risk%20assessment%20advice%20sheets.pdf

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Advicesheet

A5Risk assessment in dentistry


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Advicesheet

Risk assessment in dentistry A5

Risk assessment in dental practice 3

Introduction 3 What is risk assessment? 3 What you need to do 3 Employees with disabilities 4

COSHH 5

What is a hazardous substance? 5 Your COSHH assessment 5 Flammable substances 7

Young people and work experience students 7

Information and training 8 Immunisation 8

New and expectant mothers at work 8

Aspects of pregnancy that may affect work 9

Frequently asked questions 9

Risk assessment checklist 10

Example risk assessment 13

Useful BDA resources 16

contents page

BDA September 2007 2

This advice sheet

describes your

obligations under

current health and

safety law to conduct a

suitable and sufficient

practice risk

assessment. Other

BDA publications will

be useful in helping you

comply with these

requirements. These

are referred to in the

relevant sections of the

advice sheet and are

listed on page 16.


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Risk assessment is a legal requirement for all employers and the self-employed. The

Health and Safety at Work etc Act 1974 (section 2) requires employers and the self-

employed 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 thatrequire 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 Reform Order 2006.

Employers with five or more employees must record the significant findings of their

assessment. Recording the findings of all risk assessments, irrespective of the number of

employees, is good practice and provides documentary evidence that the assessments

have been undertaken.

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.

If you are a small practice and 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 provide you with health and safety information - they have a legal obligation

to do so.

Decide who might be harmed and how

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 particularrisk

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.

Evaluate the risks and decide whether the existing precautions are adequate or

whether more should be done.

Risk

assessment

in dental

practice

What is risk

assessment?

What you

need to do


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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

immunisations), then the risk of infection will be minimised. As well as complying with

any legal 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:

a proper check was madeyou asked who might be affectedyou 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.

Keep the written record for future use; it can help you if the local primary care

organisation 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 - instruction manuals, health and safety policy statement, infection control

policy and practice rules, for example; these may already list hazards and precautions

and you are not expected to repeat this work. It is up to you whether you combine allthe documents, or keep them separately.

Review your assessment and revise it if necessary

At some point you may bring in new machinery, equipment, substances and procedures,

which could create new hazards. Remember to amend your risk assessment if there is a

significant change and new potential hazard. Review your assessment from time to time

to ensure that the precautions are still working effectively and remind staff of the

assessments on a yearly basis at a practice meeting.

When carrying out your risk assessment, pay particular attention to employees with

disabilities; you have responsibilities under the Disability Discrimination Act and health andsafety 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 was considered in your risk assessment. Involve the employee in

the assessment, consulting on the extent of the disability and the implications it might

have on their safety at work.


Employees with

disabilities


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The Control of Substances Hazardous to Health Regulations protect workers 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!

Where preventing exposure is not reasonably practicable, it must be adequately

controlled by:

changing the process or activity to remove the need for the hazardous substance orprevent it from being generated

replace the substance with a safer alternative use it in a safer form.

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:

The label states how the substance is toxic, harmful, corrosive or irritant - irritating toeyes and skin, 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 work activities - blood borne

viruses are common in dentistry

any kind of dust in a significant amount

any other substance classed as hazardous (latex, for example).

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:

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 (maybe harmful and/orirritant)

COSHH

What is a

hazardous

substance?

corrosive harmful

irritant toxic

Your COSSH

assessment


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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)

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, orswallowing, for example

who could be affected? Staff, patients, visitors, contractors.

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.

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 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. Everyone working at the

practice should be reminded of its contents on an annual basis.

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 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

Encapsulated amalgam capsules should be used in preference to combining mercury

and alloy from reservoirs in an amalgamator. Where bottled mercury is used, biological

monitoring of exposure is recommended to help ensure that staff do not exceed safe

limits. An above average biological level of mercury might indicate a failing in routine

mercury hygiene within the practice (a mercury spill, for example) that might otherwise

go undetected.



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Ensure staff are properly informed, trained and supervised

Staff who work with hazardous substances should be provided with the following

information:

the nature of the substances they work with or are exposed to and the associatedrisks

the precautions they should take and the control measures in place

the importance of using any personal protective clothing or equipment providedthe results of any exposure monitoring and health surveillance emergency procedures (in the event of exposure or a spillage, for example).

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 vapoursgiven 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 aconsiderably high temperature, which has been known to cause aerosol cans to

explode (including deodorant and hairspray cans)

flammable substances should be stored in suitable containers away from generalwork and storage areas, especially if being stored in large quantities.

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:

the inexperience and immaturity of the individualtheir lack of awareness of risks to their health and safetytheir exposure to biological (infectious), chemical (such as mercury) or physical (such

as radiation) agents.

For work experience students (under 16 years) you must also:

inform the parents/guardians of the key findings of the risk assessment and thecontrol measures you have introduced before the young person starts work

experience

Do check that your employer's liability insurance covers work experience students or

whether additional insurance is needed.

