Health and Safety in Care Settings

The main roles of the Health and Safety Executive

• Enforce legislation (making sure the law is followed)
• Providing guidance (on health and safety in the workplace)
• Conducting investigation (to then issue instructions, improvment notices and prohibition notices)

It ensures that the 'Health and Safety at Work Act' is followed.

The HSE covers every workplace.

The act provides a framework for health and safety regulations and lays down the minimum standards required by the law.

The HSE officers can/ FUNCTIONS of the HSE:

• Enter premises
• Conduct investigations
• Take samples and photographs
• Ask questions
• Issue instructions that by law, must be carried out
• Give advice
• Initiate a prosectuion (take to court)
• Inspect documents
• Take measurements
• Issue improvments and prohibition notices (shut the place down)

(By enforcing legislation, providing guidance and conducting investigation the Health and Safety Executive ensures the 'Health and Safety at Work Act' is followed - this is the main act enforced by the HSE.)

The Health and Safety at Work Act was designed to:

• Make the workplace safer
• Reduce the number of accidents for everyone within the workplace
• Help to ensure that the service users are protected (this is done by the employers being required to regularly assess the vulnerablility of the service users)
  
  

(The main purpose of this act is to ensure that employers carry out regular risk assessment in order to ensure the safety of employees, service users and visitors.)

What must employers do?

Provide and maintain equipment. 

Ensure the health and safety of their employers. 

Deal with substances such as chemicals safely. 

Provide a written health and safety policy. 

Provide training and information for employees about safety at work. 

Assess risk to staff and visitors. 

Take action to minimuse risks. 

Establish procedures to deal with immediate danger.

What must employees do?

Take care of their own health and safety at work

Take care of health and safety of others

Co-operate with their employer

Must not interfere with anything provided for health and safety purposes

Report any situations which they believe to be unsafe

1) RIDDOR - reporting of injury disease and dangerous occurrences regulations. 

2) Safety signs and signals regulations

3) Health and safety first aid regulations 

4) COSHH- control of substances hazardous to health

5) The management of health and safety at work regulations

6) Fire precautions regulations 

7) Manual handling operations regulations

8) LOLER - lifting operations and lifting equipment regulations 

Reporting of Injuries, Diseases and Dangerous Occurrences Regulations

RIDDOR is a requirement which states you must report MAJOR ACCIDENTS, INCIDENTS & NOTIFIABLE DISEASES. 

What MUST be reported?

• Death
• Major injuries
• Accidents which result in more than 7 days off work
• Notifiable diseases
• Dangerous occurences

Why are records necessary?

• To meet requirements of the law
• Incase furhter information is required 
• Incase service users/employees condition worsens
• Incase legal action is taken
• To inform relatives

Reportable MAJOR INJURIES:

• Loss of sight
• Fracture (not fingers/toes)
• Amputations
• Dislocation of hips, shoulder, spine or knee
• Chemical/hot metal burn to the eye 
  

If it's a reportable injury, records should include:

• Name & occupation of employee affected
• Name & status of non-employee affected (e.g. service user, visitor)
• Description of circumstances
• Date & method of reporting

Reportable DISEASES:

• Measles 
• Meningitis
• Food poisoning 
• Smallpox

If it's a reportable disease, records should include:

• Date & diagnosis of disease
• Name & occupation of person affected
• Name & nature of disease
• Method of reporting

What would be reported:

> Practitioner dislocates shoulder whilst lifting serivce user and is off work for 9 days (as it's over 7 days off work).

> Service user slips in the bath and falls unconcious. Head wound and taken to hospital - kept in for 48 hours (major injury).

What would not be reported:

> Broke finger whilst making bed for service user - not major injury. 

> Elerdly service user contracts a sickness bug from other service user - not major disease. 

Key features of the legislation:

• Regulates the reporting of certain serious accidents - ensures workers are protected.
• Lists diseases which must be reported - aims to reduce infection spreading and safeguards health of people.
• Lists serious injuries which must be reported - gives protection to employees.
• Ensures investigation follows any serious incident - preventing future occurances.
• Prosectuion of employers possible - encourages safe practise.

*The main purpose of these regulations is to advise employers on the minimum requirements for the provision of safety signs at work. *

Safety signs have been standardised throughout Europe. 

Employers must provide safety signs, it's the law. 

