These FAQs help illustrate the nature of some of the issues that HSE routinely gives advice on. The list is not exhaustive and further questions and answers may be added at a later date.
Tooth whitening is a way of lightening the natural colour of teeth using bleaching methods.
It is the view of the General Dental Council (GDC) that the actual procedure of tooth whitening is the practice of dentistry, regardless of the products used. All dental practitioners in the UK are required by law to be registered with the GDC. Tooth whitening can only therefore be carried out lawfully by registered dentists. Registered dental hygienists and dental therapists are also permitted to carry out this type of work, but only on the prescription of a dentist.
The GDC has successfully prosecuted a non-registrant for performing tooth whitening. See their press release for further information.
The Health and Safety (Enforcement Authority) Regulations 1998 state that cosmetic services and therapeutic treatments carried out under supervision or control of a dentist are enforced by HSE. This includes work within retail outlets and offices. Any work-related health and safety matters associated with this type of work are therefore enforced by HSE.
If the work carried out at the premises is not undertaken by or under the supervision of a dental practitioner registered with the GDC then, it is likely they are operating illegally and this should be reported to the GDC.
Complaints about the standard of work carried out by dentists, including the way tooth whitening is performed, should also be referred to the GDC. Information about how to make a complaint can be found on their website.
Yes, however your employer should carefully consider the risks when selecting gloves in the workplace, because of the importance of latex gloves as a source of exposure to natural rubber latex (NRL) proteins.
When considering glove use in the workplace (latex or otherwise), employers should follow HSE's glove selection guidance. Your employer must be able to demonstrate that they have carried out an assessment to select which (if any) type of gloves they should provide. They must also be able to demonstrate that they have an effective glove use policy in place that, for example, takes account of those employees or others (such as members of the public), who may have a latex allergy.
HSE has provided specific information and guidance for employers relating to dermatitis and latex allergies in health and social care.
If you visit someone’s home, and are required to use the service user’s own equipment, this equipment is not considered to be supplied for use at work. Therefore, the service user has no duties under LOLER.
However, if you are required to use this equipment, the duty to ensure your safety, so far as is reasonably practicable, rests with your employer. In this situation, your employer may have no control over the condition of the equipment. They therefore need to decide whether to provide suitable alternative equipment, or take adequate steps to ensure that the service user’s equipment is properly maintained and safe to use. The responsibilities of all parties involved should be clearly set out in the care provision contract.
Where a third party organisation loans lifting equipment to help people overcome a lack of mobility, this is not defined as work equipment and LOLER will not apply. Whilst this equipment may carry out a lifting function, where it is used and operated by a service user or unpaid carers, it is not defined as work equipment.
However, as the owner and provider of the equipment you will have a general duty under the Health and Safety at Work etc Act 1974, Section 3, to provide and maintain safe equipment. This can usually be satisfied by following the principles of LOLER and the Provision and Use of Work Equipment Regulations 1998 (PUWER).
Under the Lifting Operations and Lifting Equipment Regulations 1998 (LOLER) anyone using lifting equipment should be able to check that it has been thoroughly examined and is safe to use. This means that lifting equipment and accessories such as slings need to be uniquely identifiable.
Manufacturers often label slings with a serial number, although these can fade over time or during laundering. Some also provide space on the sling label for recording thorough examination dates.
Whilst it is fine to write on the label, there is a potential problem with using some permanent markers on the fabric and load bearing webbing of slings. Most permanent markers do not state their chemical composition. If they contain solvents, such as Xylene, this can weaken the fabric. Attaching some other identifying label (for example by using a robust cable tie) is acceptable. Users should avoid sewing labels onto the sling fabric or attachments as this can also weaken the fabric. If in doubt, contact your supplier / manufacturer.
The organisation must balance the risks of using the patient’s own sling with the risks to their well being or recovery.
If a patient is taken into care with an unverified sling of their own then the employer should make a decision about the risks of using the sling.
If the risks to the patient in changing the sling, ie the delays in urgent treatment, discomfort or disturbance etc outweigh the risks of using the sling, it would be appropriate to use it until it can be changed at the earliest opportunity. Before making this decision, an experienced person should check the sling for obvious damage.
