The OSH Act established three permanent federal agencies: OSHA, within the Department of Labor; the Occupational Safety and Health Review Commission (OSHRC); and the National Institute for Occupational Safety and Health (NIOSH), within the Department of Health and Human Services. The OSH Act covers most private sector employers and their workers, in addition to some public sector employers and workers. Its reach includes all 50 states and certain territories and jurisdictions under federal authority [3].

The standard requires employers to implement an exposure control plan that mandates Universal Precautions (i.e., treating all body fluids as if they are potentially infectious). The standard also stresses hand hygiene, recommends the use of Personal Protective Equipment (PPE), sets forth processes to minimize needle sticks and blood splashing, ensures appropriate packaging of specimens, and regulates waste by employing biohazardous labeling before shipping [10,12].

The United States has been waging a war against tuberculosis (TB) for more than 150 years. After it was found that a multidrug regimen could effectively kill the Mycobacterium tuberculosis organism, the number of those infected decreased dramatically, and many sanitariums were closed. By 1980, prevention programs were ended, and pharmaceutical companies had stopped manufacturing streptomycin. By 1985, the number of new cases of TB had increased, and by the early 1990s, the development of multidrug-resistant TB caused the epidemic to begin anew [32]. Due to recent attention and increased vigilance, incidence rates for TB infection in the United States have begun to decline. In 2021, a total of 7,882 cases of TB were reported in the United States, a 12.4% decrease from 2019. It should be noted that a decrease in 2020 (incidence rate: 7,171 cases) followed by a slight increase in 2021 was observed, but the increase is most likely due to under-reporting, delayed healthcare access, and/or missed diagnosis in 2020 as a result of the COVID-19 pandemic. Overall, the incidence rate has remained relatively stable, at approximately 2.5 cases per 100,000 persons [33]. However, it has been estimated that up to 13 million persons in the United States have latent TB infection, with 5% to 10% at risk for future disease [34,35]. Furthermore, the increasing incidence of multidrug-resistant strains of the disease remains a problem.

The CDC has recommended that healthcare workers receive annual training on the nature, extent, and hazards of TB in the healthcare setting. Recommended training topics include risk assessment, use of environmental controls, how to select and use a respirator, and OSHA regulations regarding respirators. Trainees should be given opportunities to practice handling and wearing a respirator to achieve proficiency. They also should be provided with copies of training materials for future reference [44].

The following interventions are considered medical treatment and are almost always recordable on the OSHA 300 Log[9,45]:

Violence in the workplace is an issue that is increasingly receiving public attention. An estimated 2.6 million workers are injured each in the workplace, of which more than 37,000 injuries are intentionally caused by another person. While a majority of these injuries are nonfatal, the U.S. Bureau of Labor Statistics (BLS) reported that of the 5,190 fatalities in the workplace in 2021, 761 workers were fatally injured by assault and/or violent attack [40,49,51].

The Hazard Communication Standard defines a hazardous chemical as one that presents either a physical hazard (i.e., fire, explosive, or reactive) or a health hazard (i.e., one with systemic or target organ effects) in the workplace. Certain chemicals have been specifically designated as hazardous. A list of these chemicals is provided by several agencies, including [53]:

Approximately 15% of wastes generated by healthcare facilities are considered hazardous materials that may be infectious, toxic, or radioactive. These materials include [54]:

OSHA has set standards for radiation exposure levels and requires a radiation monitoring program. However, the radiation monitoring program need not continue indefinitely. Employers are not required to provide monitor badges to employees just because they work in an area where radiation is used. They are only required to provide monitor badges to those employees likely to receive a dose of radiation in excess of 25% of the allowed quarterly exposure limits and to employees who work in a high-radiation area. When an organization has compiled the necessary data through radiation surveys and monitoring results, it may reduce the scope of a program that is costly and time-consuming. The acquired data should document that employee exposure levels to radiation are less than 25% of the allowed quarterly limits set by OSHA [9].

