HEALTH AND SAFETY AT WORK ACT (1974)

All NHS and private practices, their staff and patients are covered by the provisions of the Health and Safety at Work Act (1974), as is any other workplace. In addition, other legislation is relevant to the dental workplace due to the potentially harmful nature of the equipment and chemicals used, as well as the occupational hazards associated with delivering health treatment or working in the health environment.

The Health and Safety legislation seeks to protect staff and patients while on the premises by making the staff aware of any potential hazards at work and encouraging them to find the best ways of making their premises safer for all concerned. In legal terms, the employer has a statutory duty to ensure that, as far as is reasonably practicable, the health, safety, and welfare at work of all employees and all visitors (including patients) are considered at all times. To do this, all the ­potential hazards first need to be identified, and then the likelihood of them ­causing harm to anyone must be determined. The chance that a particular workplace hazard could cause harm to someone is known as its risk, and the correct procedure to be ­followed by the employer (and their staff) to identify those hazards that could cause harm is called a risk assessment.

Compliance with the Health and Safety at Work Act is overseen and regulated by the Health and Safety Executive (HSE). This is a government body that provides guidance to employers on the correct enforcement of the Act and investigates when any serious incidents occur in any ­workplace where someone suffers serious harm or is killed. Every health workplace is required to be registered with the HSE.

Compliance with the additional legislation specific to the dental workplace is also required by the General Dental Council, under its Standards for Dental Professionals documentation.

The recent HTM 01-05 is only the most recent document to re-emphasise that it is a legal requirement for all dentists in the UK to have a legionella risk assessment. The Risk assessment must cover both the domestic hot and cold water services within the practice as well as the dental unit waterlines and associated water-containing equipment.

To comply with the basic requirements of the Health and Safety at Work Act, every employer in the dental workplace must abide by the following requirements.

  • Provide a working environment for employees that is safe, without risks to health, and adequate with regard to facilities and arrangements for their welfare at work.

  • Maintain the place of work, including the means of access and exit, in a safe condition.

  • Provide and maintain safe equipment, appliances and systems of work.

  • Ensure all staff are trained in the safe handling and storage of any dangerous or potentially harmful items or substances.

  • Provide such instruction, training and supervision as is necessary to ensure health and safety.

  • Review the Health and Safety performance of all staff annually, be aware of and investigate any failures or concerns highlighted, when they occur.

  • Display the official Health and Safety poster for all staff to refer to (Figure 4.1).

Fig 4.1

To comply with these statutory obligations, all NHS and private practices must keep their staff informed of all the safety measures adopted. Practices with five or more employees must produce a comprehensive Health and Safety policy and provide all staff with a copy. The policy will classify the practice Health and Safety procedures and name the persons responsible. It should also list the telephone numbers of all NHS and private practices, administration and equipment maintenance contractors, the local HSE contact, and emergency services.

Fire Precaution (Workplace) Regulations 1999

The above regulations were updated by the Regulatory Reform (Fire Safety) Order, which became law in 2006. This stipulates that the employer/owner of the premises (the dental workplace) must take reasonable steps to reduce the risk from fire, and to make sure that people on the premises can escape safely if there is a fire. They therefore require the employer/owner to risk assess the fire precautions that are needed for their own work premises, as these will vary from one workplace to another; a ground floor practice will be considered less dangerous to staff and patients in the event of a fire than one that is in a multi-storey building, for instance.

A typical fire risk assessment should consider the following points, and in this order.

1. Identify the fire hazards on the premises – these will include flammable materials (liquids, vapours, textiles, paper products), heating appliances with naked flames, electrical equipment, static sparks from electrical equipment, flammable sedation gases, flammable rubbish.

2. Identify who may be harmed – anyone on the premises, paying special attention to children and vulnerable adults who may be attending, and where they may be on the premises.

3. Evaluate the risk of a fire occurring – the amount of various flammable materials on the premises, and where they are used or stored, the number of heating appliances and items of electrical equipment, any sedation gases, the amount of flammable rubbish at any time.

4. Control the risk by taking precautions – reduce the amount of flammable materials used where possible, and ensure they are stored away from heat sources, replace naked flame heat sources with safer alternatives (only likely exception will be portable burners used for denture work), ensure electrical appliances are properly serviced and maintained, use and store sedation gas cylinders away from heat sources, avoid storing flammable waste near heat sources, consider if current fire detection methods, fire-fighting equipment and evacuation procedures are adequate or not.

5. Record the risk assessment findings – in particular, record all findings and details of the actions taken to improve precautions, ensure all staff are notified of the findings and any new actions to be followed.

6. Review the risk assessment periodically – annually is adequate, recording the date of the review and whether any revisions were made or not.

A typical fire risk assessment should consider the following points, and in this order.

1. Identify the fire hazards on the premises – these will include flammable materials (liquids, vapours, textiles, paper products), heating appliances with naked flames, electrical equipment, static sparks from electrical equipment, flammable sedation gases, flammable rubbish.

2. Identify who may be harmed – anyone on the premises, paying special attention to children and vulnerable adults who may be attending, and where they may be on the premises.

3. Evaluate the risk of a fire occurring – the amount of various flammable materials on the premises, and where they are used or stored, the number of heating appliances and items of electrical equipment, any sedation gases, the amount of flammable rubbish at any time.

