BDA advice

Health and safety

July 2018
 Health and safety
Contents The Health and Safety at Work etc Act 1974 is the primary legislation covering
occupational health and safety, setting out the general responsibilities of employers
3 Duty of care and others either working at or visiting the workplace. The Act is supported by
3 The Health and Safety Executive various regulations that add detail to the general requirements. The UK’s healthcare
4 The practice health and safety policy regulators also require suitable standards of quality and safety that patients have
4 Accidents a right to expect when receiving care.
5 Anaesthetic gases
5 Asbestos This advice provides a summary of the general and specific requirements that apply
5 Display screen equipment to the dental environment. Other relevant BDA advice includes:
6 Electrical safety
6 First aid
• Dental unit waterlines
7 Gas safety
• Healthcare waste
7 Lasers
• Infection control
8 Lone working
8 Manual handling • Medical devices
9 Mercury and amalgam • Medical emergencies
10 Personal protection • Radiation protection
10 Safety signs • Risk assessment
11 Stress and health support services
11 Ventilation
12 Welfare arrangements

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 Duty of care The Health and Safety Executive
The Health and Safety at Work Act (HSW Act) seeks to protect all those at work – The HSE can enter and inspect workplaces, as well as request information, interview
employers, employees and the self-employed, as well as those who might be people and take written statements.
affected by their work activities. The Health and Safety Executive (HSE) is the lead
inspection and enforcement body for health and safety matters involving Although dental practices are not subject to many routinely inspected, when these
employees, workers, visitors and contractors. Alongside the legislation, national are undertaken, an inspector will usually make an appointment to avoid
healthcare regulators describe the quality and safety standards that patients unnecessary disruption. The inspectors will have a warrant with an identifying
receiving care have a right to expect. photograph.

The approved poster Health and Safety Law – what you should know should be An inspection will generally involve an examination of the premises and equipment,
displayed or provided to all staff as a leaflet. focussing on anything with potential danger (radiographic equipment, autoclaves,
electrical appliances, and gas cylinders, for example). You are likely to be asked for
Employers have a general duty to ensure (as far as reasonably practicable) the evidence of safety checks (reports, certificates etc).
health, safety and welfare of employees, patients of the practice, self-employed
contractors who might be on the premises and any visitors to the practice by: If an inspector identifies a health and safety, risk, they will let you know what action
you need to take. If there is a legislation breach, the inspector can issue an
• Providing and maintaining safe equipment, appliances and systems of work improvement or prohibition notice or remove or destroy anything that is dangerous
• Ensuring that dangerous or potentially harmful substances are handled and or might cause serious personal injury.
stored safely
• Maintaining the workplace in a safe condition • An improvement notice specifies what requirements are not being met, the
• Providing a safe working environment with adequate welfare facilities action needed to put it right, and a timescale for doing so
• Providing training and supervision to allow employees to undertake their work • A prohibition notice (if there is a risk of serious personal injury) prohibits an
duties safely and without risk to themselves or others. activity until remedial action has been taken

Employees must take reasonable care of their own and others’ health and safety If the situation is sufficiently serious, HSE can prosecute – either instead of or in
and cooperate with the employer to implement the requirements of relevant addition to serving a notice.
legislation.
If a notice is served, you can appeal to an Industrial Tribunal within 21 days of the
The duty of care extends to external contract workers (builders, engineers, for notice being served. An appeal, suspends an improvement notice until the outcome
example) and to any sub-contractors. You will need to assess the risks involved with is determined but a prohibition notice remains in force.
the task they have been engaged for and check the contractor’s health and safety
policies and procedures and risk assessment. You should also make them aware of
your health and safety procedures.

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 The practice health and safety policy Accidents
If you have five or more employees, you must have a health and safety policy. Your All accident information should be recorded in an accident book. You should also
employees should know about the policy and, ideally, receive a copy. Self-employed use it to record details of incidents that require reporting under the Reporting of
associates, hygienists and therapists must be included and comply with the policy. Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR).

The health and safety policy usually has three parts: Reportable injuries include those that result in the individual being incapacitated
for more than seven days, taken to hospital for treatment, fractures of larger bones,
1. A statement of intent – a declaration of your commitment to provide a safe loss or impairment of sight, serious burns and loss of consciousness.
and healthy workplace and environment
2. Details of responsibilities for health and safety throughout the workplace Reportable occupational diseases include carpal tunnel syndrome, severe cramp,
3. Safe systems of work and safe working practices for all work activities. dermatitis, asthma, tendonitis or tenosynovitis of the hand or forearm, cancer, and
any disease resulting from occupational exposure to a biological agent.
An Expert template health and safety policy is available.
Dangerous occurrences include incidents involving lifting equipment, pressure
systems, explosions, biological agents and radiography.

Incidents involving medical devices should also be reported to the Medicines and
Healthcare products Regulatory Agency (MHRA) using the Yellow Card Scheme.

You may also be required to report incidents that affect the health, safety and
welfare of people who use your services to the relevant regulatory body – for
example, the CQC, HIW, RQIA.

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 Anaesthetic gases Asbestos
Depending on the work environment and the services provided, individuals may be If you are responsible for maintaining your premises, the Control of Asbestos
repeatedly exposed to low concentration of anaesthetic gases. Anxiety about Regulations require you to assess whether asbestos is present and its likely
exposure tends to increase during pregnancy but there is no conclusive evidence of condition. You should keep a record of the assessment and subsequent reviews.
an increased risk of miscarriage or developmental defects in the foetus. However,
the potential for harm cannot be dismissed and you should ensure that Workplace A step-by-step HSE guide to managing asbestos will help you identify if asbestos is
Exposure Limits (WELs) are not exceeded and, if necessary, undertake personal present and, if so, how to manage it.
sampling.

At least weekly, you should check that active scavenging and ventilation equipment
Display screen equipment (DSE)
is working properly and being used correctly. Servicing should follow manufacturer’s The Health and Safety (Display Screen Equipment) Regulations apply to those who
recommendations. Nitrous oxide and oxygen is often used to provide inhalation use DSE daily, for an hour or more at a time.
analgesia and reduce anxiety. Exhaled breath and leaks from the breathing circuit
and facemasks are the main sources of pollution. As an employer, you must protect your employees from the health risks of working
with DSE such as PCs, laptops, tablets and smartphones by:
Your employees should be aware of the risks to their health, understand why
scavenging and ventilation are necessary and know how to use the equipment • Undertaking a DSE workstation assessment
correctly. The sedation agents should be included in your COSHH assessment. • Reducing risks, including making sure that workers take breaks from work
involving DSE (see BDA advice Risk assessment)
See also: • Providing an eye test if an employee asks for one
• Providing training and information.
• Standards for conscious sedation in the provision of dental care (RCOA, 2015)
• Conscious sedation in dentistry (SDCEP, 2017) Training should be about the risk associated with DSE work and how to avoid these
by safe working practices, including:
Gas cylinders
If possible, you should store gas cylinders in external well-ventilated stores, • The importance of good posture
preferably, with piped supplies to the point of use. If internal storage is the only • Adjusting chairs and other furniture
option, cylinders should be stored within a fire-resisting enclosure that is ventilated • Arranging desk space
to a safe place outside the building. Keep stocks as low as possible. • Breaks and changes of activity
• Risk assessment
Medical oxygen usually has a three-year shelf life and cylinders should be replaced • How to report problems
or refilled.
See also the HSE’s guide to working with DSE.

© BDA July 2018 Health and safety 5

 Electrical safety First aid
Electrical equipment must be in good working order; poor electrical installations and The Health and Safety (First-Aid) Regulations require you to provide adequate and
faulty electrical appliances can lead to fire, death or injury. HSE guidance on the appropriate first aid for all employees during working hours. You should carry out
Electricity at Work Regulations describes basic safety measures to help you control an assessment of first-aid needs to decide what you should provide. As a minimum,
the risks associated with electrical installations and appliances. These include: this will include:

