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riskassessmentindentistry

advicesheet

A5

advicesheet

riskassessmentindentistry
contents
Risk assessment in dental practice Introduction What is risk assessment? What you need to do Disabled employees COSHH What is a hazardous substance? Your COSHH assessment Flammable substances Young people and work experience students Information and training Immunisation New and expectant mothers at work Aspects of pregnancy that may affect work Frequently asked questions Risk assessment checklist (A-Z) Example risk assessment 'The Jolly Smile Dental Practice' Example COSHH assessment form The following models can be found in the Practice Compendium Risk assessment for a dental practice Risk assessment for a trainee dental nurse Risk assessment for students on work experience Risk assessment pregnant and nursing mothers Infection control policy Disposal of clinical waste policy Inoculation injuries policy

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bda advice sheet A5

Risk assessment in dentistry

Risk assessment in dental practice

Risk assessment is a legal requirement for all employers and the self-employed. It is not, however, a new requirement. The Health and Safety at Work etc Act 1974 (section 2) requires employers and the selfemployed to ensure, as far as is reasonably practicable, the health and safety of all those who may be affected by work activities. The Management of Health and Safety at Work Regulations 1999 impose a specific requirement for all employers and self-employed people to assess the risks arising from work activities to workers and any others who may be affected. Other regulations that require a risk assessment to be carried out include the Control of Substances Hazardous to Health Regulations 2002, the Ionising Radiations Regulations 1999, the Manual Handling Operations Regulations 1992 and the Fire Precautions (Workplace) Regulations 1997. The BDA's advice sheets on health and safety (A3), radiation in dentistry (A11) and infection control in dentistry (A12) will also help with your practice risk assessment. Employers with five or more employees must also record the significant findings of their assessment. What is risk assessment? A risk assessment is simply a careful examination of what, in the course of your work, could cause harm to people. It helps you identify what precautions, or additional precautions, are required to prevent or minimise the risk of injury and/or ill health. Risk assessment is meant to be a practical, not theoretical, exercise to identify the hazards and assess the possible risks associated with that hazard. Hazard anything that can cause harm (ie chemicals, electricity etc) Risk the chance (big or small) of harm actually being done.

What you need to do If you are a small practice and you are confident you understand what's involved, you can do the assessment yourself or ask the help of a responsible member of staff (you do not have to be a health and safety expert!). If you are a larger practice or group of practices, you might decide to appoint someone within the practice to oversee all health and safety matters (possibly with some training) or you might 'buy in' professional help. Look for the hazards If you decide to do the assessment yourself, walk around the practice and look afresh at what could reasonably be expected to cause harm. Concentrate on significant hazards that could result in serious harm or affect several people. Ask your staff what they think. Manufacturers' instructions, safety data sheets (for chemical products) and product labels can help you spot hazards and put risks into perspective, as can an accident/incident book and ill-health records. Suppliers of equipment and chemicals will be able to supply you with health and safety information - they have a legal obligation to do so.

Decide who might be harmed and how You have to think of everyone who might be affected by a hazard and in particular:

young workers, trainees and new and expectant mothers who may be at particular risk cleaners who may work in the practice outside normal working hours, often alone outside contractors and others who may not be in the practice all the time patients, especially children and older patients.

Identify the hazards and assess the possible risks

Evaluate the risks and decide whether the existing precautions are adequate or whether more should be done For each significant hazard, you will have to decide if the risk is high, medium or low. For example, the risk of infection from blood and/or saliva is significant in dentistry but, providing current infection control guidelines are followed (including recommended vaccinations), then the risk of infection will be minimised. As well as complying with any legal
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requirements, is there anything more that you could do to keep the practice safe? The aim is to make all risks small by adding to existing precautions as necessary. If something needs to be done, draw up an 'action list' and give priority to hazards where the risks are high and/or those which could affect most people. Improving health and safety need not be costly. For example, putting some non-slip material on slippery steps is an inexpensive solution, considering the risk of injury. Record your findings If you have fewer than five employees you do not need to write anything down but it is useful to keep a written record of what you have done. If you employ five or more people you must record the significant findings of your assessment and tell your staff about your findings. Your risk assessment must be suitable and sufficient and needs to show that:

