A3 Health and Safety Law For Dental Practice

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advicesheet
Healthandsafetylawfor
dentalpractice
A3
advicesheet
dentalpractice
This advice sheet describes your obligations
under current health and safety law. The
framework of health and safety law enforcement
can look very complex but the underlying
principles are simple and, once the principles are
understood, application to a particular work
situation is largely a matter of common sense.
Other BDA publications will be useful in helping
you to comply with your health and safety
requirements. These are referred to in the
relevant sections of the advice sheet and include:
BDA Practice Compendium
Risk assessment in dentistry advice sheet (A5)
Radiation in dentistry advice sheet (A11)
Infection control in dentistry advice sheet (A12)
Clinical Governance Kit
The Checklist at the back of this document will
help you assess how well you are meeting your
requirements.
Good Practice
Compliance with health and safety legislation is
good practice and this advice sheet will help you
to put in place aspects of the legislation that are
relevant.
If you are working through the BDAs Good
Practice Scheme self assessment programme, this
advice sheet will help with the requirements of
the various commitments and especially
commitment 4 to look after the general health
and safety of patients while receiving dental care.
advicesheet
dentalpractice
contents
page
Radiation hazards
15
15
Risk assessment
Hazardous substances
Pregnant and nursing mothers
Young people
Safety signs
17
05
Stress
17
Anaesthetic gases
06
Ventilation
18
Asbestos
06
Waste disposal
18
Display screen equipment (DSE)
07
Water supplies
19
Electricity
08
20
Fire precautions
08
09
First-aid and medical emergencies

Qualified personnel
First aid box
Medical emergencies
Emergency drugs
Infection control
Welfare arrangements
Working environment
Safety
Facilities
Housekeeping
Contact details
Health and safety checklist
Lasers
10
Manual handling
Assessing and reducing the risks
Good handling technique
Medicine storage
10
Duty of care
04
The role of the Health and

Safety Executive
04
HSE inspections
04
Health and safety policy
05
Accidents
10
12
Mercury
Personal hygiene
Personal monitoring
Operative procedures
Dealing with spills
Amalgam/mercury waste
Amalgam separators
Pathological specimens
12
13
Pressure systems
14
Protective equipment
Gloves
Eye protection
Protective clothing
14
21
22
Health and safety law for dental practice
Duty of care
Hazardous to Health Regulations

2002 and the Health and Safety
(Display Screen Equipment)
Regulations 1992.
A dentists responsibilities for health

and safety are governed by the
Health and Safety at Work etc Act
1974 (HSW Act). The Act seeks to
protect all those at work
employers, employees and the selfemployed, as well as members of the
public who may be affected by the
work activities of these people.
Failure to discharge the
responsibilities laid down by the Act
can lead to prosecution by the
Health and Safety Executive.
Under the HSW Act, employees are

required to take reasonable care for
their own and others health and
safety and to cooperate with the
employer to implement the
requirements of relevant legislation.
As a last resort, an employees
continued refusal to comply with
safety rules could provide fair
grounds for dismissal (although this
decision must only be taken after
seeking appropriate advice, from the
BDA for example).
An employing dentist has a general

duty under the Act to ensure, so far
as is reasonably practicable, the
health, safety and welfare of
employees whilst at work. This duty
of care extends to patients and to
self-employed contractors who
might be on the premises. The
professional care of patients and
clinical judgment are not covered by
the Act.
In particular, a dentist should:
provide and maintain safe

equipment, appliances and
systems of work
ensure that dangerous or

potentially harmful substances
or articles are handled and
stored safely
maintain the place of work,

including the means of entrance
and exit, in a safe condition
provide a working environment

for employees that is safe,
without risks to health and with
adequate facilities and
arrangements for their welfare
at work
provide the necessary

instruction, training and
supervision to ensure health
and safety.
Health and safety legislation is
increasingly risk-led. Recent
legislation places a specific
obligation on employers to assess the
risks to their employees and others
who might be affected by their work
activities. The requirement to assess
risks may be general as with the
Management of Health and Safety at
Work Regulations 1999 or specific as
with the Control of Substances
bda advice sheet A3
The Act
seeks to
protect all
those at
work
An approved poster entitled Health

and Safety Law what you should
know (ISBN 0-71-762493-9) should
be displayed in every workplace
(Health and Safety Information for
Employees Regulations 1989). You
will need to add the name and
address of the enforcing authority
and the address of the Employment
Medical Advisory Service for your
area. The poster is available from
HSE Books (tel: 01787 881165).
The role of the Health and
Safety Executive
The Health and Safety Executive is
the statutory body responsible for
enforcing the HSW Act and
providing an advisory service. An
Inspector has the power to:
enter premises at a
reasonable time
examine and investigate all areas

of the practice
request such information,

facilities and assistance as may
be needed
interview and take written

statements from anyone they
think might give them
information relevant to
their investigation.
If a health and safety risk is
identified, the employer and
employees must be told what action
will be taken. If there is a breach of
legislation, an Inspector can:
issue an improvement notice

which specifies the legal
requirements being broken, what
action is required to put matters

right and the period of time
allowed
issue a prohibition notice, if
there is a risk of serious personal
injury, which prohibits the
carrying on of the activity giving
risk until the remedial action
specified has been taken
seize, render harmless or destroy
any substance or article
considered to be a cause of
imminent danger or serious
personal injury. This is clearly a
last resort power and would be
used only when other powers are
inadequate to deal with the
situation
prosecute anyone contravening a
legal requirement, either instead
of or in addition to serving a
notice.
Anyone who is served a notice (an

employer, a self-employed person or
an employee at the time of serving
the notice) may appeal to an
Industrial Tribunal within 21 days of
the notice being served. An
improvement notice is suspended
pending the outcome but a
prohibition notice remains in force
until the appeal is determined.
HSE inspections
A routine HSE visit might take
30-45 minutes and, although not
legally required to give notice
before calling, inspectors normally
make appointments to visit and
do their best to avoid disrupting
a practice. Inspectors carry a
warrant with an identifying
photograph and will produce this
for examination if requested.
An inspection will generally
consist of:
an examination of the premises

and equipment, with particular
attention to anything with an
obvious potential danger
(radiographic equipment,
autoclaves, electrical appliances,
and gas cylinders, for example).
Inspectors will not undertake
technical testing of equipment
but will ask about the safety
checks that have been carried
out and expect to see evidence
(reports, certificates etc).
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bda advice sheet A3
They can, where necessary,

recruit specialist technical
support
questions about who works in
the practice, the protocols and
precautions that are followed
routinely and what training staff
have received in working safely
and avoiding hazards. Particular
attention is paid to radiographic
hazards, the safe use of
anaesthetic gases (including
ventilation and cylinder storage)
and the control of other
hazardous substances. Where five
or more people work at the
practice, the inspector might ask
to see the practice safety policy.
Health and safety policy
How to comply
Practices with five or more

employees must have a written
health and safety policy, which is
brought to the attention of all
employees ideally each employee
should be given a copy. Associates
and self-employed hygienists must
be included; it is essential that they
also comply with the policy.
Health and safety policy statements
usually consist of three parts:
a statement of intent a
declaration of the employers
commitment to providing a safe
and healthy workplace and
environment
details of responsibilities for

health and safety throughout the
workplace
details of safe systems of work

and safe working practices for all
work activities.
A model safety policy for dental
practices is included in the BDA
Practice Compendium and the BDA
Clinical Governance Kit and can be
adapted to suit your practice. A more
general safety policy is available from
HSE Books (tel: 01787 881165) or
downloaded from the HSE website:
www.hse.gov.uk/pubns/indg259.pdf
BDA March 2004
Accidents
Practices
with five
or more
employees
must have
a written
health and
safety
policy
Employers are required to notify the

HSE of major accidents (including
death) and dangerous occurrences
(Reporting of Injuries, Diseases and
Dangerous Occurrences Regulations
1995 (RIDDOR)). Reports to the
HSE (Incident Control Centre) can
be made by telephone, fax or email
without delay to allow any necessary
investigation to begin promptly. The
employing dentist must also confirm
the details in writing within 10 days
on Form F2508. Accidents causing
more than three days absence from
work must also be reported by
sending a completed accident report
form (F2508) to the Health and
Safety Executive within 10 days of
the accident no immediate
notification by telephone is required.
Reports must be submitted using the
proper form and there are penalties
for failing to notify.
Major injuries are defined in the
Regulations and include:
fractures of the skull, spine

or pelvis
fracture of any bone in the arm

or leg (except in the wrist, hand,
ankle or foot)
amputation of a hand or foot;

loss of sight of an eye
loss of consciousness through

lack of oxygen
any other injury resulting in a

person being injured or admitted
to hospital as an inpatient for
more than 24 hours, unless
detained only for observation.
Notifiable dangerous occurrences are

also defined in the Regulations
and include:
explosion, collapse or bursting of

any closed vessel, including a
boiler or boiler tube, containing
any gas (including air) or vapour
above atmospheric pressure
which could have caused major
injury or resulted in significant
damage to the plant - for
example a compressor or
autoclave explosion
electrical short circuit or

overload attended by fire or
explosion causing the equipment
to be unusable for more than 24
hours and which could have
caused major injury
the uncontrolled release or

