Workers performing cleaning duties experience higher injury rates, especially in the form of musculoskeletal disorders (MSDs), than other industries. It is essential to understand the inherent risks associated with the nature of this occupation. Based on the Balance Theory (Smith & Carayon-Sainfort, 1989), this review surveys the current literature, especially those published since the previous review paper (Kumar & Kumar, 2008), and identifies which elements contributing to MSD risks were examined: task, technology, organization, environment, individual, and their interactions. Thirty-nine research papers published between 2005 and 2021 are identified and summarized. Among these papers, task and individual elements received the most attention, at 42 and 34 occurrences, respectively. The interaction elements of technology-organization, technology-environment, and organization-environment received less than three mentions. The goal of this literature review is to update the knowledge base and identify current trends for the cleaning occupation. Possible interventions for risk reduction and future research directions are suggested.

BACKGROUND:Janitors are a low-wage, ethnically and linguistically diverse, hard-to-reach population of workers with a high burden of occupational injury and illness.METHODS:Data from an extensive multimodal (mail, phone, web) survey of janitors in Washington State were analyzed to characterize their working conditions and occupational health experiences. The survey included questions on demographics, work organization and tasks, health and safety topics, and discrimination and harassment. The survey was administered in eight languages.RESULTS:There were 620 complete interviews. The majority completed the survey by mail (62.6%), and in English (85.8%). More than half of responding janitors were female (56.9%), and the mean age was 45 years. Twenty percent reported having a (health-care-provider diagnosed) work-related injury or illness (WRII) in the past twelve months. Women and janitors who were Latino had significantly higher relative risk of WRII. Increased risk was also associated with several work organization factors that may indicate poor working conditions, insufficient sleep, and possible depression. Half of injured janitors did not file workers' compensation (WC) claims.CONCLUSIONS:Janitors reported a high percentage of WRII, which exceeded previously published estimates from Washington State. Women and Latino janitors had significantly increased risk of WRII, and janitors' working conditions may influence the unequal distribution of risk. WRII surveillance via WC or medical care usage in janitors and other low-wage occupations may reflect substantial underreporting. Characterizing the nature of janitors' work experience can help identify avenues for prevention, intervention, and policy changes to protect the health and safety of janitors.

Introduction: Construction is high-hazard industry, and continually ranks among those with the highest workers' compensation (WC) claim rates in Washington State (WA). However, not all construction firms are at equal risk. We tested the ability to identify those construction firms most at risk for future claims using only administrative WC and unemployment insurance data. Methods: We collected information on construction firms with 10-50 average full time equivalent (FTE) employees from the WA unemployment insurance and WC data systems (n = 1228). Negative binomial regression was used to test the ability of firm characteristics measured during 2011-2013 to predict time-loss claim rates in the following year, 2014. Results: Claim rates in 2014 varied by construction industry groups, ranging from 0.7 (Land Subdivision) to 4.6 (Foundation, Structure, and Building Construction) claims per 100 FTE. Construction firms with higher average WC premium rates, a history of WC claims, increasing number of quarterly FTE, and lower average wage rates during 2011-2013 were predicted to have higher WC claim rates in 2014. Conclusions: We demonstrate the ability to leverage administrative data to identify construction firms predicted to have future WC claims. This study should be repeated to determine if these results are applicable to other high-hazard industries. Practical Applications: This study identified characteristics that may be used to further refine targeted outreach and prevention to construction firms at risk. Published by Elsevier Ltd.

Objective: Assess the effect of chronic comorbidities on hours and earnings recovery following a carpal tunnel syndrome (CTS) claim. Methods: The hours and earnings profiles of Washington State workers’ compensation claimants with CTS and controls, upper extremity fractures (UEF) claimants, were collected by linking to unemployment insurance data during 2007 to 2014. Chronic comorbidity status was determined from workers’ compensation bills. Results: More (43%) CTS claimants had diagnosed chronic comorbidities than UEF (24%). CTS claimants and claimants with multiple chronic comorbidities had significantly higher odds of not working post injury and poorer hours and earnings recovery compared with UEF claimants and those with no chronic comorbidities. Conclusions: This research suggests that chronic conditions should be considered as barriers to return to work among injured workers.