Keep the written record for future use; it can help you if the PCT or Health and Safety Executive inspect your practice, or if you become involved in action for civil liability. To make things simpler, you can refer to other documents, such as instruction manuals, your health and safety policy statement, infection control policy and practice rules as these may already list hazards and precautions. You don't need to repeat this work and it is up to you whether you combine all the documents, or keep them separately. Review your assessment and revise it if necessary

against ill health and injury caused by exposure to hazardous substances - from mild eye irritation through to chronic lung disease and even death. The COSHH Regulations require you to eliminate or reduce exposure to known hazardous substances in a practical way; it is not meant to be a paper exercise! What is a hazardous substance? Manufacturers of hazardous substances are required to display an orange and black warning symbol on the label and packaging of any substance that is classified as hazardous:

Review your assessment from time to time

corrosive

harmful

At some point you may bring in new machinery, equipment, substances and procedures, which could lead to new hazards. If there is any significant change, add to your assessment to take account of the new hazard. Review your assessment from time to time to make sure that the precautions are still working effectively, at least every 5 years. Employees with disabilities When carrying out your risk assessment you must pay particular attention to employees with disabilities; you have responsibilities under the Disability Discrimination Act and health and safety law to eliminate or reduce the risks and avoid inadvertent discrimination. Depending on the type of disability, the employee may be at particular risk and you will need to show that this has been considered in your risk assessment. You should involve the employee in the risk assessment, consulting on the extent of the disability and the implications it might have on their safety at work.

irritant

toxic

The label will also state how the substance is toxic, harmful, corrosive or irritant: irritating to eyes and skin or harmful if swallowed or toxic by inhalation, for example. Manufacturers and suppliers of hazardous substances are required to provide material safety data sheets, which contain more detailed information on the hazards presented and the required first-aid measures. Other substances are also classified as hazardous and include:

substances with an occupational exposure limit (mercury, for example) biological (infectious) agents directly connected with the work - blood borne viruses are common in dentistry any kind of dust in a significant amount any other substance classed as hazardous (latex, for example).

a proper check was made you asked who might be affected you dealt with all the obvious significant hazards, taking into account the number of people who could be involved the precautions are reasonable and the remaining risk is low.

COSHH
The Control of Substances Hazardous to Health Regulations were introduced to protect workers

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Your COSHH assessment Identify the hazardous substances and consider the risks Look at all the substances and chemicals that you use in the practice and identify which are hazardous. Pay particular attention to:

Decide what precautions are needed If you decide that the substance does not present a risk or the risk is trivial, you do not need to do anything more. If you identify significant risks, you need to decide how you can reduce the risk, for example, by changing to a different substance or procedure or improving ventilation.

precautions they should take to minimise any risks. You should review the assessment if you feel it is no longer valid or there has been a significant change in work activities or the substances used. In any event, it should be reviewed at least every 5 years. Ensure that precautions are followed and controls are maintained Staff must receive suitable information and training on the precautions for handling and using hazardous substances and supervised where necessary. They should understand the reasons for any control measures that are in place - such as wearing protective gloves and eyewear and the need for adequate ventilation. Monitoring exposure If your assessment shows that there could be a serious risk to health from

acids (hydrochloric, hydrofluoric, nitric, phosphoric, sulphuric) adhesives (may contain xylene or toluene which are classified as harmful) blood and saliva (infectious agents) disinfectants, strong detergents and other cleaning agents (may be harmful and/or irritant) latex gloves (risk of allergy) mercury (toxic by inhalation) nitrous oxide (can affect central nervous system at high concentrations) solvents (various ill-health effects) radiographic chemicals (irritating to eyes and skin and possibly respiratory system)

Decide how you can reduce the risk

Record and review the assessment Your COSHH assessment should be recorded and kept with any relevant material safety data sheets. It should be regarded as a 'living' document that any member of the dental team can refer to for working safely with hazardous substances. A comprehensive and well written COSHH assessment is of little use if stored in a drawer or on a shelf and staff are unaware of the hazardous substances they work with and the

Most restorative and impression materials and mouth rinses pose negligible risk so will not need to be included in your COSHH assessment. When you assess the risks, you should consider:

how often it is used? Daily, weekly, monthly, quarterly or annually how much of the substance is used? Small amounts (grams or millilitres) or medium amounts (kilograms or litres) how could people be exposed to it? Inhalation, direct contact, skin absorption, or swallowing, for example who could be affected? Staff, patients, visitors, contractors.
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the importance of using any personal protective clothing or equipment provided the results of any exposure monitoring and health surveillance emergency procedures (in the event of exposure or a spillage, for example).