escape of any substance which
could caused damage to health
or major injury for example a
serious mercury spill
inhalation, ingestion or other

absorption of any substance, or
lack of oxygen causing ill health
and requiring medical treatment
any case of acute ill health where

there is reason to believe that this
resulted from occupational
exposure to isolated pathogens
or infectious material.
Employers are required to maintain

records of all reported injuries and
dangerous occurrences, which must
include the date and time of the
accident, the name and occupation
of the person affected, the nature of
the injury, the place and
circumstances of the accident.
Accident books must comply with
data protection legislation and
appropriate versions are available
from HMSO or from HSE Books
(tel: 01787 881165).
exposure to high levels, so the

potential for harm cannot
be dismissed.
Occupational Exposure Standards
(OESs) have been set for the
following four anaesthetic agents at
which there are no significant risks
to health:
Certain diseases must also be

reported and include poisoning,
certain skin diseases, hepatitis,
tuberculosis, anthrax and bone
cancer resulting from radiation.
However, a report must only be
made if a written diagnosis is
received from a doctor. The report
form F2508A should be used.
The report forms are included in the
BDA Practice Compendium and can
be downloaded from the HSE website
www.riddor.gov.uk/reportanincident
.html. More detailed guidance on the
Regulations is available from HSE
Books: A guide to the Reporting of
Injuries, Diseases and Dangerous
Occurrences Regulations 1995
(ISBN 0-7176-1012-8).
Adverse incidents involving medical
devices should also be reported to
the Medicines and Healthcare
Products Regulatory Agency
(formally the Medical Devices
Agency). The appropriate reporting
forms are available from the BDA.
Anaesthetic gases
At high concentrations of several
thousand parts per million (ppm) all
anaesthetic agents reduce activity in
the nervous system, leading to
anaesthesia. In contrast to patients
who may be exposed to these high
concentrations a few times in their
lives, health care staff may be
exposed to much lower
concentrations day after day. There is
no conclusive evidence to suggest
that either exposure to anaesthetic
agents has resulted in an increased
risk of miscarriage or that exposure
to nitrous oxide has caused
developmental defects in the foetus.
Animal studies have, however,
demonstrated adverse effects at
bda advice sheet A3
Anaesthetic
agent
OES over an
8-hour Time
Weighted
Average
Nitrous oxide
100 ppm
Enflurane
50 ppm
Isoflurane
50 ppm
Halothane
10 ppm
Employing dentists have

responsibilities to ensure that staff
exposure to anaesthetic agents by
inhalation should be reduced to
the OES.
Employers
are required
to maintain
records of
all reported
injuries
In order to estimate exposure in

dentistry, you will need to consider
the amount of time staff are exposed
to the anaesthetic and how well the
room is ventilated. Where nitrous
oxide is used as an analgesic, staff
could be exposed to high
concentrations but if this is only for
short periods their average exposures
over an 8-hour period are unlikely to
exceed the OES. If you cannot easily
estimate exposure levels, you may
need to carry out some personal
sampling as part of your assessment
by taking time weighted air samples
in the breathing zone of those
potentially most exposed.
You should visually check (at least
once a week) that scavenging and
ventilation equipment is working
properly and have it regularly
serviced in accordance with the
manufacturers recommendations
and at least every 14 months.
Periodically review how you operate
scavenging equipment to ensure that
it is being used correctly. Make sure
your employees are aware of the
possible risks to their health,
understand why scavenging and
ventilation are necessary and how
to use the equipment properly.
In dentistry, a mixture of nitrous

oxide and oxygen is used in
inhalation analgesia for pain relief
and anxiety reduction. The main
sources of pollution are the patients
exhaled breath and leaks from the
breathing circuit and facemasks.
Where anaesthetic gases are used for
only one or two sessions a week, it is
unlikely that staff will be exposed to
levels in excess of the OES. If you
find that you are exceeding the
OES you will need to improve
the ventilation.
Further information can be found in
the Health Services Advisory
Committees publication Anaesthetic
agents: controlling exposure under
COSHH, (ISBN 0 7176 1043 8)
available from HSE Books.
Information is also available from
the Department of Health through
its guidance document Conscious
sedation in the provision of
dental care available from the
Department of Health website:
www.doh.gov.uk
Gas cylinders should be stored, if
possible, in external well-ventilated
stores preferably with piped supplies
to the point of use. Many dental
surgeries may not have a suitable
external storage area that is easily
accessible for cylinder deliveries and
internal storage may be the only
option. Cylinders should be stored
within a fire-resisting enclosure with
ventilation through an external wall
to a safe place outside the building.
Stocks should be kept as low as
possible and any flammable gases
should be kept away from sources
of ignition and not be stored with
oxygen. Medical oxygen has a three
year shelf life and cylinders should
be replaced or refilled within
this time.
Asbestos
Under the Control of Asbestos at
Work Regulations 2002, dentists who
are responsible for maintaining their
premises must assess whether
asbestos is present on the premises
and its likely condition. A record of
the assessment should be maintained
together with any subsequent
reviews. Building plans and the age
of the building may be helpful.
Parts of the building that are
BDA March 2004
bda advice sheet A3
accessible should be inspected.

Further advice on asbestos
management is contained in the
HSE guidance document A short
guide to managing asbestos in
premises (INDG223, rev3), which
can be downloaded from the HSE
website: www.hse.gov.uk/pubns/
asbindex.htm
Display screen equipment (DSE)
The use of computers within the
practice is becoming increasingly
common. Where employees
habitually use DSE for a significant
part of their normal work, you will
have certain obligations (Health and
Safety (Display Screen Equipment)
Regulations 1992).
Where DSE use is more or less
continuous on most days, the worker
will be deemed to be a user. An
employee would also be classified as
a user if most or all of the following
criteria apply:
the job cannot be done

effectively or at all without DSE
the worker has no discretion over

whether to use DSE
the job requires significant

training or particular skills
the worker uses DSE for periods

of an hour or more at a time,
more or less on a daily basis
the task depends upon the fast

transfer of information between
the worker and screen
attention and concentration

demands are high, such as
where there may be critical
consequences of an error.
Work involving DSE use should be
planned to incorporate breaks or
changes of activity. Short frequent
breaks are better than longer, less
frequent ones and ideally the
individual should have some
discretion over when they are taken.
The workstation must meet
minimum requirements. For
example, the screen should normally
have adjustable brightness and
contrast controls, to allow
individuals to find a comfortable
level for their eyes, helping to avoid
the problems of tired eyes and
eyestrain. Health and safety training
should be provided to make sure
BDA March 2004
employees can use all aspects of

their workstation equipment safely
and know how to make the best use
of it to avoid health problems, for
example by adjusting the chair,
using a wrist pad and foot rest.
Making the best of your DSE workstation
adjust the chair and DSE to find the most comfortable position for
working. Arms should be approximately horizontal and eyes the same
height as the top of the screen casing
make sure there is enough space underneath the desk to move legs freely.
Move any obstacles such as boxes or equipment
avoid excess pressure on the backs of legs and knees. A footrest,
particularly for smaller users, may be helpful
dont sit in the same position for long periods. Make sure posture is
changed as often as practicable. Some movement is desirable but avoid
repeat stretching movements
adjust the keyboard and screen to get a good keying and viewing position.
A space in front of the keyboard is sometimes helpful for resting the
hands and wrists when not keying
dont bend the hands up at the wrist when keying. Keep a soft touch on
the keys and dont overstretch fingers. Good keyboard technique
is important
try different layouts of keyboard, screen and document holder to find the
best arrangement
make sure there is enough work space to take whatever documents are
needed. A document holder may help to avoid awkward neck movements
arrange the desk and screen so that bright lights are not reflected in the
screen. Adjust curtains or blinds to prevent unwanted light
make sure the characters on the screen are sharply focused and can be
read easily. They shouldnt flicker or move
make sure the screen is free of dirt, grime or finger marks
use the brightness control to suit the lighting conditions of the room.
Users can ask the employer to

provide eye and eyesight tests. If
spectacles are required specifically
for working at the DSE, the employer
must provide them but not
spectacles that are required for any
other purpose. The results of the eye
and eyesight test can only be
disclosed to the employing dentist
with the consent of the employee
(Access to Medical Reports
Act 1988).
Electricity
Responsibilities concerning the
safety of both the fixed supply to the
premises and any moveable
(portable) appliances come under
the Electricity at Work Regulations
1989. The supply to all appliances
must be correctly wired and fused
and should be installed by
contractors registered with an
appropriate organisation, for
example, the National Inspection
Council for Electrical Installing
Contracting.
Whilst the Regulations do not
specify the need for examination and
testing, the requirements for
suitability, integrity and safety of
electrical equipment imply a need
for some form of inspection and
testing. It is not mandatory to
maintain records of inspection and
testing but they would help provide
evidence that all reasonable steps had
been taken to comply with the
requirements of the legislation.
Electrical
equipment
must be
in good
working
order at
all times
bda advice sheet A3
Visual inspection is the most

important maintenance precaution.
The cable and plug can be
inspected for:
damage to the cable covering (eg

cuts, abrasions)
damage to the plug (eg cracked

casing, bent pins)
non-standard joints including

taped joints in the cable
the outer covering (sheath) of

the cable not being gripped
where it enters the plug or
equipment. Is the coloured
insulation of the internal
wires showing?
equipment that has been used in

