Caregiver Safety

Environmental Health and Safety

Employee Flu Station

Within Cleveland Clinic’s Enterprise Quality, we have a formal Environmental Health and Safety (EHS) team charged with the implementation and monitoring of EHS management activities at Cleveland Clinic main campus and our family health centers. In addition, each community hospital maintains written management plans that address the “Environment of Care” based on management structure and individual needs.

Enterprise safety leadership regularly review regulations and standards and assess the need for changes to general safety policies, equipment, procedures, training and other activities. Ultimately, the responsibility for environmental health and safety at Cleveland Clinic extends through the entire supervisory force to every caregiver. Only through a cooperative effort by supervisors and caregivers can an effective accident prevention program be established and preserved.

Cleveland Clinic also protects our caregivers and patients through risk control efforts related to serious diseases. For example, Occupational Health promotes the health and safety of our caregivers through new hire pre-placement assessments, urine drug screenings, annual compliance, Tuberculosis testing, audiograms, as well as required immunization and flu vaccinations. In addition, we established a work restriction policy for caregivers with communicable diseases, a safety event reporting system and post-exposure guidelines and support for those exposed to blood-borne pathogens. Employees are encouraged to report all exposures and near-misses, and aggressive post-exposure follow-up procedures are followed.

EHS Data

Cleveland Clinic’s recording and reporting of accident statistics is in accordance with the requirements of the Occupational Safety and Health Administration (OSHA) and the Bureau of Labor Statistics (BLS). An injury or illness is considered to be work-related if an event or exposure in the work environment either caused or contributed to the resulting condition or significantly aggravated a pre-existing condition. Our injury data presented below represents the majority of caregivers, reflecting our Northeast Ohio enterprise. Injury rates are listed as the number of injuries per 100 full-time employees.

 OSHA Recordable Rate

In 2015, Cleveland Clinic experienced another year of reducing injury rates. Our OSHA-recordable injury rate of 3.45 and a lost-time injury rate of 0.49 are well below the U.S. hospital average. The Bureau of Labor Statistics indicated the average hospital had an OSHA-recordable injury rate of 6.2 and a lost-time injury rate of 1.4.

Lost Time Injury Rate

Injuries By Gender

There were no work-related fatalities in 2015. Injuries by gender relate closely to our overall male/female employment ratios.


Cleveland Clinic absenteeism, as measured by unscheduled paid time off (UPTO), continued to drop from 1.0 percent in 2010 to 0.67 percent in 2015. Absenteeism can be used to indicate employee health and wellness, employee engagement, job satisfaction and work-place effectiveness.

The Power of Every One

Our caregivers all share the same core mission. We care for patients, and we care for each other. We are a collective team devoted to patients. Our goal is zero preventable harm. We believe every patient deserves the same safe world-class care at every encounter. We speak up and stop the line when something is not right. The same is true when we or fellow caregivers have the potential to be harmed.

We all have the power to help, heal and change lives — beginning with our own. That is the power of the Cleveland Clinic team, and The Power of Every One. We believe people do their best in a workplace where they are valued, nurtured and encouraged to achieve. We take care of our caregivers and encourage them toward new heights of personal and professional satisfaction. In return, our caregivers make our enterprise stronger.

The Power of Everyone

Ohio Children’s Hospitals’ Solutions for Patient Safety (OCHSPS)

Cleveland Clinic Children’s Hospital is a member of the Ohio Children’s Hospitals’ Solutions for Patient Safety (OCHSPS) a non-profit corporation established to achieve the vision of making Ohio the safest place in the nation for children to receive healthcare. OCHSPS members include all eight of Ohio’s children’s hospitals. To realize this shared vision, each of the participating hospitals committed to complete transparency and data sharing to foster an “all teach, all learn” culture.

Through implementation of the Network’s best practices, children are being protected from harm. Since 2012, this national effort has led to an estimated savings of more than $92 million and saved 4,746 children from serious harm, with a consistent upward trend in harm prevented every month as of September 2015.

OCHSPS also established an Employee Safety (ES) section, the first in the nation, with the goal to reduce 25% of the total recordable incident rate (TRIR) and zero serious employee harm events by 2020. Current focus areas include bloodborne pathogen exposures, slip/trip/fall prevention, push/pull/lift/carry injuries, patient interactions, and culture change. Member hospitals are expected to employ the same metric-driven leadership methods used to prevent patient injuries.

Hospital ES section representative attend and present at monthly webinars and periodic full-day learning session were they share metrics and best practices, and openly discuss successes and challenges. In 2015, the Ohio Children’s Hospitals’ the aggregate TRIR was 2.17. The national hospital TRIR is 6.2.

Enterprise Patient Falls Prevention Initiative

Falls can result in significant patient harm. In 2015, Cleveland Clinic established a multidisciplinary Enterprise Patient Falls Committee. The Enterprise fall goals are 0 patient falls with significant harm, 90% of patients identified as a fall risk had a fall management plan in place by the end of 2015, and we implement interventions that will support a 15% decrease in all patient falls (inpatient and outpatient) in 2016.