An EU Directive was introduced on 10th May 2010 to prevent injuries and blood borne infections to hospital and healthcare workers from sharps instruments such as needles. In summary, the Directive aims to;
The Directive requires that all provisions are transposed into UK legislation by 11th May 2013.
There may be situations where employees are working alone, at risk of violence and aggression, and may need to contact someone for assistance. For example, community-based staff such as midwives, district nurses, and social workers; and site-based staff working in isolated areas of premises.
In these cases, employers should have arrangements in place to ensure that lone workers are safe. The provision of personal communication devices may be one of a number of reasonably practicable control measures to help manage the risk. Examples of devices include; telephones, mobile phones, radios, automatic warning devices and emergency alarms.
It is important to recognise that personal communication devices will not prevent incidents from occurring. However, if used correctly in conjunction with robust procedures, they will improve the protection of lone workers.
If employers provide personal communication devices, they must train employees to use them appropriately. Employees must be aware of and follow supporting procedures and arrangements. The employer must maintain the equipment and have appropriate response arrangements in place.
If the employer has identified the need for personal communication devices as a control measure, then removal of the devices based on cost alone is unacceptable, unless additional equivalent control measures are put in place.
You should develop safe bathing procedures if people you care for are assessed as being vulnerable to scalding. Where storage and distribution temperatures are being used to control Legionella (ie above 60ºC and 50ºC respectively), or high temperatures might otherwise be achieved, baths and showers should be fitted with thermostatic mixer valves (TMVs) to ensure water temperatures do not exceed 44ºC. Outlet temperatures and TMVs should be monitored and maintained to ensure the controls are effective.
Where electric showers are fitted, the potential output temperatures should be checked under fluctuating local conditions (ie different pressure / flow) to ensure that temperatures above 44ºC (max 41ºC required in NHS) are not achievable. Where electric shower temperatures have the potential to exceed 44ºC you will need to install healthcare standard electric showers unless your assessment indicates adequate control of the risk by other means.
Whilst the risk from basins is much lower, owing to there being no full body immersion, if someone is assessed as being vulnerable to the risk of scalding at basins, adequate controls on output temperature (eg TMVs) should be in place.
Employers should ensure bariatric handling activities have been adequately assessed by a competent person. It is likely that specialist training in appropriate techniques will be required. Specialist equipment may also be needed which should be regularly checked and maintained.
Organisations such as Backcare, National Back Exchange and the Royal College of Nursing provide information and guidance on appropriate techniques for handling people.
Under the regulations, employers are responsible for providing appropriate first-aid equipment, facilities and ensuring an adequate number of first-aiders. However, these requirements only relate to first aid provision for employees. The regulations do not require employers to provide first aid for non-employees (eg users of care services, patients etc.). However, HSE strongly encourages employers to consider non-employees when carrying out their first-aid needs assessment and to make provision for them.
If your assessment identifies that training in emergency techniques might help control the risk, then such training may be required under the Health and Safety at Work Act (HSWA), rather than FAW. An example might be a resident of a care home who is known to be at serious risk of choking, where training in emergency techniques may be appropriate.
Some health and social care providers are concerned that smooth floors are required to enable hygienic cleaning to reduce the risk of infection. Many providers make extensive use of smooth vinyl, which can lead to an increased risk of slip and trip accidents.
HSE has commissioned research to explore whether slip resistant flooring installed in hospitals can be cleaned to a hygienic standard using standard cleaning practices.
The research concluded that the ability to clean a typical hospital floor to a hygienic standard is not influenced by the slip resistance of the flooring.
Employers should carry out suitable and sufficient risk assessments considering the risks from:
If appropriate, identify suitable health surveillance, which should be based on risk and form part of your overall system for managing occupational health (OH) risks. You may wish to involve a health professional (OH doctor or nurse) in your health surveillance programme. Their competent advice will help develop your scheme, train a ‘responsible person’, and/or manage the programme as a whole.
A responsible person is someone who is given the responsibility to help deliver a system of occupational health surveillance. They will have received training or coaching on what they need to do in order to perform this role effectively. This may involve training from a health professional, management, health and safety professional or other, as appropriate. This person may be a supervisor, first-aider, safety representative or the employer and the role will be clearly defined. They will be someone trusted by the workforce with good communication and interpersonal skills.
Health surveillance for occupational contact dermatitis (OCD) could include the following elements:
To identify a suitable level of health surveillance you need to consider a number of factors including:
The following examples are provided to help organisations identify a suitable level of health surveillance. However, HSE expects all of the above factors to be considered; therefore, the level of surveillance may vary between individuals doing similar work.
This is appropriate when the evidence for a hazard is clear and/or there is potential for significant exposure. For example;
HSE would expect all of the above elements of health surveillance to be included.
This is appropriate when there is weak evidence of a hazard and/or there is limited potential for significant exposure. For example;
HSE accepts that a lower level of health surveillance is likely to be sufficient. Skin inspections by a responsible person may not be necessary, but employee questionnaires and providing appropriate information, instruction and training so they know when and how to report their own skin problems would be required.
Health surveillance programmes must include keeping a health record for each individual. This should include:
Legionella bacteria can grow where water temperatures are between 20 and 45°C. If you run a care home or healthcare premises, it is likely that you will have residents or patients that are at higher risk of contracting the disease.
The potential risk from Legionella bacteria is likely to come from hot and cold water systems or evaporative cooling towers. To reduce the risk of contracting the disease you will need to carry out a risk assessment identifying who is at risk, the risk from your systems and any necessary controls.
To control the risk you will need to ensure that hot and cold water storage tanks, distribution pipe work and outlets remain clean. Where temperature is used to control the risk, hot water should be stored above 60°C, hot water distribution should be above 50°C and cold water storage and distribution should be below 20°C. Infrequently used outlets should be flushed out regularly and showerheads de-scaled and cleaned.
Users of health and social care services are likely to be at higher risk of contracting Legionnaires disease, which is a form of pneumonia that can be fatal. Legionella bacteria can grow in hot and cold water systems where the conditions are suitable for bacteria growth. The disease can be contracted by breathing in tiny droplets of water, for example, when using showers, taps or fine sprays etc.
Bacteria is likely to grow where, for example;
When you ask people to carry out work within your own home you will have a general responsibility for them under civil law.
If you live in a private domestic household and you employ someone to carry out solely domestic activities (e.g. cleaning, gardening or general personal care), it is unlikely that you will have any responsibilities under the Health and Safety at Work Act 1974 (HSWA) (see section 51).
However, if you employ carers to carry out tasks that go beyond what may be considered to be ordinary domestic service, for example, hoisting a person, dealing with challenging behaviour or using complex medical equipment, then you may have responsibilities under HSWA.
Under HSWA you would need to consider the carer’s and your own safety. For example, there may be a need for suitable training and equipment for ‘higher risk’ activities.
Other bodies regulate fostering. Carers are subject to a thorough assessment process to ensure their suitability to foster children and receive training, monitoring and supervision. For this reason, HSE would not generally regulate foster care.
Further information on regulation of foster care, can be found in the fostering service regulations and Department of Health minimum standards.
Under health and safety legislation, window restrictors are required where people who are vulnerable to the risk of falling, have access to the windows, and the windows are at a height, which is likely to cause them harm.
Many factors need to be considered, including the rights and freedoms of individuals. However, if people using the care service are assessed as being at risk from falling, restricted access may be appropriate.
If the balcony is at a height likely to cause injury, you will need to consider whether the design and height of balustrades provide sufficient protection to prevent people falling or climbing over. You will also need to ensure that furniture or other footholds do not allow easy access.
No. Many factors need to be considered, including the rights and freedoms of individuals. Fatalities have occurred where people using care services have become trapped in bedrails or fallen from beds.
Even where people are vulnerable to injury, because of falling from their bed, bedrails may not always be a suitable option. You will need to assess the risk of falling, and, whether bedrails are suitable. Where provided, bedrails must be properly fitted and maintained.
HSE’s advice is that mobile phones should not be considered as items of PPE, as defined in the Personal Protective Equipment Regulations 1992.
The Regulations do not require employers to provide equipment for self-defence or deterrent purposes, for example personal sirens / alarms or truncheons for use by security staff. The Regulations do apply to PPE, such as helmets or body armour, provided to staff at risk from physical violence.
However, there may be situations where employees are lone working, or working in isolated situations, and may need to call for assistance. In these cases, you may consider the provision of communication equipment as reasonably practicable. Examples include lone worker alarms or mobile phones.
Employers have a duty under the Health and Safety at Work etc Act 1974 (HSWA), to protect, so far as is reasonably practicable, the health and safety of their employees, including from risks arising from exposure to environmental tobacco smoke (ETS).
Below are some ideas, which may be helpful. However, it is for the employer to decide how they tackle the problem of second-hand smoke, based on the findings of their risk assessment.
Examine possibilities of:
Consider educating those being cared for. Smokers may be prepared to risk their own lives, but be more concerned about the damage they might cause others.
Employers should consider drawing up a policy to limit ETS at work. There is the added complication of the care home not only being a workplace, but also where users of the service should have certain freedoms, as if in their own home. Full consultation with users of the care service is highly desirable. Employees and service users are more likely to accept a policy if they feel they have been properly consulted.
(Note: There is no legal obligation for care homes to offer designated smoking rooms if they do not wish to do so, and many care homes may not permit smoking in residents’ own rooms for safety reasons. You should also consider the impact of second-hand smoke on non-smoking residents and staff.)
An effective policy on smoking may include:
Some users of the service may wish to smoke in their bedrooms. Fire safety is important and many fires are caused by smoking in bed. Complete individual risk assessments before seeking the views of the Fire Prevention Officer.
Responsibility for enforcing the legislation, including judgements about its application, is a matter for local authorities. If you have queries about applying the Regulations to your particular situation, you may wish to contact your local authority’s department of environmental health or public protection.
The issue of exposing health and social care workers to second-hand smoke is addressed in supplementary guidance developed by the Welsh Assembly Government for the NHS, local authority and care service providers. Although aimed at Wales, the guidance will be useful across the UK.
HSE’s guidance is consistent with the British Government’s ongoing commitment to reduce people’s exposure to tobacco smoke, and recognition that introducing smoke-free workplaces advances that policy.
Following the total ban on smoking in enclosed public places and workplaces under public health legislation, HSE remains responsible for the consistent application of health and safety law across Britain, including ensuring the appropriate management of any risks arising from exposure to ETS in the workplace.
Diathermy is a surgical technique which uses heat from an electric current to cut tissue or seal bleeding vessels. Diathermy emissions, sometimes known as surgical smoke, can contain numerous toxic gases, particles and vapours and are usually invisible to the naked eye. Their inhalation can adversely affect surgeons’ and theatre staff’s respiratory system. The risks vary according to individual circumstances, such as the procedure, equipment, environment, technique and patient.
The Control of Substances Hazardous to Health Regulations (COSHH) require employers to carry out an assessment of the risks from hazardous substances and to always try to prevent exposure at source. If you cannot prevent exposure to diathermy emissions then you should control it adequately.
This is usually achieved by effective local exhaust ventilation (LEV). Typically, this takes the form of extraction incorporated into the electrosurgery system to remove emissions at source, known as 'on-tip' extraction.
RIDDOR is the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995. These Regulations require employers, the self-employed and those in control of premises to report specified workplace incidents.
In the health and social care sector there is often uncertainty over whether incidents are reportable, particularly when they involve members of the public (eg patients in a hospital or residents in a care home), or when employees receive sharps injuries or suffer from work-related stress.
Some incidents are not reportable under RIDDOR. However, this does not mean that the general provisions of the Health and Safety at Work etc Act 1974 (HSWA) do not apply.
To help explain what should be reported, HSE has produced a new information sheet. This provides clear guidance on how RIDDOR applies to the health and social care sector. It gives a number of examples to help you decide whether an incident is reportable or not.
For general guidance on the requirements of RIDDOR, such as who should report, how to report and when to report, please visit the HSE RIDDOR pages.