Flammable

substances

Young

people

and work

experience

students


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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 sharpinstruments

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

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 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.

You need to protect against inoculation injuries as far as possible and your risk

assessment should show this. Personal protective clothing and equipment includinggloves and eyewear should be provided from the start of employment and thicker

heavy duty gloves provided for the manual cleaning of dental instruments, along with a

protective apron and eyewear to shield against possible splashing. Re-sheathing of

needles is a particularly hazardous process and should not be carried out.

Further guidance on hepatitis B immunisation and a model risk assessment is available

in the BDA Advice note Hepatitis B immunisation (37).

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 return towork when they are still breastfeeding. Some hazards in the workplace, however, 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


Information

and training

Immunisation

New and

expectantmothers atwork


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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

Avoid the risk

If your assessment reveals 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, you must remove the

new or expectant mother from risk and offer suitable alternative work if any is

available. If not, you must suspend her from work (paid leave) for as long as necessary.

This is really only required 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.

morning sickness could be a problem if work demands an early start backache could be made worse by standing, manual handling and posturevaricoses veins and may be affected by standing or sitting frequent visits to the toilet may be a problem if there is difficulty in leaving the

surgery or reception as often as required

increasing size may have implications for uniform provision, working in confinedareas and manual handling

tiredness could be exacerbated by overtime, finishing late or working late shifts.

Detailed guidance on pregnancy, risk assessments and the law is available in the BDA

Advice note New and Expectant Mothers at Work (40).

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 electrical 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 shouldbe sufficient. This should be followed up with an inspection by a qualified electrician at

least every three years.

Aspects of

pregnancy that

may affect work

Frequentlyaskedquestions


10/16

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 beaffected, 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.

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

practice:

Amalgam capsules have been found to leak during mixing, contaminating theimmediate 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 accordingto 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, forexample access to hazardous substances, sharps containers etc.

COSHH: Anaesthetic agents such as nitrous oxide should be assessed

COSHH: Biological agents such as blood and saliva should be assessed. Is there apractice infection control policy in place? Have relevant staff been immunised againsthepatitis 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 significantrisks 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 hazardoussubstances (ie in the x-ray developing area) it 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 becomfortable and suitable for the individual user and there should be planned breaksor 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.


Riskassessment

checklist


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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.

Ergonomic factors are important in order to reduce the risk of musculo-skeletaldiscomfort/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, escaperoutes (with adequate signposting), fire fighting equipment and training of staff in

fire safety. The fire risks should be assessed and incorporated into your main risk

assessment.

First aid: Do you have an Appointed Person or a First Aider available on thepremises 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 outtheir various duties safely and without risk to themselves or others.

Ionising radiation:You should have Local Rules for each x-ray machine, implementedby the Radiation Protection Supervisor. The Radiation Protection Adviser for thepractice 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. Suitableeye 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 hazardousmanual 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 besuitable 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.

Pregnant and nursing mothers require an assessment of the possible risks totheir health or the health of the foetus or child. The assessment should include

exposure to biological (infectious), chemical (eg mercury/dental amalgam) or

physical (eg radiation) agents.


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Sharps instruments are hazardous and all staff must be given training in their safeuse and disposal. What to do in the event of an inoculation injury should

also be included 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 ishigh 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.

Vaccination against the common illnesses, and especially against hepatitis B, isrecommended. Records of immunisations and responses should be maintained.

Ventilation must be adequate where hazardous substances are in use - such as thex-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 placeto deal with incidents. The policy should address verbal as well as physical abuse.

Young people: Have risks to young people been assessed - including risks whichcould 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).

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 activities being carried out?

- Are the floors and stairs clean and not slippery?

- Is the temperature reasonable - at least 16C? (Local heating or cooling mayneed 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.



13/16


A risk assessment of the practice was carried out on 1 February 2007 by the practice

owner and the following are the significant findings.

A review of the risk assessment is due on 1 February 2008

Example riskassessment

Significant hazards Those at risk Existing controls or action

required

Autoclave

Risk of explosion, scalds and burns Dental nurse (and others in the staff receive full instructionimmediate area) and training in the safe use of

autoclaves manufacturers' instructions and

operating procedures are keptnearby the autoclave

malfunctions or faults are reportedto the practice manager for

remedial action autoclaves are serviced regularly

and inspected for safety purposes inaccordance with the Written

Scheme of Examination.

