A5 Risk Assessment in Dentistry

advicesheet

A5riskassessmentindentistry

nickryde

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BACK TO COMPENDIUM

advicesheet

contentsRisk assessment in dental practiceIntroductionWhat is risk assessment?What you need to doDisabled employees

COSHHWhat is a hazardous substance?Your COSHH assessmentFlammable substances

Young people and work experience studentsInformation and trainingImmunisation

New and expectant mothers at workAspects 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 thePractice CompendiumRisk assessment for a dental practiceRisk assessment for a trainee dental nurseRisk assessment for students on work experienceRisk assessment pregnant and nursing mothersInfection control policyDisposal of clinical waste policyInoculation injuries policy

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riskassessmentindentistry

bda advice sheet A5 Risk assessment in dentistry 3

Risk assessmentin dental practiceRisk assessment is a legalrequirement for all employers andthe self-employed. It is not, however,a new requirement. The Health andSafety at Work etc Act 1974 (section 2)requires employers and the self-employed to ensure, as far as isreasonably practicable, the healthand safety of all those who may beaffected by work activities.

The Management of Health andSafety at Work Regulations 1999impose a specific requirement for all employers and self-employedpeople to assess the risks arisingfrom work activities to workers andany others who may be affected.Other regulations that require a riskassessment to be carried out includethe Control of Substances Hazardousto Health Regulations 2002, theIonising Radiations Regulations 1999,the Manual Handling OperationsRegulations 1992 and the FirePrecautions (Workplace) Regulations1997. The BDA's advice sheets onhealth and safety (A3), radiation indentistry (A11) and infection controlin dentistry (A12) will also help withyour practice risk assessment.

Employers with five or moreemployees must also record thesignificant findings of their assessment.

What is risk assessment?

A risk assessment is simply a carefulexamination of what, in the courseof your work, could cause harm topeople. It helps you identify whatprecautions, or additional precautions,are required to prevent or minimisethe risk of injury and/or ill health.

Risk assessment is meant to be apractical, not theoretical, exercise to identify the hazards and assess the possible risks associated withthat hazard.

Hazard anything that can causeharm (ie chemicals,electricity etc)

Risk the chance (big or small) ofharm actually being done.

What you need to do

If you are a small practice and you are confident you understandwhat's involved, you can do theassessment yourself or ask the helpof a responsible member of staff(you do not have to be a health andsafety expert!). If you are a largerpractice or group of practices, youmight decide to appoint someonewithin the practice to oversee allhealth and safety matters (possiblywith some training) or you might'buy in' professional help.

Look for the hazards

If you decide to do the assessmentyourself, walk around the practiceand look afresh at what couldreasonably be expected to cause harm.Concentrate on significant hazardsthat could result in serious harm or affect several people. Ask yourstaff what they think. Manufacturers'instructions, safety data sheets (for chemical products) and productlabels can help you spot hazards and put risks into perspective, as can an accident/incident book andill-health records. Suppliers ofequipment and chemicals will beable to supply you with health andsafety information - they have a legalobligation to do so.

Decide who might be harmed and how

You have to think of everyone whomight be affected by a hazard and in particular:

● young workers, trainees and newand expectant mothers who maybe at particular risk

● cleaners who may work in thepractice outside normal workinghours, often alone

● outside contractors and otherswho may not be in the practiceall the time

● patients, especially children andolder patients.

Evaluate the risks and decide whetherthe existing precautions are adequateor whether more should be done

For each significant hazard, you willhave to decide if the risk is high,medium or low. For example, therisk of infection from blood and/orsaliva is significant in dentistry but,providing current infection controlguidelines are followed (includingrecommended vaccinations), thenthe risk of infection will be minimised.As well as complying with any legal

© BDA June 2003

‘Identifythe hazardsand assess

thepossible

risks’

Risk assessment in dentistry bda advice sheet A54

requirements, is there anything morethat you could do to keep the practicesafe? The aim is to make all risks smallby adding to existing precautions as necessary. If something needs tobe done, draw up an 'action list' andgive priority to hazards where therisks are high and/or those whichcould affect most people.