Young people and work experience students

If you employ a young person (aged below 18), agree to help with work experience or take on a new employee with no previous experience of working in a dental practice, you will need to carry out a risk assessment to ensure the individual is not put at risk and is aware of health and safety risks specific to dentistry. It is important that these people receive adequate information, instruction and training and a high level of supervision by an experienced person. Your risk assessment should take account of:

Flammable substances Flammable substances are not necessarily hazardous to health (they may simply be flammable) but they are obviously a risk to safety. You need to ensure that these substances present minimum risk:

store and use flammable substances in a well ventilated area so that any vapours given off from a spill or leak will be dispersed rapidly avoid sources of ignition in areas where flammable substances are stored or handled. Ignition sources include sparks from electrical equipment, cutting tools, hot surfaces, open flames from heating equipment and cigarettes sunlight is a heat source - a glass window may intensify heat during the summer to a considerably high temperature and this has been known to cause aerosol cans to explode (including deodorant and hairspray cans) flammable substances should be stored in suitable containers away from general work and storage areas, especially if being stored in large quantities.

the inexperience and immaturity of the individual their lack of awareness of risks to their health and safety their exposure to biological (infectious), chemical (such as mercury) or physical (such as radiation) agents.

a substance harmful by inhalation or irritating to the eyes, skin and respiratory system you should consider air monitoring unless ventilation throughout the practice (either from natural or mechanical ventilation) is adequate. Carry out appropriate health surveillance Mercury is one of the most hazardous substances that dentists and their staff use on a regular basis. Biological monitoring of exposure to mercury is recommended to ensure staff are not inadvertently being overexposed. Above average biological levels of mercury might indicate a failing in routine mercury hygiene within the practice that might otherwise go undetected. Ensure staff are properly informed, trained and supervised Staff who work with hazardous substances should be provided with the following information:

Information and training It can sometimes be hard to appreciate fully how little knowledge a young or inexperienced new employee might have when they start work at your practice. For example, they may be unaware of the risks of:

infection from contact with blood and saliva or from contaminated sharp instruments

the nature of the substances they work with or are exposed to and the associated risks the precautions they should take and the control measures in place

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eye injury from flying debris during operative procedures exposure to mercury vapour or contact with other hazardous chemical agents such as disinfectants and x-ray chemicals possible allergic reactions to latex gloves scalds and burns (and explosion!) from the autoclave.

Ideally, you should develop an induction training programme for all new employees to ensure that everyone in the practice is aware of the health and safety arrangements (the health and safety policy is a good starting point), infection control procedures, radiation protocols and policies as well as training on other practice management issues (including confidentiality). A competent person within the practice should oversee the training and start a training log for the new employee. Immunisation Immunisation against the common infections is usually provided to young people during their school years and it is worth checking that the usual vaccinations have been received. Routine vaccination does not include immunisation against hepatitis B, however. Ideally, dental nurses should be fully immunised against hepatitis B and their immunity confirmed before they start chairside assisting but this is not always practicable. If a new employee has not been immunised against hepatitis B, arrangements for vaccination should be made as soon as possible upon employment, with the first dose being administered within the first month. You need to protect against inoculation injuries as far as possible and your risk assessment should show this. Personal protective clothing and equipment including gloves and eyewear should be provided from the start of employment and thicker heavy duty gloves provided for the manual cleaning of dental instruments, along

Develop an induction training programme for all new employees

with a protective apron and eyewear to shield against possible splashing. Resheathing of needles should not be carried out, as this is a particularly hazardous process.

New and expectant mothers at work

Pregnancy should be regarded as part of everyday life and not equated with ill health; its health and safety implications can be adequately addressed by normal health and safety management procedures. Many women work when pregnant and many return to work when they are still breastfeeding. However, some hazards in the workplace may affect the health and safety of new and expectant mothers and that of their children. You need to be able to identify these hazards and reduce any risks. If you cannot avoid a risk by other means, you will need to make changes to working conditions or hours, offer suitable alternative work or, if that is not possible, give the worker paid leave for as long as necessary to protect her health or safety or that of her child. "New or expectant mother" means an employee who is pregnant, has given birth within the previous six months, or is breastfeeding

In assessing risks to new or expectant mothers you should take whatever action is necessary to ensure that they are not exposed to any significant risk. Risks include those to the unborn child or child of a woman who is still breastfeeding not just risks to the mother herself. Your risk assessment for new and expectant mothers will follow the same format as your general risk assessment. Dental practices do not generally pose particular hazards for new and expectant mothers but, depending on your work practices and your risk assessment, you may decide that certain equipment, substances or activities are best avoided during pregnancy and/or breastfeeding. Look for the hazards: Most of the hazards present in your dental practice that need to be considered will have been identified during your routine risk assessment but there could be different risks depending on whether workers are pregnant, have recently given birth, or are breastfeeding. You should take particular care to assess the following:

biological agents (bacteria and other micro-organisms) chemical agents - for example, mercury and anaesthetic and sedation agents physical agents - for example, radiation, manual handling and restricted posture
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Are filters for display screens mandatory to reduce radiation? No. Screen filters need only be fitted where glare is a problem. Levels of radiation emitted from display screens are well below safe levels. I've done the risk assessment in accordance with the guidance in this advice sheet but I'm worried it's not good enough! Your risk assessment must be suitable and sufficient - it does not have to be perfect. You need to be able to show that a proper check was made, you considered who might be affected, you dealt with all the obvious significant hazards, the precautions are reasonable and any remaining risk is low. A Health and Safety Inspector will want to see that the practice is run safely and that staff are well informed of any risks and any precautions they should take, rather than a mountain of paperwork.

Avoid the risk: If your assessment does reveal a risk you should explain what action you will take to prevent exposure to the risk or control it so that it is no longer a risk. If you identify a significant risk to which you cannot prevent or control exposure, then you must remove the new or expectant mother from risk. You might offer suitable alternative work if any is available. If this is not possible you must suspend her from work (paid leave) for as long as necessary. This is really only necessary if the risk assessment gives rise to genuine concern. If there is any doubt, you may want to seek further advice on what the risks are and whether they arise from work before offering alternative employment or paid leave. Review: You need to maintain your awareness of the risks and measures to prevent or control exposure for the duration of pregnancy or breastfeeding. There is no time limit on breastfeeding; it is for the individual to decide for how long she wants to breastfeed. Aspects of pregnancy that may affect work

varicose veins - could be affected by standing or sitting frequent visits to the toilet difficulty in leaving the surgery or reception as often as required increasing size - implications for uniform provision, working in confined areas and manual handling tiredness - could be exacerbated by overtime, finishing late or working late shifts.

Risk assessment checklist

You might find the following checklist helpful when you are assessing the risks in your practice:

Staff are well informed of any risks

Frequently asked questions

Do I need a COSHH assessment for every substance used at the practice? No. Assessments are only needed for hazardous substances. For bought-in products, an orange and black hazard warning symbol will alert you to a hazardous substance. Do our portable appliances need to be tested every six months? No, but the law requires them to be in good working order at all times. A formal visual check by you or another competent member of staff perhaps on an annual basis should be sufficient. This should be followed up with an inspection by a qualified electrician at least every three years.

Amalgam capsules have been found to leak during mixing, contaminating the immediate area and/or the amalgamator. Check amalgamators from time to time to ensure there are no mercury droplets present. Autoclaves and air receivers (compressors) must be regularly serviced according to the manufacturer's recommendations and inspected according to the Written Scheme of Examination, which is drawn up by a competent person. Have staff been properly trained in the safe use of the autoclave(s)? Children should be taken into account when assessing risks within the practice, for example access to hazardous substances, sharps containers etc.

morning sickness - could be a problem if work demands an early start backache - could be made worse by standing, manual handling and posture

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COSHH: Anaesthetic agents such as nitrous oxide should be assessed COSHH: Biological agents such as blood and saliva should be assessed. Is there a practice infection control policy in place? Have relevant staff been immunised against hepatitis B and their immune status checked? Do staff know what to do in the event of an inoculation injury? COSHH: Hazardous substances. Have these been assessed and any significant risks either removed or reduced? Have relevant staff been informed of the risks and of any precautions they should take? Adequate controls should be in place for acids, adhesives, blood and saliva (biological agents), disinfectants, strong detergents and other cleaning agents, latex, mercury (bottled and encapsulated), nitrous oxide, solvents and x-ray chemicals. The risk of latex allergy should be minimised by using non-powdered gloves. Note: Where local exhaust ventilation (LEV) is fitted to control exposure to hazardous substances (ie in the x-ray developing area) this should be examined and tested at least every 14 months. COSHH: Legionella is more likely to proliferate in the presence of sludge, scale, rust and algae and when water is in the temperature range of 20C to 45C. Water contaminated by legionellae only presents a risk when it is dispersed into the air in the form of an aerosol (very fine water droplets/spray). You can reduce the risk of algae contaminating dental unit waterlines by using a bottled water system and following the manufacturer's recommendations on decontamination. Display screen equipment: The workstation and environment should be comfortable and suitable for the individual user and there should be planned breaks or changes of activity from the screen and keyboard. If requested, eye tests should be

