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Health and Safety Executive


Health and Safety in General Practice

Monica Smith & Matthew Hamar Health and Social Care Service Unit

Wednesday 6th February 2013

Presentation to cover

• A brief description of the HSWA, its provisions and powers

• HSE’s role in health and social care

• How HSE work with other regulators in health and social care

• Common health and safety risks in primary care

As applied to employers

As applied to premises

Background to HSWA:

• Been regulating worker h&s since 1833 • Health and social care sectors since 1975 • Health and Safety at Work etc Act 1974 secure the health, safety and welfare of

persons at work; protect other persons from risks to their

health and safety arising out of work activities / the conduct of an undertaking. overlap

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Presentation Notes

We have been regulating a very long time Overlap in legislation – potential overlap with other regulators

Architecture of HSWA:

• Complementary duties on a range of people - covering all aspects of work:

principal duties on employers

also responsibilities on individuals – directors, managers and employees

duties on those in control of premises

duties on those that supply articles and substances for use at work

• So, Overlap with Health and Social Care Act.

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Presentation Notes

Very comprehensive

HSWA – main provisions relevant to employee and service user safety

• Section 2

• Section 3

• Section 7

• Section 36

• Section 37

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Presentation Notes

Section 2 of the Act deals with employee safety. Section 3 places general duties on employers and the self employed to conduct their undertakings in such a way as to ensure, so far as is reasonably practicable, that persons other than themselves or their employees are not exposed to risks to their health or safety. The maximum penalty for these offences is an unlimited fine. Current Sentencing Guidelines issued by the Sentencing Council suggests that where the offence is shown to have caused death, the appropriate fine will seldom be less than £100,000 and may be measured in hundreds of thousands of pounds or more. Section 7 places a duty on employees to take reasonable care for themselves and others who may be affected by their acts or omissions at work. Section 36 – other person can be charged - if you get a consultant in, important to ensure that they are competent – if they cause you to be breach, they can be in breach 10Section 37 provides that where an offence is committed with the consent or connivance of a director, manager, secretary or other similar officer of an employer such as a social care provider, or where it is committed due to their neglect, they are liable to prosecution. As for section 7, maximum penalties provide for up to two years imprisonment, and / or unlimited fines.

Operational role/powers of inspectors

• HSE/LA inspectors can enter any work premises • Take measurements, photographs, samples etc • Direct that premises be left undisturbed / articles

dismantled or tested • Take possession of articles / substances • Require any person to give any information • Inspect and take copies of documents • Seize/render harmless dangerous articles

/substances

• any other power which is necessary

Powers – Service of Notices

• Improvement Notices – Served - if - inspector - of the opinion that there has been a contravention

• Prohibition Notices – Served - if - inspector of the opinion that activities involve risk of serious personal injury – two types – immediate and deferred –

• Failure to comply – prosecution – offences are triable either way.

Health and safety – Offences and penalties

• Most offences – triable either way

• Summary conviction - £20,000 in Magistrates Court

• On indictment – unlimited fines and up to two years imprisonment

• Issue for future debate – which sanctions to use – HSE’s or other regulators?

Good Health and Safety Good for Everyone

• Ministerial statement of 21/3/11

• Register of Occupational Safety and Health Consultants

• New Health and Safety Framework

• Making Health and Safety Simpler

• Review of Health and Safety Regulation (Lofstedt)

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Our strategic aims To maximise benefit for patients, service users and employees, whilst minimising burdens by: Working with relevant stakeholders – the movers and shakers - to set and improve standards Avoiding overlap with other regulators Focussing on key areas - and where we can make a real difference

HSE’s role in health and social care

• Well established role re employee safety

• Also have a role in service user safety

• Currently often the ‘regulator of last resort’

• Need to restrict our involvement in service user safety

• But first – what takes us into health and social care regulation?

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Need to restrict number of cases – only get involved in most serious cases / fata

HSE’s role in health and social care (cont’d)

• Important for us – because of numbers employed and consequent impact any reduction in injuries/cases of ill-health can have on GB-wide health and safety performance;

• Looking for new levers to exert influence

• Keen to work collaboratively with CQC - and other regulators / stakeholders

Role of Health and Social Care Services Unit

• Develop and set policy

• Advise on health and safety matters related to health and social care in GB

• Provide advice to operational colleagues

• Produce guidance

• Work with stakeholders in England, Scotland and Wales

• Respond to relevant consultations

• Contact on [email protected]

mailto:[email protected]

Working with other regulators

• Health and social care are devolved matters and there are different regulators in England, Scotland and Wales

• Currently, HSE has working arrangements in place with – CQC – GMC – MHRA – Health Improvement Scotland – Care Inspectorate in Scotland

• Further information is available at http://www.hse.gov.uk/healthservices/arrangements.htm

http://www.hse.gov.uk/healthservices/arrangements.htm

Traditional areas for investigation and inspection: • Falling from windows/ stairs / from height

• Slip / trip / estate hazards generally

• Being burnt on hot surfaces like radiators

• Being scalded by hot water in baths

• Being trapped in bed rails

• Being lifted/moved in an unsafe manner

• Exposure to infections e.g. legionella

• Care or safety issues? Overlap….