Signs must be present when there is ar risk that has not been avoided or controlled. 

WARNING SIGNS - warn of a hazard which is present or nearby.
                              e.g. toxic material, radioactive material.

PROHIBITION SIGNS - prohibit certain actions, tell you not to do something.
                                    e.g. no smoking, no access for pedestrians.

MANDETORY SIGNS -  tell people what they must do.
                                   e.g. wear safety goggles, protective boots must be warn. 

 SAFE CONDITIONS SIGNS - give information about safety features 
                                            e.g. first aid post, fire exit, emergancy eye wash station. 

Key features of this legislation

• Defines shape of different signs
• Defines colours of diferent signs
• Ensures consistency of signs so everyone knows what they mean

The Management of Health and Safety at Work Regulations 1992

(includes law poster, first aid, health and safety policy)

This poster informs employees of their rights and responsibilites regarding health and safety. It explains the employers duty.

It shows the name, adress and telephone number of the enforcing authority. 
                                                                                           (e.g. suffolk county council)

It shows the name of the appointed member of staff responsible for the management of health and safety in the workplace.

It should be in a location which is accessible to all employees.

*If a workplace has 5 or more workers they must have a written health and safety policy to go with the poster *

Reasons for the policy:

• To set standards and expectations
• So staff know who is responsible for health and safety
• To ensure staff know correct procedures
• To maintain the law
• To provide a safe environment for employees and service users

The policy will relate to:

• Handling
• First aid
• RIDDOR

The policy document must have:

• Name of person implementing the policy
• Name of people responsible for health and safety
• List of indentified hazards and procedures to be followed
• Evacuation procedure

Places of work are required to have a first aid provision.

The extent of the provision is based on:

• The number of people
• Working with hazardous materials
• Working in dangerous conditions
• Category of risk (low risk - shops & offices, medium risk - care homes)

A risk assessment should be carried out to determine the level of the first aid provision.

The minimum required is a well stocked first aid box and an 'appointed person' for first aid.

First aid is essential to prevent injuries from worsening and it could save lives.

First aid boxes must be:

• Identifiable
• Well stocked
• Accessible location

Any time first aid is issued, records must be kept.

Records must include:

• Date, time and place of accident
• People involved
• Treatment given
• Condition of person after accident.

Control of Substances Hazardous to Health

* This regulation requires employers to control exposure to hazardous substances at work. *

Features of the legislation:

• Prevents accidents/illnesses caused by exposure to hazardous substances.
• Requires employers to perform risk assessment before using certain substances.
• Controls storage, handling and safe disposal of materials.
• Sets safe limits for storage, exposure etc.
• Encourages employers to use safer alternatives.
• Requires adequate control measures and equipment associated with them (including PPE).

Every care setting must have a COSHH file that is up to date.
It should list all of the hazardous substances that are within the premises.

COSHH covers:

• Chemicals
• Fumes
• Dusts
• Vapours
• Mists and gazes
• Biological agents

COSSH does not cover:

• Lead
• Asbestos
• Radioactive substances

Examples of substances hazardous to health

Bleaching agent: Store in clearly marked container in a locked cupboard.

Flammable chemicals: Store in a fire resistant locked cupboard away from sparks etc.

Poisons: Store in a locked cupboard with clear instructions for dealing with accidents. In a place with limited staff access.

Glue: Store locked away from young children/unauthorised people.

Risk assessment involves carefully examining something that could cause harm and then deciding whether enough precautions have been taken to prevent injury.

The Health and Safety at Work Act and the Managment of Health and Safety at Work Regulations state that it is a legal requirement for employers to carry out risk assessment.

Hazard: anything that could potentially harm a person. (e.g wet floor)

Risk: likelihood of the hazard causing harm. (e.g. the likelihood of the hazard causing harm)

When a hazard is identified, it's necessary to consider the risks they present.

Stage 1: LOOK FOR HAZARDS

Stage 2: ASSESS WHO MAY BE HARMED

Stage 3: CONSIDER RISK - are current precautions adequate?

Stage 4: DOCUMENT THE FINDINGS

Stage 5: REVIEW THE ASSESSMENT AND REVISE IF NECESSARY

LOOK FOR HAZARDS

Significant risks are identified

The person will walk around the care setting/workplace and look for things which could cause serious harm or affect serveral people. 

It could be equipment, physical environment, people's behaviour or tasks that are potential hazards. 

ASSESS WHO MAY BE HARMED

All employees, service users and visitors must be taken into consideration when making the risk assessment.

Who is at risk of being harmed by the hazard?

CONSIDER THE RISK - decide whether more should be done

This aim is to minimise risks.

Priority is given to risks that are high or effects most people.

First consideration - if the hazard can be removed or disposed of (e.g a worn carpet can be removed).

If the risk cannot be removed, these principles should be applied:

• Try a less risky option
• Prevent access to the hazard
• Provide protective clothing 
• Provide first aid 

Document the findings

If there are 5 or more employees then hazards from risk assessment must be recorded or documented. 

Staff must be told about the findings.

An example could be a 'badly worn carpet in the residents lounge due to be replaced in three months time'. This would need to be covered with tape to prevent anyone tripping over it and so staff are aware of the hazard - reducing the risk of people being harmed. 

REVIEW THE ASSESSMENT AND REVISE IF NECESSARY

Records which demonstrate necessary aspects have been covered, are useful

They make a useful reference point for when assessments are reviewed

In any care setting there are hazards which could cause injury to the service users, especially if they are older, disabled, ill or very young.

Types of hazards:

Hazards associated with equipment and materials 

Hazards associated with people. 

Hazards assoicated with the environment

> Broken lids on top of containers

> Gas or electrical appliances in poor condition 

> Worn or damaged lifting equipment 

> Incorrectly labelled substances 

> Intruders 

> Handling procedures 

> Violent or agressive behaviour 

>Visitors to the building 

> Worn carpets or rugs 

> Wet or slippery floors 

> Clutter on stairways or in hallways

All care settings will have certain common safety features such as fire alarms, smoke alarms and a health and safety policy. 

Early warning systems 

• CCTV
• Alarms on doors 

Warning signs

These are yellow triangular signs with a black boarder which are used to identify hazards. 

Employers have a duty to provide personal protective equipment at work as a result of the Personal Protective Equipment at work Regulations.

PPE is all equipment which is intended to be worn or held by a person at work which protects them against risks to their health and safety. 

The regulations require PPE to be:

• Used correctly by employees.
• Properly assessed before use in order to ensure suitability. 
• Provided with instructions on how to use safely. 
• Maintained and stored properly. 
• Free of charge for the employees. 
• Users must be trained and must wear it at all times when exposed to a hazard

What must be considered when assessing whether the PPE is suitable?

• It must be appropriate for the risk concerned. 
• It must prevent or control the risks without increasing the overall level of risk. 
• It must be adjustable in order to fit the wearer correctly. 
• It must take the state of health of those wearing it into consideration.
• It must take into consideration the needs of the job and the demands it places on the wear (e.g. the length of time PPE needs to be worn).
• It must consider the combatibilty if more than one type of PPE is being worn.

EYES - goggles can protect from chemical splashes, dust, projectiles, gases which can cause damage to the eyes. 

HEAD - helmets can protect impact from falling, falling objects, risk of head bumping. 

BREATHING -  respiratory equipment can protect from breathing in dusts and gases. 

BODY - disposable overalls can protect people from chemical splashes and special clothing such as high vis vests or boiler suits can protect from temperature extremes. 

HANDS AND ARMS - Gloves and arm cuffs can protect from temperature exremes, cuts, infection and electric shock. 

FEET AND LEGS - Safety boots can protect from wet conditions, falling objectives, electrostatic build up. 

These regulations were introduced to rationalise fire safety in the workplace. 

These regulations apply to any employer who employs 1 or more workers. 

A fire officer will come out and give advice on the premises, ensure that that there is a means of escape, maintained fire equipment and a fire safety certificate will be issued. 

The employer must:

• Carry out risk assessment
• Provide and maintain fire precautions. 
• Provide information, instruction and training on fire safety for employees. 

Fire extinguisher
Sprinkler system
Hose reels

• Sprinkler system - prevents fire becoming larger 

• Fire retardant doors - take a long time to burn through, slowing the spread

• Fire extinguishers/blanket - prevents fire becoming too large

• Closing doors and windows - reduces oxygen available to flames. 

• Must be an emergancy exit
• Escape routes must be planned
• Emergancy doors must open outwards and never blocked
• Sign posting to show the escape routes
• Emergancy lighting should be checked regularly 
• Registers should be taken so everyone is accounted for
• Care workers must follow evacuation procedure
• If the care setting has lots of people in beds, people will be moved in to adjoining safe zones away from the location of the fire (phased evacuation plan). 

• Practitioners know what to do in the event of a real fire. 
• Knowledge will be semi-automatic therefore no hesitance in event of fire. 
• Allows practitioners to identify any issues with the current evacuation procedure.
• Changes can be made.
• New or temporary staff will become familiar with procedure. 
• Service users won't panic. 

Water -

+ Used for fires involving solids (paper, wood, cloth).

- Not used for burning fat, oil or electronics. 

Foam - 

+ Used for solids, paper, wood, cloth and liquids such as  oils and paint

- Not used for chip fat or pan fires or electrical equipment. 

Dry powder -

+ Used on solids, flammable liquids, electrical equipment. 

- Not used on chip fat or pan fires. 

Carbon dioxide - 

+ Flammable liquids, electrical equipment and cooking fat/oil
- Not used on flammable gases or chip fat.

Security to which allows service users to choose their visitors and retain their privacy:

• Service users are entitled to decide who they will or will not see.
• The care worker must respect the wishes of the service user and not try to persuade them to accept visitors they are unhappy about.
• If the unwanted visitor is forceful, the care duty has a duty to protect the service users interests. 

Security which protects service users from intruders:

• No one must be allowed onto the premises without being signed in - preventing unauthorised people gaining access to the care setting. 

Security which protects people's property:

• Staff are expected to safeguard service users property which is brought into the care home. 
• All possessions should be recorded on admission.
• If any property goes missing, a search investigation must be taken out before reporting to the police. 

Security against being abused

Physical abuse - any force against the service user. 

Sexual abuse - when informed consent is not given.

Emotional abuse - putting someone down, , teasing. 

Financial - withholding or refusing access to money. 

Institutional - privacy and dignity not respected. 

Measures to be taken to maintain a secure early years setting:

• Visitors should ring a bell in order to gain access to the building. 
• Official visitors (e.g. from a gas board) should have their identification checked before being allowed into the building. 
• Adult should supervise children on arrivals or when children are playing outside. 
• Door handles should be too high for children to reach. 
• CCTV is useful to monitor outside premises. 

Often care homes have a locked door system whereby people cannot access the building without ringing a bell but the service users can open the door from inide. 

However, some care homes have door alarms which set alarms off if a service user tries to open any of the external doors, this prevents confused service users from wandering off. 

It is the duty of the care home to provide:

• Security which allows the service users to retain their privacy and choose visitors. 
• Security which protects the service users from intruders. 
• Secturity which protects service users property. 
• Security against being abused. 

The Manual Handling Operations Regulations were introduced in order to reduce the numbers of injuries caused by moving and handling in all industries

Employers must:

• Carry out and review risk assessments.
• Try to reduce risks. 
• Avoid manual handling by providing equipment.
• Provide information on the load to be lifted. 

Employees must:

• Safeguard themselves and others. 
• Use equipment appropriatly. 
• Co-operate with the employer. 

If the care worker has to move and handle then they must consider:

• Is the job necessary?
• Can the job be done using a mechanical aid?
• Are there different ways of moving the service user?

Care workers can be held personally and legally accountable for their actions or inactions if they are a care worker who normally deals with handling. 

Lifting Operations and Lifting Equipment Regulations

These regulations aim to reduce risks to people's health and safety by providing lifting equipment to be used at work. 

These regulations state that equipment must be:

• Strong and stable enough for the particular use. 
• Positioned and installed correctly to minimise risk. 
• Used safely (the move is planned, organised and perfomed by trained people). 
• Information visibly marked (e.g. weight limits).
• Examined before used the first time and re-examined every six months and a report made. 

1) Never manually handle unless you have no other option. 

2) Wear appropriate clothing and footwear (no loose clothing or heeled shoes).

3) Assess the person or object to be moved before starting manoeuvre. 

4) Appoint a team leader to give instruction. 

5) Explain to the service user what is happening. 

6) Bend the knees not the back. 

7) Do not twist. 

8) Know your own handling capacity and do not exceed it. 

A risk assessment must be carried out for all manual handling operations.