Caregivers can be injured while attempting to prevent a fall or while lifting a fallen patient. Programs that prevent patient falls will help prevent related caregiver injuries. One team focused on how the physical environment might contribute to falls. The team developed assessment tools for inpatient and outpatient areas and made facility design recommendations, including adoption of the Facilities Guidelines Institute (FGI) Patient Handling White Paper. Work on this important initiative continues into 2016.

Bloodborne Pathogens

Bloodborne pathogen (BBP) exposures cause the greatest number of injuries at Cleveland Clinic and reducing these exposures is our goal. In 2015, an enterprise steering committee was established to provide executive oversight, advocacy, support, common messaging, performance expectations, and decision making for the initiative. Education, audit/feedback, and equipment/environment sub-teams were established to focus on specific elements of BBP exposure reduction. An implementation guide was developed, and a goal of reducing bloodborne pathogen exposures by 20% from 2014 was established. In addition, the definition of bloodborne pathogen was expanded from the OSHA regulatory definition to exposure to any body fluid including urine, feces, spit and vomit.

Local prevention teams are being rolled out in three phases. The first phase covered 31% of enterprise BBP exposures and consisted of five Main Campus Institutes and four Regional Hospitals. The second phase covered 58% of exposures and includes the remainder of the Main Campus Institutes and Regional Hospitals. The third phase covers the ambulatory surgery centers (ASCs), Weston (Florida) and Akron General Medical Center. Best practices are shared monthly among the various local prevention teams.

A work unit based bloodborne pathogen trainer course was revised to create a more active role for the trainers, and 145 Bloodborne Pathogen Exposure Prevention Champions were trained in 2015. Champions are expected to review personal protective equipment use, evaluate sharp safety equipment for their work units and report their findings to their local prevention team and the Education Subcommittee. They are also expected to work with caregivers on their units to develop an individual BBP exposure reduction goal. Bloodborne pathogen exposure numbers are distributed throughout Cleveland Clinic so employees can see how exposures are occurring and take steps to prevent future exposures.

Exposures at the Main Campus in 2015 increased by about 11% over 2014 exposures, but this may be due to the expanded definition of exposure and increased caregiver focus on reporting. The chart below shows Occupational Safety and Health Administration (OSHA) regulatory definition exposures, and the increase is less. The goal for 2016 is set at a 25% reduction, and exposures will be monitored carefully in 2016 to see if the reduction efforts implemented are effective.

Cleveland Clinic Bloodborne Pathogen Exposures


With the sudden rise in active shooter incidents in the United States, providing our caregivers with training to survive such an incident is a top priority at Cleveland Clinic. The Protective Services Department adopted the A.L.I.C.E. Active Shooter Response model that was developed by the A.L.I.C.E. Training Institute. Thirty-five caregivers from various disciplines across the Cleveland Clinic Health System received A.L.I.C.E. Instructor training to help facilitate enterprise wide training.

The Emergency Management Department, in conjunction with the Cleveland Clinic Police Department, developed a healthcare-oriented A.L.I.C.E. training module that is used by all of our certified Instructors to provide consistency in the delivery of the material. The training is delivered through various media: as a module that is embedded in the annual mandatory online Emergency Management training; as “lunch-and-learn” live training sessions; during monthly department meetings; and as whole-house in-service training.

The A.L.I.C.E. Active-Shooter Response training has been a huge success with Cleveland Clinic caregivers. Every new caregiver and contracted vendor participates in training, and over 49,000 caregivers receive an annual refresher course.

Victim Advocate Program

In 2014, Cleveland Clinic’s Police Department secured Victims of Crime Act grant funding for our Victim Assistance Program. This program is dedicated to providing Cleveland Clinic patients, visitors and employees with support, education, and resources to cope in the aftermath of a criminal offense. The Victim Assistance Program continued to offer these services in 2015 to victims or survivors of any crime, such as domestic violence, sexual assault, workplace violence, harassment, assault or human trafficking. The services are available free of charge at Cleveland Clinic main campus, regional hospitals and family health centers.

Emergency Management

Cleveland Clinic’s Emergency Management Department maintains standardized programs in line with all local hospitals, city, state and federal government agencies to assure interoperability during disaster or emergency conditions.

Infection Prevention

Washing Hands

Cleveland Clinic’s hand washing campaign addresses traditional and waterless hand washing as a means of infection prevention for our caregivers, patients and visitors.

“We value the critical role our caregivers play in creating the culture of safety that protects our patients. The goal is zero preventable harm. We must speak up and stop the line when something is not right. And the same is true when we or fellow caregivers have the potential to be harmed.”

—Stuart Kline, CIH, CSP, CSM, CHMM, CHEM, Director, Environmental Health and Safety