BACKGROUND Temporary workers face increased risk of injury as compared to permanent workers in similar occupations. This study explores the role played by several potential risk factors. METHODS Injured temporary and permanent workers, matched by industry, tenure and demographic characteristics, were interviewed to isolate the association of temporary employment with several injury risk factors. RESULTS Temporary workers had higher workers' compensation claims rates than their permanent worker-peers. In interviews temporary workers a reported a lower frequency of exposure to hazards. However, they also reported being less likely to be equipped to cope with hazards by such countermeasures as experience screening, safety training and task control. CONCLUSION Policies are needed to improve screening and training of temporary workers to assigned tasks, to discourage job-switching, to improve temporary workers' hazard awareness, to protect their right to report unsafe conditions. The responsibilities of agencies and host employers for ensuring the safety of their temporary workers need clarification in regulatory policy.

BACKGROUND:We aimed to determine the strength of evidence on the effectiveness of legislative and regulatory policy levers in creating incentives for organizations to improve occupational health and safety processes and outcomes. METHODS:A systematic review was undertaken to assess the strength of evidence on the effectiveness of specific policy levers using a "best-evidence" synthesis approach. RESULTS:A structured literature search identified 11,947 citations from 13 peer-reviewed literature databases. Forty-three studies were retained for synthesis. Strong evidence was identified for three out of nine clusters. CONCLUSIONS:There is strong evidence that several OHS policy levers are effective in terms of reducing injuries and/or increasing compliance with legislation. This study adds to the evidence on OHS regulatory effectiveness from an earlier review. In addition to new evidence supporting previous study findings, it included new categories of evidence-compliance as an outcome, nature of enforcement, awareness campaigns, and smoke-free workplace legislation. Am. J. Ind. Med. 59:919-933, 2016. © 2016 Wiley Periodicals, Inc.

BACKGROUND:Carpal tunnel syndrome (CTS) is among the most burdensome of all musculoskeletal disorders as measured by workers' compensation claims costs and lost earnings. But the burden of CTS extends beyond direct claim costs.METHODS:A survey covering health, social, economic and work-related outcomes was administered to 1,255 injured workers whose Washington State Fund workers' compensation claims had closed 6 years previously. Logistic and linear regression methods were used to model the outcomes of CTS claimants across four separate outcome domains.RESULTS:Workers diagnosed with CTS suffer substantial deficits across all four outcome domains as compared to the two comparison groups of claimants. Former CTS claimants were almost twice as likely not to be working as compared to the fractures cohort.CONCLUSIONS:A comprehensive measurement of the burden of CTS shows losses extend beyond direct claims costs to include continuing pain, loss of function, adverse financial impacts and household disruption which extend long after claim closure. Am. J. Ind. Med. 58:1255-1269, 2015. © 2015 Wiley Periodicals, Inc.

The growth of the contingent workforce presents many challenges in the occupational safety and health arena. State and federal laws impose obligations and rights on employees and employers, but contingent work raises issues regarding responsibilities to maintain a safe workplace and difficulties in collecting and reporting data on injuries and illnesses. Contingent work may involve uncertainty about the length of employment, control over the labor process, degree of regulatory, or statutory protections, and access to benefits under workers' compensation. The paper highlights differences in regulatory protections and benefits among various types of contingent workers and how these different arrangements affect safety incentives. It discusses challenges caused by contingent work for accurate data reporting in existing injury and illness surveillance and benefit programs, differences between categories of contingent work in their coverage in various data sources, and opportunities for overcoming obstacles to effectively using workers' compensation data. Am. J. Ind. Med. 57:764–775, 2014. © 2014 Wiley Periodicals, Inc.