conditions where it is not
suitable (eg wet or dusty
workplaces)
damage to the outer cover of the

equipment or obvious loose
parts or screws
overheating (burn marks or

staining).
Inspection could also include the
removal of the plug cover and
checking that:
a fuse is being used (ie that it is a

proper fuse and not a piece of
wire, a nail etc)
the cord grip is holding the outer

part (sheath) of the cable tightly
the wires, including the earth

where fitted, are attached to the
correct terminals
no bare wire is visible other than

at the terminals and the terminal
screws are tight
there is no sign of internal
damage, overheating or entry
of liquid, dust or dirt.
This internal inspection does not

apply to moulded plugs where only
the fuse can be checked.
It is not necessary to have an
electrician to carry out the visual
inspection, competent members of
staff can do it if they have enough
knowledge and training and know
how to avoid danger to themselves.
All earthed equipment and most
leads and plugs connected to
equipment should have an
occasional combined inspection and
test by an appropriately trained
(competent) person to identify the
faults that cannot be found by the
visual check. The Health and Safety
Executive has suggested intervals of
up to five years in low risk
environments depending on the type
of equipment used. For dental
practices every two or three years
might be more appropriate.
Fire precautions
The Fire Precautions (Workplace)
Regulations 1997 require you to
assess what fire precautions are
needed by carrying out a fire risk
assessment as part of your general
Electrical equipment must be in

good working order at all times. The
frequency of inspection and testing
will depend upon the type of
equipment and the circumstances
under which it is used. A piece of
electrical equipment in constant use
may require six-monthly testing
whereas an item which is rarely used
may require testing at only twoyearly intervals.
Portable electrical equipment is
described as equipment that has a
cable and a plug and is normally
moved around or can easily be
moved from place to place (kettle,
heaters, fans and televisions, for
example) and also equipment that
could be moved (photocopiers and
desktop computers, for example).
BDA March 2004
bda advice sheet A3
risk assessment. The Regulations

specify the following requirements
for emergency routes and exits:
they must be kept free of

obstruction at all times and allow
employees (and patients) to
evacuate the premises quickly
and safely
where possible they should lead

directly to a place of safety
they should be appropriately and

clearly indicated
emergency lighting should be

provided where necessary
emergency doors must open in

the direction of the escape and in
an easy and immediate action
sliding and revolving doors

should not be used as
emergency exits.
In deciding what fire precautions are
appropriate, you should think about:
the size and layout of the

workplace
the work activities, including the

equipment and substances that
are used
the maximum number of people

likely to be present at any
one time.
If there is a fire, it is important that
everyone in the workplace is alerted
as quickly as possible. Early discovery
will allow people to escape safely
before the fire takes hold and blocks
escape routes or makes escape
difficult. All workplaces should have
arrangements for detecting and
giving warning of fire. In most cases,
fires are detected by people in the
workplace and no further warning
device is needed. But a fire may
break out in a part of the practice
that is unoccupied and put people
at risk, so some form of automatic
fire detection system should
be considered.
If fire breaks out and trained staff
can safely extinguish it using suitable
fire-fighting equipment, the risk
to others will be removed. All
workplaces should have suitable firefighting equipment. The water-type
extinguisher or suitable alternative
is the most useful fire-fighting
equipment for general fire risks;
one extinguisher for every 200
square metres of floor space is
BDA March 2004
recommended with a minimum of

one per floor. Where the fire source
might be electrical, other types of
extinguishers should be considered
(carbon dioxide or dry powder, for
example). Fire extinguishers should
be sited on exit routes, preferably
near to exit doors or, where they are
provided for specific risks, near to
the hazards they protect. Fire
detection devices and fire-fighting
equipment must be regularly
checked to ensure its continued
good working order.
First-aid and medical
emergencies
All workplaces must have adequate
first-aid provisions, the extent of
which depends upon the hazards
present and the number of people
employed (including associates and
self-employed hygienists). Access to
first-aid facilities must be available
for all employees during working
hours, even when shifts are worked.
You must
ensure that
everyone has
reasonably
quick access
to first-aid
The Health and Safety (First-Aid)

Regulations 1981 require you to
assess the first-aid requirements of
the practice taking the following
factors into account:
the hazards and risks associated

with the work your practice
risk assessment will help
the number of people at the

practice and where they work
previous accidents (recorded in

the accident book)
access to emergency facilities

and services
arrangements for covering

planned and unplanned absences
patients although there is no

legal requirement to provide
first-aid treatment and facilities
to non-employees.
You must ensure that everyone has
reasonably quick access to first-aid.
Those who work outside the practice
(domiciliary visits, for example)
must still be provided with adequate
first-aid cover (and may include a
mobile telephone).
Qualified personnel: Dental
practices with fewer than 50
workers are required to have an
appointed person on the premises
at all times the practice is open.
The basic emergency first-aid

course for appointed persons is
recommended and should
include emergency actions,
cardiopulmonary resuscitation
(CPR), control of bleeding,
treatment of wounds
and treatment of the
unconscious patient.
If you have more than 50 workers or
assess the working environment to
be hazardous, you will need to
ensure that qualified first-aiders are
on the premises at all times. Training
for first-aiders includes:
dealing with emergencies at work
administering CPR
administering first-aid to
unconscious casualties
administering first-aid to
bleeding or wounded casualties
administering first-aid for

burns/scalds, bone/muscle/joint
injuries, shock, eye injuries,
poisonings, casualties overcome
by gas or fumes
safe transport of casualties
recognition of, and appropriate

procedures for dealing with,
common illnesses
competent record keeping and

effective communication or
information to doctors etc.
If your assessment shows that firstaiders are needed in your practice,
they will need to attend a course
leading to a certificate of
competence from a training
organisation approved by the HSE.
These courses provide at least 24
hours of training, usually over four
days or several weeks. First-aid
certificates are valid for three years
and requalification requires a further
12 hours of training, usually over
two days. Dentists are not qualified
as first-aiders unless they have
undertaken appropriate training.
First-aid courses are arranged by a
number of organisations, including
St John Ambulance and the
British Red Cross.
First aid box: all dental practices
must have at least one first-aid box
clearly marked with a white cross on
green background. First-aid boxes
should contain sufficient quantities
of suitable first-aid materials and
10
nothing else. Minimum quantities

for a low risk workplace may be
considered as:
a general guidance leaflet on

first-aid
20 individually wrapped sterile

adhesive dressings (assorted
sizes) appropriate for the
work environment
2 sterile eye pads
4 individually wrapped
triangular bandages
(preferably sterile)
6 safety pins
6 medium-sized individually
wrapped sterile unmedicated
wound dressings
(approx 12cm x 12cm)
2 large sterile individually

wrapped unmedicated wound
dressings (approx 18cm x 18cm)
1 pair of disposable gloves.
Where mains tap water is not

readily available for eye irrigation,
sterile water or sterile normal
saline solution (0.9%) in sealed
disposable containers should be
provided. Once opened they
should not be re-used.
Medical emergencies can occur at
any time, so it is imperative that you
ensure all members of the dental
team are properly trained, have the
necessary resources available and are
prepared to deal with an emergency,
including a collapsed patient.
Training should include the
preparation and use of emergency
drugs (where appropriate) and
resuscitation routines in a simulated
emergency. This training should
occur at least annually.
In order to be able to deal with a
medical emergency, all dental
practices should have available
and in working order:
portable suction apparatus to

clear the oropharynx
oral airways to maintain the

natural airway
equipment with appropriate

attachments to provide
intermittent positive pressure
ventilation of the lungs
a portable source of oxygen

together with emergency drugs.
If you decide to keep defibrillators as
bda advice sheet A3
part of your emergency equipment

(as these are now readily available
and relatively inexpensive), you must
be fully trained in their use.
The practice
infection
control
policy should
be displayed
in each
surgery
Emergency drugs: there is no

recommended list of emergency
drugs for dental practices you need
to decide what drugs to hold
considering the treatments you
provide and the patients you attend.
The Dental Practitioners Formulary
contains useful guidelines on the
management of the more common
medical emergencies that may arise
in dental practice and the medicines
that should be administered. It is a
useful reference when deciding
which emergency drugs to keep.
If you undertake domiciliary visits,
you will need to decide which
emergency equipment and drugs
should be taken, bearing in mind
that a medical emergency may occur
during the visit.
Infection control
Dentists have a duty to take
appropriate precautions to protect
patients and other members of the
dental team from the risk of crossinfection. Failure to employ
adequate methods of infection
control would almost certainly
render a dentist liable to a charge of
serious professional misconduct
(GDC, Maintaining Standards,
November 1997 as amended).
The need is obvious for surgery staff
to be thoroughly instructed in the
handling, decontamination and
disposal of instruments to avoid
cross-infection, injury from
instruments or from sterilising
equipment. Basic training in surgery
procedures should identify the risks
and how they are avoided.
To minimise the risk of transmission
between patients and between
patients and dental clinical staff, a
sensible and practicable routine for
the prevention of infection and
cross-infection should be followed
with every patient. The practice
infection control policy should be
displayed in each surgery to ensure
the same infection control
procedures are employed.
The BDAs advice sheet on infection

control (A12) contains more
information on the protocols and
precautions that should be in place
routinely for all patients and the
BDAs Practice Compendium
contains a model infection control
policy that can be adapted to suit
your practice.
Lasers
Laser equipment is classified from
class 1 to class 4 depending on the
power output. The classification and
labelling of all laser products are the
responsibility of the manufacturer.
Class 1 lasers are virtually safe but
classes 3 and 4 must be used only
under medical or dental supervision.
Most dental lasers are class 3B or 4.
Lasers should conform to BS EN
60825-1:1994 (Radiation safety of
laser products, equipment
classification, requirements and
users guide).
Your local Primary Care Trust is
responsible for providing health and
safety advice about lasers. You will
need to appoint a Laser Protection
Adviser (LPA), have local rules in
place and establish a laser controlled
area. Warning signs must be
displayed at every entrance.
Laser equipment must only be used
by staff who have received
appropriate training and the
equipment should be regularly
maintained according to the
manufacturers instructions with
records kept to show that this has
been done. Patients must give
informed consent to treatment
involving lasers.
Manual handling
Manual handling injuries currently
account for over a quarter of all
reported injuries and are the cause of
more absences from work than any
other cause. Many manual handling
injuries build up over time rather
than being caused by a single
handling incident.
The Manual Handling Operations
Regulations 1992 set out clear duties
for the employer and the employee.
Manual handling should be avoided
wherever possible and where it
BDA March 2004
bda advice sheet A3
cannot be avoided the employer

must assess the risks and reduce the
lieklihood of injury. Employees must
make use of the training and
equipment provided.
The extent of manual handling
within the practice must be
identified so you need to assess what
actions pose a significant risk to
employees. Then you need to decide
whether it is possible to avoid these
actions. Where risky manual
handling cannot be avoided, a more
thorough assessment is required,
which must be documented. Your
assessment must not be limited to
weight. It should include factors
such as the task, the load itself,
the work environment and
individual capacity.
BDA March 2004
Manual handling: assessing and reducing the risks

What to look for
Ways of reducing the risk

of injury
The tasks: do they involve
holding loads away from trunk?
twisting, stooping or reaching

upwards?
large vertical movements?
long carrying distances?
strenuous pushing or pulling?
unpredictable movement
of loads?
repetitive handling?
insufficient rest or recovery time?
Can you
improve workplace layout to

improve efficiency?
reduce the amount of twisting

and stooping?
avoid lifting from floor level or

above shoulder height?
cut carrying distances?
avoid repetitive handling?
vary the work, allowing one set

of muscles to rest while
another is used?
The loads: are they
heavy, bulky or unwieldy?
difficult to grasp?
unstable or unpredictable?
intrinsically harmful eg sharp

or hot?
Can you make the load
lighter or less bulky?
easier to grasp?
more stable?
less damaging to hold?
have you asked your suppliers

to help?
The working environment:

are there
constraints on posture?
poor floors?
variations in levels?
hot/cold/humid conditions?
strong air movements?
poor lighting conditions?
restrictions on movement or
posture from clothes or personal
protective equipment?
Can you
remove obstructions to free

movement?
provide better flooring?
avoid steps and steep ramps?
prevent extremes of hot

and cold?
improve lighting?
consider less restrictive clothing

or personal protective
equipment?
Individual capacity: does the job
require unusual capability?
endanger those with a health

problem?
endanger pregnant women?
call for special information

or training?
Can you
take better care of those who

have a physical weakness or
are pregnant?
give your employees more

information eg about the range
of tasks they are likely to face?
provide training?
11
12
Training is important but on its own,

it cannot overcome a lack of
mechanical aids, unsuitable loads
and bad working conditions.
Training should enable an employee
to recognise when manual handling
might be harmful, when mechanical
aids should be used and good
handling techniques.
Good handling technique
Stop and think: Plan the lift. Where is the load to be placed? Use appropriate
handling aids if possible. For a long lift, such as floor to shoulder height,
consider resting the load midway on a table or bench in order to change grip.
Position the feet: Feet apart, giving a balanced and stable base for lifting
(tight skirts and unsuitable footwear make this difficult). Leading leg as far
forward as is comfortable
Adopt a good posture: When lifting from a low level, bend the knees. But do
not kneel or overflex the knees. Keep the back straight (tucking in the chin
helps). Lean forward a little over the load if necessary to get a good grip. Keep
the shoulders level and facing in the same direction as the hips
Get a firm grip: Try to keep the arms within the boundary formed by the
legs. The best position and type of grip depends on the circumstances and
individual preference; but it must be secure. A hook grip is less tiring than
keeping the fingers straight
Keep close to the load: Keep the load close to the trunk for as long as possible.
Keep the heaviest side of the load next to the trunk. If a close approach to the
load is not possible, slide it towards you before trying to lift
Dont jerk: Lift smoothly, keeping control of the load
bda advice sheet A3
Medicine storage
Medicines may undergo chemical or
physical deterioration especially
when stored in extreme
temperatures, damp or direct
sunlight. It can reduce their
therapeutic effectiveness and, if
significant, have serious
implications. Medicines should
always be stored according to the
manufacturers recommendations.
The Misuse of Drugs (Safe Custody)
Regulations 1973 require certain
controlled drugs, that is most
schedule 2 and some schedule 3
drugs, to be kept in a locked
container or cupboard which can
only be opened by the dentist. It is
good practice to keep all medicines
in a locked cupboard. Police crime
prevention officers are available and
willing to give advice on this.
Stocks of medicines should be kept
to the minimum required for routine
needs and foreseeable emergencies.
Regular stock checks should be
carried out and outdated stocks
destroyed. Strict records of
medicines should be kept.
Emergency drugs should be kept
securely but be accessible at all times.
Mercury
Move the feet: Dont twist the trunk when turning to the side
Put down then adjust: If precise positioning of the load is necessary, put it
down first, then slide it into the desired position
All those involved with the handling

of mercury in any form should
understand its potential hazards and
receive training in safe handling
procedures to deal with mercury
spills, including the safe disposal of
contaminated materials. Routine
personal hygiene is essential to
minimise the possibility of
absorbing mercury via skin contact.
Careful dispensing, handling and
disposal will help the potential
hazards of mercury be avoided.
The overall risk of mercury is
minimised greatly by using
pre-dispensed capsules.
Working environment:
The occupational exposure limit for
mercury vapour is 25 micrograms
per cubic metre (g/m3) based on a
time-weighted average over an eighthour working day. Dental surgeries
must be efficiently ventilated to
ensure this exposure limit is not
BDA March 2004
bda advice sheet A3
exceeded. A ventilation system that

exhausts to the outside of the
building is preferable but, for many
surgeries, this is may not be an
option. Where ventilation systems
are not available, opening a window
will encourage a fresh supply of air
and help reduce atmospheric
mercury below the maximum
permitted level. Recycling air
conditioning systems are
not recommended.
Floor coverings in dental surgeries
should be non-slip and impervious
and should cove slightly up the wall
or cabinetry to eliminate crevices.
Joints between sheets of floor
covering should be kept to a
minimum and sealed, and avoided in
the vicinity of the dental chair or
amalgam preparation area. Tiled
floors are not recommended and
carpets should never be used.
The area where amalgam is prepared
should be well ventilated and away
from any form of heat (radiator,
autoclave and sunlight, for example).
The worksurface should be smooth
and impervious and, if possible, cove
slightly up the wall to prevent
mercury accumulating in
inaccessible areas.
Personal hygiene: Mercury
vaporises at room temperature
particularly if it is in the form of fine
droplets, which have a very large
surface area. This vapour can easily
enter the body via inhalation and
this is now considered the most likely
route for mercury uptake in dental
staff. Mercury can also be absorbed
through the skin but with the
routine use of protective gloves this
risk has been virtually eliminated.
Hands that have been exposed to
mercury should be washed
immediately with liquid soap in a
stream of cold tap water until no
stain on the skin is seen. Disposable
towels should be used for
hand drying.
Personal monitoring: Under the
Control of Substances Hazardous
to Health Regulations 2002 the
employing dentist must assess the
risk to employees of exposure to
mercury, taking into account the
amount of work carried out each
week, the measures taken to prevent
BDA March 2004
spillage and vapour release and the

level of ventilation. Those who
routinely work with mercury should
undergo regular monitoring to
ensure they do not exceed the
exposure limits. This is particularly
important for female dental staff of
childbearing age. At present, the
simplest form of monitoring for
dental health care workers is to
measure the concentration of
mercury present in the urine using
atomic absorption spectroscopy,
considered by the Health and Safety
Executive to be a satisfactory index
of exposure. Urinalysis is available
through the UK Mercury Screening
Service (tel: 0114 290 0521) and will
provide dentists and their staff with
an indication of their biological
mercury levels and any advice and
follow up consultations.
employing
dentist must
assess the
risk to
employees
of exposure
to mercury
Operative procedures:
Amalgamators should be placed in a
shallow tray lined with aluminium
foil. The tray should be large enough
to catch any stray droplets, which
will combine with the foil and form a
non-volatile amalgam. When
refilling the mercury reservoir, use a
small funnel to reduce the possibility
of a spill. Pre-proportioned capsules
minimise contact with mercury and
further reduces the possibility of
a spill.
Dealing with spills: Spilt mercury is
a hazard and must be cleaned up
immediately. A spillage kit should be
readily available and include:
disposable plastic gloves
paper towels
a bulb aspirator for the collection

of large drops of mercury
a suitable container fitted with

a seal and a mercury
absorbent paste.
Commercial kits are available from
many dental supply companies. Lead
from radiographic packets is also
very useful for dealing with small
spills, as the mercury combines with
the lead to form a non-volatile
amalgam. If there is a serious
mercury spill, it must be cleaned up
immediately and the surgery well
ventilated until an assessment can be
made of the atmospheric level of
mercury. Advice can be obtained
from the UK Mercury Screening
Service and the HSE Infoline (tel:

0870 154 5500). The HSE Guidance
Note MS12 Mercury: medical
guidance notes provides general
information on working with
mercury including occupational
exposure limits, clinical effects of
acute and chronic poisoning,
prevention and health surveillance.
Amalgam/mercury waste:
Amalgam waste or mercury
collected from spills should be
stored in a sealed, clearly labelled
container under a mercury
suppressing solution or paste.
The disposal of waste amalgam,
waste mercury and used amalgam
capsules is controlled and must be
collected by a person licensed to
carry such waste. The relevant
paperwork should be completed
and kept.
Amalgam separators: Amalgam
separators reduce the amount of
waste amalgam discharged to sewer.
There are several types available
including gravity fed filtration
(sedimentation), centrifugal and
ionisation, which can either be fitted
to each dental chair or service the
whole practice (depending on the
type selected). As well as the cost of
purchasing the separator, there may
be costs associated with installation,
which you should check this with
the manufacturer. You should
also ask about the maintenance and
servicing requirements.
Dentists using Royal Mail to send
patients specimens to pathology
laboratories for diagnostic opinion
or tests must comply with the UN
602 packaging requirements. The
602 packaging requirements ensure
that strict performance tests
(including drop and puncture tests)
have been met. The outer shipping
package must bear the UN packaging
specification marking. Only first
class letter post, special delivery or
data post services must be used. The
parcel post must not be used.
Every pathological specimen must
be enclosed in a primary container
that is watertight and leakproof. The
primary container must be wrapped
in sufficient absorbent material to
13
14
absorb all fluid in case of breakage

and then placed in a second durable
watertight, leakproof container.
Several wrapped primary containers
may be placed in one secondary
container provided sufficient
additional absorbent material is used
to cushion the primary containers.
Finally, the secondary container
should be placed in an outer
shipping package that protects it and
its contents from physical damage
and water whilst in transit.
bda advice sheet A3
examination detailing the periodic

examination of the vessel.
The written scheme must be
regularly reviewed. Records must
be kept to show that the periodic
examinations have been carried out
in line with the written scheme. The
maximum intervals for inspection
are 14 months for autoclaves and
26 months for air receivers.
Inspection can be arranged through
BDA Insurance Services (tel: 0870
241 1761). Examination for safety
reasons is not equivalent to servicing
and performance testing, which
should be carried out in accordance
with the manufacturers instruction.
Where the Regulations do not apply,
for example small capacity air
receivers, regular maintenance is
still essential.
The shipping package must be

conspicuously labelled PACKED IN
COMPLIANCE WITH THE POST
OFFICE INLAND LETTER POST
SCHEME. The sender must also sign
and date the package in the space
provided. Information concerning
the sample (data forms, letters and
descriptive information) should be
taped to the outside of the
secondary container.
A competent person is defined as

someone who has practical and
theoretical knowledge and actual
experience of the type of machinery
or plant to be examined, able to
detect defects or weaknesses and to
assess their importance in relation
to the strength or function of the
particular vessel.
A dentist sending a pathological

specimen through the post without
complying with the above
requirements may be liable
to prosecution.
British Standards
a safety valve to prevent overpressurisation, a reducing valve
to prevent the maximum
pressure being exceeded, an
isolating or stop valve in the inlet
line, a pressure indicator and a
drainage system
the maximum allowable working

pressure should be clearly
marked on the autoclave
autoclaves with quick opening

doors should not be capable of
being pressurised unless the door
is completely closed, the securing
mechanism fully engaged and
the chamber sealed.
Maintenance checks, following the
manufacturers instruction, should
be carried out at regular intervals
by an experienced person properly
trained and competent to
recognise defects.
Protective equipment
The Health and Safety Executive has

produced guidance to help users of
autoclaves comply with the law.
Safety at autoclaves (Guidance Note
PM73, second edition), available
from HSE Books (tel: 01787 881165),
describes the hazards specific to
autoclaves because of the need to
open them frequently during the
sterilisation process to load and
unload the contents and the
safeguards that should be in place.
Employers must provide protective

equipment where it is necessary to
ensure safe systems of work
(Personal Protective Equipment at
Work Regulations 1992). Employees
cannot be charged for supplying,
cleaning, repairing or replacing
protective equipment, including
protective clothing. Personal
protective equipment (PPE) made
or sold in the UK must carry the CE
mark to indicate that it has been
satisfactorily type-examined by an
Approved Body. In dentistry,
protective clothing can minimise the
risks at work but it is not a substitute
for more basic safety measures.
The Pressure Systems Safety

Regulations 2000 were introduced to
prevent the risk of serious injury
from the release of stored energy as a
result of a pressure system failure. All
autoclaves and air-receivers with a
capacity of more than 250 Bar-litres
must comply with the Regulations.
The hazards identified include:
explosive displacement of a door

if the door of an autoclave is
not properly secured whilst
under internal pressure, it may
be displaced allowing an
explosive release of stored energy
violent opening of the door due

to residual pressure at the end of
a process cycle
scalding
explosion of sealed glass

containers containing liquids.
Gloves: Medical gloves for single use

(to BS EN 455, parts 1 and 2) should
be worn for all clinical procedures as
they protect against contact with
blood, saliva and other tissue fluids.
Heavy-duty gloves give protection
against burns or skin irritation
when handling disinfecting agents,
domestic cleaning agents, cleaning
solvents and radiographic
processing chemicals. Damaged
gloves do not provide adequate
protection and should be replaced
and not kept in use.
Before an autoclave or air-receiver is

used, a competent person should
draw up a written scheme of
The following safeguards should be

in place:
the design should meet relevant
Care should be taken when choosing

latex gloves. Latex is covered by the
COSHH Regulations, which restricts
Pathological specimens containing

Hazard Group 4 pathogens should
not be sent through the post. This
group includes any organism that
causes severe human disease and is a
serious hazard to laboratory
workers. It may present a high risk of
spread in the community and there
is usually no effective prophylaxis or
treatment available.
Pressure systems
All those who use autoclaves within
the practice should be thoroughly
trained in their use (Provision and
Use of Work Equipment
Regulations 1998).
those who
use
autoclaves
should be
thoroughly
trained in
their use
BDA March 2004
bda advice sheet A3
the use of both powdered latex

gloves and those with a high
leachable protein content as far as
is reasonably practicable. Further
advice is contained in the Medicines
and Healthcare Products Regulatory
Agencys publication Latex
sensitisation in the health care
setting (use of latex gloves) (DB
9601) available on request from the
MHRA (tel: 020 7972 8000), and the
HSE publication Latex and you.
Eye protection should be worn by
those working in close proximity to
the patient during treatment.
Eyewear should have full lenses and
side protection; half lenses do not
give enough protection against
splatter and projectiles from the
mouth, for example, tooth and
amalgam particles.
Protective clothing should be worn
only in the surgery or laboratory and
not taken into eating areas. Uniforms
should avoid any features that could
collect mercury or catch equipment.
Contaminated clothing should be
washed in a washing machine using
a biological detergent and a hot wash
cycle (at least 65C). Suitable shoes
can protect against spillage, irritants
and other substances.
Radiation hazards
Your requirements under the
Ionising Radiations Regulations
1999 and the Ionising Radiation
(Medical Exposure) Regulations
2000 are consolidated in the BDAs
advice sheet on radiation in dentistry
(A11) and includes:
the various appointments that

you need to make within
the practice
risks from dental radiology
current radiation protection

legislation
education and training

requirements for those involved
in the taking or processing
of radiographs
patient selection and clinical

justification
diagnostic interpretation of
the radiograph
equipment for dental radiology
quality assurance.
BDA March 2004
provide
adequate
information,
instruction
and training
for all staff
Local Rules should be kept with each

x-ray machine and should detail the
working practices needed to comply
with the Regulations.
To comply, you should:
notify the Health and Safety

Executive of the use of radiation
within the practice
appoint an external Radiation

Protection Adviser (RPA)
appoint a suitably qualified and

trained person within the
practice to act as the Radiation
Protection Supervisor (RPS).
Where possible a deputy RPS
should also be appointed to take
responsibility when necessary
ensure that equipment meets all

appropriate standards and is
serviced and maintained
according to the manufacturers
recommendations and the
RPAs guidance
ensure routine tests are carried

out every three years by a
competent authority such as the
National Radiological Protection
Board or the medical physics
department of your local hospital
provide local rules which must

contain the name of the RPA,
RPS, a description of the
controlled area and any local
requirements. Model Local Rules
can be found in the the BDAs
Practice Compendium
provide adequate information,
instruction and training for

all staff
personal monitoring for staff is
required if individual workload
exceeds 100 intra-oral or 50
panoral films per week. A postal
monitoring service is provided
by the NRPB
provide a contingency plan to
specify actions to be followed
in the event of equipment
malfunction.
Risk assessment
Employers are required to assess the
risks to those in the workplace and
any others who may be affected
(Management of Health and Safety
at Work Regulations 1999).
Employers with five or more
employees (including self-employed
associates and PCDs) must record
the significant findings of this
assessment. Further information on
risk assessment can be found in the
BDAs advice sheet on risk
assessment in dentistry (A5) and
the Clinical Governance Kit.
A risk assessment is nothing more
than a careful examination of what
in your workplace could cause
people harm, so that you can weigh
up whether you have taken enough
precautions or need to do more.
The following step-by-step approach
will help you carry out a risk
assessment within your practice.
15
16
Step 1: look for the hazards.