All have common characteristics

• They affect both patients / service users and employees

• Work with other stakeholders to agree, set, implement and monitor standards is essential

• We will only make a significant difference with a strategic, co-ordinated, collaborative approach

• Commissioning is relevant to them all and is important to the commissioning board, HSE and LAs

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Monitoring standards to ensure that all is clear about what they each need to do

Commissioning • The legal duties – Section 3 HSWA

• Social care is important, but so also is primary and secondary care

• Guidance is vital – seeking a proportionate approach to the commissioner’s duties: burdens vs. benefits

• Joint work with others is essential - CB

• Linked work on community equipment supply and direct payments

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Are any of you involved in CCGs? HSE shortly to consult on a HLS about commissioning Section 3 of HSWA applies – if placing a vulnerable person in a care home, important to check that the care home does not introduce health and safety risks

Common health and safety issues in primary care settings

• Employer duties and responsibilities – To assess and control real risks – To report serious injuries / diseases – http://www.hse.gov.uk/healthservices/ri

ddor.htm

• Premises

http://www.hse.gov.uk/healthservices/riddor.htm

http://www.hse.gov.uk/healthservices/riddor.htm

Risk assessment

• To also cover balance and proportionality

• Sensible risk management concentrating on real risks likely to cause harm

• 5 steps of risk assessment

http://www.hse.gov.uk/risk/index.htm

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Identify the hazards Decide who might be harmed and how Evaluate the risks and decide on precaution Record your findings and implement them Review your assessment and update if necessary Don’t overcomplicate the process. In many organisations, the risks are well known and the necessary control measures are easy to apply. You probably already know whether, for example, you have employees who move heavy loads and so could harm their backs, or where people are most likely to slip or trip. If so, check that you have taken reasonable precautions to avoid injury. If you run a small organisation and you are confident you understand what’s involved, you can do the assessment yourself. You don’t have to be a health and safety expert.

http://www.hse.gov.uk/risk/index.htm

Tackling work-related stress

The truth about work-related stress

• No one definition but plenty of Google entries!

• HSE defines work-related stress as:

• “…the adverse reaction people have to excessive pressure or other types of demand placed on them.”

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Mult-ifactorial – home life / work life

What does it mean for business?

• Increased sickness absence

• One case can lead to an average of 21 days off work

• Poor productivity

• Staff not working to their full potential

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Presentation Notes

Stress is a major cause of occupational ill health, poor productivity and human error. That means increased sickness absence, people off work for a long time, high staff turnover and poor performance in your organisation. And there are studies that link stress to an increase in accidents. To put it simply, managing the causes of work-related stress and minimising its impact makes good business sense.

So what can you do?

As stress remains a big problem • Line manager competency – the first line of defence

http://preventingstress.hse.gov.uk/content/Home.aspx • Management Standards – tell us about your experiences

Research has identified 4 areas of manager behaviour that are effective in managing stress

RESPECTFUL AND RESPONSIBLE: MANAGING EMOTIONS AND HAVING INTEGRITY

MANAGING AND COMMUNICATING EXISTING AND FUTURE WORK

MANAGING THE INDIVIDUAL WITHIN THE TEAM REASONING/MANAGING DIFFICULT SITUATIONS

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In GP practice its about common sense and relational communiation The Management Standards are designed to: - Help simplify risk assessment for stress - Encourage partnership working - Allow benchmarking against other organisations

http://preventingstress.hse.gov.uk/content/Home.aspx

COSHH

• Guidance on good control practice • Practical, plain English, no technical

terms • Step-by-step risk assessment • Provides solutions – identifies adequate

controls • Tells you when expert help is needed • COSHH Essentials –

http://www.coshh-essentials.org.uk/

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Presentation Notes

Common sense – are there real risks, what are the control measures,

Infection control

Control of infection is an important consideration throughout the healthcare environment. There may be the potential for exposure to a range of human pathogens with the consequent risk of harm or disease.

The COSHH also applies to infections at work. This means that the general requirements of COSHH, i.e. risk assessment and prevention or control of exposure will apply in all primary care settings.

Infection control

All practices should have an infection control policy that addresses such issues as:

• education and training of staff in infection control issues; • protocols on hand washing; • aseptic procedures; • good sanitation - disinfection and decontamination including

domestic cleaning; • ill-health reporting and recording; • monitoring, surveillance and audit; • prevention of exposure to blood-borne viruses, including

prevention of sharps injuries and immunisation policies for at risk staff;

• use of personal protective equipment including powder-free latex gloves;

• generation, collection and disposal of clinical waste.