Every service user who requires manual handling must be assessed for:

• Weight
• Factors affecting handling (e.g. unpredictability)
• Methods to be used
• Equipment required to help with the move

The risk assessment should be recorded unless:

• It could be repeated easily and could be explained as it is simple and obvious. 
• The manual operation is straight forward and would take longer to record than to carry out. 

When assessing for moving and handling the care worker must consider:

The task

The load/weight

Working environment 

Individuals capability

There are 4 main points associated with service user injury during a transfer:

1) Friction

2) Joint damage

3) Resistance from service users

4) Falls

This system means that every service user is associated with a colour. 

Red (most difficult)

Yellow 

Green 

The colour rating is dependent on an assessment of the service user's condition, based upon the handling hazard they present. 

Carers can see at a glance what difficulty they will have moving the person. 

Aids to assist a service user in sitting to standing:

• Raised chair
• Raised toilet seat
• Tip-up chairs
• Grab rails 

Aids to encourage independent transfers/reduce stress on care workers:

• Transfer boards
• Slide sheets
• Turntables 
• Handling belts 
• Draw sheets 

Aids to assist the carer in moving service user from bed to bed:

• Large transfer board
• Large slidnig sheet. 

Aids to move service users on the bed:

• Trapeze
• Bed ladder
• Transfer sheets 

Equipment selected should:

1) Reduce handling effort for carers.

2) Be properly maintained. 

3) Suitable for the condition and comfort of the service user. 

4) Be capable of moving the service user safely. 

Cross infection = the passing of microbes/infection from one person or surface to another person or surface.

Cross infection can happen in many different ways:

• Clothing 
• Hands (unwashed or using same gloves)
• Droplets of infection in the air
• Equipment not sterilised
• Linen not washed

• Must be used by all health and social care workers.

• They prevent the spread of micro-organisms that may cause infection. 

• Standard precautions should be used at all times when dealing with blood, excretions (urine, vomit, faeces) or secretions (saliva, sputum).

• Standard precautions are there to protect people within care settings.

Perform hand hygiene:

• When necessary; before and after contact with a service user. 

Use personal protective equipment:

• Gloves and aprons.
• Protectsd the skin, face, eyes, mouth from splashes/contamination and from potentially harmful micro-organisms. 

Prevent occupational exposure to infection:

• Cover all breaks in skin, avoid splashes with blood or body fluid. 
• Protects all workers from exposure to micro-organisms that cause infections (eg. HIV).

Manage blood and body fluid spillages:

• Immediatly after spillage disinfect area. 
• Protects everyone in surrounding area from exposure to micro-organisms in the spillage. 

Manage care equipment:

• Prevent re-use of disposable items.
• Re-usable items are decontaminated between use. 
• To ensure equipment does not spread infection. 

Control of environment:

• Ensure cleaning and maintenance responsibilities are clear. 
• To ensure fitting and fixtures in care settings are decomtaminated to prevent cross infection. 

Safe disposal of waste:

• Know procedure for safe disposal of clinical waste. 
• To prevent avoidable exposure to micro-organisms.

Safely manage linen:

• Safe storage,handling, transport and processing. 
• To prevent infection being spread through linen. 

Provide care in most appropriate place:

• If there is a concern seek advice from the Infection Control Team. 
• Prevents spread of infection through inappropriate placements or transport of service users. 

Clinical waste is anything contaminated by body fluids. This is potentially hazardous to the care worker who many have to deal with it on a regular basis. 

GROUP A = identifiable human tissue, blood, soiled surgical dressings, swabs and other similar solid waste. 

GROUP B= Discarded syringe needles, broken glass etc - SHARPS.

GROUP C = Microbiological cultures and potentially infected waste from pathology departments and other research laborities. 

GROUP D = Drugs or other pharmaceutical products. 

GROUP E = Items used to dispose of urine faeces and other bodily secretion that does not fall into group A. 

The cateogry of the waste determines the packing and labelling requirements. 

There are is a widely used colour system which helps with waste segregation:

YELLOW = group A goes into this bin - clinical waste for incineration or other suitable means of disposal. 

YELLOW WITH BLACK STRIPES = group E goes into this bin - non infectious waste (tampons, sanitary towels and stoma pads).

BLACK = Non-clinical or house hold waste (e.g. paper towels). 

Group B must be disposed of in sharps containers.