PURPOSE:Little is known about the independent effect of workers' residential location and work-commuting on their long-term disability due to work-related injuries. We examined 149,110 incident claims while adjusting for multiple risk factors in a large, population-based sample of Washington State workers' compensation State Fund claims during 2002-2008.METHODS:Claimants' residential addresses were geocoded with census tract and aggregated into four category classification of the Rural Urban Commuting Area Codes (RUCAs) which takes into account for tract-level work-commuting. We used logistic regressions to assess the association between RUCAs and whether or not a person was off work for more than 180 days due to injury; Quantile regressions to predict various percentiles of cumulative lost workdays by RUCAs.RESULTS:Compared to those who live in the Urban Core, workers in other areas experienced longer average paid time loss days due to work-related injury. The association between residential location and long-term disability was significant, odds ratio (OR) 1.19 (95 % confidence interval (CI) 1.11-1.27) for residents of Small Town and Isolated Rural and OR 1.17 (95 % CI 1.12-1.22) for those of Sub Urban, and persisted after controlling for injury nature, socio-demographic, employment-related, and claim administrative characteristics. The impact of residential location and work-commuting elevated as the duration of disability increased.CONCLUSIONS:This study shows that residential location and work-commuting has a significant and time-varying impact on duration of work disability. Workers living in Sub Urban and Small Town and Isolated Rural areas represent a particularly vulnerable group with respect to risk of long-term work disability.

Objectives: This study reports trends in the pattern of injuries related to workplace violence over the period 1997-2007. It tracks occupations and industries at elevated risk of workplace violence with a special focus on the persistently high claims rates among healthcare and social assistance workers.Methods: Industry and occupational incidence rates were calculated using workers' compensation and employment security data from Washington State.Results: Violence-related claims rates among certain Healthcare and Social Assistance industries remained particularly high. Incidents where workers were injured by clients or patients predominated. By contrast, claims rates in retail trade have fallen substantially.Conclusions: Progress to reduce violence has been made in most of the highest hazard industries within the Healthcare and Social Assistance sector with the notable exception of psychiatric hospitals and facilities caring for the developmentally disabled. State legislation requiring healthcare workplaces to address hazards for workplace violence has had mixed results. Insufficient staffing, inadequate violence prevention training and sporadic management attention are seen as the key barriers to violence prevention in healthcare/social assistance workplaces.

BACKGROUND Workers with depression and frequent mental distress (FMD) have lost work productivity. Limited systematic comparisons exist for the prevalence of depression and FMD across occupational groups. METHODS Using a state-added question for occupation coupled to measures of depression and FMD on the Washington State (WA) 2006 and 2008 Behavioral Risk Factor Surveillance System survey, we estimated the prevalence and odds ratios (ORs) among the 20,560 WA workers. RESULTS The prevalences of current depression and FMD were 5.2% and 7.5%, respectively. The prevalence varied considerably across occupations. Compared with Management occupation, Truck drivers had significantly increased odds for both current depression [OR = 6.18, 95% confidence interval (CI): 2.52-15.16] and FMD (OR = 1.85, 95% CI: 1.01-3.41). Cleaning/Building services (OR = 1.95, 95% CI: 1.11-3.40) and Protective services (OR = 1.97, 95% CI: 1.19-3.27) were associated with increased FMD. CONCLUSIONS These findings demonstrate the need for research on possible sources of the differences for current depression and FMD across occupations.