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Presentation Notes

Should magazines be banned in Magazines can help reduce the stress sometimes suffered by patients waiting for an appointment and there are no current infection control or health and safety reasons for banning them. Similar considerations apply to the provision of toys that can be easily cleaned. Should magazines or toys be banned be banned from waiting rooms Magazines that are visibly soiled should be removed. Toys should be selected with ease of cleaning in mind i.e. they should have hard surfaces that can be washed or disinfected, as per the healthcare facility’s decontamination policy. They should be cleaned on a regular basis, and should be decontaminated if visibly soiled with blood or other body fluid. Soft toys should not be used, because of the difficulty of decontamination. This overall approach should be reviewed, in exceptional circumstances, in line with national guidance (for example specific advice should be sought and followed in the event of a pandemic influenza outbreak). HSE recognises that other regulators, including the Care Quality Commission, Healthcare Inspectorate Wales and the Healthcare Environment Inspectorate, have an important role in patient care and safety. We are grateful for their help and support in providing this answer.

Glove Selection

Employers should carefully consider the risks when selecting gloves for use in healthcare.

Latex proteins which can be found in single use gloves can have the potential to cause asthma and dermatitis.

You must assess the risks when selecting gloves for use in the workplace. This is required to decide on the most suitable glove type, eg, single use or reusable and material they are manufactured from.

You should consider the following: • Decide whether or not protective gloves are required at

all? • If required, they must be suitable. This means they provide

adequate protection against the hazard.

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Presentation Notes

Key message – don’t use powdered latex gloves!!

Glove Selection

• To ensure suitability, consider: – the work, substances handled, other hazards, type and

duration of contact. – the wearer, comfort and fit – the task, i.e need for dexterity, sterility issues.

• If the assessment leads to latex as the most suitable glove type for protection against the hazard, then: – Single use latex gloves should be low protein, powder free – Staff with existing allergies to latex proteins should be

provided with alternatives – Consider the risks to others, i.e patients.

• Remember, if latex gloves are used in the workplace, suitable health surveillance must be in place – a low level is likely to be sufficient.

• Further info: www.hse.gov.uk/skin/employ/latex-gloves.htm

http://www.hse.gov.uk/skin/employ/latex-gloves.htm

Dermatitis

Dermatitis – caused by contact with something that irritates the skin, i.e. latex proteins and wet work.

2008/09 inspection if Acute NHS organisations (40) by HSE OH inspectors.

Highlights from report (or low lights): • 91% unable to identify actual incidence of skin problems • 70% had flawed systems for reporting diagnoses cases under

RIDDOR • 46% of staff questioned had problems with their skin • Only 34% of trusts provided information and training on hand

washing and alcohol gels. However training on signs and symptoms, prevention and control was not included.

HSE will be publishing an updated report for 2010/12 later this year. Further info: www.hse.gov.uk/healthservices /dermatitis.htm

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Presentation Notes

Important to report in accordance with Riddor

http://www.hss.gov.uk/healthservices /dermatitis.htm

Prevention of sharps injuries in healthcare sector

The current picture • Estimate

– 1.7 million workers in healthcare – Over 30,000 employers/contractors

• Needlestick injuries: – Estimates around 100,000 annual – 2010 Care Quality Commission survey of NHS staff -

2% reported that they had suffered a needlestick injury in the previous 12 month period

– HPA ‘Eye of the needle report’ • HSL “Systematic Review – An evaluation of the efficacy of

safer sharps devices,” 2011 (RR914) • HSE - 22 NHS Trusts/Boards review of management of the

risks of exposure to employees from blood borne viruses (BBV) as a consequence of sharps injuries

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How many of you have had a sharps injury? Are you aware of needlestick injuries in practice? Only reportable if its been contaminated by known

European Directive on Sharps in the Hospital and Healthcare sector

• Council Directive 2010/32/EU implementing the Framework Agreement on prevention of sharp injuries in the hospital and healthcare sector between HOSPEEM and EPSU

• Must be implemented by 11 May 2013

• Based on a social partner agreement (European healthcare employer (HOSPEEM) and trade union (EPSU) bodies)

• Proposed new GB Regulations: The Health and Safety (Sharp Instruments in Healthcare) Regulations 2012

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So why are we introducing new Regulations on sharps in healthcare? By May 2013 must transpose the 2010 European Directive. This Directive implements a social partner agreement between HOSPEEM (the European Healthcare employers) and EPSU (the European healthcare TUs). Government guidelines to all departments, in particular, require that we: Endeavour to make sure that UK Regulations do not put UK businesses at a competitive disadvantage compared to other EU countries. For example, we cannot just add the new requirements on top of existing requirements if this would create more regulation in the UK. Copy out the wording of the Directive, if possible. Implement on the latest date allowed for in the Directive. there are already existing requirements for employers to carry out risk assessments for work involving medical sharps. In relation to sharps, healthcare employers will want to look at their own accident history, the evidence in the ‘Eye of the needle’ report on the highest risk occupations and activities, any guidance issued by NHS or other organisations. The risk assessment should be carried out in consultation with the staff who will be doing the work and may also involve competent advice (for example, from OH).

The Sharps Regulations What are sharps?

• Medical instruments or other objects that are necessary for carrying out healthcare work and could cause an injury by cutting or pricking the skin.

• Not kitchen knives

• Includes clean as well as used sharps

The Sharps Regulations Who will they apply to?

