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Responsibility for health and safety
Any questions or concerns about health and safety should be directed to Dr Giddy or Mr Phillips. While overall responsibility for health and safety rests with Dr Giddy and Mr Phillips, all personnel have a responsibility to act in a safe manner. Everyone must have regard to their own safety and the safety of those around them. A resume of these responsibilities (and other matters relating to health and safety law) is on display in the staff room.
Welfare arrangements Risk: In view of facilities provided and practice history: LOW RISK. Breaks: Practice staff take adequate breaks in accordance with the working time directive. Rest facilities: There is a designated staff room and a picnic bench outside for summer use. Drinking water: There is a supply of tap and bottled water in the staff room. Making drinks: There are facilities to make hot drinks in the staff room and the practice provides tea, coffee, milk, fruit squash, hot chocolate and other beverages. Toilets: There are separate male and female toilet facilities. Hand washing: There are hand washing facilities with soap and disposable hand towels in the staff room, toilets and surgeries. In the surgeries there is also an alcohol based hand wash. Temperature: The building is fitted with climate control systems that heat the practice in winter and cool it in summer, producing a comfortable working environment at all times. The filters are cleaned every 3 months to ensure efficient operation (refer to Testing/Maintenance/Audit Schedule in Hygeia Document Database). Wall thermometers are placed in all areas to verify that air temperatures are acceptable in accordance with the Workplace (Health Safety and Welfare) Regulations 1992. Problems and issues: There have been no problems or issues in relation to general welfare arrangements since November 1998 when Dr Giddy and Mr Phillips took on responsibility for the practice.
Radiation Risk: In view of precautions, testing and monitoring: LOW RISK. Refer to separate local rules and radiography risk assessment for full details. Problems and issues: There have been no problems or issues in relation to radiation since November 1998 when Dr Giddy and Mr Phillips took on responsibility for the practice.
Mercury Risk: In view of precautions, testing and monitoring: LOW RISK. Discontinuance of use: As at February 2008, several European countries have banned the commercial use of mercury, including the placement of amalgam fillings. The European Union is expected to impose a Europe-wide ban in the next few years. The reason for this is concern over the potential environmental damage caused by free mercury when it is released from amalgam fillings post-mortem during cremation NOT concern for the safety of amalgam as a dental restorative material per se. Nonetheless, we have decided to discontinue the use of amalgam (and, therefore, mercury) at hygeia once existing stocks have been exhausted, which is expected by summer 2008. Procedures for dealing with waste amalgam will remain in place after this date since it will still be generated during removal of existing amalgam restorations. However, free mercury spillage will become impossible, so the spillage kit will be removed. Also, it is intended that urine analysis will be discontinued at this time. Spillages: A special mercury spillage kit is kept in surgery 1. Dr Giddy and Mr Phillips are familiar with it and its use. Surfaces where any spillages may occur in the surgeries are impermeable and smooth - in particular the amalgamator machine sits in a foil-lined tray to assist in the detection and removal of any spillages. We have minimised the risk of spillages by switching from a traditional mercury/amalgam mixing system (which involves handling free liquid mercury) to an encapsulated amalgam system. The amalgamator machine is checked every 6 months for signs of internal and external mercury contamination (refer to Testing/Maintenance/Audit Schedule in Hygeia Document Database). Ventilation: Both surgeries were fitted with an automatic ventilation system in 2000. This operates whenever the lights are switched on. The system complies with BDA requirements on ventilation. Monitoring: All clinical staff are monitored for evidence of excessive occupational exposure to mercury. Urine samples are sent to the UK Mercury Screening Service once a year. A level of <10µmols Hg/mol Creatinine is acceptable (refer to Testing/Maintenance/Audit Schedule in Hygeia Document Database). Training: All new clinical staff receive training in handling dental amalgam and correct disposal of associated waste (refer also to the practice waste disposal policy for further information). Problems and issues: There have been no problems or issues in relation to mercury since November 1998 when Dr Giddy and Mr Phillips took on responsibility for the practice.