BACKGROUND:Studies of regulatory effectiveness have shown mixed evidence of impact of inspections on injury rates. We examine changes in workers compensation claims rates and costs for Washington employers having either an inspection, with or without citation, or a voluntary consultation activity.METHOD:We merge 10 years of enforcement and consultation activity with workers compensation records at the individual workplace level for stable firms with a single business location and at least 10 full-time employees. The change in claims incidence rates (CIRs) was estimated, controlling for workplace claims rate history, size, and industry. Separate analyses were performed for non-musculoskeletal and musculoskeletal (MSD) CIRs, claims costs and for enforcement activities with citation and without citation.RESULTS:Enforcement activities are associated with a significant reduction in CIRs and costs. Similar results may also be attributable to consultations. Inspections were associated with a 4% decline in time-loss claims rates relative to uninspected workplaces. The effect strengthens when MSD claims are excluded. Citations for non-compliance are associated with a 20% decline in non-MSD CIRs relative to uninspected workplaces. There is also some evidence for a reduction in MSD claims rates beginning in the second year following inspection. Enforcement and consultation activity is associated with substantial decreases in claims costs.CONCLUSIONS:Enforcement activities make a significant contribution to reducing CIRs and costs. Similar results following consultations may also exist. Inspections with citations are more effective than those without. Claims rates for non-MSD injuries, related to hazards covered by specific standards, are more affected in the year following the visit, while those for MSDs take longer to begin falling.

Objectives. We examined the disparities in health-care coverage between low- and high-income workers in Washington State (WA) to provide support for possible policy decisions for uninsured workers. Methods. We examined data from the WA Behavioral Risk Factor Surveillance System 2003–2007 and compared workers aged 18–64 years of low income (annual household income <$35,000) and high income (annual household income ≤$35,000) on proportions and sources of health-care coverage. We conducted multivariable logistic regression analyses on factors that were associated with the uninsured. Results. Of the 54,536 survey respondents who were working-age adults in WA, 13,922 (25.5%) were low-income workers. The proportions of uninsured were 38.2% for low-income workers and 6.3% for high-income workers. While employment-based health benefits remained a dominant source of health insurance coverage, they covered only 40.2% of low-income workers relative to 81.5% of high-income workers. Besides income, workers were more likely to be uninsured if they were younger; male; Hispanic; less educated; not married; current smokers; self-employed; or employed in agriculture/forestry/fisheries, construction, and retail. More low-income workers (28.7%) reported cost as an issue in paying for health services than did their high-income counterparts (6.7%). Conclusion. A persistent gap in health-care coverage exists between low- and high-income workers. The identified characteristics of these workers can be used to implement policies to expand health insurance coverage.

BACKGROUND:Workers in the United States with limited English proficiency likely perform more hazardous work, experience higher rates of work-related injury and illness, and have worse disability outcomes.METHODS:We conducted a descriptive study of employment characteristics, timeliness and utilization of workers' compensation (WC) insurance benefits, cost and occupational health outcomes for Washington State WC state fund, non-traumatic low back disorders (LBD) claimants by language preference.RESULTS:A greater proportion of Spanish language preferring (SLP) LBD claims filed were accepted and resulted in lost work time than English language preferring (ELP) LBD claims. There were significant differences in the demographic, employment, and occupational characteristics between the SLP and ELP compensable claimant populations. The SLP LBD compensable claimants had greater time loss duration, greater medical and total claim costs, more use of physical therapy and vocational services than the ELP LBD compensable claimants. With the exception of the timeliness for providing the first time loss payment, the time periods for provision of insurance benefits did not differ between the SLP and ELP populations. SLP compensable claimants received less back surgery and had comparable permanent partial disability payments to the ELP population. Employers were more likely to protest the acceptance of a SLP compensable than one in an ELP LBD compensable claim.CONCLUSION:For those injured workers accessing the Washington State WC system, we observed differences based on language preference for pre-injury, and workers compensation outcomes. Further research is needed to explain the observed differences.

BACKGROUND In Washington State an ergonomics rule was adopted in 2000 that focused on primary prevention. The implementation process followed a 6-year phase-in schedule where employers came into compliance based upon their size and industry. In late 2003 the rule was repealed by an industry-funded voter initiative. Evaluating the implementation of this rule offers a unique opportunity to observe the general deterrent effect of a new public health regulation and to study how employers and workers responded to new requirements. METHODS Weighted survey regression methods were used to analyze the results from three employer surveys covering more than 5,000 workplaces administered in 2001, 2003, and 2005. These were compared to a baseline employer survey conducted in 1998 before the rule was promulgated. Questions covered the following topics: WMSDs experienced at the workplace; levels of employee exposure to musculoskeletal hazards; steps being taken, if any, to address these hazards; results of these steps; and sources of ergonomic information/assistance used. RESULTS From 1998 to 2003 there was a reduction in reported exposures among workplaces in the highest hazard industries. Following the rule's repeal, however, hazard exposures increased. While more workplaces reported taking steps to reduce exposures between 1998 and 2001, this gain was reversed in 2003 and 2005. Employers who took steps reported positive results in injury and absenteeism reduction. Large workplaces in the high hazard industries were more active in taking steps and used a wide variety of resources to address ergonomics issues. Small employers relied more on trade associations and the state.