Employers with duties: • Employers whose primary work activity is the

management, organisation or provision of healthcare

• Contractors to healthcare employers whose employees will be exposed to risks from sharps

Workers who will be protected: • Agency or bank workers • Students who carry out work involving risks of

sharps injury • Employees of healthcare organisations working

in a patient’s home or elsewhere

Presenter

Presentation Notes

The Regulations will only apply in the hospital and healthcare sector, as specified in the Directive. This includes contractors who work for healthcare employers where their workers will also be at risk of injury from sharp, for example cleaners, laundry and waste collection services. I have covered a couple of examples of the types of employees whose employers will be required to take action on these Regulations.

Regulation 4 Use and disposal of sharps

• ‘New’ risk control measures – Avoid use of medical sharps SFARP. – Use of sharps incorporating safety

mechanisms (safer sharps) – Medical sharps are not capped after use; and

where recapping is unavoidable, use safety devices to prevent injuries

– Place clearly marked, secure sharps containers close to the area where they are used

• Review these procedures regularly to ensure effectiveness

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Presentation Notes

So what will the regulations require?: WHEN CARRYING OUT THE RISK ASSESSMENT YOU SHOULD BE BEARING IN MIND THAT: Where it is reasonably practical to do so ‘safer sharps’ must be used. Recapping should be avoided. However, in some limited circumstances recapping is an important aspect of work, and where it is unavoidable safety equipment must be provided to prevent injury. Sharps disposal boxes and instructions for their use must be located as close to the area where sharps are used as practical. The Regulations require that procedures are reviewed. New safer devices are becoming available all the time. As more healthcare employers look at the work they do with sharps and explore how it could be done safely we can also expect more solutions to become available. The overall aim must be to select the right equipment for the job and a method of work that will in practice reduce the risks of injury. Trusts that have introduced safer sharps tell us about examples of changes that they described as ‘no brainers’. Of course there are also tasks where finding an appropriate safe working method involved consideration of options. So this is not about overnight change on 11 May 2013 or one solution fits all.

Regulation 5 Information and training

• Provide information on: – the risks from medical sharps, – relevant legal duties on employers and workers, – good practice in preventing injury, – support available to an injured person, and – the benefits and drawbacks of vaccination.

• Work with safety representatives in developing and promoting this information

• Provide training on: – the correct use of safer sharps, – safe use and disposal of medical sharps, and – what to do in the event of a sharps injury

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Presentation Notes

The Regulations will also require that employers provide the following information. This information will need to be given to all employees who may be at risk of a sharps injury – so will include staff who may encounter an inappropriately discarded sharp. Information can be provided in written form, posters, or via electronic media. The Directive specifically requires that awareness raising materials are developed with safety representatives, so we have (at this stage) included this requirement.

Regulation 6 Arrangements in the event of injury

• In the event of a sharps injury – The employer must:

• make a record • investigate the circumstances and causes, and • take any action required

• Follow-up of a sharps injury: – where the injury involves a potential risk of infection

• provide medical treatment, including post-exposure prophylaxis (if advised by a doctor)

• consider whether counselling is appropriate • NB - the training they provide must cover the above

procedures

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Presentation Notes

There are new requirements in the Regulations that follow on from a sharps injury. The employer must make a record of the injury, investigate the circumstances and causes and take any action that they find is necessary. In order to make sure that this happens in practice, the employer must provide training on the procedures for reporting (as I just mentioned). Finally, where an injury has occurred and there may be a risk of infection, the employer must provide medical treatment, including PEP (if a doctor advises). They should also consider whether counselling is appropriate. Again the training provided by the employer must set out the arrangements they have made in order to ensure that this advice and treatment will be available in the event of an injury.

Regulation 7 Notification of injuries

• The employee or other person who receives a sharps injury must, as soon as practicable notify their employer.

• The employee when requested by the employee must provide sufficient information as to the circumstances of the incident to enable the employer to comply with regulation 6.

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What next Prepare Regulations for Parliamentary scrutiny Produce HSE guidance (for March 2013) Work with partners to raise awareness and promote improved control of risk from sharps in the hospital and healthcare sector Regulations in force 11 May 2013 So the next few months will be very busy. We are preparing HSE guidance for publication in March 2013. We want to work with partners to raise awareness of the changes.

Lone Working

• Staff at risk from violent and aggressive behaviour – 4 times more likely in health.

• 3rd biggest causes of major injuries and over 7 day injuries reported under RIDDOR in health and social care.

• Lone working staff at more risk, i.e. community staff and staff working alone in offices.

• More difficult to control the working environment

• High level of under reporting as staff except it as ‘nature of the job’.

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Need to know where people have been

Lone Working

What you need to do: • Assess the risks. You may need both generic and

individual assessments. • Generic assessments will consider the overall risks of staff

working out in the community, and identify control measures.

• Individual assessments will consider the risks from specific known individuals – considering referral information, information from other agencies, and past history.

• If individuals to be visited are a known risk, consider meeting the individual elsewhere, or with two or more staff, or other special arrangements.

• Provide adequate control measures if staff are to complete community visits.

Lone working

• Have suitable local procedures in place, which include; recording visits, movement plans, provision of communication devices, contact between visits, emergency procedures, including having, car details, NOK details etc.

• ‘Red Folder’ – code word for a problem… • Provide the right level of training – (As a minimum all

frontline NHS Staff should have received the NHS Protect Conflict Resolution training)

• Monitor and test procedures, particularly if you are expected to respond to a lone worker in trouble.

• HSE, NHS Protect and POSHH guidance www.hse.gov.uk/healthservices/voilence

http://www.hse.gov.uk/healthservices/voilence

Manual handling

• Manual handling is a major cause of back pain

• It can be avoided or the risk reduced

• What manual handling tasks are carried out in your business?

• How heavy is your heaviest load?

• What shape is it?

• Do you move and assist people?

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Presentation Notes

Home in on moving and assisting of people

7 Steps to managing Manual Handling

1. Identify the problem and agree to act

2. Involve the right people

3. Assess the risks

4. Avoid/reduce the risks

5. Train and inform – managers and workers

6. Managing back pain

7. Carry out regular checks

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Concentrate more on standards and guidance for people handling

When Lifting Consider

• Load weight • Hand distance from lower back • Vertical lift region • Trunk twisting • Postural constraint • Grip on load • Floor surface • Environmental factors • Other individual risk factors

http://www.hse.gov.uk/healthservices/moving-handling.htm



Slips & trips

• Slips and trips are the most common of workplace hazards.

• Over 10,000 workers suffered serious injury because of a slip or trip last year.

• 95% of major slips result in broken bones

• Most slips occur on wet or contaminated floor conditions.

• The solutions are often simple and cost effective.

Presenter

Presentation Notes

Slips and trips are the most common of workplace hazards and make up over a third of all major injuries. Over 10,000 workers suffered serious injury because of a slip or trip last year and 95% of major slips result in broken bones and they can also be the initial cause of other types of accident such as a fall from height. Most slips occur on wet or contaminated floors and most trips are due to poor housekeeping. The solutions are often simple and cost effective.

What is the risk

Serious Injury arising from slips or trips from:

• uneven surfaces

• changes in level

• poorly selected slippery floors

• contamination or wet areas

• poor lighting

• cleaning

What is the risk?

Health and social care sector has:

• high number of staff and members of public (high foot fall)

• vulnerable population

• lack of control over footwear worn by visitors

• high number of varied premises

• frequent contamination & cleaning

What is the risk?

Serious Injury arising from slips or trips from:

• uneven surfaces

• changes in level

• poorly selected slippery floors

• contamination or wet areas

• poor lighting

• cleaning

What is the risk?

Health and social care sector has:

• high number of staff and members of public (high foot fall)

• vulnerable population

• lack of control over footwear worn by visitors

• high number of varied premises

• frequent contamination & cleaning



Contamination

Footwear Trip Hazards

Cleaning

Slips and Trips – common factors

Floor

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Presentation Notes

The cause of slip accidents is rarely one single factor, but normally several of the above factors combining to cause the accident. For example, clean dry flooring is rarely slippery. It is the combination of contamination and a floor that becomes slippery with that contamination – typically this could be water at the entrance & in bathrooms, grease and water in the kitchen etc. So, cleaning – is vital in removing the contamination – but wet cleaning can introduce the contamination too!


Health and Safety Executive Slips and Trips – contamination

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Contamination - spillages are one of the most common causes of slips in the workplace. In healthcare, contamination could be from water, hand gels, foodstuffs and bodily fluids. Failure to appropriately remove or clean the contamination and keep people away from the area is essential.



Slips and Trips – cleaning

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Do’s and don’ts of cleaning Using the wrong cleaning method (e.g. leaving the floor wet and not mopped dry after cleaning) can put staff at risk by leaving the floor slippery. Use something absorbent, like paper towel, for small spill. If mops are used, you will wet a large area – which is increasing the chance of somebody walking on the wet floor. It is reasonable to use warning signs, and you are required to do everything that is reasonable to avoid these accidents, but put the signs away when the hazard has gone. All too often, the signs are always there, and people ignore them.



Slips and Trips – trip hazards

Slips and Trips – trip hazards

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Presentation Notes

Trip hazards - an unexpected obstacle in your path can cause a serious trip and fall. It is important to keep walkways clear (hospitals often struggle to find adequate storage space) They should ensure equipment, boxes, bags, cables and other obstacles aren’t left hanging around. Flooring can also easily become damaged or worn leading to trip hazards

Trip hazards - Stairs

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The main picture – it is difficult to see the edges of the stairs, so the user may overstep and fall. Simple marking of the edges such as that in the inset picture would be very effective in reducing the risk. For building constructed or undergoing major refurbishment since 2003, this has been a requirement in Part K of the Building Regs for commercial premises, i.e. including in care homes. The building regs are not applied in retrospect but this is considered good practice, especially where there are vulnerable users.

Slips and trips - footwear

• Flat shoes

• Good grip

• Kept clean

• Fit well

• Avoid certain footwear – open-toed shoes, sandals,

flip-flops, heels and smooth soles, etc.

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Presentation Notes

Footwear - wearing appropriate footwear (i.e. slip resistant sole, properly fitting) can make all the difference We’d expect hospitals to have a sensible footwear policy. Who tends not to wear sensible shoes? The managers! Think about the message that gives to staff… In some instances, it may be necessary to consider issuing staff with particular footwear, which would be personal protective equipment – PPE.

