Advice Pa t i e nt ca re a n d s a fe t y H e a l t h , s a fe t y a n d r i s k a s s e s s m e nt H e a l t h a n d s a fe t y

Health and safety

This advice provides a summary of the general and specific health and safety requirements that apply to the dental
environment.

Overview
The Health and Safety at Work etc Act 1974 is the primary legislation covering occupational health and safety and the general responsibilities of employers and
others either working at or visiting the workplace. The Act is supported by various regulations that add detail to the general requirements. The UK’s healthcare regulators
also require suitable standards of quality and safety that patients have a right to expect when receiving care.

Key learning points

This advice provides a summary of the general and specific requirements that apply to the dental environment, including

Your general and specific responsibilities to your employees, patients and visitors to the practice
The role of the HSE and its powers to take enforcement action
The value of a health and safety policy to describe your safe systems of work and safe working practices for all work activities
An overview of your responsibilities and guidance on meeting these • Links to more detailed advice and the legislation.

Other relevant BDA advice includes:

Dental unit waterlines

Healthcare waste
Infection control
Medical devices
Medical emergencies
Radiation protection
Risk assessment

Duty of care
The Health and Safety at Work Act (HSW Act) seeks to protect all those at work – employers, employees and the self-employed, as well as those who might be affected by
their work activities. The Health and Safety Executive (HSE) is the lead inspection and enforcement body for health and safety matters involving employees,
workers, visitors and contractors. Alongside the legislation, national healthcare regulators describe the quality and safety standards that patients receiving care have a right
to expect.

The approved poster Health and Safety Law – what you should know should be displayed or provided to all staff as a leaflet .

Employers have a general duty to ensure (as far as reasonably practicable) the 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:

Providing and maintaining safe equipment, appliances and systems of work

Safely storing and handling dangerous or potentially harmful substances
Maintaining the workplace in a safe condition
Providing a safe working environment with adequate welfare facilities
Providing training and supervision to allow employees to undertake their work duties safely and without risk to themselves or others.

Employees must take reasonable care of their own and others’ health and safety and cooperate with the employer to implement the requirements of relevant legislation.

The duty of care extends to external contract workers (builders, engineers, for example) and to any sub-contractors. You must assess the risks involved with the task they
have been engaged for. Check the contractor’s health and safety policies and procedures and risk assessment and make them aware of your health and safety procedures.
The Health and Safety Executive
The HSE can enter and inspect workplaces, as well as request information, interview people and take written statements.

Although dental practices are not subject to many routinely inspected, when these are undertaken, an inspector will usually make an appointment to avoid unnecessary
disruption. The inspectors will have a warrant with an identifying photograph.

An inspection will usually involve an examination of the premises and equipment, focussing on anything with potential danger – for example, radiographic equipment,
autoclaves, electrical appliances, and gas cylinders. You are likely to be asked for evidence of safety checks (reports, certificates etc).

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, they can issue an improvement or
prohibition notice or remove or destroy anything that is dangerous or might cause serious personal injury.

An improvement notice specifies what requirements are not being met, the action needed to put it right, and a timescale for doing so
A prohibition notice (if there is a risk of serious personal injury) prohibits an activity until remedial action has been taken

If the situation is sufficiently serious, HSE can prosecute – either instead of or in addition to serving a notice.

If a notice is served, you can appeal to an Industrial Tribunal within 21 days of the notice being served. An appeal suspends an improvement notice until the outcome is
determined but a prohibition notice remains in force.

The practice health and safety policy

If you have five or more employees, you must have a health and safety policy. Your employees should know about the policy and, ideally, receive a copy. Self-employed
associates, hygienists and therapists must be included and comply with the policy.

The health and safety policy usually has three parts:

1. A statement of intent – a declaration of your commitment to provide a safe and healthy workplace and environment
2. Details of responsibilities for health and safety throughout the workplace
3. Safe systems of work and safe working practices for all work activities.

An Expert template health and safety policy is available.

Accidents
All accident information should be recorded in an accident book . You should also use it to record details of incidents that require reporting under the
Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR).

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,
loss or impairment of sight, serious burns and loss of consciousness.

Reportable occupational diseases include carpal tunnel syndrome, severe cramp, dermatitis, asthma, tendonitis or tenosynovitis of the hand or forearm, cancer, and
any disease resulting from occupational exposure to a biological agent.

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.