Look around the practice for
hazards and ask other members of
the practice if they are aware of any
hazards. Manufacturers instructions
(for equipment and products) and
material safety data sheets (for
hazardous substances) are important
in helping to identify hazards and
risks. Accidents and ill-health
records can also be useful.
Step 4: record your findings.

This means writing down the more
significant findings and recording
your most important conclusions.
For example, portable electrical
appliances visual inspection of
equipment cable and plug, internal
wiring and fuse checked; all
found sound.
You do not have to show how you
did the assessment; you only have to
show that:
a proper check was made
you asked who might be affected
you dealt with all the obvious

significant hazards
the precautions are reasonable
and the remaining risk is low.
To make things easier, you can refer

to other assessments in the practice
such as your health and safety policy
statement, COSHH assessments and
manufacturers instructions these
may already list hazards and
precautions that you need to be
aware of.
Step 2: decide who might be

harmed and how.
Consider those who may not be in
the practice all the time, for example,
cleaners, contractors and those who
may share your premises. Is there a
possibility that they could be affected
by your activities? Give particular
consideration to children and ensure
they do not have access to hazardous
substances, sharps containers,
clinical waste etc.
Step 3: evaluate the risks arising
from the hazards and decide
whether existing precautions are
adequate or if more should be done.
Even after all precautions have been
taken, some risks may remain. You
have to decide for each significant
hazard whether the risk is high,
medium or low. Have you done
everything that is required by law?
For example, have you assessed all
the hazardous substances? Are
generally accepted standards in
place? You must do whatever is
reasonably practicable to keep your
workplace safe by minimising all
risks. If you find that something
needs to be done, ask yourself
whether you can eliminate the risk
altogether or, if not, what you can
do to control the risk so that harm
is unlikely.
bda advice sheet A3
Step 5: review your assessment

from time to time.
Sooner or later you will add new
equipment or substances to the
practice, which could introduce new
hazards. If there is a significant
change, you should add to the
assessment to take account of these
new hazards.
You must
do whatever
is reasonably
practicable
to keep your
workplace
safe
In your risk assessment, you must

assess the hazards and risks arising
from work with display screen
equipment, manual handling,
hazardous substances, young
workers and pregnant or nursing
staff. You will also need to consider
the risk of fire in the workplace and
assess whether the existing
precautions are adequate.
Risk assessment - hazardous
substances
Further information on carrying out

your COSHH assessment can be
found in the BDAs advice sheet on
risk assessment in dentistry (A5) and
the Clinical Governance Kit.
You may have already covered some
aspects of your COSHH assessment
in your general risk assessment. It is
not necessary to duplicate
assessments, so where you have
already addressed a risk and
identified how to reduce or control
it, simply cross-reference your
COSHH assessment with the
practice risk assessment or combine
the assessments.
Exposure limits:
there are two types of occupational
exposure limits for hazardous
substances; occupational exposure
standards (OESs) and maximum
exposure limits (MELs). MELs are
set for substances for which no safe
level of exposure can be identified or
for substances for which safe levels
may exist but difficult to achieve
in practice. Exposure to these
substances has or is liable to have
serious health implications of
workers for example, may cause
cancer or occupational asthma.
Where the material safety data sheet
provided by the manufacturer refers
to an OES or MEL, dentists are
obliged to meet the requirements of
Employers must ensure that

exposure of workers to hazardous
substances is either prevented or,
where this is not reasonably
practicable, adequately controlled
(Control of Substances Hazardous to
Health Regulations 2002 (COSHH)).
When carrying out your COSHH
assessment, you need to
identify the hazardous

substances in the practice
decide who might harmed

and how
assess the risks associated with

their use
carry out any necessary health

surveillance
prevent or control the risk
ensure staff are aware of the risks

and trained to handle hazardous
substances carefully
make a record of your assessment

and update it regularly
corrosive
harmful
irritant
toxic
BDA March 2004
bda advice sheet A3
those levels in order to ensure a safe

working environment for their
employees. Few substances used in
dentistry are assigned a MEL. One
example is glutaraldehyde, which has
recently been set a MEL of 0.05ppm
for both long-term and short-term
exposures.
Risk assessment - pregnant and
nursing mothers
You must take particular account of
risks to new and expectant mothers.
If you cannot avoid a risk by other
means, you will need to make
changes to working conditions or
hours or offer suitable alternative
work. If this is not possible, the
employee should be given paid leave
for as long as necessary to protect her
health or safety or that of her child.
Your risk assessment may show there
is a substance or work process in
your practice that could damage the
health or safety of new or expectant
mothers or their children. You need
to bear in mind that there could be
different risks depending on whether
workers are pregnant, have recently
given birth or are breast-feeding.
For example, mercury is a very toxic
substance and your risk assessment
might reveal that a pregnant dental
nurse is at risk from mercury vapour
whilst chairside assisting. You might
decide to seek additional biological
monitoring for mercury at regular
intervals during the pregnancy to
ensure that she is not exposed to
levels of mercury in excess of the
occupational exposure standard.
Anxieties that the member of staff
has about aspects of her work must
be taken into account and, wherever
possible, work practices altered to
alleviate concerns.
A model risk assessment for
pregnant and nursing mothers
is available in the BDA Practice
Compendium, which you can
adapt to suit your individual
circumstances.
Risk assessment young people
Young workers may be particularly at
risk from workplace hazards because
of their lack of awareness of existing
potential risks, immaturity or
BDA March 2004
inexperience. A young person is

defined as a person who has not
reached the age of 18 and so will
include work experience students
as well as trainee dental nurses.
Before employing young people, you
must carry out a risk assessment to
identify any specific risks that they
might face:
the inexperience and immaturity

of young people
their lack of awareness of risks to

their health and safety
the fitting out and layout of the

practice and surgery
exposure to biological, chemical

or physical agents
use and handling of

work equipment
what the work involves the

processes and activities to
be undertaken
any health and safety training

given or intended to be given.
With work experience students who
are under 16 years, you will have to
inform the parents or legal guardian
of the findings of your risk
assessment. The BDAs advice sheet
on risk assessment (A5) provides
further information. A model risk
assessment for trainees and young
people at work is available in the
BDA Practice Compendium.
Safety signs
Employers are required to use a
safety sign wherever a hazard exists
that cannot be adequately controlled
by any other means (The Health and
Safety (Safety Signs and Signals)
Regulations 1996). When everything
else has been done to remove the
hazard, safety signs should be used to
reduce the risk further. Safety signs
include acoustic signals, illuminated
signs, marking of pipework and
containers and hand signals.
All safety signs are required to
contain a pictogram (symbol) as
part of their design. There are a few
exceptions to this rule. Fire signs
such as Fire Door Keep Shut do
not contain a symbol as part of
design and so technically do not
follow the pattern prescribed by the
Regulations. It is unlikely, however,
that the use of these signs will

be precluded.
Dentists should have, as a minimum,
the following safety signs within
the practice:
Fire safety signs these signs

provide safety information on
escape routes, emergency exits,
location of fire fighting
equipment and a means of
giving warning in the event of a
fire (illuminated signs and
acoustic signals are included)
First aid where first-aid

facilities are located and the
designated person
Radiation adequate warning

signals when the equipment is
in use.
Stress
Work related stress is an increasing
concern for employers and is
currently the second most common
cause of ill health associated with
work. Stress can be defined as the
adverse reaction people have to
excessive pressure or other types of
demand placed on them. Potential
causes of work-related stress include:
organisational culture e.g. poor

communication, name and
blame attitude
physical and psychological

demands associated with the job
level of control over the job
relationships with managers,

peers, etc
management of change at work
individuals not knowing what

their role is, what their work
entails or what their
responsibilities are
lack of managerial and/or

peer support.
Stress sufferers often demonstrate
well-recognised physiological
symptoms, which include headaches,
aching muscles particularly neck and
shoulders, rashes and increased
sweating. Common psychological
and behavioural signs include:
depression or general
negative outlook
increased anxiousness
increased irritability
17
18
lack of concentration
loss of aptitude
poor work performance
increased sickness absence
inability to cope with
normal tasks
poor time keeping
increased intake of alcohol,
caffeine, nicotine etc.
Stress related complaints must be