We found support for several hypotheses linking work practices to employee outcomes: reducing biomechanical workload is associated with decreased burnout via perceptions that job demands are less threatening; lower demands are associated with higher job satisfaction primarily through decreases in burnout; employers who include employees in decision making processes have employees with lower levels of burnout and higher satisfaction; and having a disability management program is associated with having employees who report less job-related burnout. This study demonstrates the importance of programs that increase perceived organizational support and the importance of job design strategies that take into account physical workload.

To the Editor: Professor Oleinick provides clarification on the findings of his paper, which supported the use of Minnesota workers' compensation cases with days away from work (DAFW) for epidemiologic study.1 We appreciate his comments and agree that workers' compensation systems data, with recognition of their limitations, are often informative for policy purposes and epidemiologic study.2,3 As we discussed in our paper, lack of certainty about case eligibility for workers' compensation and lack of information on severity could influence estimates of underreporting.4 Eligibility requirements for workers' compensation coverage vary by state. Nevertheless, it is likely that even serious injuries and illnesses with DAFW are underreported to workers' compensation systems and other systems used for epidemiologic study. For example, in Michigan, the Bureau of Labor Statistics (BLS) Annual Survey and Workers' Compensation systems both missed approximately 18% of injury or illness cases involving greater than 7 days away from work.5 We suggest that further investigations are needed on the factors that influence underreporting of serious and less serious occupational injury and illness to state workers' compensation systems. Z. Joyce Fan, PhD David Bonauto, MD, MPH Michael Foley, MA Barbara Silverstein, PhD, MPH, CPE Safety and Health Assessment and Research for Prevention Program (SHARP) Washington State Department of Labor and Industries Olympia, Washington

BACKGROUND:The long-term earnings losses borne by injured workers, beyond those covered by workers' compensation insurance, are rarely estimated. The post-claim earnings of a cohort of carpal tunnel syndrome (CTS) claimants are tracked over a period of 6 years and compared to the earnings of claimants with either upper extremity fractures or dermatitis.METHODS:Quarterly earnings records of 4,443 workers in Washington State who filed claims with the State Fund in 1993 or 1994 for CTS are compared to those of 2,544 with upper-extremity fracture claims and 1,773 with medical-only dermatitis claims. Multivariate regression was used to identify the effect of injury type on earnings from that of other potential predictors.RESULTS:CTS claimants recover to about half of their pre-injury earnings level relative to that of comparison groups after 6 years; they also endured periods on time-loss three times longer than claimants with upper extremity fractures. CTS surgery claimants had better outcomes than those who did not have surgery. Earnings recovery fractions among CTS claimants were better for workers who: (1) were younger; (2) had stable pre-claim employment; (3) lived in the Puget sound area; (4) worked for large businesses; (5) worked in non-construction/transportation industries; or (6) were in the higher pre-injury earnings categories. Cumulative excess loss of earnings of the 4,443 CTS claimants was 197 million dollars to 382 million dollars over 6 years, a loss of 45,000-89,000 dollars per claimant. This underscores the importance of prevention, early diagnosis, and accommodation for return to work.

