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BACKGROUND: The current national system of occupational injury and illness surveillance is based on reporting from a sample of employers and extrapolation from the sample. This system both undercounts the true numbers of workplace injuries and illnesses and does not allow the targeting of the individual companies where these conditions occurred. A state-level multi data source surveillance system based on reports from hospitals and health care providers can be used not only to provide a more accurate overall count but also to initiate individual inspections.
METHODS: Michigan’s public health regulations require hospitals, clinics and health care providers to report all injuries (not just occupational) and all occupational illnesses to the state. In addition, laboratories are required to report all blood lead measurements including a negative result. These regulations were used to develop a multi data surveillance system that includes medical records, laboratories, poison control center data and death certificates for six work-related conditions: amputations; asthma; burns; crush injuries; elevated blood lead levels; and skull fractures. The major source for identifying these conditions, other than elevated lead levels, was the actual discharge summary or emergency department summary from the individual’s medical encounter. These records were submitted by all Michigan hospitals, including Veteran’s Administration hospitals. Criteria were developed to identify the most severe outcomes for each condition to determine which cases would be referred for an enforcement inspection by the state OSHA plan.
RESULTS: There were 1,341 enforcement inspections conducted for the six conditions under surveillance. The actual time period over which these inspections were conducted varied from one year for crush injuries to 25 years for work-related asthma, depending on when each condition was first placed under surveillance. There were a total of 4,354 violations cited and $ 2.3 million in monetary penalties assessed. The above data plus median, maximum and ranges will be presented by each of the individual conditions.
CONCLUSIONS: The Michigan multi data source surveillance system has been successful in integrating individual case based workplace enforcement inspections into its overall surveillance program. These case based inspections have successfully identified correctable workplace problems. Other follow back components of the surveillance system include data compilation and educational outreach. Individual enforcement inspections are one aspect of follow back that can be successfully used to increase the impact of surveillance and should be routinely performed as part of state based occupational surveillance.