Improving health and safety neednot be costly. For example, puttingsome non-slip material on slipperysteps is an inexpensive solution,considering the risk of injury.

Record your findings

If you have fewer than five employeesyou do not need to write anythingdown but it is useful to keep a writtenrecord of what you have done. If youemploy five or more people youmust record the significant findingsof your assessment and tell your staffabout your findings.

Your risk assessment must besuitable and sufficient and needs toshow that:

● a proper check was made

● you asked who might be affected

● you dealt with all the obvioussignificant hazards, taking intoaccount the number of peoplewho could be involved

● the precautions are reasonableand the remaining risk is low.

Keep the written record forfuture use; it can help you ifthe PCT or Health andSafety Executive inspect yourpractice, or if you become involved in action for civil liability.To make things simpler, youcan refer to otherdocuments, such asinstruction manuals, yourhealth and safety policystatement, infection controlpolicy and practice rules asthese may already listhazards and precautions.You don't need to repeat thiswork and it is up to youwhether you combine all thedocuments, or keep them

separately.

Review your assessment and reviseit if necessary

At some point you may bring in new machinery, equipment,substances and procedures, whichcould lead to new hazards. If there isany significant change, add to yourassessment to take account of thenew hazard. Review your assessmentfrom time to time to make sure thatthe precautions are still workingeffectively, at least every 5 years.

Employees with disabilities

When carrying out your riskassessment you must pay particularattention to employees withdisabilities; you have responsibilitiesunder the Disability DiscriminationAct and health and safety law toeliminate or reduce the risks andavoid inadvertent discrimination.Depending on the type of disability,the employee may be at particularrisk and you will need to show thatthis has been considered in your riskassessment. You should involve theemployee in the risk assessment,consulting on the extent of thedisability and the implications itmight have on their safety at work.

COSHHThe Control of Substances Hazardousto Health Regulations wereintroduced to protect workers

against ill health and injury causedby exposure to hazardous substances- from mild eye irritation through tochronic lung disease and even death.The COSHH Regulations requireyou to eliminate or reduce exposureto known hazardous substances in apractical way; it is not meant to be a paper exercise!

What is a hazardous substance?

Manufacturers of hazardous substancesare required to display an orange andblack warning symbol on the labeland packaging of any substance thatis classified as hazardous:

The label will also state how thesubstance is toxic, harmful, corrosiveor irritant: irritating to eyes and skinor harmful if swallowed or toxic byinhalation, for example. Manufacturersand suppliers of hazardoussubstances are required to providematerial safety data sheets, whichcontain more detailed informationon the hazards presented and therequired first-aid measures.

Other substances are also classifiedas hazardous and include:

● substances with an occupationalexposure limit (mercury, forexample)

● biological (infectious) agentsdirectly connected with the work- blood borne viruses arecommon in dentistry

● any kind of dust in a significantamount

● any other substance classed ashazardous (latex, for example).

© BDA June 2003

‘Review yourassessmentfrom time to

time’

corrosive harmful

irritant toxic


Your COSHH assessment

Identify the hazardous substancesand consider the risks

Look at all the substances andchemicals that you use in the practiceand identify which are hazardous.Pay particular attention to:

● acids (hydrochloric, hydrofluoric,nitric, phosphoric, sulphuric)

● adhesives (may contain xylene or toluene which are classified as harmful)

● blood and saliva (infectious agents)

● disinfectants, strong detergentsand other cleaning agents (maybe harmful and/or irritant)

● latex gloves (risk of allergy)

● mercury (toxic by inhalation)

● nitrous oxide (can affect centralnervous system at highconcentrations)

● solvents (various ill-healtheffects)

● radiographic chemicals(irritating to eyes and skin andpossibly respiratory system)

Most restorative and impressionmaterials and mouth rinses posenegligible risk so will not need to beincluded in your COSHH assessment.