To the Editor: The recent article by Fan1 misstates the findings of my study2 and, because I believe a correct understanding of what we found provides a useful insight into the utility of at least some workers' compensation databases for the study of work injuries, I write to correct the record. The goal of workers' compensation statutes is not to enumerate work injuries but to provide financial support for the costs of medical care required to treat the injury and for some fraction of resulting lost wages for injured workers until they can return to work. For the purposes of evaluating ascertainment in workers' compensation systems, work injuries fall into four groups: injuries that lead to neither medical care nor days away from work (including those injuries in which the worker may continue to “work hurt”), injuries that do not require medical care but do lead to days away from work (many companies require a physician's report if the absence exceeds a specified time interval, generally 2–3 days), injuries that do require some type of medical care but do not lead to days away from work or where the employer provides a light duty job during recovery, and injuries that result in both medical care and days away from work. Moreover, in what can best be characterized as puritanical zeal to prevent fraudulent claims, all states require some minimum “waiting period” of days away from work before the worker is eligible to recover lost wages, currently in the range of 1–8 days (Ontario, in contrast, requires payment for lost time from the time of injury with the employer paying for the day of injury and the compensation system paying for subsequent days away from work). If the worker is out less than the required period, the wage loss remains uncompensated. Given the legal requirements of this remedial legislation, workers who do not require medical care and who do not have more than the required period of work absence simply never enter the workers' compensation system. The workers' compensation system is intended to ascertain only the workers in the last two groups (while it is theoretically possible for a worker to be injured seriously enough to be away from work more than the required minimum period and thus qualify for wage compensation, but not require medical care, most employer policies mitigate against this result). It is reasonable to conclude that the most seriously injured workers are far more likely to fall in the group that requires medical care and that also qualifies for wage compensation than in the group requiring only medical care. However, some workers with serious acute trauma such as long bone fractures may return to work immediately in light duty jobs after receiving emergency medical care. Given this structure for workers' compensation, what our study showed, using Minnesota data and adjusting for the algorithm used to count days away from work (it varies from state to state and adjustment required system detail that comparatively few systems can provide), was that the number of workers' wage compensation claims filed during the period of 1992 to 2000 was 92% to 97% concordant with the number of U.S. Bureau of Labor Statistics (BLS) cases with days away from work, adjusted to include only the cases with 4 or more days away from work (the waiting period in Minnesota, like Washington, is 3 days). After reviewing possible undercounts in both systems, we concluded that the concordance estimates were reasonable and that wage compensation cases were well ascertained by the Minnesota compensation system. In addition, earlier work3 indicated that the factors affecting return to work after a work injury differed by time from injury so that absence of data for injuries producing less than 4 days away from work would not be expected to affect modeling estimates for factors producing longer periods away from work. We believe that our report supports the use of wage compensation cases in at least some workers' compensation systems to study the natural history of work injuries producing more than three days away from work, clearly an important group for policy purposes. While the underreporting noted in the Fan article indicates that workers' compensation data may not be suitable for the study of all work injuries (they sought information on medical treatment and equated that with filing a workers' compensation claim), that finding should not be allowed to cast aspersions on the use of workers' compensation data to study the course of the more serious injuries. Unlike the arts, the best is not the enemy of the good in science (with apologies to Voltaire, 1772). Good data can be quite useful and their use should not be postponed waiting for more perfect data. Arthur Oleinick, MD, JD, MPH Associate Professor Emeritus Department of Environmental Health School of Public Health University of Michigan Ann Arbor, MI

OBJECTIVE:We quantified the underreporting of work-related injury or illness to workers' compensation (WC). METHODS:Using data from 2612 wage-earning respondents who participated in the 2002 Washington State Behavioral Risk Factor Surveillance System, we assessed work-related injury or illness in the previous year and identified the factors associated with WC claim filing by logistic regression. RESULTS:The self-reported rate of work-related injury or illness of respondents was 13%. Among those who had a work-related injury or illness, 52% filed a WC claim. After adjustment for age, gender, and race, those who filed WC claims were more likely to be overweight and married. WC claim filing varies considerably across industry and occupation groups holding all other measured factors constant. CONCLUSIONS:Individual and industry/occupation factors are related to underreporting of work-related injury or illness to the WC system.