• Providing training, where necessary, for those working with electrical equipment • A suitably stocked first-aid kit
• Making sure the equipment is safe and maintained in a safe condition • Someone to take charge of first-aid arrangements
• Reducing the voltage to the lowest needed; battery-operated devices are safest • Information for employees about first-aid arrangements.
• Using an RCD to detect faults in the electrical system and switching off the
supply. First-aid kit
There is no mandatory list of items to include but, as minimum, you should have:
Maintaining electrical equipment
Preventive maintenance includes user checks; visual inspection of the cable and • A general on first-aid
inside the plug; and, where necessary, portable appliance testing (PAT) by someone • 20 individually wrapped sterile plasters (assorted sizes)
with the necessary knowledge to carry out the test and interpret the results; it does • 2 sterile eye pads
not need to be carried out by an electrician. • 4 individually wrapped triangular bandages (preferably sterile)
• 6 safety pins
Simple and sensible precautions can be undertaken by all users, including a visual • 6 medium-sized individually wrapped sterile unmedicated wound dressings
check of the supply cable and the plug. Where possible, the plug cover should be
• At least 3 pairs of disposable gloves.
removed to check for signs of internal damage, that it is fitted with the correct fuse,
the cable grip is anchoring the cable and there are no bare wires visible at the
You should not keep tablets and medicines in the first-aid box.
terminals.
Qualified personnel
The type and frequency of user checks, inspections and testing needed depends on
the equipment, the environment and results of previous checks. HSE suggests If you have five or more people working at the practice, you should consider having
recommended intervals for checking portable electrical equipment depending on at least one appropriately trained person:
whether the equipment is earthed or double-insulated but, generally, the
manufacturer’s recommendations for the frequency of testing should be followed. • Emergency first aid at work (EFAW) – one-day training that allows the first-aider
to give emergency first aid to someone who is injured or becomes ill at work
You should maintain a record of the checks and tests undertaken to demonstrate • First aid at work (FAW) – three-day training that includes the same content as
compliance with the requirement. EFAW and equips the first-aider to deal with a range of injuries and illnesses.

First-aiders should undertake annual refresher training.

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 If your assessment shows that you to not require a trained first-aider, you must Lasers
appoint someone to look after first-aid equipment and facilities and call the
emergency services when required. An appointed person does not need first-aid Laser equipment is classified (by the manufacturer) according to power output
training. (from class 1 to class 4. Class 1 lasers are virtually safe but classes 3 and 4 must be
used only under medical or dental supervision. Most dental lasers are class 3B or 4.
First aid courses are arranged by a number of organisations, including St John
Ambulance and the British Red Cross. If you use laser equipment, you must have quality assurance arrangements in place
and appropriate safeguards for your patients. You must:
Employee information
• Be suitably skilled and competent and ensure staff have also received
You must inform your employees of the first-aid arrangement at the practice by, for
appropriate training
example, displaying notices identifying the first-aider or appointed person and
where the first-aid box is kept. • Appoint a Laser Protection Adviser (LPA) and have local rules in place
• Operate the laser in an appropriate environment and within a laser controlled
Basic advice on first aid at work contains advice on first aid in an emergency but is area
not a substitute for effective training. • Display warning signs at every entrance
• Maintain equipment according to the manufacturer’s instructions, keeping
records to show that this has been done
Gas safety • Obtain informed consent from patients undergoing treatment involving lasers.
You must ensure that a competent person installs, maintains and/or repairs your
gas appliances and gas pipework. Rooms with gas appliances must be adequately In Wales, if you provide non-surgical cosmetic treatments using a Class 4 laser, you
ventilated and checked to ensure air inlets are not blocked and flues and chimneys must be registered by Healthcare Inspectorate Wales (HIW), meet certain minimum
are not obstructed. standards and comply with regulations under the Care Standards Act 2000 (see also
BDA advice HIW registration).
Further information is available from the Gas Safe Register.
Further information on the use of lasers can be found in the MHRA’s guidance on
the safe use of lasers in dental practices.

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 Lone working Manual handling
When treating patients, you should always work with another appropriately-trained Incorrect manual handling is the most common cause of injury at work, accounting
member of the dental team, except when for over a third of all workplace injuries. Many manual handling injuries build up
over a period rather than being caused by a single handling incident. The Manual
• Treating patients in an out-of-hours emergency Handling Operations Regulations set out clear duties for the employer and the
• Providing treatment as part of a public health programme, or employee:
• There are other exceptional circumstances (unavoidable, non-routine
circumstances); leave or training are not exceptional circumstances. • Avoid the need for manual handling, wherever possible
• Assess the risk of injury from any manual handling that can’t be avoided, and
Before working without an appropriately-trained member of the dental team when • Reduce the risk of injury from hazardous manual handling, wherever possible.
treating a patient, you must assess the possible risk to the patient of continuing
treatment. Employees should follow safe systems of work, use equipment provided for their
safety, inform you of any hazardous handling activities and to make sure their
In a care or domiciliary setting, you should be supported by an appropriately trained activities do not put others at risk.
professional.
You should identify the extent of manual handling within the practice, assess what
Clearly, the GDC recommends having another member of the dental team working actions pose a significant risk to employees and decide whether it is possible to
with you whenever you provide patient care (Standards for the dental team - 6.2). avoid them. Where risky manual handling cannot be avoided, you should undertake
However, you may decide that having another member of the team available to a more thorough assessment and document it. Your assessment must not be limited
provide support if needed meets the requirement to ‘work with’ an appropriately to weight and should include factors such as the task, the load itself, the work
trained team member without putting patients at risk. If this is planned, you should environment and individual capacity.
undertake a risk assessment of personal safety and security risks and identify the
controls in place to ensure the safety of the lone worker and the patient. Training should enable an employee to recognise when manual handling might
be harmful, when mechanical aids should be used and good handling techniques.