When you assess the risks, youshould consider:

● how often it is used? Daily,weekly, monthly, quarterly orannually

● how much of the substance isused? Small amounts (grams ormillilitres) 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.

Decide what precautions are needed

If you decide that the substance doesnot present a risk or the risk istrivial, you do not need to doanything more. If you identifysignificant risks, you need to decidehow you can reduce the risk, forexample, by changing to a differentsubstance or procedure orimproving ventilation.

Record and review the assessment

Your COSHH assessment should be recorded and kept with anyrelevant material safety data sheets.It should be regarded as a 'living'document that any member of thedental team can refer to for workingsafely with hazardous substances.A comprehensive and well writtenCOSHH assessment is of little use ifstored in a drawer or on a shelf andstaff are unaware of the hazardoussubstances they work with and the

precautions they should take tominimise any risks.

You should review the assessment ifyou feel it is no longer valid or therehas been a significant change inwork activities or the substancesused. In any event, it should bereviewed at least every 5 years.

Ensure that precautions are followedand controls are maintained

Staff must receive suitable informationand training on the precautions forhandling and using hazardoussubstances and supervised wherenecessary. They should understandthe reasons for any control measuresthat are in place - such as wearingprotective gloves and eyewear andthe need for adequate ventilation.

Monitoring exposure

If your assessment shows that therecould be a serious risk to health from

© BDA June 2003

‘Decidehow you

can reducethe risk’


a substance harmful by inhalation orirritating to the eyes, skin andrespiratory system you shouldconsider air monitoring unlessventilation throughout the practice(either from natural or mechanicalventilation) is adequate.

Carry out appropriate healthsurveillance

Mercury is one of the mosthazardous substances that dentistsand their staff use on a regular basis.Biological monitoring of exposureto mercury is recommended toensure staff are not inadvertentlybeing overexposed. Above averagebiological levels of mercury mightindicate a failing in routine mercuryhygiene within the practice thatmight otherwise go undetected.

Ensure staff are properly informed,trained and supervised

Staff who work with hazardoussubstances should be provided withthe following information:

● the nature of the substances theywork with or are exposed to andthe associated risks

● the precautions they should takeand the control measures in place

● the importance of using anypersonal protective clothing orequipment provided

● the results of any exposuremonitoring and healthsurveillance

● emergency procedures (in theevent of exposure or a spillage,for example).

Flammable substances

Flammable substances are notnecessarily hazardous to health (theymay simply be flammable) but theyare obviously a risk to safety. Youneed to ensure that these substancespresent minimum risk:

● store and use flammablesubstances in a well ventilatedarea so that any vapours givenoff from a spill or leak will bedispersed rapidly

● avoid sources of ignition in areaswhere flammable substances arestored or handled. Ignitionsources include sparks fromelectrical equipment, cutting tools,hot surfaces, open flames fromheating equipment and cigarettes

● sunlight is a heat source - a glasswindow may intensify heat duringthe summer to a considerablyhigh temperature and this hasbeen known to cause aerosolcans to explode (includingdeodorant and hairspray cans)

● flammable substances should bestored in suitable containersaway from general work andstorage areas, especially if beingstored in large quantities.

Young people andwork experiencestudentsIf you employ a young person (aged below 18), agree to help withwork experience or take on a newemployee with no previousexperience of working in a dentalpractice, you will need to carry out a risk assessment to ensure theindividual is not put at risk and isaware of health and safety risksspecific to dentistry. It is importantthat these people receive adequateinformation, instruction and trainingand a high level of supervision by anexperienced person.

Your risk assessment should takeaccount of:

● the inexperience and immaturityof the individual

● their lack of awareness of risks to their health and safety

● their exposure to biological(infectious), chemical (such asmercury) or physical (such asradiation) agents.

