standard. OSHA pointed out that these devices were being marketed as equipment that could prevent MSDs, although the evidence to support these claims was inconclusive. A number of commenters and studies in the record (see, e.g., 32-30 1-15, 32-30-1-6, 32-30-1-7, 32-30-1-29, 32-30-1-14) suggest that OSHA should allow the use of back belts as PPE on the grounds that these devices have been shown to reduce workplace injuries. For[Page 68362] example, Mr. Jeffrey Whitaker commented that: As safety professionals we realize that back supports alone are not a solution and we apply the hierarchy of controls in our work with our customers on a daily basis. We recommend engineering and work practice controls be used whenever possible but we all know of hundreds of workers' whose jobs will never or cannot be changed. These workers need at least a modicum of support when doing their jobs. Back supports are used in these situations to provide a basic line of defense for vulnerable workers (Ex. 30-2724).

Back supports should be recognized as an acceptable component of an overall back safety program under the hierarchy of controls. As with any PPE, back supports are not the first intervention option. In many jobs, however, neither engineering controls nor work practice or administrative controls are feasible or practicable. In these circumstances, OSHA's PPE standard allows employers to provide workers with protective equipment that is appropriate for the hazards present * * * OSHA should clarify that employers may use back supports as a supplement to their overall back injury prevention program (Ex. 30-3857).

However, other organizations and commenters cautioned against the use of back belts as PPE. For example, in a 1994 report reviewing the available scientific literature on the use of back belts, NIOSH expressed concern that wearing a belt may alter workers' perceptions of their capacity to lift heavy workloads (i.e., belt wearing may foster an increased sense of security, which may not be warranted or substantiated) (Ex. 15-16). NIOSH does not recommend the use of back belts as PPE, and neither do a number of professional societies (Exs. 15-15, 15-17, 15-33, and 500-41-99).

However, in response to comments submitted to the record regarding
back belts, OSHA has reviewed the available scientific literature
addressing the efficacy of back belts in reducing MSDs. OSHA has
conducted an extensive review of the evidence in the record on the
effectiveness of back belts in industrial use. The evidence is mixed.
Several studies (see, e.g., Exs. 32-30-1-21, 32-30-1-22, 32-30-1-2, 32-
30-1-8, 33-30-1-16, 32-31-1-23) of back belt use showed negative results. For example, a 1996 study by Rafacz and McGill (Ex. 32-30-1- 21) that investigated the effectiveness of back belts in 20 healthy male subjects found that belt wearing increased diastolic blood pressure during every task performed by the study subjects. The authors concluded that ``wearing an abdominal belt may put undue strain on the cardiovascular system and * * * that screening for cardiovascular compromise should be conducted before occupational belt-wearing.'' Another study (Alexander et al. 1995) that evaluated belt use in nursing, dietary, and environmental services workers found no significant differences in the number of self-reported back injuries. The authors concluded that ``This finding supports research [showing] that universal prescription of back belts did not decrease the number of back injuries and that there [is] no support for uninjured workers wearing back belts to reduce risk of injury.'' (Ex. 32-30-1-2).

A number of back belt studies in the literature report inconclusive results (see, e.g., Exs. 32-30-1-22, 32-30-1-8, 32-30-1-24, 32-30-1- 12). For example, a study by Kraus et al.1996 (Ex. 32-30-1-12) reported a lower acute back injury rate among belt users than non-users, but cautioned that a number of confounders, such as the inability to evaluate injury status, job lifting intensity, or length of employment ``may be important confounders or effect modifiers that delimit the potential effect of back supports.''

However, a number of recent studies (see, e.g., Exs. 32-30-1-25, 32-30-1-6, 32-30-1-7, 32-30-1-14, 32-30-1-19) contain limited evidence that back belt use can, in certain circumstances, provide some protection to workers. For example, a 1998 study evaluated trunk stiffening during flexion and lateral bending and concluded that: `increased spine stability may provide greater protection against injury following unexpected or sudden loading'' (Ex. 32-30-1-6). A 1995 review of the literature on back belt effectiveness (Ex. 32-30-1-7) concluded: ``Based on our assessment of the * * * studies reviewed in this paper, a major finding is that back supports designed solely for specific purposes could be biomechanically, physiologically, and psychophysically effective in relieving the loads on the lumbar spine for employees engaged in many industrial operations.'' A study by one of OSHA's expert witnesses, Dr. Stephen Lavender (Ex. 32-30-1-14) that evaluated the effect of lifting belts, foot movement, and lift asymmetry on trunk motions, concluded that the lateral bending and twisting motions of the torso are controlled with belt use.

OSHA's review of the voluminous record on the back belt issue shows that back belts may have protective effects in certain industrial settings, such as sudden unexpected loading of the spine (Ex. 32-30-1- 14). OSHA is aware that several of these studies had small sample sizes (e.g., 10 subjects) (Ex. 32-30-1-6), lacked control groups, and were of short duration. Nevertheless, the Agency is persuaded that the evidence for the effectiveness of back belts, although limited, exceeds that available for other types of equipment that workers wear that is classified as PPE (e.g., palms pads, knee pads). OSHA has therefore decided not to prohibit the classification of back belts as PPE for the purposes of this standard. Accordingly, the note to that effect contained in the proposal does not appear in the final rule. Permitting back belts to be used as PPE means that employers will be required to provide them to their workers, if they choose to do so, at no cost to employees. Further, as with any PPE, back belts used in this manner are subject to OSHA's standard for PPE (29 CFR 1910.132).

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