treated seriously and fully
investigated. Successful stress
management will depend on good
communication amongst staff,
identifying the reasons for the stress
and then developing a strategy to
deal with the causes. Further
information on work related stress
can be found in the HSE publication
HSG 218 Tackling work related
stress and on the HSE website,
(www.hse.gov.uk/stress/index.htm)
or from the HSE Infoline
(tel: 0870 154 5500).
Ventilation
Air turbines, ultrasonic scalers, airwater syringes and dental lathes can
produce splatter reaching a distance
of seven feet and an aerosol
containing tooth particles, bacteria,
fungi and possibly viruses and oil.
Instruments on the bracket table can
easily become contaminated.
Aerosol inhalation may lead to
chronic coughs and bronchitis and
can be harmful to the eyes. Risks are
considerably reduced by good
ventilation and the use of high-speed
suction, face masks and glasses.
Enclosed workplaces must be
ventilated with sufficient fresh or
purified air; an open window will
provide sufficient ventilation in most
cases. Where ventilation systems are
used, the fresh air supply rate should
not fall below 5-8 litres per second
per occupant but the means of
ventilation should not create
uncomfortable draughts.
Recycling air conditioning systems
are not recommended.
Where exposure to a hazardous
substance cannot be prevented, it
should be controlled by other means.
Local exhaust ventilation is one of
the most common and effective
methods of control available.
bda advice sheet A3
Personal protective equipment is

regarded as a last resort.
Waste disposal
Stress
sufferers
often
demonstrate
wellrecognised
physiological
symptoms
Dentists, as producers of nondomestic waste, are required to sort

their waste, store it safely and
securely in an appropriate container
and arrange for its disposal
(Environmental Protection Act
1990). You will also need to maintain
records and have the relevant
documentation available (transfer
notes, for example) to demonstrate
compliance (Environmental
Protection (Duty of Care)
Regulations 1991).
All waste from the practice should be
segregated into clinical and nonclinical waste. If waste is mixed
indiscriminately the entire load will
have to be regarded as clinical waste
and disposed of by the more
expensive hazardous waste
disposal method.
Clinical waste is waste that is
contaminated with blood, saliva and
other body fluids and may prove
hazardous to any person coming into
contact with it. Clinical waste sacks
must be no more than three-quarters
full, have the air gently squeezed out
to avoid bursting when handled, be
labelled and tied at the neck, not
knotted. Sharps waste (needles and
scalpel blades) must be sealed in UN
type approved puncture proof
containers (to BS7320), which must
be labelled before disposal. Sharps
containers should be disposed of
when no more than two-thirds full.
Clinical waste should be disposed of
by high temperature incineration, or
other disposal facility licensed to
handle it.
Only someone registered to carry
clinical and non-clinical waste
should collect it from the practice.
When waste is transferred, a written
description of the waste must be
transferred with it. In addition, a
transfer note must be completed
and copies kept by both parties.
The following information must
be included in the transfer note:
identification of the waste
whether it is loose or in
a container
the kind of container

(if applicable)
the time, date and place
of transfer
the name and address of the
transferor and transferee
whether the transferor is the
producer or importer of
the waste
which (if any) authorised
transport purpose applies
which categories best describe
the transferor and transferee, eg
waste management licence
holder, registered carrier etc.
the licence number of either or
both parties and the council that
issued it.
Repeated transfers of the same kind

of waste between the same parties
can be covered by one transfer note
for up to one year. Both parties must
keep copies of the transfer note for
two years since either party may have
to prove in court where the waste
came from and what happened to it.
Dentists are now required to add
the appropriate European Waste
Catalogue (EWC) code to the
description of the waste on the
transfer note.
Prescribed medicines and waste
classified as irritant, harmful, toxic,
carcinogenic or corrosive are
regarded as special waste (Special
Waste Regulations 1996). Local
anaesthetic solution is a prescribed
medicine so partially discharged
cartridges must be disposed of as
special waste. If these are disposed
of via the sharps box, then the
container must be disposed of as
special waste. Fully discharged
cartridges are not regarded as
special waste.
Disposal of special waste is subject to
additional controls: consignment
notes must be used at each stage of
the disposal process and signed at
each transfer of the waste from
source to disposal site. Consignment
notices must be kept for three years.
An additional levy is also payable by
the producer of the waste.
Radiographic developer and fixer
are classified as special waste.
These solutions must not be
BDA March 2004
bda advice sheet A3
European waste catalogue codes for dental waste

Waste types
Code
Sharps Box
If the sharps box is used to dispose of other wastes such as LA cartridges
(fully discharged) or extracted teeth
18 01 01
Healthcare medicines (POMs and partially discharged LA cartridges)*
18 01 09
Extracted teeth (no amalgam present)
18 01 02
Yellow Sacks
Clinical waste (contaminated swabs, gloves etc.)
18 01 04
Female Hygiene Waste
18 01 04
Amalgam Waste
Amalgam waste
Extracted teeth containing amalgam
18 01 10
General Waste
Paper and cardboard
Biodegradable kitchen waste
Packaging material
20 01 01
20 01 08
15 01 06
Radiographic Solutions*
Developer
Fixer
09 01 01
09 01 04
potentially hazardous situations,

especially if the waterlines have
become contaminated with
Legionella, for example.
The following precautions may help
reduce or eliminate the problem of
contaminated dental unit waterlines:
the ultrasonic scaler, triple

syringe and handpiece should
be supplied by bottled water
(clean water system).
The manufacturers
recommendations on
decontamination and
disinfection of the bottled
water system must be
followed closely
effective anti-retraction systems

should be installed
sterile water should be used

where surgical flaps or other
surgical access into body cavities
is anticipated
the manufacturers
recommendations on
decontamination and
disinfection of interposed
cisterns must be
followed rigorously.
*denotes Special Waste that will require a consignment note
discharged to sewer and dentists are

advised to seek the services of a waste
collection agency licensed to collect
and dispose of chemical waste.
Waste amalgam is to be reclassified
as special waste, which will make its
disposal more controlled. At present,
an authorised person should collect
it and a transfer note completed with
a written description of the waste. It
should not be sent through the post.
Water supplies
Mains supplied water services must
be protected from contamination by
backsiphonage (The Water Supply
(Water Fittings) Regulations 1999).
The level of protection required
depends upon the risk posed. The
presence of blood and saliva in waste
from the dental surgery requires the
highest level of protection.
Depending on your individual
circumstances, a Type AA, AB or
AUK1 air gap may be needed, but
you should seek further advice from
your local water company.
BDA March 2004
Dental equipment requiring an air

gap for protection against
backsiphonage includes the dental
spittoon, the delivery system (the
dental handpiece, three-in-one
syringe and ultrasonic scaler),
wet-line suction apparatus and
automatic radiographic processors.
It is possible that an interposed
cistern will be the most
straightforward means of isolating
the equipment from the mains water
supply. An interposed cistern may,
however, result in loss of water
pressure and a pressurised cistern
may need to be installed.
Manufacturers of dental equipment
are aware of the requirements of the
Regulations and provide equipment
with an integral air gap; you will
need to check this with the
manufacturer. As a result of water
being stored in an interposed cistern,
biofilms of micro-organisms and
their products can develop and
contaminate the associated dental
water lines. Aerosolisation of
contaminated water can result in
If you suspect that a waterline has

become contaminated and the
recommended decontamination and
disinfection process is ineffective,
advice should be sought from the
consultant microbiologist of a local
hospital (or dental hospital) or the
Health Protection Agency.
The BDAs advice note on water
supplies to dental practice gives
more information on how to
comply with the requirements
of the Regulations.
Welfare arrangements
You must ensure the welfare at work
of all your employees (Workplace
(Health, Safety and Welfare)
Regulations 1992).
Working environment
Lighting should be sufficient to
enable people to work safely
and without eyestrain.
Where necessary, local
lighting should be provided
at individual workstations.
19
20
Temperature. The workplace

should be reasonably
comfortable without the
need for special clothing. The
temperature should normally be
at least 16C and thermometers
must be available to check. There
is no maximum temperature but
you should remember the general
duty for you to provide a safe
place of work and excessive heat
may adversely affect employees.
Ventilation. Windows will
generally provide sufficient
ventilation. Where additional
ventilation is required,
mechanical systems should
be provided.
Room dimensions. Workrooms
should have enough free space
to allow people to move around
with ease. As a guide, the total
volume of the room, when
empty, divided by the number
of people working in it should
be at least 11m3; more if much
of the room is taken up
by furniture.
Workstations should be
arranged so that each task can
be carried out safely and
comfortably. Seating should
provide support to the lower
back and be appropriate for
the task.
Safety
bda advice sheet A3
Doors and gates should have a

transparent panel unless they
are low enough to see over.
Facilities
Toilets and washing facilities
should be sufficient to allow
everyone in the practice to use
them without delay. The table
shows the minimum number of
toilets that should be provided.
Separate male and female toilets
should normally be provided
unless the toilet is in a separate
room and the door can be
secured from the inside. Toilet
paper should also be provided
and where females are
employed there should be a
suitable means for disposing
of sanitary dressings.
Housekeeping
Maintenance of workplace and
equipment. Both should be in
good working order and good
repair. Equipment should be
regularly maintained
(with records).
Cleanliness throughout the
practice is essential and includes
floors, walls and ceilings.
Cleaning should not present
a health or safety risk.
Changing and storing clothing.