Information and training

It can sometimes be hard to appreciatefully how little knowledge a young or inexperienced new employeemight have when they start work at your practice. For example, theymay be unaware of the risks of:

● infection from contact withblood and saliva or fromcontaminated sharp instruments

© BDA June 2003


● eye injury from flying debrisduring operative procedures

● exposure to mercury vapour orcontact with other hazardouschemical agents such asdisinfectants and x-ray chemicals

● possible allergic reactions to latexgloves

● scalds and burns (andexplosion!) from the autoclave.

Ideally, you should develop aninduction training programme for allnew employees to ensure thateveryone in the practice is aware ofthe health and safety arrangements(the health and safety policy is a goodstarting point), infection controlprocedures, radiation protocols and policies as well as training onother practice management issues(including confidentiality). Acompetent person within the practiceshould oversee the training and starta training log for the new employee.

Immunisation

Immunisation against the commoninfections is usually provided to youngpeople during their school years andit is worth checking that the usualvaccinations have been received.

Routine vaccination does not includeimmunisation against hepatitis B,however. Ideally, dental nursesshould be fully immunised againsthepatitis B and their immunityconfirmed before they start chairsideassisting but this is not alwayspracticable. If a new employee hasnot been immunised againsthepatitis B, arrangements forvaccination should be made as soonas possible upon employment, withthe first dose being administeredwithin the first month.

You need to protect againstinoculation injuries as far as possibleand your risk assessment shouldshow this. Personal protectiveclothing and equipment includinggloves and eyewear should beprovided from the start ofemployment and thicker heavy dutygloves provided for the manualcleaning of dental instruments, along

© BDA June 2003

‘Develop aninductiontraining

programmefor all newemployees’

with a protective apron and eyewearto shield against possible splashing.Resheathing of needles should notbe carried out, as this is aparticularly hazardous process.

New andexpectantmothers at workPregnancy should be regarded aspart of everyday life and not equatedwith ill health; its health and safetyimplications can be adequatelyaddressed by normal health andsafety management procedures.Many women work when pregnantand many return to work when theyare still breastfeeding. However,some hazards in the workplace mayaffect the health and safety of newand expectant mothers and that oftheir children. You need to be able toidentify these hazards and reduceany risks.

If you cannot avoid a risk by othermeans, you will need to makechanges to working conditions orhours, offer suitable alternative workor, if that is not possible, give theworker paid leave for as long asnecessary to protect her health orsafety or that of her child.

"New or expectant mother"means an employee who is pregnant,has given birth within the previous sixmonths, or is breastfeeding

In assessing risks to new orexpectant mothers you should takewhatever action is necessary toensure that they are not exposed toany significant risk. Risks includethose to the unborn child or child ofa woman who is still breastfeeding -not just risks to the mother herself.

Your risk assessment for new andexpectant mothers will follow the sameformat as your general risk assessment.Dental practices do not generallypose particular hazards for new andexpectant mothers but, depending onyour work practices and your riskassessment, you may decide thatcertain equipment, substances oractivities are best avoided duringpregnancy and/or breastfeeding.

Look for the hazards: Most of thehazards present in your dentalpractice that need to be consideredwill have been identified during yourroutine risk assessment but therecould be different risks depending on whether workers are pregnant,have recently given birth, or arebreastfeeding. You should takeparticular care to assess the following:

● biological agents (bacteria andother micro-organisms)

● chemical agents - for example,mercury and anaesthetic andsedation agents

● physical agents - for example,radiation, manual handling andrestricted posture


Avoid the risk: If your assessmentdoes reveal a risk you should explainwhat action you will take to preventexposure to the risk or control it sothat it is no longer a risk. If youidentify a significant risk to whichyou cannot prevent or controlexposure, then you must remove thenew or expectant mother from risk.You might offer suitable alternativework if any is available. If this is notpossible you must suspend her fromwork (paid leave) for as long asnecessary. This is really onlynecessary if the risk assessment givesrise to genuine concern. If there isany doubt, you may want to seekfurther advice on what the risks areand whether they arise from workbefore offering alternativeemployment or paid leave.