Biological agents Dentist, dental nurse, hygienist, biological agents are covered by

Risk of infection from - patient COSHH -see separate assessment

Blood/saliva universal precautions and current

Bacteria/micro-organisms infection control guidelines arefollowed -see practice infectioncontrol policy

relevant staff are immuised against

hepatitis B and their responseschecked

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 Receptionist / practice manager individual workstation assessments

undertaken for regular users -see

separate asessments

equipment and seating can beadjusted to individual needs

eye test is provided if requested byemployee

window blind is provided to controlglare 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 All staff staff advised to visually check plugs,Risk of - cables or equipment for signs of

electric shock or burns overheating or damage and report fire from damaged equipment. these to the practice manager for

remedial action. visual inspection of all portable

appliances is carried out annually/sixmonthly by the practice owner[orother competent member of staff]

and findings recorded


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all electrical equipment is inspected

and tested by a qualified electricianat regular intervals (every three

years suggested)

For action: Training for staff to include

simple visual checks of electrical

equipment.

Eye injury Dentist, dental nurse, hygienist, use of protective eyewearRisk of - patient during clinical procedures for both

flying debris and splatter from staff and patients and when cleaningrotary instruments instruments and equipment prior

splashing during the cleaning of to sterilisationinstruments. use of high speed aspiration for

procedures involving rotaryinstruments

use of rubber dam wheneverpossible 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 Dentist, dental nurse, patient use of suitable protective eyewearRisk of damage to the eye from blue or light shield (red, orange or yellow)

(and white) light avoid prolonged or direct viewing

Fire All staff, patients and visitors. fire alarm system (if fitted) checked

and tested annually by serviceengineer

self-contained smoke alarms arecleaned and batteries changed

annually staff trained in the evacuation

procedure

fire fighting equipment is checkedand tested annually by serviceengineer

fire exits and fire-fightingequipment 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 tobe during patient time)

procedures to be followed in theevent 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 Dentist, dental nurse, hygienist, Hazardous substances are covered

Risk of skin, eye and respiratory tract cleaner, patient, visitors and by COSHH - see separate assessment

irritation, asthma, allergy and contractors staff made aware of the risks frompoisoning the hazardous substances they

work with and the precautionsneeded 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.


15/16


Manual handling All staff involved in lifting and/or a training and information provided

Risk of injury to back or other part awkward or repetitive handling including good handling techniquesof the body (for example, stock deliveries, and how to recognise harmful

assisting elderly and disabled manual handlingpatients into and out of chair). 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).

Radiation - ionising Patient, dentist, dental nurse. Radiation Protection AdviserRisk of accidental over-exposure appointed - see separate risk

from x-ray equipment assessment Radiation Protection Supervisor is

on the premises at all times those involved in the taking and

processing of radiographs havereceived the appropriate training

and possess the relevant knowledge

x-ray equipment is regularly checkedand maintained in accordance withthe manufacturer's, suppliers and

RPA's advice arrangements for dealing with

accidental or unintended doses arecontained in the Local Rules.

x-ray equipment can be switched offin the event of malfunction withoutentering the controlled zone

current guidelines on radiologystandards are followed closely - seeGuidance notes on the safe use of

x-ray equipment (NRPB/DH, June2001) and BDA Advice SheetRadiation in dentistry (A11).

Sharps Dentists, dental nurses, hygienists, all staff trained in the safe use andRisk of infection from used needles, patients, waste contractors disposal of sharps -see practice

instruments and spicules of teeth or policy on disposal of clinical waste

bone thick household type gloves provided

for handling and cleaning usedinstruments prior to sterilisation

needles are only re-sheathed usinga device

sharps are discarded into anapproved container

all staff are immunised againsthepatitis B and their response to

the vaccine checked sharps injuries are reported

immediately and dealt with asappropriate -see practice policy oninoculation injuries

if required, medical advice will besought as soon as possible.

For action: Regular updates on the

procedures to be followed in the

event of an inoculation injury (practice

meeting).


16/16

Slips, trips and falls Staff, patients and visitors. good quality flooring, which is well

Risk of injury. maintained all staff trained to maintain good

housekeeping standards spills cleared up immediately

walk areas kept unobstructed.

Waste Disposal Staff and waste contractors. waste segregated and disposed ofRisk of exposure to infectious or in appropriate containers - see

hazardous waste. practice policy on disposal ofhealthcare waste

waste collected for disposal byauthorised waste disposal company

records of disposal maintained.

Advice Sheets:

Health & Safety Law for Dental Practice (A3) Radiation in Dentistry (A11) Infection Control in Dentistry (A12)

Advice Notes:

BDA Advice Notes have been produced on topics where a specific assessment needs

to be made and more detailed guidance is necessary. These contain model assessments

and are available on the BDA website. They include:

COSHH (58)

Fire precautions and Fire Risk Assessment (88)

Hepatitis B Immunisation (37) Laser Registration with the Healthcare Commission (12) New and Expectant Mothers at Work (40)Work Experience Students and Young Trainees (59)

The following models are included in the BDA 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

Useful BDA

Resources

British Dental Association

64 Wimpole Street London W1G 8YS Tel: 020 7563 4563 Fax: 020 7487 5232

E-mail: [email protected] www.bda.org BDA September 2007

Documents

risk%20assessment%20advice%20sheets.pdf