The HSE guide to manual handling is a useful source of information.

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 Mercury and amalgam Pressure vessels
Mercury in any form is potentially hazardous, so unnecessary exposure should be The Pressure Systems Safety Regulations were introduced to prevent the risk of
prevented. General precautions include: serious injury from the release of stored energy because of a pressure system failure.
Air-receivers with a capacity of more than 250 Bar-litres and all autoclaves must
• Training those working with mercury to follow safe handling procedures when comply with the regulations.
dealing with mercury spills and disposing of contaminated materials
• Using pre-proportioned amalgam capsules to reduce exposure and encourage Before an autoclave or air-receiver with a capacity of more than 250 Bar-litres is
safe handling, ensuring you comply with COSHH requirements (see BDA advice used, a ‘competent’ person must draw up a written scheme of examination detailing
Risk assessment) the periodic examination of the vessel (usually 14 months for autoclaves and 24-48
• Good ventilation, preferably using a ventilation system that exhausts to the months for air receivers). The written scheme must be regularly reviewed and
outside of the building, or encouraging a fresh supply of air by opening a records kept showing that examinations have been carried out in line with the
surgery window. Recycling conditioning systems are not recommended. written scheme. Inspection and insurance can be arranged through Lloyd & Whyte.

Encapsulated amalgam significantly reduces the risk of exposure to mercury but if A ‘competent person’ has practical and theoretical knowledge and experience of the
hands are exposed to mercury, they should be washed immediately with liquid soap type of machinery or plant to be examined, can detect defects or weaknesses and
in a stream of cold tap water until no stain on the skin is seen. Use disposable towels assess their importance in relation to the strength or function of the vessel.
for hand drying.
Examination for safety reasons is not the same as servicing and performance
The disposal of waste amalgam, waste mercury and used amalgam capsules is testing, which should be carried out in accordance with the manufacturer’s
controlled – see BDA advice Healthcare waste. instruction.

Hazards associated with using autoclaves include door displacement if not properly
secured, violent opening of the door due to residual pressure at the end of a cycle,
scalding and explosion of sealed glass containers containing liquids.

Autoclaves should have a safety valve to prevent over-pressurisation, a reducing

valve to prevent the maximum pressure being exceeded, an isolating or stop valve
in the inlet line, a pressure indicator and a drainage system. The maximum
allowable working pressure should be clearly marked on the autoclave.

Autoclaves with quick opening doors should not be capable of being pressurised
unless the door is completely closed, the securing mechanism fully engaged and the
chamber sealed.

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 Personal protection Safety signs
The Personal Protective Equipment at Work Regulations require you to provide The Health and Safety (Safety Signs and Signals) Regulations require you to use a
protective equipment (PPE) where it is necessary to ensure safe systems of work. safety sign wherever a hazard exists that cannot be adequately controlled by any
You cannot charge employees for supplying, cleaning, repairing or replacing PPE, other means. Safety signs include acoustic signals, illuminated signs, marking of
including protective clothing. Protective clothing can minimise the risks at work but pipework and containers and hand signals. Safety signs generally contain a
it is not a substitute for more basic safety measures. pictogram (symbol) as part of their design, although there are some exceptions –
for example, ‘Fire Door Keep Shut’.
Gloves
Medical gloves for single use (to BS EN 455, parts 1 and 2) should be worn for all As a minimum, you should have the following safety signs within the practice:
clinical procedures to protect against contact with blood, saliva and other tissue
fluids. Heavy duty gloves give protection against burns or skin irritation when • Fire safety signs to provide safety information on escape routes, emergency
handling disinfecting agents, domestic cleaning agents, cleaning solvents and exits, location of fire-fighting equipment and a means of giving warning in the
radiographic processing chemicals. Damaged gloves should be replaced. event of a fire (illuminated signs and acoustic signals are included)
• First aid signs to locate first-aid facilities and identify the designated person
Latex is a hazardous substance. The COSHH Regulations restricts, as far as is • Radiation warning signals when the equipment is in use.
reasonably practicable, the use of powdered latex gloves and those with a high
leachable protein content. Further information is available: Skin at work (HSE) and
Latex allergy: occupational aspects of management (Royal College of Physicians).