provided and spectacles provided if required for use with the DSE. Electrical equipment should be in good working order at all times. User checks, formal visual inspection and combined inspection and testing should be carried out at appropriate intervals. User checks are a simple visual check of the equipment and its cable and plug before use - whoever is using the equipment can do this. A competent member of staff can carry out a more formal visual inspection on an annual basis provided they have enough knowledge and training. Earthed equipment should also have an occasional combined inspection and test by a qualified electrician. Emergency drugs and equipment should be held in every practice. The Dental Practitioners Formulary provides guidance on the various emergencies that might occur and the drugs to hold at the practice. Every dental practice should have available the following equipment: portable suction apparatus, oral airways, equipment with appropriate attachments to provide intermittent positive pressure

ventilation of the lungs and a portable source of oxygen. Where intravenous sedation is undertaken, a pulse oximeter and equipment for measuring blood pressure are required. Any necessary reversal drugs should also be immediately available.

Is there a practice infection control policy in place?

Ergonomic factors are important in order to reduce the risk of musculo-skeletal discomfort/ disorders. Back, neck, shoulder and other sprains or strains can be caused by poor posture due to space constraints, unsuitable seating or poor lighting. Seating should be suitable for the individual and provide adequate support for the lower back. Twisted, stooped or stretched postures should be avoided. Check all staff are able to carry out their various duties comfortably. Advise staff to report any possible work related sprains or strains to you as soon as they become apparent. Fire precautions for the practice should include fire detection/ warning, escape routes (with adequate signposting), firefighting equipment and training of staff in fire safety. The fire risks should be assessed and incorporated into your main risk assessment.

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Fire certificates are required if there are more than 20 people employed to work at any one time, or more than 10 people are employed to work at any one time other than on the ground floor. First aid: Do you have an Appointed Person or a First Aider available on the premises at all times? Is there an appropriately stocked first aid box? Infection control: You should have an infection control policy in place. Information, instruction and training for all staff to enable them to carry out their various duties safely and without risk to themselves or others. Ionising radiation: You should have Local Rules for each x-ray machine, implemented by the Radiation Protection Supervisor. The Radiation Protection Adviser for the practice should help you carry out your radiation risk assessment. Is x-ray equipment maintained and checked as advised by the manufacturer and the RPA? Lasers: Class 3B and 4 lasers present a risk of injury to the eyes and skin. Suitable eye protection should be available to all those at risk, including the patient. Lasers are a fire risk and should be kept away from flammable materials and anaesthetic gases. A Laser Protection Adviser and Supervisor should be appointed and Local Rules drawn up. Lone workers may be at risk. Foreseeable risks should be assessed and addressed. Manual handling may be hazardous. An assessment should ensure hazardous manual handling has been identified (particularly the lifting/carrying/ assisting of unconscious, sedated or disabled patients) and appropriate training provided. Personal protective equipment, gloves, eye protection and masks, must be suitable for its intended use. PPE is often recommended when working with hazardous substances, for example heavy-duty gloves for use with disinfectants and other cleaning products or radiographic chemicals.

Smoking: Practices must have arrangements in place to protect non-smokers from the discomfort caused by tobacco smoke in rest rooms or areas. Vaccination against the common illnesses, and especially against hepatitis B, is recommended. Records of immunisations and responses should be maintained. Ventilation must be adequate where hazardous substances are in use - such as the x-ray developing area. Surgeries should also be adequately ventilated to reduce the risk of infection from aerosols generated during patient treatment. Violence can be a problem in any workplace and it is useful to have a policy in place to deal with incidents. The policy should address verbal as well as physical abuse. Young people: Have risks to young people been assessed including risks which could arise because of their lack of awareness, experience and training? In particular consider the risks involving exposure to biological agents (infection), hazardous substances (such as mercury and other chemicals) and physical agents (such as radiation).