Anaesthetic gases
Depending on the work environment and the services provided, individuals may be repeatedly exposed to low concentration of anaesthetic gases. Anxiety about exposure
tends to increase during pregnancy but there is no conclusive evidence of 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 Exposure Limits (WELs) are not exceeded and, if necessary, undertake personal sampling.

At least weekly, you should check that active scavenging and ventilation equipment is working properly and being used correctly. Servicing should follow manufacturer’s
recommendations. Nitrous oxide and oxygen is often used to provide inhalation analgesia and reduce anxiety. Exhaled breath and leaks from the breathing circuit and
facemasks are the main sources of pollution.

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 correctly. The
sedation agents should be included in your COSHH assessment.
See also:

Standards for conscious sedation in the provision of dental care (RCOA, 2015)
Conscious sedation in dentistry (SDCEP, 2017)

Gas cylinders
If possible, you should store gas cylinders in external well-ventilated stores, preferably, with piped supplies to the point of use. If internal storage is the only option, cylinders
should be stored within a fire-resisting enclosure that is ventilated to a safe place outside the building. Keep stocks as low as possible.

Medical oxygen usually has a three-year shelf life and cylinders should be replaced or refilled.

Asbestos
If you are responsible for maintaining your premises, the Control of Asbestos Regulations require you to assess whether asbestos is present and its likely condition.
You should keep a record of the assessment and subsequent reviews.

A step-by-step HSE guide to managing asbestos will help you identify if asbestos is present and, if so, how to manage it.

Display screen equipment (DSE)

The Health and Safety (Display Screen Equipment) Regulations apply to those who use DSE daily, for an hour or more at a time.

As an employer, you must protect your employees from the health risks of working with DSE such as PCs, laptops, tablets and smartphones by:

Undertaking a DSE workstation assessment

Reducing risks, including making sure that workers take breaks from work involving DSE (see BDA advice Risk assessment )
Providing an eye test if an employee asks for one
Providing training and information.

Training should be about the risk associated with DSE work and how to avoid these by safe working practices, including:

The importance of good posture

Adjusting chairs and other furniture
Arranging desk space
Breaks and changes of activity
Risk assessment
How to report problems.

See also the HSE’s guide to working with DSE .

Electrical safety
Electrical equipment must be in good working order; poor electrical installations and faulty electrical appliances can lead to fire, death or injury. HSE guidance on the
Electricity at Work Regulations describes basic safety measures to help you control the risks associated with electrical installations and appliances. These include:

Providing training, where necessary, for those working with electrical equipment
Making sure the equipment is safe and maintained in a safe condition
Reducing the voltage to the lowest needed; battery-operated devices are safest
Using an RCD to detect faults in the electrical system and switching off the supply.

Maintaining electrical equipment

Preventive maintenance includes user checks; visual inspection of the cable and inside the plug; and, where necessary, portable appliance testing (PAT) by someone
with the necessary knowledge to carry out the test and interpret the results; it does not need to be carried out by an electrician.

Simple and sensible precautions can be undertaken by all users, including a visual check of the supply cable and the plug. Where possible, the plug cover should be
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 terminals.

The type and frequency of user checks, inspections and testing needed depends on the equipment, the environment and results of previous checks. HSE suggests
recommended intervals for checking portable electrical equipment depending on whether the equipment is earthed or double-insulated but, generally, the manufacturer’s
recommendations for the frequency of testing should be followed.

You should maintain a record of the checks and tests undertaken to demonstrate compliance with the requirement.
First aid
The Health and Safety (First-Aid) Regulations require you to provide adequate and appropriate first aid for all employees during working hours. You should carry
out an assessment of first-aid needs to decide what you should provide. As a minimum, this will include: a suitably stocked first-aid kit; someone to take charge of first-aid
arrangements; and information for employees about first-aid arrangements.

First-aid kit
There is no mandatory list of items to include but, as minimum, you should have:

A general guidance leaflet on first-aid

20 individually wrapped sterile plasters (assorted sizes)
2 sterile eye pads
4 individually wrapped triangular bandages (preferably sterile)
6 safety pins
6 medium-sized individually wrapped sterile unmedicated wound dressings
At least 3 pairs of disposable gloves.

You should not keep tablets and medicines in the first-aid box.

Qualified personnel
If you have five or more people working at the practice, you should consider having at least one appropriately trained person:

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
First aid at work (FAW) – three-day training that includes the same content as EFAW and equips the first-aider to deal with a range of injuries and illnesses.

