But most practice managers would agree that the work performed by clinical, administrative and support staff presents a number of potential risks to the health of both employees and the public.
This article looks at the risks associated with the storage and use of hazardous substances on practice premises and, in particular, considers practices’ duties under the Control of Substances Hazardous to Health Regulations (COSHH) 2002. In general terms, the risks are much the same for medical and dental premises, although there are likely to be more hazardous substances stored at GP surgeries.
One of the more significant risks in practices relates to cleaning operations which often take place outside normal opening hours. Depending on the size of the premises, practices may use a single cleaner or a team of workers who will make use of a variety of cleaning agents.
Due to the requirement to maintain a high standard of cleanliness in premises, some of the substances used by cleaning staff will be more powerful – and potentially more dangerous – than those found in the typical home. Some of the most powerful cleaning agents, such as sulphuric acid and bleach products, are highly acidic or alkaline and can inflict serious injury if accidentally spilled onto skin or splashed in eyes.
It is important to bear in mind that, whether the cleaner is self-employed or supplied by an agency, the practice may still bear some legal responsibility for any injury resulting from a spillage. In the event of such an injury, the practice is required to demonstrate legal compliance by proving that a suitable COSHH risk assessment had been carried out, that the risk of injury from the cleaning fluid had been identified, and that suitable and sufficient control measures had been taken to ensure the health, safety and wellbeing of persons affected by their operations. This can be done through various means including ensuring you have followed the steps explained in the ‘COSH hierarchy of control’:
- Design and use appropriate work processes, systems and engineering controls and use suitable work equipment and materials.
- Control the exposure of the substance at source
- Where adequate control cannot be achieved by other means, provide adequate protective equipment (such as gloves, aprons, protective clothing, safety glasses etc.).
The same principles apply to every hazardous substance routinely stored and used at the practice’s premises.
A second key COSHH consideration is drug supplies stored on practice premises. The practice should maintain a comprehensive inventory of all drugs, and staff should be required to maintain permanent records of the arrival of drugs at the practice as well as when and to whom they are issued. This requirement applies even more rigidly to controlled drugs and stems indirectly from the Harold Shipman case which centred on the alleged murder of more than 200 patients by Dr Shipman. Shipman ran a single-handed practice and routinely obtained supplies of diamorphine which he then used to deliver fatal doses to elderly patients.
Full guidance on the receipt, storage and issuing of controlled drugs is available from a variety of NHS sources, while the Misuse of Drugs Act and the Misuse of Drugs Regulations clearly set out the legal requirements. Guidance is also given on the recommended security arrangements for controlled drugs kept on practice premises.
Another relevant COSHH consideration centres on the procedures required for the taking, receipt, storage and dispatch of blood, urine and stool samples. Patients will rarely turn up at the surgery with their own blood samples, but GPs and nursing staff will take blood samples on a daily basis. In addition to the obvious dangers associated with the use of sharps, it needs to be borne in mind that blood is a major infection hazard and the practice is required to ensure they have assessed the hazards associated with taking blood samples, identified who is at risk, put suitable control measures in place and provided appropriate training to those involved. These steps need to be recorded in writing and reviewed periodically.
Similar considerations apply to urine and stool samples and to vomit. Patients may supply urine samples while at the surgery, bring stool samples in for analysis and will sometimes vomit unexpectedly while on the premises.
The practice is advised to apply the same process as that described above for blood. Each set of risks is subtly different so different hazards and control measures will apply.
Finally, it is worth noting that consideration must be given to the range of so-called superbugs, including MRSA and C. difficile whilst assessing the risks from exposure. While many outbreaks of infection take place in hospital, these infections can easily be acquired in the community, and this means that practices should apply appropriate risk assessments and control measures in respect of these. Although compensation claims stemming from superbug infection are relatively rare, no medical or dental practice wants to find itself on the receiving end of a claim based on a negligent failure to take the required control steps.
This article was originally written by Ian McKinnon, Law At Work. It was updated by Steven McCallum, Health and Safety Manager at Law At Work, on February 4, 2016