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The basis of British health and safety law is the Health and Safety at Work Act 1974. The Management of Health and Safety at Work Regulations 1999 (the Management Regulations) make more explicit what employers are required to do to manage health and safety, and these regulations apply to every work activity. The main requirement on employers is to carry out a risk assessment, and for those with five or more employees they need to record the significant findings of the risk assessment. Besides carrying out a risk assessment, employers also need to:

• make arrangements for implementing the health and safety measures identified as necessary by the risk assessment
• appoint competent people to help them to implement the arrangements
• set up emergency procedures
• provide clear information and training to employees
• work together with other employers sharing the same workplace.

In recent years much of Britain’s health and safety law has originated in Europe. Proposals from the European Commission may be agreed by Member States, who are then responsible for making them part of their domestic law.

Approved Codes of Practice offer practical examples of good practice. They give advice on how to comply with the law by providing a guide as to what is reasonable practice and have a special legal status. If employers are prosecuted for a breach of health and safety law, and it is proved that they have not followed the relevant provisions of the Approved Code of Practice, a court can find them at fault unless they can show that they have complied with the law in some other way.

Regulations are law, approved by Parliament and are usually made under the Health and Safety at Work Act. This applies to regulations based on EC Directives as well as ‘home-grown’ ones. Some regulations apply across all companies, such as the Manual Handling Regulations, which apply wherever things are moved and the Display Screen Equipment Regulations that apply wherever VDUs are used. Other regulations apply to hazards unique to specific industries, such as mining or nuclear.

The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) require employers and others to report accidents and some diseases that arise out of or in connection with work. These reports enable the enforcing authorities to identify where and how risks arise and to investigate serious accidents.

The following are examples of the type of incidents that need to be reported:

• accidents
• death or major injuries
• diseases
• infections
• dangerous occurrences.

Who should report?

The duty to notify and report rests with the ‘responsible person’. This may be the employer of an injured person, a self-employed person, or someone in control of premises where work is carried out.

Accidents

Accidents include acts of physical violence to people at work, but not violence to other people, such as patients or visitors. An accident is something that arises ‘out of or in connection with’ work. Reportable major injuries include:

• fractures, except to fingers, thumbs or toes
• amputation
• dislocation of the shoulder, hip, knee or spine
• loss of sight (temporary or permanent)
• chemical or hot metal burn to the eye
• any penetrating injury to the eye
• injury resulting from an electric shock or electrical burn, leading to unconsciousness or requiring resuscitation or admittance to hospital for more than 24 hours
• acute illness requiring medical treatment, or loss of consciousness resulting from the absorption of any substance by inhalation, ingestion or through the skin or exposure to a biological agent
• any other injury which leads to hypothermia, heat-induced illness or unconsciousness.

Diseases

You must report any case in which a doctor notifies you in writing that one of your employees is suffering from a disease specified in RIDDOR, which is linked with the corresponding activity. Self-employed people need to make their own arrangements to notify any reportable diseases they suffer.

Reportable diseases include:

• some skin diseases, such as occupational dermatitis
• occupational asthma or respiratory sensitisation
• infections such as hepatitis, tuberculosis, legionellosis and tetanus
• any other infection reliably attributable to work with biological agents, exposure to blood or body fluids or any potentially infective material
• other conditions, such as occupational cancer and certain musculoskeletal disorders.

Infections

For the purposes of RIDDOR, an infection is the entry and multiplication of an infectious agent in the body causing a damaging reaction in the tissue. The infection and the damage caused may give clinical signs and symptoms of disease (symptomatic), or may not be evident (asymptomatic). An infection should only be reported when you can reliably attribute it to the work that a person does. Infections that could have been acquired equally easily at work or in the community are not reportable. Colonisation, in other words the presence and multiplication of infectious agents in or on the body, without a damaging reaction in the tissue, is not the same as infection and is not reportable as a disease.

Dangerous occurrences

Dangerous occurrences are specific events that may not result in a reportable injury, but have the potential to do significant harm. Reportable dangerous occurrences include the following:

• the collapse, overturning or failure of load-bearing parts of lifts and lifting equipment
• the accidental release of a biological agent likely to cause severe human illness
• the accidental release of any substance which may damage health
• the explosion, collapse or bursting of any closed vessel or associated pipework
• an electrical short circuit or overload causing fire or explosion
• an explosion or fire causing suspension of normal work for over 24 hours.

How to report

You must report fatal accidents, accidents resulting in major injuries, accidents to people who are not at work and dangerous occurrences to the Incident Contact Centre by telephone, fax, via the Internet or by post without delay. For internet reporting go to www.riddor.gov.uk

The Incident Contact Centre can be contacted by:
post: Incident Contact Centre, Caerphilly Business Park, Caerphilly, CF83 3GG.
telephone (charged at local call rate): 0845 300 9923
fax (charged at local call rate): 0845 300 9924
email: riddor@natbrit.com

Keeping records

Records must be kept of any reportable injury, disease or dangerous occurrence and be kept for three years from the date it occurred. This includes, date and method of reporting; date, time and place of the event; personal details of those involved; and a brief description of the nature of the event or disease.

Occupational health and safety services (OHSS) can be provided by different organisations and are an essential part of managing the health of people at work in the NHS. The range of services provided varies depending upon the healthcare setting but includes:

• general guidance and advice
• health issues
• safety issues
• health promotion.

OHSS standards have been developed as part of the Improving Working Lives standard and are divided between health and safety, occupational health and other standards. Health and safety standards include:

• risk management
• risk assessment following accidents.

Occupational health standards:

• pre-employment
• in-service referral
• immunisation
• health surveillance
• ill health retirement.

Other standards:

• access to counselling services.

A contamination injury is one that causes exposure to blood or high-risk body fluids. These occur through:

• puncture of the skin with a dirty needle or sharps incident
• cuts or breaks in the skin
• splashes of blood or body fluid to the eyes or mouth
• human bites (especially those that draw blood)
• extensive spillage of blood or body fluids onto the skin (especially where there are cuts, abrasions, active eczema or dermatitis).

Body fluids are divided into high or low risk, sweat is not included as a body fluid. High risk fluids are:

• blood
• visibly blood stained body fluids and those derived from blood
• amniotic fluid
• vaginal secretions
• semen
• breast milk
• cerebrospinal fluid
• peritoneal fluid
• saliva in association with dentistry
• synovial fluid.

Low risk fluids are:

• urine
• vomit
• saliva
• faeces with no visible blood staining.

The main general risks from contamination incidents are infections with bloodborne viruses of hepatitis B (HBV), human immunodeficiency virus (HIV) and hepatitis C (HCV). Since 1993 healthcare workers who are hepatitis B e-antigen positive and HIV positive must not perform exposure prone procedures. Healthcare workers whose hepatitis B carrier status is unknown should not perform exposure prone procedures. Any healthcare workers who are HBsAg positive must not perform exposure prone procedures until their e-antigen status has been established.

Following a contamination injury, speed is essential and includes:

for wounds

• encourage bleeding by gently squeezing the site (do not suck)
• wash it in warm running water with soap, then dry it
• apply a waterproof dressing

for splashes to the eye

• irrigate thoroughly for at least five minutes with eyewash solution or sterile water (use tap water if these are not available)
• remove contact lenses

for splashes to the mouth

• irrigate thoroughly for at least five minutes with drinking water
• do not swallow the water.

Once first aid has been performed, report the incident to your manager and contact your occupational health services.