Think about all the objects you use every day that are made with pieces of metal. Before that object got to you, a worker in the metal manufacturing industry used a machine to cut, saw, bend and assemble the metal pieces into the countless products that make our lives easier. But sometimes those machines break. And when they do, a simple and inexpensive procedure helps ensure both worker and machine can return safely to the job.

The procedure is known as lockout/tagout (LOTO) and it’s used to disable machinery and prevent the release of hazardous energy during servicing and repair. In other words, a machine’s power source is isolated, turned securely off, and then locked and tagged to prevent an unintended startup during servicing. Seems simple enough and in fact, OSHA has standards that require comprehensive LOTO procedures to protect workers across a range of industries. According to the federal agency, millions of U.S. workers face risks related to the release of hazardous energy, and compliance with LOTO standards is estimated to prevent 120 work-related fatalities and 50,000 injuries every year.

Still, failure to implement LOTO is currently No. 5 among the top 10 most frequently cited standards following an OSHA inspection. Thankfully, a new study offers some much-needed insight into ways to increase LOTO use and ultimately protect workers from preventable injury, disability and death.

“This is easy stuff — there’s nothing complicated about lockout,” said David Parker, a senior physician researcher at HealthPartners. “You get a huge return for an incredibly minimal investment. This is basically a zero-cost intervention.”

Parker is the co-author of a study published this month in the Journal of Occupational and Environmental Medicine (JOEM) that examined outcomes from a nationwide intervention to improve LOTO in small metal fabrication businesses. The origins of the intervention began many years ago at the Minnesota Department of Health, where Parker helped create a surveillance program to monitor work-related amputation injuries. That effort eventually led to the National Machine Guarding Program, which was designed to assist small metal fabrication businesses in improving machine safety protocols, including LOTO. Results from this month’s JOEM study are based on findings from the National Machine Guarding Program.

To implement the LOTO intervention, researchers partnered with insurance safety consultants, who are the most common source of safety information used by small businesses, according to the study. Safety consultants provided participating businesses with a baseline evaluation, two intervention visits, and a 12-month follow-up visit. Consultants also used software specifically designed for the study that generated reports that business owners could use to drive improvements. Among the 160 businesses that completed the intervention — all of which focus on metal fabrication as their main source of revenue — only 8 percent started off with procedures that were posted and contained machine-specific steps for effective LOTO. By the end of the intervention, that indicator had increased by 25 percentage points. In addition, the presence of lockable disconnects increased from 88 percent to 92 percent.

Researchers also found that businesses that started with the lowest scores made the greatest changes, while those that began with higher scores made smaller changes and eventually wrapped up the intervention period with near perfect scores. Significant LOTO procedure improvements were documented in small businesses (those with three to 10 employees) as well as in bigger ones (those with 50 to 150 employees). Providing technical guidance seemed key to the intervention: LOTO procedure scores improved by 28 percentage points for businesses that received technical guidance versus just 5 percentage points among businesses that did not.

Another significant factor was having a safety committee. The study found that establishing a safety committee during the intervention period was linked with a 5 percent greater improvement in the lockable disconnect score, a 39 percent greater improvement in the LOTO procedure score, and a 25 percent greater increase in the LOTO program score. Researchers noted that while the literature is limited regarding the positive effects of safety committees — in which management and workers take on a shared responsibility for safety — data from the National Machine Guarding Program help underscore their importance.

Parker and study co-authors Samuel Yamin, Min Xi, Lisa Brosseau, Robert Gordon, Ivan Most and Rodney Stanley write:

Some LOTO procedures might be complex and entail multiple steps and numerous sources of energy, including stored energy such as air pressure used to power pneumatic devices, capacitors, and compressed springs; however, for most metal fabrication machines, lockout can be accomplished with a few straightforward steps. Similarly, business-level LOTO program management is largely administrative in nature, as it consists primarily of allocating personnel time for maintaining written programs and procedures, annual audits of procedures, and conducting or arranging for employee training. Therefore, most aspects of compliant and protective LOTO programs can be achieved at relatively low expense and accomplished by insurance safety consultants.

Parker told me that while the intervention resulted in improvements, the study didn’t pinpoint which intervention characteristics were most compelling in driving change. For instance, does it matter who delivers the intervention or is it the intervention itself that can drive significant improvements, regardless of the messenger? Parker said they’re digging deeper into such questions right now — “stay tuned,” he noted. Still, he said the study offers a framework for evaluating and improving LOTO programs.

“A business needs to see the person knocking at the door as a trusted partner,” he said. “They have to believe you’re there in the best interest of the company. And that’s not necessarily easy in some places…but most (employers) want what’s best for their employees.”

In general, Parker added that while some OSHA standards can be somewhat “opaque,” there is “absolutely nothing opaque” about LOTO standards. And yet between 2003 and 2013, OSHA reported that 16 percent of nonfatal, catastrophic injuries as well as 9 percent of fatalities within manufacturing were lockout-related. (Those of you who keep up with Celeste Monforton’s “Not an accident” posts about fatal work-related injuries will know that LOTO failures often come up.) Parker said it’s time that OSHA stepped up its efforts to make sure this extremely low-cost and life-saving intervention makes its way into every workplace.

“Quite truthfully, I think state-based and federal OSHA need to have an ongoing and serious special emphasis on lockout,” Parker said. “They just need to go to absolutely every single little manufacturing business and say ‘Let’s see your procedures.’ It needs to happen almost like an immunization program. I just don’t know how else it’s going to happen.”

To download a full copy of the new LOTO study, visit the Journal of Occupational and Environmental Medicine.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for nearly 15 years.