What needs to be done?

• Risk assessment of risks of S&T at all premises

• specifying appropriate flooring

• ensuring contamination is minimised

• arrangements to manage contamination

• appropriate cleaning techniques

• keeping staff and public off wet / contaminated floors – especially where smooth floors!

• footwear for certain staff at higher risk (e.g. kitchen / cleaners etc.)

Presenter

Presentation Notes

Appropriate flooring – particularly during refurb or new build - Research undertaken by HSL at C&V NHS Trust – shows that safety floors can be hygeinically cleaned. Argument that floors need to be smooth for infection control not an excuse for not fitting improved slip resistance (when wet) flooring Minimising contamination – arrangements to reduce spillages Manage contamination – ensuring contamination is dealt with – not always easy in some areas

Potential concerns

Summary • slippery floors • smooth floors in wet areas or areas likely

to be contaminated (e.g. kitchen, bathrooms, near main entrances)

• wet cleaning without adequate segregation until dry

• lack of appropriate spillage response • lack of suitable footwear (for key staff)

Potential concerns

Summary (cont.)

• obstructed / cluttered walkways

• damaged / uneven flooring or surfaces

• poor lighting

• lack of handrails where changing level

Case Study

• Alison – Health professional in large NHS Trust

• Basic slipping accident on a wet floor

• Broken ankle and severely damaged foot

• Suffered complications

• Leg amputated below the knee

• Career over, mobility restricted, quality of life impaired forever

Presenter

Presentation Notes

Case study: Woman loses leg following two slip accidents Alison was an occupational therapist in a large hospital when she had two slip accidents at work. The first happened in 1986. Alison slipped on rotting leaves on the concrete steps of the hospital on her way in. The leaves were supposed to be cleared on a daily basis, but had not been because of staffshortages. She fell heavily on her right knee and was still in pain three months later, when she was told she needed surgery. In 1992 she slipped again, this time on a wet vinyl floor. Someone had mopped the floor and failed to dry it or put out any barriers or warning signs. She slipped and fell directly onto her right ankle. Over the next few years she faced 30 operations. Eventually she was told that the only solution was to have her foot amputated. On her 32nd operation her leg was amputated at the knee. As anyone can imagine, these easily avoidable accidents have had a horrendous effect on Alison’s life. She was an active 21 year old who enjoyed dancing, aerobics and jogging. She cannot do any of these activities now and spends a lot of her time using a wheelchair. Although she received extensive compensation, she has lost her job and will never work again because of ongoing problems. Alison said no amount of money can compensate for what happened to her.

Slips and trips due to icy conditions and winter weather

Slip and trip accidents increase during the Autumn and Winter season for a number of reasons:

• there is less daylight, • leaves fall onto paths and become wet and

slippery and • cold weather spells cause ice and snow to build

up on paths. • There are effective actions that you can take to

reduce the risk of a slip or trip. Regardless of the size of your site, always ensure that regularly used walkways are promptly tackled

• http://www.hse.gov.uk/slips/faq.htm#icyconditions

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Presentation Notes

Gritting – the pros and cons The most common method used to de-ice floors is gritting as it is relatively cheap, quick to apply and easy to spread. Rock salt (plain and treated) is the most commonly used ‘grit’. It is the substance used on public roads by the highways authority. Salt can stop ice forming and cause existing ice or snow to melt. It is most effective when it is ground down, but this will take far longer on pedestrian areas than on roads. No tests have been carried out on how much grit to use. As a guide, on roads a rate of approximately 10-15gms/m 2 for precautionary salting and 20-40gms/m2 during ice and snow conditions is recommended. Gritting should be carried out when frost, ice or snow is forecast or when walkways are likely to be damp or wet and the floor temperatures are at, or below freezing. The best times are early in evening before the frost settles and/or early in the morning before employees arrive. Salt doesn’t work instantly; it needs sufficient time to dissolve into the moisture on the floor. If you grit when it is raining heavily the salt will be washed away, causing a problem if the rain then turns to snow. Compacted snow, which turns to ice, is difficult to treat effectively with grit. Be aware that ‘dawn frost’ can occur on dry surfaces, when early morning dew forms and freezes on impact with the cold surface. It can be difficult to predict when or where this condition will occur. Bags of rock salt can be purchased from most large Builders Merchants at an average cost of £4.00 for a 25kg bag.

http://www.hse.gov.uk/slips/faq.htm

http://www.hse.gov.uk/slips/faq.htm

Falls on stairs

• Can present hazard to anyone

• Should be safe, well maintained, well marked, well lit, have handrails and be kept clear

• Steep, winding or open risers should be avoided wherever possible

• Other regulator / fire prevention officer should be involved

Presenter

Presentation Notes

Consider other falls – windows, at height areas

Links / further information

• HSE Information sheet – slips and trips in healthcare http://www.hse.gov.uk/pubns/hsis2.pdf

• HSE Health and social care webpage http://www.hse.gov.uk/healthservices/slips/index.htm