Eye protection and protective clothing

Eye protection should be worn by the patient and those working close to the patient
during treatment. Eyewear should have full lenses and side protection; half lenses
do not give enough protection against splatter and projectiles such as tooth and
amalgam particles.

Protective clothing should be worn in the surgery or laboratory and should avoid any
features that could collect mercury or catch equipment. Contaminated clothing
should be washed in a washing machine using a biological detergent and a hot wash
cycle (at least 60°C). Suitable shoes that can protect against spillage, irritants and
other substances should be worn.

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 Stress and health support services Ventilation
Work related stress is an increasing concern for employers and is currently the Air turbines, ultrasonic scalers, air-water syringes and dental lathes can produce
second most common cause of ill health associated with work. Stress can be defined splatter and aerosols, which can contaminate dental instruments in the working
as ‘the adverse reaction people have to excessive pressure or other types of demand environment.
placed on them’. Stress-related complaints must be treated seriously and fully
investigated. The risks associated with aerosols (chronic coughs and bronchitis and eye problems)
can be reduced by good ventilation and the use of high-speed suction, face masks
Potential causes of work-related stress include: and glasses. Enclosed workplaces must be ventilated with fresh or purified air; an
open window will provide sufficient ventilation in most cases. Where ventilation
• Organisational culture – poor communication, ‘name and blame’ attitude systems are used, the fresh air supply rate should not fall below 5-8 litres per second
• Physical and psychological demands associated with the job per occupant but the means of ventilation should not create uncomfortable
• Relationships with managers, peers, etc and/or lack of support draughts. Recycling air conditioning systems are not recommended.
• Management of change at work
• Not knowing what the job entails or their responsibilities.

Stress sufferers often demonstrate well-recognised physiological symptoms, which

include headaches, aching muscles, rashes and increased sweating. Common
psychological and behavioural signs include:

• Depression or general negative outlook

• Increased anxiousness or irritability
• Lack of concentration, loss of aptitude, poor work performance or time keeping
• Increased sickness absence
• Inability to cope with normal tasks
• Increased intake of alcohol, caffeine, nicotine, etc

Further information and advice is available from:

• BDA online course to learn about the causes of stress and burnout
• Dentists Health Support Trust for support and advice on health, alcohol and
drug issues
• Practitioner Health Programme for London professionals needing support and
advice on addiction and mental health problems

© BDA July 2018 Health and safety 11

 Welfare arrangements You must provide toilet paper and a suitable means for disposing of sanitary
dressings.
You must provide adequate and appropriate welfare facilities for employees and • A changing room should be provided for those who change into work clothing.
staff while they are at work. ‘Welfare facilities’ are those that are necessary for well- You should also consider the security of personal clothing and possessions.
being: washing, toilet, rest and changing facilities, and somewhere clean to eat and • You should provide a rest area where staff can relax and eat their meals at work.
drink during breaks.
Housekeeping
Working environment
• The workplace and equipment should be in good working order and good repair.
• Lighting should be sufficient to enable people to work safely and without Equipment should be regularly maintained (with records).
eyestrain. Where necessary, local lighting should be provided. • Cleanliness throughout the practice is essential and includes floors, walls and
• Temperature should normally be at least 16°C. There is no maximum ceilings.
temperature but you have a general duty to provide a safe place of work and
excessive heat may adversely affect employee. See also the HSE guidance on providing the right workplace facilities.
• Ventilation. Windows will generally provide sufficient ventilation but where
additional ventilation is required, mechanical systems should be provided.
• Rooms should have enough free space to allow people to move around with
ease. As a guide, the total volume of the room, when empty, divided by the
number of people working in it should be at least 11m3; more if much of the
room is taken up by furniture.
• Workstations should be arranged so that each task can be carried out safely
and comfortably. Seating should provide support to the lower back and be
appropriate for the task.

Safety
• Floor surfaces should be free from holes, unevenness or slipperiness, which
could cause a person to trip, slip or fall, or to drop anything being carried
• Windows and skylights should be able to be opened, closed and cleaned from
the inside (safely)
• Glazed doors and partitions should be made of a safety material or be
protected against breakage, for example, by obvious marking
• Doors and gates should have a transparent panel unless they are low enough
to see over.

Hygiene facilities
• Toilets and washing facilities should be sufficient to allow everyone in the
practice to use them without delay. If you have more than five employees, you
should consider two toilets, especially if patients use toilets provided for staff.

© BDA July 2018 Health and safety 12