It is important that the practice works as a team

Pregnant and nursing mothers require an assessment of the possible risks to their health or the health of the foetus or child. The assessment should include exposure to biological (infectious), chemical (eg mercury) or physical (eg radiation) agents. Sharps instruments are hazardous and all staff must be given training in their safe use and disposal. The necessary action in the event of an inoculation injury should also be provided as part of the training. Slips, trips and falls can occur where there are uneven floors, trailing cables, slippery areas due to spillages, including outdoor areas. These are the single most common cause of injuries at work. Stress can occur in any area of work, including dentistry, especially where there is high patient turnover and increasing demands on staff. It is important that the practice works as a team and that staff feel they can raise issues relating to stressful working.

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Water regulations: Is the mains water supply protected from contaminated (blood and saliva) backflow from the practice? This is usually achieved by an air gap. Work equipment needs to be suitable for its use and properly maintained. Workplace premises and environment: Is the building or premises in good repair? Are floors, corridors and stairs etc free of obstructions? Can windows be opened and cleaned safely? Is furniture with sharp corners sited so as to avoid injury? Is the lighting good and suitable for the various work being

carried out? Are the floors and stairs clean and not slippery? Is the temperature reasonable at least 16C? (Local heating or cooling may need to be provided.) Is space sufficient for the work being done? Are there suitable clean toilet facilities? Are there arrangements to protect non-smokers from tobacco smoke? Outside entrance and exit areas should be checked for slip and trip hazards, including hazards created by wet and/or icy weather conditions. Check also for 'surprise' steps that could cause falls and low ceilings and low door frames that could bump heads.

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Example risk assessment

The Jolly Smile Dental Practice A risk assessment of the practice was carried out on 1 February 2003 by the practice owner and the following are the significant findings. A review of the risk assessment is due on 1 February 2004
Significant hazards Autoclave Risk of explosion, scalds and burns Those at risk Existing controls or action required

Dental nurse (and others in the immediate area)

staff receive full instruction and training in the safe use of autoclaves manufacturers' instructions and operating procedures are kept nearby the autoclave malfunctions or faults are reported to the practice manager for remedial action autoclaves are serviced regularly and inspected for safety purposes in accordance with the Written Scheme of Examination.

Biological agents Risk of infection from Blood/saliva Bacteria/micro-organisms

Dentist, dental nurse, hygienist, patient

biological agents are covered by COSHH see separate assessment universal precautions and current infection control guidelines are followed see practice infection control policy relevant staff are immunised against hepatitis B and their responses checked regular training in infection control procedures is provided see also Sharps. For action: Regular training and updates in infection control guidelines for all staff.

Display screen equipment Risk of upper limb disorders.

Receptionist / practice manager

individual workstation assessments undertaken for regular users - see separate assessments equipment and seating can be adjusted to individual needs eye test is provided if requested by employee window blind is provided to control glare on screen [if glare is a problem] training in software used is provided information on DSE health and safety has been provided (HSE leaflet).

Electrical Risk of electric shock or burns fire from damaged equipment.

All staff

staff advised to visually check plugs, cables or equipment for signs of overheating or damage and report these to the practice manager for remedial action. visual inspection of all portable appliances is carried out annually/six monthly by the practice owner [or other competent member of staff] and findings recorded all electrical equipment is inspected and tested by a qualified electrician at regular intervals (every three years suggested) For action: Training for staff to include simple visual checks of electrical equipment.

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Significant hazards Eye injury Risk of flying debris and splatter from rotary instruments splashing during the cleaning of instruments.

Those at risk

Existing controls or action required.

Dentist, dental nurse, hygienist, patient

use of protective eyewear during clinical procedures for both staff and patients and when cleaning instruments and equipment prior to sterilisation use of high speed aspiration for procedures involving rotary instruments use of rubber dam whenever possible to restrict the operative field immunisation against hepatitis B for all clinical health care workers and response to the vaccine checked

Eye injury from light curing unit Risk of damage to the eye from blue (and white) light

Dentist, dental nurse, patient

use of suitable protective eyewear or light shield (red,orange or yellow) avoid prolonged or direct viewing

Fire

All staff, patients and visitors.

fire alarm system (if fitted) checked and tested annually by service engineer self-contained smoke alarms are cleaned and batteries changed annually staff trained in the evacuation procedure fire fighting equipment is checked and tested annually by service engineer fire exits and fire-fighting equipment are clearly marked access to exits and extinguishers is kept clear at all times fire drills are held twice yearly (but for practical reasons do not have to be during patient time) procedures to be followed in the event of a fire are displayed [where]. For action: Practice manager to make regular inspections to ensure that fire precautions are followed and housekeeping standards are maintained.

Hazardous substances Risk of skin, eye and respiratory tract irritation, asthma, allergy and poisoning.

Dentist, dental nurse, hygienist, cleaner, patient, visitors and contractors

Hazardous substances are covered by COSHH see separate assessment staff made aware of the risks from the hazardous substances they work with and the precautions needed to avoid or control these risks substances assessed include acids, adhesives, blood and saliva, disinfectants, strong detergents and other cleaning agents, latex gloves, mercury, nitrous oxide, solvents and radiographic chemicals.

Manual handling Risk of injury to back or other part of the body.

All staff involved in lifting and/or awkward or repetitive handling (for example, stock deliveries, assisting elderly and disabled patients into and out of chair)

training and information provided including good handling techniques and how to recognise harmful manual handling information on manual handling techniques is available (HSE leaflet) and kept [where] For action: Annual review of manual handling techniques to be undertaken (practice meeting).

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Significant hazards Radiation - ionising Risk of accidental over-exposure from x-ray equipment

Those at risk

Existing controls or action required.

Patient, dentist, dental nurse.

Radiation Protection Adviser appointed see separate risk assessment Radiation Protection Supervisor is on the premises at all times those involved in the taking and processing of radiographs have received the appropriate training and possess the relevant knowledge x-ray equipment is regularly checked and maintained in accordance with the manufacturer's, suppliers and RPA's advice arrangements for dealing with accidental or unintended dose are contained in the Local Rules. x-ray equipment can be switched off in the event of malfunction without entering the controlled zone current guidelines on radiology standards are followed closely - see Guidance notes on the safe use of x-ray equipment (NRPB/DH, June 2001) and BDA Advice Sheet Radiation in dentistry (A11).

Sharps Risk of infection from used needles, instruments and spicules of teeth or bone.

Dentists, dental nurses, hygienists, patients, waste contractors

all staff trained in the safe use and disposal of sharps see practice policy on disposal of clinical waste thick household type gloves provided for handling and cleaning used instruments prior to sterilisation needles are only re-sheathed using a device sharps are discarded into an approved container all staff are immunised against hepatitis B and their response to the vaccine checked sharps injuries are reported immediately and dealt with as appropriate - see practice policy on inoculation injuries if required, medical advice will be sought as soon as possible. For action: Regular updates on the procedures to be followed in the event of an inoculation injury (practice meeting).

Slips, trips and falls Risk of injury.

Staff, patients and visitors.

good quality flooring, which is well maintained all staff trained to maintain good housekeeping standards spills cleared up immediately walk areas kept unobstructed.

Waste Disposal Risk of exposure to infectious or hazardous waste.

Staff and waste contractors.

waste segregated and disposed of in appropriate containers - see practice policy on disposal of clinical waste waste collected for disposal by authorised waste disposal company records of disposal maintained.

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Example COSHH assessment form for individual chemical substances

Substance __________________________ Date __________ How often is the substance used?

Daily Monthly

Weekly Quarterly or Annually

What is/are the health hazard/s? (see label or safety data sheet)

How much is being used? (On a daily etc basis) Toxic by inhalation. Danger of cumulative effects

Small grams or millilitres

Medium kilograms or litres

Harmful by inhalation, in contact with skin and if swallowed Harmful if swallowed Possible risk of irreversible effects Risk of serious damage to eyes Irritating to eyes and skin

How is exposure to the substance controlled?

Protective gloves and eyewear Substance is used in an adequately ventilated area Substance is used in an area with local exhaust ventilation Other ________________________________________

Irritating to eyes, skin and respiratory system Risk - providing the substance is stored and handled as directed May cause sensitisation by skin contact Other ____________________________________________ and staff have been trained in its correct use, the risk is assessed as:

Low

Significant Action will be taken immediately to reduce the risk.

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British Dental Association 64 Wimpole Street London W1G 8YS Tel: 020 7563 4563 Fax: 020 7487 5232 E-mail: enquiries@bda-dentistry.org.uk BDA June 2003