A changing room should be
provided for workers who
change into special clothing.
Work clothing and personal
clothing should be stored in a
well-ventilated place where it
can dry out if necessary.
Effective measures should
be taken to provide security
of clothing.
Rest areas where staff can relax
and eat their meals at work
should be provided. No
smoking areas should be
made available.
Floor surfaces should be free

from holes, unevenness or
slipperiness, which could cause
a person to trip, slip or fall, or to
drop anything being carried.
Windows and skylights should
be able to be opened, closed and
cleaned from the inside (safely).
Minimum number of toilets
Glazed doors and partitions

should be made of a safety
material or be protected against
breakage, for example, by
obvious marking.
1 to 5
6 to 25
26 to 50
Employees present at any one time
Number of toilets
If patients also use the toilets provided for staff, it may be necessary to
increase the number of toilets so that staff can use the facilities without
undue delay
BDA March 2004
bda advice sheet A3
Contact details
Useful addresses
HSE Regional offices can be
located by calling the HSE
InfoLine on 0870 154 5500
HSE Books
PO Box 1999
SUDBURY
Suffolk CO10 6FS
Tel: 01787 881165
Fax: 01787 313995
BDA Insurance Services
Lloyd & Whyte
(Insurance Brokers) Ltd
Wessex Lodge
11-13 Billetfield
TAUNTON
Somerset TA1 3BR
Tel: 0870 241 1761
Fax: 01823 335157
BDA March 2004
Medicines and Healthcare Products

Regulatory Agency
Hannibal House
Elephant and Castle
London SE1 6TQ
Tel: 020 7972 8000
Fax: 020 7972 8108
National Radiological Protection
Board (NRPB)
Northern Centre
Hospital Lane
COOKRIDGE
Leeds LS16 6RW
Tel: 01132 300232
UK Mercury Screening Service
Sheffield Analytical Services
PO Box 187
137 Portobello Street
SHEFFIELD S1 4DS
Tel: 0114 290 0521
21
22
bda advice sheet A3
Health and Safety Checklist

Comment
Management of health and safety
Is the health and safety poster on display or a leaflet provided?
Is the Certificate of Employers Liability Insurance displayed?
Is there a safety policy for the practice? Has it been signed by employer?
Has the safety policy been made available to all staff?
Accidents
Are the contact details of the local HSE available?
Are report forms F2508 and F2508A accessible?
Is there an accident book in the practice?
Are the MHRA contact details available to report adverse incidents?
Anaesthetic gases
Are the rooms used well ventilated?
Is active scavenging used? Is the equipment in good working order and
regularly serviced?
Have staff received training on the control measures in place to keep exposure to
a minimum?
Display screen equipment
Have users been identified?
Have they received the appropriate information, instruction and training?
Has a risk assessment been carried out on each user and their workstation?
Have the assessments been documented?
Have users been given eyesight tests when requested?
Has eyewear been provided if required?
Has work been planned to allow for breaks or changes of activity?
Electricity
Is all portable electrical equipment regularly visually inspected?
Are there records of these visual checks?
Is electrical equipment periodically checked by a competent person?
BDA March 2004
bda advice sheet A3

Comment
Are records kept of these inspections?
Have staff been trained in the safe use of electrical equipment?
Fire precautions
Is a fire certificate required?
Has a fire risk assessment been carried out and shown to staff?
Are fire detection measures in place?
Is adequate fire fighting equipment available?
Are all staff trained to use fire fighting equipment and know what to do in the event
of a fire?
Is the fire safety equipment regularly checked and maintained?
First-aid / medical emergencies
Is there a trained first-aider or appointed person in the practice at all times?
Does everyone know where the first-aid box is kept? Is it fully stocked?
Are all members of the dental team trained in CPR?
Has training been undertaken in the last 12 months?
Is the appropriate emergency equipment available?
Are emergency drugs and a portable supply of oxygen readily available?
Lasers
Are local rules and warning signs displayed?
Is equipment regularly maintained and records kept?
Have users been appropriately trained?
Manual handling
Has a manual handling assessment been carried out?
Are staff trained in good handling techniques?
Where risks have been identified, have control measures been introduced?
Medicine storage
Are medicines stored according to manufacturers instructions?
BDA March 2004
23
24
bda advice sheet A3

Comment
Are medicines kept in a locked cupboard with restricted access?
Are stocks regularly checked and out dated stock disposed of?
Are records kept of supplies and suppliers?
Mercury
Have clinical staff been informed of the hazards?
Do clinical staff receive regular biological monitoring?
Do staff know what to do in the event of a spillage?
Is a fully stocked mercury spillage kit available?
Are the surgeries adequately ventilated?
Are floors and work-surfaces impervious and smooth?
Are staff trained in the use of the amalgamator?
Is first class or special delivery used when sending pathological specimens?
Do packages comply with UN 602 requirements?
Are outer packages labelled PACKED IN COMPLIANCE WITH THE POST OFFICE
INLAND LETTER POST SCHEME?
Pregnant and nursing mothers
Has a risk assessment been carried out for pregnant and nursing members of staff?
Have work practices been altered to eliminate health risks where appropriate?
Are any anxieties about work being addressed?
Pressure systems autoclaves and air-receivers
Have staff been trained in how to use the equipment?
Is there a written scheme of examination for each autoclave and air-receiver,
detailing the extent and frequency of examination?
Do you have records of these examinations and any work required?
Is the equipment serviced in line with the manufacturers instructions?
Do you have records of servicing?
BDA March 2004
bda advice sheet A3

Comment
Radiation
Have you informed HSE that radiation equipment is being used?
Has a RPS and RPA been appointed?
Has the RPA carried out a risk assessment?
Has a controlled area been designated for each piece of equipment?
Are there Local Rules for each piece of equipment?
Is the radiation equipment maintained and serviced? Are there records?
Are contingency plans in place in case of accidental over-exposure or malfunction
of the equipment?
Have staff been trained for the tasks they are required to do? Are there records of
the training provided?
Has a clinical audit been carried out within the last 12 months?
Risk assessment
Have the hazards in the workplace been identified?
Have employees at risk been identified?
Have adequate controls been put in place to remove or reduce the risks?
Has the risk assessment been recorded and dated?
Have staff been informed of the outcome of the assessments?
Are the assessments updated regularly?
Have you carried out separate assessments for any young workers and pregnant staff?
Risk assessment hazardous substances
Have you identified all hazardous substances used in the practice?
Have you considered biological hazards?
Have you assessed the risks to employees?
Are the control measures adequate or does more need to be done?
Have you considered the need for health surveillance (with mercury use, for example)?
Have the assessments been documented and dated?
Have you made staff aware of the risks involved with the hazardous substances
identified and trained them to use these substances safely?
Are the assessments reviewed on a regular basis?
BDA March 2004
25
26
bda advice sheet A3

Comment
Safety signs
Are fire fighting equipment and escape routes clearly marked?
Are the first-aid facilities clearly marked and the designated person identified?
Do all safety signs contain a pictogram?
Does all radiographic equipment have warning signals to indicate when equipment
is in use?
Waste
Is waste segregated into non-clinical, clinical and special waste prior to disposal?
Is waste collected by someone registered to carry it?
Are waste transfer notes / consignment notes completed and signed by both parties?
Do you have waste transfer notes for the last 2 years and consignment notes for
the last 3 years?
Are the appropriate EWC codes inserted on the transfer note?
Welfare
Is there adequate ventilation in the practice?
Is a suitable working temperature maintained?
Is the lighting sufficient to carryout all work activities?
Are there sufficient toilets for employees?
Are sanitary disposal facilities provided in toilets used by females?
Are suitable rest and eating facilities provided?
Are floors free from tripping hazards?
BDA March 2004
British Dental Association

64 Wimpole Street London W1G 8YS Tel: 020 7563 4563 Fax: 020 7487 5232
E-mail: enquiries@bda.org.uk BDA March 2004

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BACK TO COMPENDIUM

Display screen equipment (DSE)

First-aid and medical emergencies

The role of the Health and

Health and safety policy

Health and safety law for dental practice

Hazardous to Health Regulations

A dentists responsibilities for health

Under the HSW Act, employees are

An employing dentist has a general

provide and maintain safe

ensure that dangerous or

maintain the place of work,

provide a working environment

provide the necessary

bda advice sheet A3

An approved poster entitled Health

examine and investigate all areas

request such information,

interview and take written

issue an improvement notice

action is required to put matters

Anyone who is served a notice (an

an examination of the premises

bda advice sheet A3

Health and safety law for dental practice

They can, where necessary,

Health and safety policy

Practices with five or more

details of responsibilities for

details of safe systems of work

BDA March 2004

Employers are required to notify the

fractures of the skull, spine

fracture of any bone in the arm

amputation of a hand or foot;

loss of consciousness through

any other injury resulting in a

Notifiable dangerous occurrences are

explosion, collapse or bursting of

electrical short circuit or

the uncontrolled release or

inhalation, ingestion or other

any case of acute ill health where

Health and safety law for dental practice

Employers are required to maintain

exposure to high levels, so the

Certain diseases must also be

bda advice sheet A3

Employing dentists have

In order to estimate exposure in

In dentistry, a mixture of nitrous

bda advice sheet A3

Health and safety law for dental practice

accessible should be inspected.

the job cannot be done

the worker has no discretion over

the job requires significant

the worker uses DSE for periods

the task depends upon the fast

attention and concentration

employees can use all aspects of

Making the best of your DSE workstation