Because of the potential for injury, these spills (and their cleanup) are regulated by OSHA [9,10,53]. Factors to consider if a spill occurs include:

Annual inspections by the fire marshal, quarterly fire drills, annual fire safety in-services, and monthly fire extinguisher documentation are all elements of a successful fire safety program. Staff education and documentation of the education are integral parts of the fire safety plan.

Over the last several decades, concerns about the quality of indoor office environments have risen dramatically in the United States. The term "sick building syndrome" (SBS) describes a range of acute health and comfort effects that workers link to time spent in a building. Workers identify the building as the cause of their symptoms because they find relief from the symptoms when they leave the building [60]. SBS may be caused by inadequate ventilation, chemical contaminants from indoor or outdoor sources, and biologic contaminants. Although some symptoms and illnesses have been associated with a building's characteristics (e.g., dampness), medical and environmental tests often are not able to identify an offending contaminant in SBS. In contrast, a building-related illness (BRI) is one in which the symptoms of a diagnosable illness can be both identified and directly attributed to a specific airborne building contaminant. Examples of such illnesses include asthma, hypersensitivity pneumonitis, inhalation fever, rhinosinusitis, and infection [60,61,62].

An area of IEQ concern for hospitals is the operating room, where workers may be exposed to waste anesthetic gases, including nitrous oxide and halogenated anesthetics (e.g., halothane, enflurane, and isoflurane), while administering anesthesia. Exposure may also occur in the recovery room when the patient exhales the gases.

Although the scope of ergonomics is broad, OSHA primarily uses the term to define and assess work-related factors that put individuals at risk of musculoskeletal disorders (MSDs), which account for 33% of all worker injury and illness cases annually [65]. Examples of ergonomic risk factors have been identified in jobs and tasks that require prolonged, repetitive movements; recurrent heavy lifting, pushing, or pulling; and prolonged, awkward working positions. Employee exposure to vibration and cold may also be risk factors [66].

Hypersensitivity immune system response is an actual latex allergy. This type of response is characterized by pruritus, inflammation, swelling, hives, and wheezing, usually immediately after exposure. Even low levels of exposure may trigger allergic reactions in some sensitized individuals. The response may progress to anaphylaxis in susceptible individuals, which is evidenced by hypotension, confusion, and extreme airway constriction. Individuals experiencing anaphylactic shock require immediate treatment. Allergy to latex should be suspected in any individual who develops specific symptoms, such as nasal irritation, hives, shortness of breath, wheezing, or unexplained shock [78,79].

Attorneys who investigate incidents of employee injury will expect to be able to examine available documentation, including incident reports, medical records that include treatment of the employee, and training and education records. Safety conditions that might have caused the injury, any perceived unsafe conditions that exist, the safety committee minutes that show how the facility has addressed the condition, and further actions to correct the condition may also be reviewed.

The General Duty Clause mandates employers to furnish employees with a workplace that is free from recognized hazards that may cause death or serious physical harm. To avoid citations, employers should comply with standards. This may be accomplished by employing an internal safety staff or by employing an outside private consultant. Free consultations are available to small businesses with no more than 250 employees at one site and no more than 500 employees total at all sites [81]. Consultation may be invaluable for small, rural facilities.

After the inspection has been completed, a closing conference will occur during which potential problems will be discussed. If the consultant has deemed a condition to be an "imminent danger," the employer should take immediate action to correct the condition. If a condition is deemed to be a "serious violation" (according to OSHA regulations), the consultant and employer will together devise a corrective action plan. The consultant may also recommend increased training and monitoring, safety promotion, and accountability procedures [81].

Employers should understand the limits of the OSHA inspection. For example, employers may voluntarily consent to an inspection but they are not required, according to the Fourth Amendment to the U.S. Constitution, to admit inspectors who do not present a warrant [83]. Although the additional time it takes OSHA to secure a warrant may allow the employer to resolve immediate and critical compliance issues, employers who proactively create and use area-specific self-inspection checklists may help minimize hazards and avoid compliance violations [83].

As of January 2023, the violations, and their associated penalties, that have been structured for the workplace include [41,82]: