Health and Safety in Private Practice

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Health and Safety in Private Practice

• Gordon Burrow MSc, FChS, CMIOSH
• Chartered Safety and Health Practitioner

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Health and Safety in Private Practice
COSHH and CHIP Ergonomics Manual Handling Health
and Safety Policy Documentation
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COSHH and CHIP

• Chemicals (Hazard Information and Packaging for
  Supply) Regulations.
• Some special chemicals, for example medicines and
  cosmetics, are not covered because other more
• specific laws apply.
• Therefore unlikely that CHIP will apply to
  Podiatrists
• Assume that any chemicals you sell are classified
  as Medicines

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COSHH

• Control of Substances Hazardous to Health
  Regulations 2002
• Using chemicals or other hazardous substances at
  work can put peoples health at risk,
• Law requires employers (PPs) to control exposure
  to hazardous substances to prevent ill health.
• Have to protect both employees and others who may
  be exposed by complying with the Control of
  Substances Hazardous to Health Regulations 2002
  (COSHH)

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Hazardous substances

• Hazardous substances include
• substances used directly in work activities (e.g.
  adhesives, paints, cleaning agents)
• substances generated during work activities (e.g.
  fumes/dusts)
• naturally occurring substances (e.g. pollen
  dust)
• biological agents such as bacteria and other
  micro-organisms.

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Effects of hazardous substances

• skin irritation or dermatitis as a result of skin
  contact
• asthma as a result of developing allergy to
  substances used at work
• losing consciousness as a result of being
  overcome by toxic fumes
• cancer, which may appear long after the exposure
  to the chemical that caused it
• infection from bacteria and other micro-organisms
  (biological agents).

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Steps to COSHH

• Step 1 Assess the risks
• Step 2 Decide what precautions are needed
• Step 3 Prevent or adequately control exposure
• Step 4 Ensure that control measures are used and
  maintained
• Step 5 Monitor the exposure
• Step 6 Carry out appropriate health surveillance
• Step 7 Prepare plans and procedures to deal with
  accidents, incidents and emergencies
• Step 8 Ensure employees are properly informed,
  trained and supervised

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Step 1 Assess the risks

• You must
• identify the hazardous substances present in your
  workplace
• consider the risks these substances present to
  peoples health.
• Identify
• Dusts, infections, chemicals (medicines),
  cleaning materials, aerosols (Podosprays), gloves
  (latex)
• Consider health risks
• How much of the substance is in use or produced
  by the work activity and how could people be
  exposed to it?
• Who could be exposed to the substance and how
  often?
• Is there a possibility of substances being
  absorbed through the skin or swallowed (e.g. as a
  result of a substance getting into the mouth from
  contaminated hands during eating or smoking)?

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Step 2 What precautions are needed?

• Infection control policy how do you clean
  surfaces, with what and when, how often?
• Work surfaces, flooring, equipment etc
• Storage? where, how, access, inventory,
  rotation of stock, how much quantities?
• Use how is it used from bottle, dispensed,
  where,
• Ventilation?
• Disposal how, when, inventory?
• PPE? gloves, face mask, eye protection
• Spillage what to do, spillage kit?
• Fire precautions - flammable, interactions?

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Step 3 Prevent or adequately control

• change the process or activity so that the
  hazardous substance is not needed or generated
• replace it with a safer alternative
• use it in a safer form, e.g. pellets instead of
  powder. Phenol swabs instead of liquified phenol?

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Adequately control?

• use appropriate work processes, systems and
  engineering controls, and provide suitable work
  equipment and materials e.g. use processes which
  minimise the amount of material used or produced,
  or equipment which totally encloses the process
• control exposure at source (e.g. local exhaust
  ventilation), and reduce the number of employees
  exposed to a minimum, the level and duration of
  their exposure, and the quantity of hazardous
  substances used or produced in the workplace

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Adequately control?

• provide personal protective equipment (e.g. face
  masks, respirators, protective clothing), but
  only as a last resort and never as a replacement
  for other control measures which are required.

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Step 4 Ensure control measures are used and
maintained

• The objective being to ensure that every element
  of the control measure continues to perform as
  originally intended. This applies to items of
  equipment such as local exhaust ventilation and
  to systems of work, which will have to be
  regularly checked to make sure that they are
  still effective.
• e.g. have drills etc serviced and maintained

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Step 5. Monitor exposure

• measure the concentration of hazardous substances
• in the air breathed in by workers where your
  assessment concludes that
• there could be serious risks to health if control
  measures failed or deteriorated
• exposure limits might be exceeded or
• control measures might not be working properly.

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• you do not need to do this if you can show by
  another method of evaluation that you are
  preventing or adequately controlling employees
  exposure to hazardous substances,

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Step 6 Carry out Health Surveillance (where
appropriate)

• Possibly not needed in Podiatry private practice?
• May be if employ pregnant workers
• Or if very specialised services

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Step 7 Prepare plans and procedures for
emergencies

• Accidents
• Incidents
• Spillages
• However, you do not have to introduce these
  emergency procedures if
• the quantities of substances hazardous to health
  present in your workplace are such that they
  present only a slight risk to your employees
  health and
• the measures you have put in place under Step 3
  are sufficient to control that risk.
• Most likely in Podiatry to not need these
  detailed plans

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Step 8 Ensure properly informed, educated and
trained

• Safety Material Data sheets
• http//physchem.ox.ac.uk/MSDS/MSDS
• Oxford University site with SMDS
• http//www.prc.cnrs-gif.fr/reach/anglais/chemical/
  chemical.htm Chemical covered by REACH
  (Registration, Evaluation, Authorisation and
  Restriction of chemicals) but also other
  important chemical data
• http//chemfinder.cambridgesoft.com/
• Chemical finder database searchable
• http//www.atsdr.cdc.gov/toxpro2.htmlFinal
• US site but gives good information

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Ergonomics

• Essentially human factors (also known as
  Ergonomics) is concerned with all those factors
  that can influence people and their behaviour. In
  a work context, HSE has defined human factors as
  the environmental, organisational and job
  factors, and human and individual characteristics
  which influence behaviour at work.

