Advicesheet

Risk assessment in dentistry A5

 Advicesheet

Risk assessment in dentistry A5

contents page
This advice sheet Risk assessment in dental practice 3
describes your • Introduction 3
obligations under • What is risk assessment? 3
current health and • What you need to do 3
safety law to conduct a • Employees with disabilities 4
suitable and sufficient
practice risk
COSHH 5
assessment. Other
BDA publications will • What is a hazardous substance? 5
be useful in helping you • Your COSHH assessment 5
comply with these • Flammable substances 7
requirements. These
are referred to in the Young people and work experience students 7
relevant sections of the • Information and training 8
advice sheet and are • Immunisation 8
listed on page 16.
New and expectant mothers at work 8
• Aspects of pregnancy that may affect work 9

Frequently asked questions 9

Risk assessment checklist 10

Example risk assessment 13

Useful BDA resources 16

© BDA September 2007 2

Risk assessment is a legal requirement for all employers and the self-employed. The
Health and Safety at Work etc Act 1974 (section 2) requires employers and the self- Risk
employed to ensure, as far as is reasonably practicable, the health and safety of all
those who may be affected by work activities. assessment
The Management of Health and Safety at Work Regulations 1999 impose a specific in dental
requirement for all employers and self-employed people to assess the risks arising from
work activities to workers and any others who may be affected. Other regulations that practice
require a risk assessment to be carried out include the Control of Substances Hazardous
to Health Regulations 2002, the Ionising Radiations Regulations 1999, the Manual
Handling Operations Regulations 1992 and the Fire Reform Order 2006.

Employers with five or more employees must record the significant findings of their
assessment. Recording the findings of all risk assessments, irrespective of the number of
employees, is good practice and provides documentary evidence that the assessments
have been undertaken.

A risk assessment is simply a careful examination of what, in the course of your work,
could cause harm to people. It helps you identify what precautions or additional What is risk
precautions are required to prevent or minimise the risk of injury and/or ill health. Risk assessment?
assessment is meant to be a practical, not theoretical, exercise to identify the hazards
and assess the possible risks associated with that hazard.

Hazard - anything that can cause harm (ie chemicals, electricity etc)
Risk - the chance (big or small) of harm actually being done.

If you are a small practice and are confident you understand what's involved, you can
do the assessment yourself or ask the help of a responsible member of staff (you do
What you
not have to be a health and safety expert!). If you are a larger practice or group of need to do
practices, you might decide to appoint someone within the practice to oversee all
health and safety matters (possibly with some training) or you might 'buy in'
professional help.

Look for the hazards

If you decide to do the assessment yourself, walk around the practice and look afresh
at what could reasonably be expected to cause harm. Concentrate on significant
hazards that could result in serious harm or affect several people. Ask your staff what
they think. Manufacturers' instructions, safety data sheets (for chemical products) and
product labels can help you spot hazards and put risks into perspective, as can an
accident/incident book and ill-health records. Suppliers of equipment and chemicals will
be able to provide you with health and safety information - they have a legal obligation
to do so.

Decide who might be harmed and how

Think of everyone who might be affected by a hazard and in particular:

• young
risk
workers, trainees and new and expectant mothers who may be at particular

• cleaners who may work in the practice outside normal working hours, often alone
• outside contractors and others who may not be in the practice all the time
• patients, especially children and older patients.
Evaluate the risks and decide whether the existing precautions are adequate or
whether more should be done.

© BDA September 2007 3

 For each significant hazard, you will have to decide if the risk is high, medium or low. For
example, the risk of infection from blood and/or saliva is significant in dentistry but,
providing current infection control guidelines are followed (including recommended
immunisations), then the risk of infection will be minimised. As well as complying with
any legal requirements, is there anything more that you could do to keep the practice
safe? The aim is to make all risks small by adding to existing precautions as necessary. If
something needs to be done, draw up an 'action list' and give priority to hazards where
the risks are high and/or those which could affect most people.

Improving health and safety need not be costly. For example, putting some non-slip
material on slippery steps is an inexpensive solution, considering the risk of injury.