Sharps, inoculation injuries and immunisation Risk: In view of precautions and testing: LOW RISK. Disposal of contaminated sharps: All sharps are placed into special sharps boxes immediately after use. Used sharps containers (these are never filled to more than two-thirds full) are stored in the lockable clinical waste bins until they are collected for safe disposal. Refer to the Waste Disposal and Cross Infection Control policies for full details. Procedure for inoculation injuries: Refer to the practice Cross Infection Control policy for full details. Personal Protective Equipment: The practice routinely uses examination gloves, heavy duty gloves, face masks and safety glasses to help prevent inoculation injuries. Clinical staff are also issued with special surgery footwear that has hardened toe-caps to prevent injury to the feet caused by dropping sharps. Refer to the practice Cross Infection Control policy for full details. Disposable syringe system: The practice routinely uses a disposable syringe system (rather than a disposable needle system) to help prevent needlestick injuries. Indeed, since the introduction of the Safety Plus system there have been no reported needlestick injuries. Refer to the practice Cross Infection Control policy for full details. Immunisation: All clinical staff are required to be immunised against Hepatitis B, Tuberculosis (TB), Tetanus, Poliomyelitis (Polio), Pertussis (whooping cough), Diphtheria, Rubella, Mumps and Varicella. Clinical staff are also required to be tested for Hepatitis C. Refer to the practice Cross Infection Control policy for full details. Problems and issues: There have been a number of needlestick incidents since November 1998 when Dr Giddy and Mr Phillips took on responsibility for the practice. However, none has involved a high risk patient and no staff have been infected as a result. There have been no further reported needlestick injuries since the introduction of the Safety Plus disposable syringe system.
Decontamination, disinfection, sterilisation and hand hygiene Risk: In view of precautions and testing: LOW RISK. Equipment & procedures: The practice operates a detailed Cross Infection Control policy. Hand hygiene: New clinical staff are trained in proper hand hygiene and hand washing as part of their induction process. Soap is available at all wash basins. Alcohol based hand wash (Desderman N) is used in the surgeries. Re-usable towels are NEVER used at the practice - only paper towels are available. Refer to the practice's Cross Infection Control policy. Problems and issues: There have been no problems or issues with decontamination, disinfection, sterilisation or hand hygiene since November 1998 when Dr Giddy and Mr Phillips took on responsibility for the practice.
COSHH Risk: In view of precautions: LOW RISK. Other risk assessments: Various other risk assessments are also relevant to the Control of Substances Hazardous to Health (COSHH) Regulations 1994. For example, mercury is dealt with above in its own section. The practice Waste Disposal Policy and Cross Infection Control Policy contain detailed instructions on safe disposal and handling of various substances. The storage of hazardous substances is also dealt with in the section titled "Storage of drugs and dental supplies", below. COSHH assessments: It is the responsibility of the Practice Director to assess all potentially hazardous substances in use at the practice by considering Materials Safety Data Sheets and information on product packaging. A full inventory of all chemicals in use is kept (refer to Surgery Consumables and Stationery and Supplies stock lists) to assist in this task. The conclusion of today's assessment is that existing precautions, training, equipment and monitoring are adequate to deal with all substances in use at the practice. In particular, ventilation and storage facilities are safe and adequate. Face masks, eye protection and gloves are in use. The most potentially hazardous chemical we use is mercury and staff are monitored to ensure they are not exposed to unacceptable levels; also, mercury handling has been changed to make it safer (ie switch to encapsulated system) and mercury amalgam use will cease from 2008. Personal Protective Equipment: Only clinical staff are required to use or handle hazardous substances in the course of their duties and they already use gloves, masks and eye protection for cross infection control purposes which also provide protection from hazardous chemicals. Ventilation: Refer to section on "Mercury", above. Monitoring: Refer to section on "Mercury", above. Training: All new clinical staff receive training in COSHH procedures as part of their induction training. Problems and issues: There have been no problems or issues in relation to COSHH since November 1998 when Dr Giddy and Mr Phillips took on responsibility for the practice.
Electricity Risk: In view of precautions and testing: LOW RISK. Portable appliances: Are tested every year to ensure they are safe for use (refer to Testing/Maintenance/Audit Schedule in Hygeia Document Database). Electric wiring: Is tested every five years to ensure that it is still safe for use (refer to Testing/Maintenance/Audit Schedule in Hygeia Document Database). System design: The electrical system was checked and partially replaced/redesigned in 1999 to improve safety. All circuits are now protected by MCBs and all external lighting and power sockets are protected by RCDs. Circuits have all been properly identified and re-labeled. Problems and issues: There have been no problems or issues in relation to electricity since November 1998 when Dr Giddy and Mr Phillips took on responsibility for the practice.
Fire Risk: In view of precautions and testing: LOW RISK. Alarm system: The building is fitted with a fire and intruder alarm system. There are smoke detectors in each surgery, the reception/waiting area, the office and the staff room. The alarm system is connected to a monitoring service that summons the fire brigade in the event of a fire even if no one at the practice manages to call for assistance. The fire station is less than three minutes from here by road. The system is tested to ensure it is operating correctly and the smoke detectors are cleaned every 6 months (refer to Testing/Maintenance/Audit Schedule in Hygeia Document Database). Fire fighting equipment: Fire extinguishers are available in the surgeries, staff room and reception/waiting area. They are tested annually (refer to Testing/Maintenance/Audit Schedule in Hygeia Document Database). Signage & exits: There is only one exit and it bears a luminous fire exit sign. One exit in reception is sufficient since all other rooms open into reception. There are fire safety notices in reception and in the staff room. Training: All new staff receive training in evacuation procedures, use of fire fighting equipment, operation of alarm systems, etc. Problems and issues: There have been no problems or issues in relation to fire since November 1998 when Dr Giddy and Mr Phillips took on responsibility for the practice.
Violence and Aggression Risk: In view of history of practice: LOW RISK. Precautions: Although there has never been a problem with this, the reception desk is fitted with a personal attack button linked to the intruder alarm system that can be used to summon help in an emergency. Generally, lone working is not permitted but if this is unavoidable then the lone worker is instructed to lock the entrance door and not to allow anyone into the building unless they know who they are. Training: All new staff receive training in operation of the alarm system and personal attack button. Reception staff are instructed that if they are threatened and money is demanded, they are to hand over the money and not attempt to tackle a criminal themselves. Problems and issues: There have been no problems or issues in relation to violent or aggressive patients since November 1998 when Dr Giddy and Mr Phillips took on responsibility for the practice.
Tripping and Slipping Risk: In view of precautions: LOW RISK. Internal flooring: Clinical areas and washrooms are fitted with Altro Walkway non-slip floor coverings. Other indoor areas are fitted with heavy duty commercial contract carpeting specially designed for healthcare settings. There are no stairs, steps, sills or slopes inside the building. Staff are instructed not to walk on wet floors after they have mopped them - and, therefore, to leave mopping the surgery floors until the very last job before they leave each day - refer to DSA's checklist 2. Furniture: Furniture in the building is arranged so as to provide easy access without obstructions in order to minimise the possibility of trips and falls and also to help people with visual impairments and wheelchair users to navigate safely. Outside areas: The practice car park is flat and free from pot holes and obstructions. There is a concrete ramp leading to the front door. Pathways and approaches are broad, free from obstructions and benefit from flush (lowered) kerbs. External lighting: There are 21 external lights at the practice. They illuminate the exterior for both safety and security purposes. The system is controlled by a timer and light sensor so that the exterior and approaches are lit between 6.00am and 8.00pm (whenever it is dark at those times). The system will even switch the lights on during daylight hours if it suddenly becomes darker, eg where there is a storm. The system is also connected to motion detectors that turn the external lights on if someone approaches the building during the night between 8.00pm and 6.00am. These things assist with safe access and egress, particularly during the winter months and for people with visual impairments. Footwear: Clinical staff are issued with special protective footwear that has a non-slip sole. This is to give added slip resistance when floors are wet. Problems and issues: There has been only one incident in relation to slipping or tripping since November 1998 when Dr Giddy and Mr Phillips took on responsibility for the practice. This incident (in January 1999) involved someone slipping on a wet surgery floor after they had mopped it. There was no significant injury. Since then the flooring in the surgeries has been replaced with Altro Walkway (which offers high slip-resistance even when wet). Staff were, at the time of this incident, already under standing instructions not to walk on wet floors (and therefore to leave this task until the very last of the day) - refer to DSA's checklist 2 - and had already been issued with non-slip footwear (see above). There have been no further incidents.
Waste disposal Risk: In view of precautions: LOW RISK. Waste disposal policy: The practice has a comprehensive waste disposal policy that deals with correct handling and disposal of all the different types of waste we produce. Refer to the policy document for full information. Training: All new clinical staff receive training in waste disposal procedures as part of their induction training. Problems and issues: There have been no problems or issues in relation to waste disposal since November 1998 when Dr Giddy and Mr Phillips took on responsibility for the practice.
Work equipment Risk: In view of precautions, testing and monitoring: LOW RISK. Testing/Maintenance/Audit schedule: The practice operates a comprehensive testing and maintenance regime. Autoclaves are serviced and have an annual pressure vessel inspection. The compressor undergoes a pressure vessel inspection on a bi-annual basis. Electrical appliances and wiring are tested regularly (see above). Fire extinguishers are tested annually (see above). X-ray equipment is tested every 3 years (refer to the local rules and radiation risk assessment). The alarm system also undergoes regular testing (see above). Amalgam mixers are checked for mercury contamination. Monitoring: For example, in addition to testing the x-ray equipment every 3 years, clinical staff are issued with personal dosemeters that are tested every 3 months. In addition to checking the amalgam mixing machines and other safety measures, clinical staff have their mercury levels monitored. Training: All new clinical staff receive training in the use of all necessary equipment as part of their induction training. Problems and issues: There have been no problems or issues in relation to defective or incorrectly operated work equipment since November 1998 when Dr Giddy and Mr Phillips took on responsibility for the practice.
First aid and medical emergencies Hazard #2: Possible harm to patient suffering medical emergency or collapse during treatment: SIGNIFICANT HAZARD. Risk #1: According to our own accident records, injuries are rare and have always been minor - eg small cuts, abrasions, etc. Significant precautions are also taken to avoid injury (eg our Risk and COSHH assessments, PPE, training, etc.) so the risk is assessed as: LOW RISK. Risk #2: Patient medical emergencies are extremely rare in dental practice. Significant precautions are also taken so these problems are assessed as: LOW RISK. Medical risk assessment/medical history taking: All patients are required to complete medical history questionnaires and these are verified verbally by the dentist or hygienist. These allow us to identify patients at particular risk so that we can take measures to reduce the chance of a problem arising. Emergency drug kit: There is a fully stocked emergency drug kit kept in surgery 1. The contents are checked and, if necessary, replaced every 6 months (refer to Testing/Maintenance/Audit Schedule in Hygeia Document Database). In accordance with GDC/Resuscitation Council guidance (Medical Emergencies and Resuscitation - July 2006) the kit contains GTN spray, a Salbutamol inhaler, adrenaline injections, aspirin, Glucagon injection, glucose and Midazolam; the kit also has a pocket mask with oxygen port, a spacer for use with inhalers, a set of oropharyngeal airways and single use sterile syringes and needles. AED and other resuscitation equipment: We also keep a Res-Q-Vac portable suction unit, an automated blood glucose measurement device, resuscitation bags with masks and a Defibtech Automated External Defibrillator. Emergency oxygen: There is a BOC Medical "Lifeline O2 Pro" emergency oxygen kit (including oxygen face masks, tubing and oropharyngeal airways) together with a spare cylinder in surgery 1. The cylinders are tested or replaced and the contents of the kit are checked and, if necessary, replaced every 12 months by a visiting BOC engineer (refer to Testing/Maintenance/Audit Schedule in Hygeia Document Database. The cylinders are type CD with a nominal capacity of 460 litres each and an adjustable flow rate of up to 15 litres per minute - sufficient to maintain a patient for over 90 minutes. Training: ALL STAFF receive annual training in CPR, first aid procedures and defibrillator use. First aid kit: There is a fully stocked first aid kit kept in the staff room. The contents are checked and, if necessary, replaced every 6 months (refer to Testing/Maintenance/Audit Schedule in Hygeia Document Database). Practice location: The practice is located only a 3 minute drive from the nearest ambulance station meaning that professional assistance is quickly available. Accident reporting: An accident report book is kept at reception. The Practice Director is responsible for compliance with RIDDOR requirements. Problems and issues: There have been no problems or issues in relation to first aid since November 1998 when Dr Giddy and Mr Phillips took on responsibility for the practice. There have been a number of occasions when patients have fainted or a faint has been narrowly avoided but no serious medical emergencies have arisen.
Manual handling Risk: In view of precautions: LOW RISK. Manual handling policy: The practice operates a simple manual handling policy. Staff are instructed not to move any large, heavy or awkward item at all unless they HAVE TO. They are instructed that they must seek help from the Practice Director or Clinical Director if they are in any doubt about their ability to move an item safely. When deliveries are received the delivery person must always be asked to place the items in a convenient area so that large, heavy boxes can be unpacked without the need to move them again. Staff are not permitted to lift patients into or out of wheelchairs (though they are allowed to give some assistance). A small movable step is provided to help staff reach items stored at a high level (and we try to ensure that items are stored within easy reach). Training: All new staff receive training in basic manual handling procedures as part of their induction training. They are given a demonstration in safe lifting - ie bending the knees rather than the back. Problems and issues: There has been only one issue in relation to manual handling since November 1998 when Dr Giddy and Mr Phillips took on responsibility for the practice. In 2004, Dr Giddy experienced mild back pain for several weeks after lifting a patient out of their wheelchair. We no longer do this and there have been no further problems.
Display Screen Equipment & workstations Risk: In view of precautions, monitoring and practice history: LOW RISK. Affected staff: The only staff affected by DSE safety issues are those whose work requires the use of DSE for continuous periods of an hour or more on most working days. In practice this means that only the receptionist and the Practice Director are affected by these provisions. Equipment selection: The practice has installed high resolution flat screen LCD monitors that do not flicker as old CRT screens do. The new monitors also have a very high refresh rate that helps reduce eye strain. Keyboards are provided with wrist supports and are inclinable. All areas where DSE is used has been fitted with CAT2 lighting to help reduce eye strain. Workstation assessment: The Practice Director is responsible for workstation design and assessment. Indeed, he actually built the workstations at reception and in the office. Assessment is carried out in accordance with guidance published by the Occupational Health Service for Primary Care in Devon and Cornwall. Monitoring: All affected staff are reminded to arrange eye tests (cost reimbursed by the practice) at intervals of 3 years. Problems and issues: There have been no problems or issues in relation to Display Screen Equipment since November 1998 when Dr Giddy and Mr Phillips took on responsibility for the practice.
Storage of drugs and dental supplies Risk: In view of precautions: LOW RISK. Storage: All stocks of dental medicaments, anaesthetics and other dental consumables are stored in a locked metal cabinet inside surgery 1. The lock on the cabinet prevents unauthorised access. The Emergency Drug Kit, oxygen cylinders and AED are stored in a low-level cupboard immediately behind the dentist's seat in surgery 1. This is not locked, but the items are out of view and are impossible to access without being seen (see below - access). NHS prescription pads were kept in a locked cabinet but we no longer use pre-printed prescription pads so this is no longer an issue. We do not dispense prescription drugs and so there are no security issues associated with these. Access: The supplies are stored inside the surgery itself. The surgery is never left unattended. Even if the clinical staff were to leave the room there is always someone at reception with a clear view of anyone entering or leaving the surgery. It is therefore practically impossible for an unauthorised person to gain access. Problems and issues: There have been no problems or issues in relation to storage of dental supplies since November 1998 when Dr Giddy and Mr Phillips took on responsibility for the practice. |
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risk assessment - general Undertaken 29.7.2006; updated
10.8.2006, 15.12.2006, 8.3.2007, 28.2.2008