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Ergonomics to consider

• Manual handling
• The task involves frequent repetitive lifting.
• The task requires awkward postures, such as
  bending or twisting.
• The task is performed under time pressures and
  incorporates too few rest breaks.
• Work-related stress
• Work demands are too high or too low.
• The employee has little say in how they
  organise their work.
• Poor support from management and/or colleagues.
• Conflicting demands, eg high productivity and
  quality.

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Ergonomics to consider

• Managing the working day
• Insufficient recovery time between shifts.
• Poor scheduling of shifts.
• Juggling shifts with domestic
  responsibilities.
• Employees working excessive overtime.

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Ergonomics

• Look at layout of surgery
• How close do you work with patient chair,
  trolley, pedal bin, light fitting?
• How comfortable is your chair height,
  position, back support, leg support, foot
  support?
• Do you need to stoop, bend, twist to undertake
  activities?
• Could you re-arrange activities?
• Could you re-arrange equipment?

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Instruments

• How do you choose these?
• Do you consider hand position/wrist position when
  operating?
• How much force is needed?
• Size of hand?
• Size of hand tools?
• Grip strength?
• Span width?

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Needle stick safe removal
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Health and Safety Policy

• Do you have one?
• Do you need one?

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Health and safetypolicy statement

• This is the Health and Safety Policy Statement of
• (name of company)
• Health and Safety at Work etc Act 1974
• ? to provide adequate
• control of the health and
• safety risks arising from
• our work activities
• ? to consult with our
• employees on matters
• affecting their health and
• safety
• to provide and maintain
• safe plant and equipment
• ? to ensure safe handling
• and use of substances
• ? to provide information,
• instruction and supervision

• Our statement of general policy is
• for employees
• ? to ensure all employees
• are competent to do their
• tasks, and to give them
• adequate training
• ? to prevent accidents and
• cases of work-related ill
• health
• ? to maintain safe and
• healthy working
• conditions and
• ? to review and revise this
• policy as necessary at
• regular intervals.
• Signed
• (Employer)

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Responsibilities

• Overall and final responsibility for health and
  safety is that of
• -----------------------------------
• 2 Day-to-day responsibility for ensuring this
  policy is put into
• practice is delegated to
• ----------------------------------------
• 3 To ensure health and safety standards are
  maintained/
• improved, the following people have
  responsibility in the
• following areas
• ----------------------------------------

• All employees have to
• ? co-operate with supervisors and managers on
  health and
• safety matters
• ? not interfere with anything provided to
  safeguard their
• health and safety
• ? take reasonable care of their own health and
  safety and
• ? report all health and safety concerns to an
  appropriate
• person (as detailed in this policy statement).

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Health and safety risks arising from ourwork
activities

• Risk assessments will be undertaken by
  -----------------
• ? The findings of the risk assessments will be
  reported to ----------
• ? Action required to remove/control risks will be
  approved by
• ----------------------------
• --------------------will be responsible for
  ensuring the action required
• is implemented.
• -------------------------------------
• will check that the implemented actions have
  removed/reduced the risks.
• ? Assessments will be reviewed every
  -------------------
• or when the work activity changes, whichever is
  soonest.

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Safe plant and equipment

• ------------- will be responsible for
  identifying all equipment/plant needing
  maintenance.
• -------------- will be responsible for ensuring
  effective maintenance procedures are drawn up.
• --------------- will be responsible for ensuring
  that all identified maintenance is implemented.
• Any problems found with plant/equipment should be
  reported to ----------------------------------
• ------------- will check that new plant and
  equipment meets health and safety standards
  before it is purchased.

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Safe handling and use of substances

• -------------------will be responsible for
  identifying all substances which need a COSHH
  assessment.
• ------------------ will be responsible for
  undertaking COSHH assessments.
• ------------------- will be responsible for
  ensuring that all actions identified in the
  assessments are implemented.
• ---------------- will be responsible for ensuring
  that all relevant employees are informed about
  the COSHH assessments.
• ------------------- will check that new
  substances can be used safely before they are
  purchased.
• Assessments will be reviewed every -------------
• or when the work activity changes, whichever is
  soonest.

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Information, instruction and supervision

• The Health and Safety Law poster is displayed at/
  leaflets are issued by ---------------
• ? Health and safety advice is available from
  ----------
• ? Supervision of young workers/trainees will be
• arranged/undertaken/monitored by --------------
• -------------- is responsible for ensuring that
  our employees working at locations under the
  control of other employers, are given relevant
  health and safety information.

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Accidents, first aid and work-related ill health
Competency for tasks and training

• Identify what tasks require training and who will
  undertake this and how often.
• Identify where and how training records will be
  kept.

Specify if health surveillance is needed and who
will conduct it Specify first aider and where
first aid box is held Where accident book is and
who is responsible for reporting/recording
incidents, accidents and near misses.
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Emergency and Fire Procedures

• ----------------is responsible for ensuring the
  fire risk assessment is undertaken and
  implemented.
• ? Escape routes are checked by/every
  -------------
• ? Fire extinguishers are maintained and checked
  by/every -------------------------
• ? Alarms are tested by/every --------------------
• ? Emergency evacuation will be tested every
  -------------

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Risk assessments

• www.hse.gov.uk/risk.
• Downloadable form for use.

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• Questions?