Record your findings

If you have fewer than five employees you do not need to write anything down but it is
useful to keep a written record of what you have done. If you employ five or more
people you must record the significant findings of your assessment and tell your staff
about your findings.

Your risk assessment must be suitable and sufficient and needs to show that:

• a proper check was made

• you asked who might be affected
• you dealt with all the obvious significant hazards, taking into account the number of
people who could be involved
• the precautions are reasonable and the remaining risk is low.
Keep the written record for future use; it can help you if the local primary care
organisation or Health and Safety Executive inspect your practice, or if you become
involved in action for civil liability. To make things simpler, you can refer to other
documents - instruction manuals, health and safety policy statement, infection control
policy and practice rules, for example; these may already list hazards and precautions
and you are not expected to repeat this work. It is up to you whether you combine all
the documents, or keep them separately.

Review your assessment and revise it if necessary

At some point you may bring in new machinery, equipment, substances and procedures,
which could create new hazards. Remember to amend your risk assessment if there is a
significant change and new potential hazard. Review your assessment from time to time
to ensure that the precautions are still working effectively and remind staff of the
assessments on a yearly basis at a practice meeting.

Employees with When carrying out your risk assessment, pay particular attention to employees with
disabilities; you have responsibilities under the Disability Discrimination Act and health and
disabilities safety law to eliminate or reduce the risks and avoid inadvertent discrimination.
Depending on the type of disability, the employee may be at particular risk and you will
need to show that this was considered in your risk assessment. Involve the employee in
the assessment, consulting on the extent of the disability and the implications it might
have on their safety at work.

© BDA September 2007 4

The Control of Substances Hazardous to Health Regulations protect workers against ill
health and injury caused by exposure to hazardous substances - from mild eye irritation COSHH
through to chronic lung disease and even death. The COSHH Regulations require you to
eliminate or reduce exposure to known hazardous substances in a practical way; it is not
meant to be a paper exercise!

Where preventing exposure is not reasonably practicable, it must be adequately

controlled by:

• changing the process or activity to remove the need for the hazardous substance or
prevent it from being generated
• replace the substance with a safer alternative
• use it in a safer form.
Manufacturers of hazardous substances are required to display an orange and black What is a
warning symbol on the label and packaging of any substance that is classified as
hazardous: hazardous
substance?

corrosive harmful

irritant toxic

The label states how the substance is toxic, harmful, corrosive or irritant - irritating to
eyes and skin, harmful if swallowed or toxic by inhalation, for example. Manufacturers
and suppliers of hazardous substances are required to provide material safety data
sheets, which contain more detailed information on the hazards presented and the
required first-aid measures.

Other substances are also classified as hazardous and include:

• substances with an occupational exposure limit (mercury, for example)

• biological (infectious) agents directly connected with work activities - blood borne
viruses are common in dentistry
• any kind of dust in a significant amount
• any other substance classed as hazardous (latex, for example).
Identify the hazardous substances and consider the risks. Your COSSH
Look at all the substances and chemicals that you use in the practice and identify which assessment
are hazardous. Pay particular attention to:

• acids (hydrochloric, hydrofluoric, nitric, phosphoric, sulphuric)

• adhesives (may contain xylene or toluene which are classified as harmful)
• blood and saliva (infectious agents)
• disinfectants,
irritant)
strong detergents and other cleaning agents (maybe harmful and/or

© BDA September 2007 5

 • latex gloves (risk of allergy)
• mercury (toxic by inhalation)
• nitrous oxide (can affect central nervous system at high concentrations)
• solvents (various ill-health effects)
• radiographic chemicals (irritating to eyes and skin and possibly respiratory system)
Most restorative and impression materials and mouth rinses pose negligible risk so will
not need to be included in your COSHH assessment. When you assess the risks, you
should consider:

• how often it is used? Daily, weekly, monthly, quarterly or annually

• how much of the substance is used? Small amounts (grams or millilitres) or medium
amounts (kilograms or litres)
• how could people be exposed to it? Inhalation, direct contact, skin absorption, or
swallowing, for example
• who could be affected? Staff, patients, visitors, contractors.
Decide what precautions are needed
If you decide that the substance does not present a risk or the risk is trivial, you do not
need to do anything more. If you identify significant risks, you need to decide how you
can reduce the risk, for example, by changing to a different substance or procedure or
improving ventilation.