First-aiders should undertake annual refresher training.

If your assessment shows that you do not require a trained first-aider, you must appoint someone to look after first-aid equipment and facilities and, if required, call the
emergency services. An appointed person does not need first-aid training.

First aid courses are arranged by a number of organisations, including St John Ambulance and the British Red Cross .

Employee information
You must inform your employees of the first-aid arrangement at the practice by, for example, displaying notices identifying the first-aider or appointed person and where
the first-aid box is kept. Basic advice on first aid at work contains advice on first aid in an emergency but is not a substitute for effective training.

Gas safety
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
ventilated and checked to ensure air inlets are not blocked and flues and chimneys are not obstructed. Further information is available from the Gas Safe Register .

Lasers
Laser equipment is classified (by the manufacturer) according to power output (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.

If you use laser equipment, you must have quality assurance arrangements in place and appropriate safeguards for your patients, including:

Being suitably skilled and competent and ensuring staff receive training
Appoint a Laser Protection Adviser (LPA) and have local rules in place
Use the laser in an appropriate environment and within a laser-controlled area
Display warning signs at every entrance
Follow manufacturer’s instructions for maintain equipment and keep records
Obtain informed consent from patients undergoing treatment involving lasers.

In Wales, if you provide non-surgical cosmetic treatments using a Class 4 laser, you must be registered by Healthcare Inspectorate Wales (HIW), meet certain
minimum standards and comply with regulations under the Care Standards Act 2000 (see also BDA advice HIW registration ).

See also the MHRA’s guidance on the safe use of lasers in dental practices .

Lone working
When treating patients, you should always work with another appropriately-trained member of the dental team, except when providing urgent treatment outside of
normal working hours or as part of a public health programme, or there are other exceptional circumstances (unavoidable, non-routine circumstances); leave or training are
not exceptional circumstances.

Before working without an appropriately-trained member of the dental team when treating a patient, you must assess the possible risk to the patient of continuing
treatment.

In a care or domiciliary setting, you should be supported by an appropriately trained professional.

The GDC recommends having another member of the dental team working with you whenever you provide patient care ( Standards for the dental team - 6.2).
However, you may decide that having another member of the team available to provide support (if needed) meets the requirement to ‘work with’ an appropriately trained
team member without putting patients at risk. If this is planned, you should 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.

Manual handling
Incorrect manual handling is the most common cause of injury at work, accounting 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 Handling Operations Regulations require employers and employees to:

Avoid the need for manual handling, wherever possible

Assess the risk of injury from any manual handling that can’t be avoided, and
Reduce the risk of injury from hazardous manual handling, wherever possible.

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 activities do
not put others at risk.

You should identify the extent of manual handling within the practice, assess what actions pose a significant risk to employees and decide whether it is possible to avoid
them. Where risky manual handling cannot be avoided, you should undertake a more thorough assessment and document it. Your assessment must not be limited to
weight and should include factors such as the task, the load itself, the work environment and individual capacity.

Training should enable an employee to recognise when manual handling might be harmful, when mechanical aids should be used and good handling techniques.

See the HSE guide to manual handling .

Mercury and amalgam

Mercury in any form is potentially hazardous, so unnecessary exposure should be prevented. General precautions include:

Training those working with mercury to follow safe handling procedures when dealing with mercury spills and disposing of contaminated materials
Using pre-proportioned amalgam capsules to reduce exposure and encourage safe handling, ensuring you comply with COSHH requirements (see BDA advice Risk
assessment )
Good ventilation, preferably using a ventilation system that exhausts to the outside of the building or encouraging a fresh supply of air by opening a surgery window.
Recycling conditioning systems are not recommended.

Encapsulated amalgam significantly reduces the risk of exposure to mercury but if hands are exposed to mercury, they should be washed immediately with liquid soap in a
stream of cold tap water until no stain on the skin is seen. Use disposable towels for hand drying.

The disposal of waste amalgam, waste mercury and used amalgam capsules is controlled – see BDA advice Healthcare waste .

Pressure vessels
The Pressure Systems Safety Regulations were introduced to prevent the risk of 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 comply with the regulations.