• HSE shattered lives – healthcare webpage http://www.hse.gov.uk/shatteredlives/industry-health.htm#js_incidents1

• HSE STEP eLearning package http://www.hse.gov.uk/slips/step/index.htm • SHTM61 – Flooring – https://publications.spaceforhealth.nhs.uk/ • Slips pages on HSE website - www.hse.gov.uk/slips • e-bulletin - www.hse.gov.uk/slips/ebulletin/index.htm • Footwear - http://www.hse.gov.uk/slips/footprocure.htm • Hazard spotting checklist -

www.hse.gov.uk/shatteredlives/hazardchecklist.pdf • HSL Research – Hygienic cleaning of safety floors in healthcare

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Presentation Notes

http://www.hse.gov.uk/pubns/hsis2.pdf

http://www.hse.gov.uk/healthservices/slips/index.htm

http://www.hse.gov.uk/shatteredlives/industry-health.htm

http://www.hse.gov.uk/slips/step/index.htm

https://publications.spaceforhealth.nhs.uk/

http://www.hse.gov.uk/slips

http://www.hse.gov.uk/slips/ebulletin/index.htm

http://www.hse.gov.uk/slips/footprocure.htm

http://www.hse.gov.uk/shatteredlives/hazardchecklist.pdf

Legionella

Those greatest at risk includes

• Old and infirm

• Men more susceptible than women

• Over 45 years of age

• Smokers

• Alcoholics

• Diabetics

• Existing respiratory problems

• Immuno-suppressed people

Legionella – cases

0

50

100

150

200

250

300

350

2000 2001 2002 2003 2004 2005 2006 2007 2008

NosocomialTravel AbroadCommunity

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Presentation Notes

Majority of cases from Community – sources often not identified

Risk Assessment should include:

• the management responsibilities and name of the responsible person;

• an assessment & comprehensive schematic (where complex) of the system;

• details of precautions taken including: - the control method/s – inspection / monitoring

and maintenance programme (eg checking the system is kept clean;

• records of operation, monitoring and remedial work;

• population exposed and risk

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Presentation Notes

Risk assessment should include: Responsibilities of competent person An assessment of the system present. Consideration of boiler type / method of heating etc. & detailed schematic drawing Identification and implementation of control measures Remedial action to further reduce risk e.g. removal of deadlegs / fitting of insect screens / raising of hot storage temps if required. Record keeping – this will need to show monitoring is in place, correct temperatures are maintained and that any departure from this is identified and remedied within reasonable time period.

Methods of control of legionella in hot and cold water systems

• temperature regime;

• biocide treatments;

• ionisation treatment;

• ozone; and

• UV treatments

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Presentation Notes

There are numerous ways of managing the risk from legionella bacteria in hot and cold water systems: Temperature control is the most common and can be the most effective. However, other methods can be affective but are likely to need specialist assistance and regular maintenance and monitoring to ensure it is effective. Not always easy to know that some systems are not performing properly. Reduced temps often used with other methods so any lapses in treatment leave system vulnerable Also, some systems may only treat at point of application rather than throughout system e.g. ozone and UV Ionisation difficult to maintain in hard water areas – build-up of scale on electrodes

Store cold water at <200C

distribute cold water at <200C Store hot

water >=600C

Return water >=500C distribute hot water

at >= 50ºC

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Presentation Notes

Temperatures to be achieved: Cold Water and storage and supply Storage should be less than 20 degrees C Outlets should be less than 20 degrees C Hot Water storage and supply Storage should be greater than 60 degrees C Supply to outlets & distribution should be greater than 50 degrees C NB vent pipe from calorifier should ideally not discharge into cold water tank. If it does systems to identify any discharge should be considered. Easier to carry out remedial action to discharge to a safer point. Case Scalding of baby following discharge from vent pipe into plastic cold water store.

Legionella – other controls

• Remove any dead legs • Flush infrequently used outlets weekly • Avoid use of flexible rubber hosing – eg.

EPDM • Keep cold and hot water tanks / cylinders

clean • Insulate pipework / tanks http://www.hse.gov.uk/healthservices/legion

ella.htm

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Presentation Notes

EPDM – ethylene propylene diene monomer Better materials are: PE ‘polyethylene’ and PVC ‘poly-vinyl chloride’ QUESTION FOR GP’S - Do you request testing for Legionnaires Disease when presented with pneumonia in residents at care homes???

http://www.hse.gov.uk/healthservices/legionella.htm

http://www.hse.gov.uk/healthservices/legionella.htm

Risks of scalding / burns

Scalding • Water temperature at sinks too high – if

vulnerable people likely to use sinks restrict to maximum of 44 Deg C

Burns • Sit or rest against hot radiators • Fall in confined spaces or bathrooms and rest

against hot pipes and/or radiators Need to assess risks and identify hot surfaces that

need covering http://www.hse.gov.uk/healthservices/scalding-

burning.htm

http://www.hse.gov.uk/healthservices/scalding-burning.htm

http://www.hse.gov.uk/healthservices/scalding-burning.htm

Asbestos duty to manage

• Control of Asbestos Regulations 2012 require duty-holder (owner or person responsible for maintenance, etc) to manage the risk from asbestos - “The duty to manage”. Actions required are:

• Take reasonable steps to find out if asbestos-containing material (ACM) is present in non-domestic premises

• If so, its amount, location and its condition

• Presume materials contain asbestos unless you know otherwise

• Keep up to date record of location, condition

What you need to do

• Assess risks of anyone being exposed to asbestos fibres

• Plan in detail how to manage risks

• Put plan into action

• Periodically review and monitor plan

• Provide information on location and condition to anyone who may come into contact with ACM’s

• The duty-holder is the person who has clear responsibility for maintenance and repair

• Applies to all non-domestic premises

Practical steps

• Check what you already know about your building, e.g. look at plans and other documents.