Record and review the assessment

Your COSHH assessment should be recorded and kept with any relevant material
safety data sheets. It should be regarded as a 'living' document that any member of the
dental team can refer to for working safely with hazardous substances. A
comprehensive and well written COSHH assessment is of little use if stored in a
drawer or on a shelf and staff are unaware of the hazardous substances they work with
and the precautions they should take to minimise any risks.

You should review the assessment if you feel it is no longer valid or there has been a
significant change in work activities or the substances used. Everyone working at the
practice should be reminded of its contents on an annual basis.

Ensure that precautions are followed and controls are maintained

Staff must receive suitable information and training on the precautions for handling and
using hazardous substances and supervised where necessary. They should understand
the reasons for any control measures that are in place - such as wearing protective
gloves and eyewear and the need for adequate ventilation.

Monitoring exposure
If your assessment shows that there could be a serious risk to health from a substance
harmful by inhalation or irritating to the eyes, skin and respiratory system you should
consider air monitoring unless ventilation throughout the practice (either from natural
or mechanical ventilation) is adequate.

Carry out appropriate health surveillance

Encapsulated amalgam capsules should be used in preference to combining mercury
and alloy from reservoirs in an amalgamator. Where bottled mercury is used, biological
monitoring of exposure is recommended to help ensure that staff do not exceed safe
limits. An above average biological level of mercury might indicate a failing in routine
mercury hygiene within the practice (a mercury spill, for example) that might otherwise
go undetected.

© BDA September 2007 6

Ensure staff are properly informed, trained and supervised
Staff who work with hazardous substances should be provided with the following
information:

• the nature of the substances they work with or are exposed to and the associated
risks
• the precautions they should take and the control measures in place
• the importance of using any personal protective clothing or equipment provided
• the results of any exposure monitoring and health surveillance
• emergency procedures (in the event of exposure or a spillage, for example).
Flammable substances are not necessarily hazardous to health (they may simply be Flammable
flammable) but they are obviously a risk to safety. You need to ensure that these
substances present minimum risk: substances
• store and use flammable substances in a well ventilated area so that any vapours
given off from a spill or leak will be dispersed rapidly
• avoid sources of ignition in areas where flammable substances are stored or handled.
Ignition sources include sparks from electrical equipment, cutting tools, hot surfaces,
open flames from heating equipment and cigarettes
• sunlight is a heat source - a glass window may intensify heat during the summer to a
considerably high temperature, which has been known to cause aerosol cans to
explode (including deodorant and hairspray cans)
• flammable substances should be stored in suitable containers away from general
work and storage areas, especially if being stored in large quantities.

If you employ a young person (aged below 18), agree to help with work experience or
take on a new employee with no previous experience of working in a dental practice,
Young
you will need to carry out a risk assessment to ensure the individual is not put at risk and
is aware of health and safety risks specific to dentistry. It is important that these people
people
receive adequate information, instruction and training and a high level of supervision by
an experienced person.
and work
Your risk assessment should take account of:
experience
• the inexperience and immaturity of the individual students
• their lack of awareness of risks to their health and safety
• their exposure to biological (infectious), chemical (such as mercury) or physical (such
as radiation) agents.

For work experience students (under 16 years) you must also:

• inform the parents/guardians of the key findings of the risk assessment and the
control measures you have introduced before the young person starts work
experience

Do check that your employer's liability insurance covers work experience students or
whether additional insurance is needed.

© BDA September 2007 7

 Information It can sometimes be hard to appreciate fully how little knowledge a young or
inexperienced new employee might have when they start work at your practice. For
and training example, they may be unaware of the risks of:

• infection from contact with blood and saliva or from contaminated sharp
instruments
• eye injury from flying debris during operative procedures
• exposure to mercury vapour or contact with other hazardous chemical agents such
as disinfectants and x-ray chemicals
• possible allergic reactions to latex gloves
• scalds and burns (and explosions) from the autoclave.
Develop an induction training programme for all new employees to ensure that
everyone in the practice is aware of the health and safety arrangements (the health and
safety policy is a good starting point), infection control procedures, radiation protocols
and policies as well as training on other practice management issues (including
confidentiality).A competent person within the practice should oversee the training and
start a training log for the new employee.

Immunisation Immunisation against the common infections is usually provided to young people during
their school years and it is worth checking that the usual vaccinations have been
received.

Routine vaccination does not include immunisation against hepatitis B, however. Ideally,
dental nurses should be fully immunised against hepatitis B and their immunity
confirmed before they start chairside assisting but this is not always practicable. If a
new employee has not been immunised against hepatitis B, arrangements for
vaccination should be made as soon as possible upon employment.

You need to protect against inoculation injuries as far as possible and your risk
assessment should show this. Personal protective clothing and equipment including
gloves and eyewear should be provided from the start of employment and thicker
heavy duty gloves provided for the manual cleaning of dental instruments, along with a
protective apron and eyewear to shield against possible splashing. Re-sheathing of
needles is a particularly hazardous process and should not be carried out.

Further guidance on hepatitis B immunisation and a model risk assessment is available

in the BDA Advice note Hepatitis B immunisation (37).

New and Pregnancy should be regarded as part of everyday life and not equated with ill health;
its health and safety implications can be adequately addressed by normal health and
expectant safety management procedures. Many women work when pregnant and return to

mothers at work when they are still breastfeeding. Some hazards in the workplace, however, may
affect the health and safety of new and expectant mothers and that of their children.
work You need to be able to identify these hazards and reduce any risks.

If you cannot avoid a risk by other means, you will need to make changes to working
conditions or hours, offer suitable alternative work or, if that is not possible, give the
worker paid leave for as long as necessary to protect her health or safety or that of her
child.

New or expectant mother means an employee who is pregnant, has given birth within
the previous six months, or is breastfeeding

In assessing risks to new or expectant mothers you should take whatever action is
necessary to ensure that they are not exposed to any significant risk. Risks include

© BDA September 2007 8

those to the unborn child or child of a woman who is still breastfeeding - not just risks
to the mother herself.

Your risk assessment for new and expectant mothers will follow the same format as
your general risk assessment. Dental practices do not generally pose particular hazards
for new and expectant mothers but, depending on your work practices and your risk
assessment, you may decide that certain equipment, substances or activities are best
avoided during pregnancy and/or breastfeeding.

Look for the hazards

Most of the hazards present in your dental practice that need to be considered will
have been identified during your routine risk assessment but there could be different
risks depending on whether workers are pregnant, have recently given birth, or are
breastfeeding. You should take particular care to assess the following:

• biological agents (bacteria and other micro-organisms)

• chemical agents - for example, mercury and anaesthetic and sedation agents
• physical agents - for example, radiation, manual handling and restricted posture
Avoid the risk
If your assessment reveals a risk you should explain what action you will take to
prevent exposure to the risk or control it so that it is no longer a risk. If you identify a
significant risk to which you cannot prevent or control exposure, you must remove the
new or expectant mother from risk and offer suitable alternative work if any is
available. If not, you must suspend her from work (paid leave) for as long as necessary.
This is really only required if the risk assessment gives rise to genuine concern. If there
is any doubt, you may want to seek further advice on what the risks are and whether
they arise from work before offering alternative employment or paid leave.

Review
You need to maintain your awareness of the risks and measures to prevent or control
exposure for the duration of pregnancy or breastfeeding. There is no time limit on
breastfeeding; it is for the individual to decide for how long she wants to breastfeed.

• morning sickness could be a problem if work demands an early start Aspects of

• backache could be made worse by standing, manual handling and posture pregnancy that
• varicoses veins and may be affected by standing or sitting may affect work
• frequent visits to the toilet may be a problem if there is difficulty in leaving the
surgery or reception as often as required
• increasing size may have implications for uniform provision, working in confined
areas and manual handling
• tiredness could be exacerbated by overtime, finishing late or working late shifts.
Detailed guidance on pregnancy, risk assessments and the law is available in the BDA
Advice note New and Expectant Mothers at Work (40).

Do I need a COSHH assessment for every substance used at the practice? Frequently
No. Assessments are only needed for hazardous substances. For bought-in products,
an orange and black hazard warning symbol will alert you to a hazardous substance. asked
Do our portable electrical appliances need to be tested every six months?
questions
No, but the law requires them to be in good working order at all times. A formal visual
check by you or another competent member of staff perhaps on an annual basis should
be sufficient. This should be followed up with an inspection by a qualified electrician at
least every three years.

© BDA September 2007 9

 Are filters for display screens mandatory to reduce radiation?
No. Screen filters need only be fitted where glare is a problem. Levels of radiation
emitted from display screens are well below safe levels.

I've done the risk assessment in accordance with the guidance in this advice sheet
but I'm worried it's not good enough!
Your risk assessment must be suitable and sufficient - it does not have to be perfect. You
need to be able to show that a proper check was made, you considered who might be
affected, you dealt with all the obvious significant hazards, the precautions are
reasonable and any remaining risk is low. A Health and Safety Inspector will want to see
that the practice is run safely and that staff are well informed of any risks and any
precautions they should take, rather than a mountain of paperwork.

Risk You might find the following checklist helpful when you are assessing the risks in your
practice:
assessment
checklist • Amalgam capsules have been found to leak during mixing, contaminating the
immediate area and/or the amalgamator. Check amalgamators from time to time to
ensure there are no mercury droplets present.

• Autoclaves and air receivers (compressors) must be regularly serviced according

to the manufacturer's recommendations and inspected according to the Written
Scheme of Examination, which is drawn up by a competent person. Have staff been
properly trained in the safe use of the autoclave(s)?

• Children should be taken into account when assessing risks within the practice, for
example access to hazardous substances, sharps containers etc.

• COSHH: Anaesthetic agents such as nitrous oxide should be assessed

• COSHH: Biological agents such as blood and saliva should be assessed. Is there a
practice infection control policy in place? Have relevant staff been immunised against
hepatitis B and their immune status checked? Do staff know what to do in the event
of an inoculation injury?

• COSHH: Hazardous substances. Have these been assessed and any significant
risks either removed or reduced? Have relevant staff been informed of the risks and
of any precautions they should take? Adequate controls should be in place for acids,
adhesives, blood and saliva (biological agents), disinfectants, strong detergents and
other cleaning agents, latex, mercury (bottled and encapsulated), nitrous oxide,
solvents and x-ray chemicals. The risk of latex allergy should be minimised by using
non-powdered gloves.
Note: Where local exhaust ventilation (LEV) is fitted to control exposure to hazardous
substances (ie in the x-ray developing area) it should be examined and tested at least
every 14 months.

• COSHH: Legionella is more likely to proliferate in the presence of sludge, scale,

rust and algae and when water is in the temperature range of 20°C to 45°C.Water
contaminated by legionellae only presents a risk when it is dispersed into the air in
the form of an aerosol (very fine water droplets/spray). You can reduce the risk of
algae contaminating dental unit waterlines by using a bottled water system and
following the manufacturer's recommendations on decontamination.

• Display screen equipment: The workstation and environment should be

comfortable and suitable for the individual user and there should be planned breaks
or changes of activity from the screen and keyboard. If requested, eye tests should
be provided and spectacles provided if required for use with the DSE.

© BDA September 2007 10

• Electrical equipment should be in good working order at all times. User checks,
formal visual inspection and combined inspection and testing should be carried out
at appropriate intervals. User checks are a simple visual check of the equipment and
its cable and plug before use - whoever is using the equipment can do this. A
competent member of staff can carry out a more formal visual inspection on an
annual basis provided they have enough knowledge and training. Earthed equipment
should also have an occasional combined inspection and test by a qualified electrician.

• Ergonomic factors are important in order to reduce the risk of musculo-skeletal

discomfort/disorders. Back, neck, shoulder and other sprains or strains can be
caused by poor posture due to space constraints, unsuitable seating or poor
lighting. Seating should be suitable for the individual and provide adequate support
for the lower back. Twisted, stooped or stretched postures should be avoided.
Check all staff are able to carry out their various duties comfortably. Advise staff to
report any possible work related sprains or strains to you as soon as they become
apparent.

• Fire precautions for the practice should include fire detection/warning, escape
routes (with adequate signposting), fire fighting equipment and training of staff in
fire safety. The fire risks should be assessed and incorporated into your main risk
assessment.

• First aid: Do you have an Appointed Person or a First Aider available on the
premises at all times? Is there an appropriately stocked first aid box?

• Infection control: You should have an infection control policy in place.

• Information, instruction and training for all staff to enable them to carry out
their various duties safely and without risk to themselves or others.

• Ionising radiation: You should have Local Rules for each x-ray machine, implemented
by the Radiation Protection Supervisor. The Radiation Protection Adviser for the
practice should help you carry out your radiation risk assessment. Is x-ray equipment
maintained and checked as advised by the manufacturer and the RPA?

• Lasers: Class 3B and 4 lasers present a risk of injury to the eyes and skin. Suitable
eye protection should be available to all those at risk, including the patient. Lasers
are a fire risk and should be kept away from flammable materials and anaesthetic
gases. A Laser Protection Adviser and Supervisor should be appointed and Local
Rules drawn up.

• Lone workers may be at risk. Foreseeable risks should be assessed and addressed.
• Manual handling may be hazardous. An assessment should ensure hazardous
manual handling has been identified (particularly the lifting/carrying/assisting of
unconscious, sedated or disabled patients) and appropriate training provided.

• Personal protective equipment, gloves, eye protection and masks, must be

suitable for its intended use. PPE is often recommended when working with
hazardous substances, for example heavy-duty gloves for use with disinfectants and
other cleaning products or radiographic chemicals.

• Pregnant and nursing mothers require an assessment of the possible risks to

their health or the health of the foetus or child. The assessment should include
exposure to biological (infectious), chemical (eg mercury/dental amalgam) or
physical (eg radiation) agents.

© BDA September 2007 11

 • use
Sharps instruments are hazardous and all staff must be given training in their safe
and disposal. What to do in the event of an inoculation injury should
also be included as part of the training.

• Slips, trips and falls can occur where there are uneven floors, trailing cables,
slippery areas due to spillages, including outdoor areas. These are the single most
common cause of injuries at work.

• Stress can occur in any area of work, including dentistry, especially where there is
high patient turnover and increasing demands on staff. It is important that the
practice works as a team and that staff feel they can raise issues relating to stressful
working.

• Vaccination against the common illnesses, and especially against hepatitis B, is

recommended. Records of immunisations and responses should be maintained.

• Ventilation must be adequate where hazardous substances are in use - such as the
x-ray developing area. Surgeries should also be adequately ventilated to reduce the
risk of infection from aerosols generated during patient treatment.

• Violence can be a problem in any workplace and it is useful to have a policy in place
to deal with incidents. The policy should address verbal as well as physical abuse.

• Young people: Have risks to young people been assessed - including risks which
could arise because of their lack of awareness, experience and training? In particular
consider the risks involving exposure to biological agents (infection), hazardous
substances (such as mercury and other chemicals) and physical agents (such as
radiation).

• Water regulations: Is the mains water supply protected from contaminated

(blood and saliva) backflow from the practice? This is usually achieved by an air gap.

• Work equipment needs to be suitable for its use and properly maintained.
• Workplace premises and environment:
- Is the building or premises in good repair?
- Are floors, corridors and stairs etc free of obstructions?
- Can windows be opened and cleaned safely?
- Is furniture with sharp corners sited so as to avoid injury?
- Is the lighting good and suitable for the various work activities being carried out?
- Are the floors and stairs clean and not slippery?
- Is the temperature reasonable - at least 16°C? (Local heating or cooling may
need to be provided.)
- Is space sufficient for the work being done?
- Are there suitable clean toilet facilities?
- Are there arrangements to protect non-smokers from tobacco smoke?
- Outside entrance and exit areas should be checked for slip and trip hazards,
including hazards created by wet and/or icy weather conditions.
- Check also for 'surprise' steps that could cause falls and low ceilings and low
door frames that could bump heads.

© BDA September 2007 12

A risk assessment of the practice was carried out on 1 February 2007 by the practice
owner and the following are the significant findings. Example risk
A review of the risk assessment is due on 1 February 2008
assessment

Significant hazards Those at risk Existing controls or action

required
Autoclave
Risk of explosion, scalds and burns Dental nurse (and others in the • staff receive full instruction
immediate area) and training in the safe use of
autoclaves
• manufacturers' instructions and
operating procedures are kept
nearby the autoclave
• malfunctions or faults are reported
to the practice manager for
remedial action
• autoclaves are serviced regularly
and inspected for safety purposes in
accordance with the Written
Scheme of Examination.
Biological agents Dentist, dental nurse, hygienist, • biological agents are covered by
Risk of infection from - patient COSHH - see separate assessment
• Blood/saliva • universal precautions and current
• Bacteria/micro-organisms infection control guidelines are
followed - see practice infection
control policy
• relevant staff are immuised against
hepatitis B and their responses
checked
• regular training in infection control
procedures is provided
• see also Sharps
For action: Regular training and
updates in infection control guidelines
for all staff.
Display screen equipment Receptionist / practice manager • individual workstation assessments
undertaken for regular users - see
separate asessments
• equipment and seating can be
adjusted to individual needs
• eye test is provided if requested by
employee
• window blind is provided to control
glare on screen [if glare is a problem]
• training in software used is provided
• information on DSE health and safety
has been provided (HSE leaflet).
Electrical All staff • staff advised to visually check plugs,
Risk of - cables or equipment for signs of
• electric shock or burns overheating or damage and report
• fire from damaged equipment. these to the practice manager for
remedial action.
• visual inspection of all portable
appliances is carried out annually/six
monthly by the practice owner [or
other competent member of staff]
and findings recorded

© BDA September 2007 13

 • all electrical equipment is inspected
and tested by a qualified electrician
at regular intervals (every three
years suggested)
For action: Training for staff to include
simple visual checks of electrical
equipment.
Eye injury Dentist, dental nurse, hygienist, • use of protective eyewear
Risk of - patient during clinical procedures for both
• flying debris and splatter from staff and patients and when cleaning
rotary instruments instruments and equipment prior
• splashing during the cleaning of to sterilisation
instruments. • use of high speed aspiration for
procedures involving rotary
instruments
• use of rubber dam whenever
possible to restrict the operative field
• immunisation against hepatitis B for
all clinical health care workers and
response to the vaccine checked
Eye injury from light curing unit Dentist, dental nurse, patient • use of suitable protective eyewear
Risk of damage to the eye from blue or light shield (red, orange or yellow)
(and white) light • avoid prolonged or direct viewing
Fire All staff, patients and visitors. • fire alarm system (if fitted) checked
and tested annually by service
engineer
• self-contained smoke alarms are
cleaned and batteries changed
annually
• staff trained in the evacuation
procedure
• fire fighting equipment is checked
and tested annually by service
engineer
• fire exits and fire-fighting
equipment are clearly marked
• access to exits and extinguishers is
kept clear at all times
• fire drills are held twice yearly (but
for practical reasons do not have to
be during patient time)
• procedures to be followed in the
event of a fire are displayed [where].
For action: Practice manager to make
regular inspections to ensure that fire
precautions are followed and
housekeeping standards are maintained.
Hazardous substances Dentist, dental nurse, hygienist, • Hazardous substances are covered
Risk of skin, eye and respiratory tract cleaner, patient, visitors and by COSHH - see separate assessment
irritation, asthma, allergy and contractors • staff made aware of the risks from
poisoning the hazardous substances they
work with and the precautions
needed to avoid or control these risks
• substances assessed include acids,
adhesives, blood and saliva,
disinfectants, strong detergents and
other cleaning agents, latex gloves,
mercury, nitrous oxide, solvents
and radiographic chemicals.

© BDA September 2007 14

 Manual handling All staff involved in lifting and/or a • training and information provided
Risk of injury to back or other part awkward or repetitive handling including good handling techniques
of the body (for example, stock deliveries, and how to recognise harmful
assisting elderly and disabled manual handling
patients into and out of chair). • information on manual handling
techniques is available (HSE leaflet)
and kept [where]
For action: Annual review of manual
handling techniques to be undertaken
(practice meeting).
Radiation - ionising Patient, dentist, dental nurse. • Radiation Protection Adviser
Risk of accidental over-exposure appointed - see separate risk
from x-ray equipment assessment
• Radiation Protection Supervisor is
on the premises at all times
• those involved in the taking and
processing of radiographs have
received the appropriate training
and possess the relevant knowledge
• x-ray equipment is regularly checked
and maintained in accordance with
the manufacturer's, suppliers and
RPA's advice
• arrangements for dealing with
accidental or unintended doses are
contained in the Local Rules.
• x-ray equipment can be switched off
in the event of malfunction without
entering the controlled zone
• current guidelines on radiology
standards are followed closely - see
Guidance notes on the safe use of
x-ray equipment (NRPB/DH, June
2001) and BDA Advice Sheet
Radiation in dentistry (A11).
Sharps Dentists, dental nurses, hygienists, • all staff trained in the safe use and
Risk of infection from used needles, patients, waste contractors disposal of sharps - see practice
instruments and spicules of teeth or policy on disposal of clinical waste
bone • thick household type gloves provided
for handling and cleaning used
instruments prior to sterilisation
• needles are only re-sheathed using
a device
• sharps are discarded into an
approved container
• all staff are immunised against
hepatitis B and their response to
the vaccine checked
• sharps injuries are reported
immediately and dealt with as
appropriate - see practice policy on
inoculation injuries
• if required, medical advice will be
sought as soon as possible.
For action: Regular updates on the
procedures to be followed in the
event of an inoculation injury (practice
meeting).

© BDA September 2007 15

Slips, trips and falls Staff, patients and visitors. • good quality flooring, which is well
Risk of injury. maintained
• all staff trained to maintain good
housekeeping standards
• spills cleared up immediately
• walk areas kept unobstructed.
Waste Disposal Staff and waste contractors. • waste segregated and disposed of
Risk of exposure to infectious or in appropriate containers - see
hazardous waste. practice policy on disposal of
healthcare waste
• waste collected for disposal by
authorised waste disposal company
• records of disposal maintained.

Useful BDA Advice Sheets:

Resources • Health & Safety Law for Dental Practice (A3)

• Radiation in Dentistry (A11)
• Infection Control in Dentistry (A12)
Advice Notes:

BDA Advice Notes have been produced on topics where a specific assessment needs
to be made and more detailed guidance is necessary. These contain model assessments
and are available on the BDA website. They include:

• COSHH (58)
• Fire precautions and Fire Risk Assessment (88)
• Hepatitis B Immunisation (37)
• Laser Registration with the Healthcare Commission (12)
• New and Expectant Mothers at Work (40)
• Work Experience Students and Young Trainees (59)
The following models are included in the BDA Practice Compendium

• Risk assessment for a dental practice

• Risk assessment for a trainee dental nurse
• Risk assessment for students on work experience
• Risk assessment pregnant and nursing mothers
• Infection control policy
• Disposal of clinical waste policy
• Inoculation injuries policy

British Dental Association

● 64 Wimpole Street ● London W1G 8YS ● Tel: 020 7563 4563 ● Fax: 020 7487 5232
● E-mail: enquiries@bda.org ● www.bda.org ● © BDA September 2007