Before an autoclave or air-receiver with a capacity of more than 250 Bar-litres is used, a ‘competent’ person must draw up a written scheme of examination detailing the
periodic examination of the vessel (usually 14 months for autoclaves and 24-48 months for air receivers). The written scheme must be regularly reviewed and records kept
showing that examinations have been carried out in line with the written scheme. Inspection and insurance can be arranged through Lloyd & Whyte .

A ‘competent person’ has practical and theoretical knowledge and experience of the type of machinery or plant to be examined, can detect defects or weaknesses and
assess their importance in relation to the strength or function of the vessel.

Examination for safety reasons is not the same as servicing and performance testing, which should be carried out in accordance with the manufacturer’s 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.

Personal protection
The Personal Protective Equipment at Work Regulations require you to provide necessary protective equipment (PPE) to ensure safe systems of work. You cannot
charge employees for supplying, cleaning, repairing or replacing PPE, including protective clothing. Protective clothing can minimise the risks at work but is not a substitute
for more basic safety measures.

Gloves
Medical gloves for single use (to BS EN 455, parts 1 and 2) should be worn for all clinical procedures to protect against contact with blood, saliva and other tissue fluids.
Heavy duty gloves give protection against burns or skin irritation when handling disinfecting agents, domestic cleaning agents, cleaning solvents and radiographic
processing chemicals. Damaged gloves should be replaced.

Latex is a hazardous substance. The COSHH Regulations restricts, as far as is 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). Shoes that can protect against spillage, irritants and other substances
should be worn.

Safety signs
The Health and Safety (Safety Signs and Signals) Regulations require you to use a safety sign wherever a hazard exists that cannot be adequately controlled
by any other means. Safety signs include acoustic signals, illuminated signs, marking of pipework and containers and hand signals. Safety signs generally contain a
pictogram (symbol) as part of their design, although there are some exceptions – for example, ‘Fire Door Keep Shut’.

As a minimum, you should have the following safety signs within the practice:

Fire safety signs to provide safety information on escape routes, emergency exits, location of fire-fighting equipment and a means of giving warning in the event of a
fire (illuminated signs and acoustic signals are included)
First-aid signs to locate first-aid facilities and identify the designated person
Radiation warning signals when the equipment is in use.

Stress and health support services

Work-related stress is an increasing concern for employers and is currently the second most common cause of ill health associated with work. Stress can be defined as ‘the
adverse reaction people have to excessive pressure or other types of demand placed on them’. Stress-related complaints must be treated seriously and be fully investigated.

Potential causes of work-related stress include:

Organisational culture – poor communication, ‘name and blame’ attitude

Physical and psychological demands associated with the job
Relationships with managers, peers, etc and/or lack of support
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
Employee Assistance Programme provided by Health Support; available to all BDA members regardless of their employment status.

Ventilation
Air turbines, ultrasonic scalers, air-water syringes and dental lathes can produce splatter and aerosols, which can contaminate dental instruments in the working
environment.

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 and
glasses. Enclosed workplaces must be ventilated with fresh or purified air; an open window will provide enough ventilation in most cases. Where ventilation systems are
used, the fresh-air supply rate should not fall below 5-8 litres per second per occupant but the means of ventilation should not create uncomfortable draughts. Recycling air-
conditioning systems are not recommended.

Welfare arrangements
You must provide adequate and appropriate welfare facilities for employees and staff while they are at work. ‘Welfare facilities’ are necessary for well-being: washing, toilet,
rest and changing facilities, and a clean place to eat and drink during breaks.

Working environment
Lighting should enable people to work safely and without eyestrain. Where necessary, local lighting should be provided.
Temperature should normally be at least 16°C. There is no maximum temperature but you have a general duty to provide a safe place of work and excessive heat
may adversely affect employee.
Ventilation. Windows will generally provide enough ventilation but where additional ventilation is required, mechanical systems should be provided.
Rooms should 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/skylights should open and close and be cleanable from the inside.
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 can be seen over.

Hygiene facilities
Toilets and washing facilities should 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 the same toilets. You must provide toilet paper and a suitable means for disposing of sanitary dressings.
A rest area where staff can relax and eat their meals at work.
A separate room for those who change into work clothing and a means of securing personal clothing and possessions.

Housekeeping
The workplace and equipment should be in good working order and good repair. Equipment should be regularly maintained (with records).
Cleanliness throughout the practice, including floors, walls and ceilings.

See also the HSE guidance on providing the right workplace facilities .

Copyright (C) 2024 British Dental Association All rights reserved