4. Control the risk by taking precautions – reduce the amount of flammable materials used where possible, and ensure they are stored away from heat sources, replace naked flame heat sources with safer alternatives (only likely exception will be portable burners used for denture work), ensure electrical appliances are properly serviced and maintained, use and store sedation gas cylinders away from heat sources, avoid storing flammable waste near heat sources, consider if current fire detection methods, fire-fighting equipment and evacuation procedures are adequate or not.

5. Record the risk assessment findings – in particular, record all findings and details of the actions taken to improve precautions, ensure all staff are notified of the findings and any new actions to be followed.

6. Review the risk assessment periodically – annually is adequate, recording the date of the review and whether any revisions were made or not.

All dental workplaces then undergo a fire safety inspection, so that the premises can be formally recorded as having carried out the necessary risk assessment. Although several companies provide the means for this to be carried out by post, a visit by a suitably qualified inspector from the Fire Brigade will hold more weight if a fire does occur and the practice is held to account for its level of compliance.

All dental workplaces then undergo a fire safety inspection, so that the premises can be formally recorded as having carried out the necessary risk assessment. Although several companies provide the means for this to be carried out by post, a visit by a suitably qualified inspector from the Fire Brigade will hold more weight if a fire does occur and the practice is held to account for its level of compliance.

The inspection will give advice with regard to the following.

• The number and positioning of smoke detectors.
• The number and positioning of fire extinguishers.
• Written records of staff training in the use of fire extinguishers.
• The types of fire extinguishers to be provided, with at least two types present in all workplaces.

Fire detection
The Regulatory Reform (Fire Safety) Order 2005 states that an electrical fire alarm system and/or an automatic detection system are only necessary on premises where these devices would be necessary to give warning in case of fire. The types of premises involved would be large workplaces, perhaps over several levels, where a fire breaking out in one area could go undetected by an ordinary smoke alarm or unnoticed by a person for some time. Hospital departments and health clinics are examples of places where these additional fire detection methods would be required.

In smaller workplaces (the majority of dental practices), a fire risk assessment should determine that adequate fire detection is provided by battery-operated smoke alarms around the premises (Figure 4.2). The local fire station, or the fire inspector, will give advice on the number required and their suitable locations at key points throughout the premises.

They should be tested on a regular basis to ensure they are functioning correctly, and a record kept of these test dates and results. Obviously, the battery should be changed as soon as it begins to fail, or the alarm changed if any malfunctions occur.

Fig 4.2

Fire detection
The Regulatory Reform (Fire Safety) Order 2005 states that an electrical fire alarm system and/or an automatic detection system are only necessary on premises where these devices would be necessary to give warning in case of fire. The types of premises involved would be large workplaces, perhaps over several levels, where a fire breaking out in one area could go undetected by an ordinary smoke alarm or unnoticed by a person for some time. Hospital departments and health clinics are examples of places where these additional fire detection methods would be required.

In smaller workplaces (the majority of dental practices), a fire risk assessment should determine that adequate fire detection is provided by battery-operated smoke alarms around the premises (Figure 4.2). The local fire station, or the fire inspector, will give advice on the number required and their suitable locations at key points throughout the premises.

They should be tested on a regular basis to ensure they are functioning correctly, and a record kept of these test dates and results. Obviously, the battery should be changed as soon as it begins to fail, or the alarm changed if any malfunctions occur.

Fig 4.2

Evacuation and escape routes

During the risk assessment process, consideration should be given to whether, in the event of a fire, all persons on the premises could leave safely and reach a place of safety. There should be no possibility of anyone being cut off from escaping from the premises by either smoke or flames.
In particular, the following areas of fire safety must be complied with.

• Escape routes must be kept free from all obstructions to allow immediate evacuation from the premises if necessary. Key-operated doors must be kept unlocked during normal working hours.

• Fire exits must lead directly to a place of safety, usually outside the building itself.

• They must be clearly marked by green ‘Fire Exit’ signs, with an accompanying pictogram of a running man (Figure 4.4).

• Emergency lighting should be provided if necessary – this applies to hospitals rather than individual practices and will have been identified during the fire risk assessment.

• Emergency doors should open manually in the direction of escape and should not be operated electrically.

• Sliding or revolving doors should not be used as fire exits.

• All staff must be aware of the fire safety and evacuation process, and the procedure for evacuation should be practised at least annually.

• In addition, some staff should be charged with certain actions during the evacuation procedure, such as checking certain areas are clear or closing certain doors to contain the fire.

Special consideration also needs to be given to the needs of disabled persons, and in small workplaces they should only be treated in ground-floor surgeries so that they can be easily evacuated

Fig 4.4

The culmination of the findings from the fire risk assessment will ultimately be the development of a written fire policy or an emergency plan. This is a legal requirement in workplaces with more than five employees and must be available to all employees and to the fire inspector. It should detail what action everyone on the premises should take in the event of a fire, and may be covered by a simple ‘Fire Action’ poster displayed in the reception area (Figure 4.5). Larger premises will be expected to provide more detail still, and a suitable emergency plan should cover the following points.

• Action to take in the event of a fire.
• Alarm warnings (klaxon, whistle, etc.).
• How to call rescue services.
• Evacuation arrangements, including details for disabled persons.
• Assembly point.
• Method of accounting for all persons (day list, for example).
• Key escape routes.
• Location and use of fire-fighting equipment.
• Responsibilities of nominated persons.
• Power shutdown methods.
• Staff training.

Fig 4.5

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