• Contact anyone else who may already have useful information about the building, e.g. landlord, surveyor, architect or contractor who knows the building.

• Carry out an inspection (survey) of the building. You can do this in house, especially if you simply assume materials contain asbestos. Or use an independent expert if samples have to be analysed.

• Record the results of the inspection, identifying the parts of the building where ACMs may be located.

Practical steps

• Assess the risk of asbestos fibres being released into the air from the ACMs in those areas. What is ACMs’ condition and how likely they are to be damaged or disturbed.

• Draw up a management plan. State which areas, if any, need ACMs to be sealed, encapsulated or, as a last resort, removed.

• An example management plan can be found at: – http://www.hse.gov.uk/asbestos/managing/managementp

lan.pdf

• Don’t forget to periodically review your management plan to ensure that it remains up to date.

• Make sure you act on your plan.

http://www.hse.gov.uk/asbestos/managing/managementplan.pdf

http://www.hse.gov.uk/asbestos/managing/managementplan.pdf

Construction Design and Management (CDM)

• A 'client' is anyone having construction or building work carried out as part of their business. This could be an individual, partnership or company and includes property developers or management companies for domestic properties.

• On all projects clients will need to:

– Check competence and resources of all appointees – Ensure that there are suitable management

arrangements for the proper welfare facilities – Allow sufficient time and resources for all stages – Provide pre-construction information to all designers

and contractors e.g. if there is asbestos in the building

Presenter

Presentation Notes

What you need to do Identify the job Select a suitable contractor determine a contractor’s competence by asking:- what experience they have in the type of work you want done; what their health and safety policies and practices are; about their recent health and safety performance (number of accidents etc); what qualifications and skills they have; their selection procedure for sub-contractors; for their safety method statement; what health and safety training and supervision they provide; their arrangements for consulting their workforce; if they have any independent assessment of their competence; if they are members of a relevant trade or professional body; or whether they or their employees hold a ‘passport’ in health and safety training.

Electrical safety

• The law requires electrical equipment to be maintained to prevent danger. The type and frequency of user checks, inspections and testing needed will depend on the equipment, the environment in which it is used and the results of previous checks

What you need to do

• Check that the electrical equipment is in good condition

• Many faults with work equipment can be found during a simple visual inspection: – Switch off and unplug the equipment before

you start any checks. – Check that the plug is correctly wired (but

only if you are competent to do so). – Ensure the fuse is correctly rated by checking

the equipment rating plate or instruction book. – Check that the plug is not damaged and that

the cable is properly secured with no internal wires visible.

What you need to do – cont’d

• Check the electrical cable is not damaged and has not been repaired with insulating tape or an unsuitable connector. Damaged cable should be replaced with a new cable by a competent person.

• Check that the outer cover of the equipment is not damaged in a way that will give rise to electrical or mechanical hazards.

• Check for burn marks or staining that suggests the equipment is overheating.

• Position any trailing wires so that they are not a trip hazard and are less likely to get damaged.

• http://www.hse.gov.uk/pubns/indg236.htm

http://www.hse.gov.uk/pubns/indg236.htm

Myth: All office equipment must be tested by a qualified electrician every year

• The reality • No. The law requires employers to assess risks

and take appropriate action. • HSE's advice is that for most office electrical

equipment, visual checks for obvious signs of damage and perhaps simple tests by a competent member of staff are quite sufficient.

• Check out our guidance below. • http://www.hse.gov.uk/electricity/faq-portable-

appliance-testing.htm • Download a printable poster version70KB

http://www.hse.gov.uk/myth/july.pdf

http://www.hse.gov.uk/electricity/faq-portable-appliance-testing.htm

http://www.hse.gov.uk/electricity/faq-portable-appliance-testing.htm

Gas safety

• If gas appliances, such as ovens, cookers and boilers, are not properly installed and maintained, there is a danger of fire, explosion, gas leaks and carbon monoxide (CO) poisoning.

• Employers need to comply with the relevant regulations to help ensure worker and public safety. You can do this by following our advice on maintaining and servicing gas appliances, by using a Gas Safe registered engineer or a competent person.

http://www.hse.gov.uk/gas/domestic/index.htm

Presenter

Presentation Notes

In domestic properties and workplaces such as shops, restaurants, schools and hospitals, this must be carried out by someone on the Gas Safe Register who is qualified to work on gas appliances.



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http://www.hse.gov.uk/healthservices/index.htm

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