Review: You need to maintain yourawareness of the risks and measuresto prevent or control exposure forthe duration of pregnancy orbreastfeeding. There is no time limiton breastfeeding; it is for theindividual to decide for how longshe wants to breastfeed.

Aspects of pregnancy that mayaffect work

● morning sickness - could be aproblem if work demands anearly start

● backache - could be made worseby standing, manual handlingand posture

● varicose veins - could be affectedby standing or sitting

● frequent visits to the toilet -difficulty in leaving the surgeryor reception as often as required

● increasing size - implications for uniform provision, workingin confined areas and manualhandling

● tiredness - could be exacerbatedby overtime, finishing late orworking late shifts.

Frequently askedquestionsDo I need a COSHH assessment forevery substance used at the practice?

No. Assessments are only needed forhazardous substances. For bought-inproducts, an orange and blackhazard warning symbol will alertyou to a hazardous substance.

Do our portable appliances need tobe tested every six months?

No, but the law requires them to bein good working order at all times.A formal visual check by you oranother competent member of staffperhaps on an annual basis shouldbe sufficient. This should be followedup with an inspection by a qualifiedelectrician at least every three years.

Are filters for display screensmandatory to reduce radiation?

No. Screen filters need only be fittedwhere glare is a problem. Levels ofradiation emitted from displayscreens are well below safe levels.

I've done the risk assessment inaccordance with the guidance in thisadvice sheet but I'm worried it's notgood enough!

Your risk assessment must besuitable and sufficient - it does nothave to be perfect. You need to beable to show that a proper check was made, you considered whomight be affected, you dealt with all the obvious significant hazards,the precautions are reasonable andany remaining risk is low. A Healthand Safety Inspector will want to seethat the practice is run safely andthat staff are well informed of anyrisks and any precautions theyshould take, rather than a mountainof paperwork.

Risk assessmentchecklistYou might find the followingchecklist helpful when you areassessing the risks in your practice:

● Amalgam capsules have beenfound to leak during mixing,contaminating the immediatearea and/or the amalgamator.Check amalgamators from timeto time to ensure there are nomercury droplets present.

● Autoclaves and air receivers(compressors) must be regularlyserviced according to themanufacturer's recommendationsand inspected according to theWritten Scheme of Examination,which is drawn up by acompetent person. Have staffbeen properly trained in the safeuse of the autoclave(s)?

● Children should be taken intoaccount when assessing riskswithin the practice, for exampleaccess to hazardous substances,sharps containers etc.

© BDA June 2003

‘Staff arewell

informed ofany risks’


● COSHH: Anaesthetic agentssuch as nitrous oxide should be assessed

● COSHH: Biological agents suchas blood and saliva should beassessed. Is there a practiceinfection control policy in place?Have relevant staff beenimmunised against hepatitis Band their immune status checked?Do staff know what to do in theevent of an inoculation injury?

● COSHH: Hazardous substances.Have these been assessed and any significant risks eitherremoved or reduced? Haverelevant staff been informed ofthe risks and of any precautionsthey should take? Adequatecontrols should be in place foracids, adhesives, blood and saliva(biological agents), disinfectants,strong detergents and othercleaning agents, latex, mercury(bottled and encapsulated),nitrous oxide, solvents and x-raychemicals. The risk of latexallergy should be minimised byusing non-powdered gloves.Note: Where local exhaustventilation (LEV) is fitted to controlexposure to hazardous substances(ie in the x-ray developing area)this should be examined andtested at least every 14 months.

● COSHH: Legionella is morelikely to proliferate in thepresence of sludge, scale, rustand algae and when water is inthe temperature range of 20°C to45°C. Water contaminated bylegionellae only presents a riskwhen it is dispersed into the air in the form of an aerosol(very fine water droplets/spray).You can reduce the risk of algaecontaminating dental unitwaterlines by using a bottledwater system and following themanufacturer's recommendationson decontamination.

● Display screen equipment: Theworkstation and environmentshould be comfortable andsuitable for the individual userand there should be plannedbreaks or changes of activityfrom the screen and keyboard.If requested, eye tests should be

© BDA June 2003

‘Is there apracticeinfectioncontrolpolicy inplace?’

provided and spectaclesprovided if required for use withthe DSE.

● Electrical equipment should bein good working order at alltimes. User checks, formal visualinspection and combinedinspection and testing should be carried out at appropriateintervals. User checks are asimple visual check of theequipment and its cable and plugbefore use - whoever is using theequipment can do this. Acompetent member of staff cancarry out a more formal visualinspection on an annual basisprovided they have enoughknowledge and training. Earthedequipment should also have anoccasional combined inspectionand test by a qualified electrician.

● Emergency drugs andequipment should be held inevery practice. The DentalPractitioners’ Formularyprovides guidance on the variousemergencies that might occurand the drugs to hold at thepractice. Every dental practiceshould have available thefollowing equipment: portablesuction apparatus, oral airways,equipment with appropriateattachments to provideintermittent positive pressure

ventilation of the lungs and aportable source of oxygen.Where intravenous sedation isundertaken, a pulse oximeterand equipment for measuringblood pressure are required. Anynecessary reversal drugs shouldalso be immediately available.

● Ergonomic factors are importantin order to reduce the risk ofmusculo-skeletal discomfort/disorders. Back, neck, shoulderand other sprains or strains canbe caused by poor posture due tospace constraints, unsuitableseating or poor lighting. Seatingshould be suitable for theindividual and provide adequatesupport for the lower back.Twisted, stooped or stretchedpostures should be avoided.Check all staff are able to carryout their various dutiescomfortably. Advise staff toreport any possible work relatedsprains or strains to you as soonas they become apparent.

● Fire precautions for the practiceshould include fire detection/warning, escape routes (withadequate signposting), fire-fighting equipment and trainingof staff in fire safety. The firerisks should be assessed andincorporated into your main risk assessment.


● Fire certificates are required ifthere are more than 20 peopleemployed to work at any onetime, or more than 10 people areemployed to work at any one timeother than on the ground floor.

● First aid: Do you have anAppointed Person or a First Aideravailable on the premises at alltimes? Is there an appropriatelystocked first aid box?

● Infection control: You shouldhave an infection control policyin place.

● Information, instruction andtraining for all staff to enablethem to carry out their variousduties safely and without risk tothemselves or others.

● Ionising radiation: You shouldhave Local Rules for each x-raymachine, implemented by theRadiation Protection Supervisor.The Radiation ProtectionAdviser for the practice shouldhelp you carry out yourradiation risk assessment. Is x-ray equipment maintainedand checked as advised by themanufacturer and the RPA?

● Lasers: Class 3B and 4 laserspresent a risk of injury to theeyes and skin. Suitable eyeprotection should be available to all those at risk, including the patient. Lasers are a fire risk and should be kept awayfrom flammable materials and anaesthetic gases. A LaserProtection Adviser andSupervisor should be appointedand Local Rules drawn up.

● Lone workers may be at risk.Foreseeable risks should beassessed and addressed.

● Manual handling may behazardous. An assessment shouldensure hazardous manualhandling has been identified(particularly the lifting/carrying/assisting of unconscious, sedatedor disabled patients) andappropriate training provided.

● Personal protective equipment,gloves, eye protection and masks,

© BDA June 2003

must be suitable for its intendeduse. PPE is often recommendedwhen working with hazardoussubstances, for example heavy-duty gloves for use withdisinfectants and other cleaningproducts or radiographicchemicals.

● Pregnant and nursing mothersrequire an assessment of thepossible risks to their health or thehealth of the foetus or child. Theassessment should includeexposure to biological (infectious),chemical (eg mercury) orphysical (eg radiation) agents.

● Sharps instruments arehazardous and all staff must begiven training in their safe useand disposal. The necessaryaction in the event of aninoculation injury should also beprovided as part of the training.

● Slips, trips and falls can occurwhere there are uneven floors,trailing cables, slippery areas dueto spillages, including outdoorareas. These are the single mostcommon cause of injuries at work.

● Stress can occur in any area ofwork, including dentistry,especially where there is highpatient turnover and increasingdemands on staff. It is importantthat the practice works as a teamand that staff feel they can raiseissues relating to stressful working.

● Smoking: Practices must havearrangements in place to protectnon-smokers from thediscomfort caused by tobaccosmoke in rest rooms or areas.

● Vaccination against thecommon illnesses, andespecially against hepatitis B, isrecommended. Records ofimmunisations and responsesshould be maintained.

● Ventilation must be adequatewhere hazardous substances arein use - such as the x-raydeveloping area. Surgeriesshould also be adequatelyventilated to reduce the risk of infectionfrom aerosols generated duringpatient treatment.

● Violence can be a problem in any workplace and it is useful to have a policy in place to dealwith incidents. The policy shouldaddress verbal as well as physical abuse.

● Young people: Have risks toyoung people been assessed -including risks which could arisebecause of their lack of awareness,experience and training? Inparticular consider the risksinvolving exposure to biologicalagents (infection), hazardoussubstances (such as mercury andother chemicals) and physicalagents (such as radiation).

‘ It isimportantthat thepractice

works as ateam’


● Water regulations: Is the mainswater supply protected fromcontaminated (blood andsaliva) backflow from thepractice? This is usuallyachieved by an air gap.

● Work equipment needs to besuitable for its use and properlymaintained.

● Workplace premises andenvironment:

- Is the building or premises ingood repair?

- Are floors, corridors and stairsetc free of obstructions?

- Can windows be opened andcleaned safely?

- Is furniture with sharp cornerssited so as to avoid injury?

- Is the lighting good and suitablefor the various work being

carried out? - Are the floors and stairs clean

and not slippery? - Is the temperature reasonable -

at least 16°C? (Local heating orcooling may need to beprovided.)

- Is space sufficient for the workbeing done?

- Are there suitable clean toiletfacilities?

- Are there arrangements toprotect non-smokers fromtobacco smoke?

- Outside entrance and exit areasshould be checked for slip andtrip hazards, including hazardscreated by wet and/or icyweather conditions.

- Check also for 'surprise' stepsthat could cause falls and lowceilings and low door framesthat could bump heads.

© BDA June 2003


Significant hazards Those at risk Existing controls or action required

AutoclaveRisk of explosion, scalds and burns Dental nurse (and others in the ● staff receive full instruction and training in the safe use

immediate area) 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 WrittenScheme of Examination.

Biological agentsRisk of infection from - Dentist, dental nurse, ● biological agents are covered by COSHH -

● Blood/saliva hygienist, patient see separate assessment● Bacteria/micro-organisms ● universal precautions and current infection control

guidelines are followed -see practice infection control policy

● relevant staff are immunised against hepatitis B andtheir responses checked

● regular training in infection control procedures is provided

● see also Sharps.For action: Regular training and updates in infectioncontrol guidelines for all staff.

Display screen equipmentRisk 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).

ElectricalRisk of - All staff ● staff advised to visually check plugs, cables or equipment● electric shock or burns for signs of overheating or damage and report these ● fire from damaged equipment. to the practice manager for remedial action.

● visual inspection of all portable appliances is carriedout annually/six monthly by the practice owner [orother competent member of staff] and findings recorded

● all electrical equipment is inspected and tested by aqualified electrician at regular intervals (every threeyears suggested)

For action: Training for staff to include simple visualchecks of electrical equipment.

© BDA June 2003

Example risk assessmentThe 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 Those at risk Existing controls or action required.

Eye injuryRisk of - Dentist, dental nurse, ● use of protective eyewear during clinical procedures● flying debris and splatter from hygienist, patient for both staff and patients and when cleaning

rotary instruments instruments and equipment prior to sterilisation● splashing during the cleaning ● use of high speed aspiration for procedures involving

of instruments. 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 unitRisk of damage to the eye from blue Dentist, dental nurse, patient ● use of suitable protective eyewear or light shield (and white) light (red,orange or yellow)

● avoid prolonged or direct viewing

Fire All staff, patients and visitors. ● fire alarm system (if fitted) checked and testedannually by service engineer

● self-contained smoke alarms are cleaned andbatteries 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 inspectionsto ensure that fire precautions are followed andhousekeeping standards are maintained.

Hazardous substancesRisk of skin, eye and respiratory Dentist, dental nurse, hygienist, cleaner, ● Hazardous substances are covered by COSHH - tract irritation, asthma, allergy patient, visitors and contractors see separate assessmentand poisoning. ● staff made aware of the risks from the hazardous

substances they work with and the precautionsneeded to avoid or control these risks

● substances assessed include acids, adhesives, bloodand saliva, disinfectants, strong detergents and othercleaning agents, latex gloves, mercury, nitrous oxide,solvents and radiographic chemicals.

Manual handlingRisk of injury to back or other All staff involved in lifting and/or ● training and information provided including goodpart of the body. awkward or repetitive handling handling techniques and how to recognise harmful

(for example, stock deliveries, manual handlingassisting elderly and disabled patients ● information on manual handling techniques is available into and out of chair) (HSE leaflet) and kept [where]

For action: Annual review of manual handling techniquesto be undertaken (practice meeting).

© BDA June 2003


Radiation - ionisingRisk of accidental over-exposure Patient, dentist, dental nurse. ● Radiation Protection Adviser appointed -from x-ray equipment see separate risk assessment

● Radiation Protection Supervisor is on the premises at all times

● those involved in the taking and processing ofradiographs have received the appropriate trainingand possess the relevant knowledge

● x-ray equipment is regularly checked and maintainedin accordance with the manufacturer's, suppliers andRPA's advice

● arrangements for dealing with accidental or unintendeddose are contained in the Local Rules.

● x-ray equipment can be switched off in the event ofmalfunction without entering the controlled zone

● current guidelines on radiology standards arefollowed closely - see Guidance notes on the safe use of x-ray equipment (NRPB/DH, June 2001) and BDAAdvice Sheet Radiation in dentistry (A11).

SharpsRisk of infection from used needles, Dentists, dental nurses, hygienists, ● all staff trained in the safe use and disposal of sharps -instruments and spicules of teeth patients, waste contractors see practice policy on disposal of clinical wasteor bone. ● 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 inoculationinjuries

● if required, medical advice will be sought as soon aspossible.

For action: Regular updates on the procedures to be followedin the event of an inoculation injury (practice meeting).

Slips, trips and fallsRisk 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 DisposalRisk of exposure to infectious Staff and waste contractors. ● waste segregated and disposed of in appropriate or hazardous waste. containers - see practice policy on disposal of

clinical waste● waste collected for disposal by authorised waste

disposal company● records of disposal maintained.

Significant hazards Those at risk Existing controls or action required.

© BDA June 2003


Substance __________________________ Date __________

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

■■ Toxic by inhalation. Danger of cumulative effects

■■ 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

■■ Irritating to eyes, skin and respiratory system

■■ May cause sensitisation by skin contact

■■ Other ____________________________________________

How often is the substance used?

■■ Daily ■■ Weekly

■■ Monthly ■■ Quarterly or Annually

How much is being used? (On a daily etc basis)

■■ Small - ■■ Medium -

grams or millilitres kilograms or litres

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 ________________________________________

Risk - providing the substance is stored and handled as directed

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.

Example COSHH assessment form for individual chemical substances

© BDA June 2003

British Dental Association ● 64 Wimpole Street ● London W1G 8YS ● Tel: 020 7563 4563 ● Fax: 020 7487 5232

● E-mail: [email protected] ● © BDA June 2003

Documents

A5 Risk Assessment in Dentistry