41.1 Health and Safety Legislation, COSHH, RIDDOR and Sharps

2. Health & Safety Legislation in UK Dental Practice

UK Health and Safety Legislative Pillars in Dentistry
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  ├── Health and Safety at Work Act 1974 (HASAWA)
  │     └── Overarching primary legislation; employer duty of care to ensure health, safety, and welfare
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  ├── COSHH Regulations 2002 (Control of Substances Hazardous to Health)
  │     └── Risk assessment and safety data sheets for hazardous chemicals (mercury, monomer, disinfectants)
  │
  ├── RIDDOR 2013 (Reporting of Injuries, Diseases & Dangerous Occurrences)
  │     └── Statutory reporting of deaths, major fractures, occupational infections (HIV/HBV sharps injury)
  │
  └── Health and Safety (Sharp Instruments in Healthcare) Regulations 2013
        └── Mandates safer sharps, point-of-use disposal bins, and absolute ban on manual needle recapping

Health and Safety at Work Act 1974 (HASAWA)

The primary statute imposing a general duty on every employer to ensure, "so far as is reasonably practicable", the health, safety, and welfare of all employees, patients, and visitors. Any practice employing five or more staff members must maintain a formal, written Health and Safety Policy.

Control of Substances Hazardous to Health (COSHH 2002)

COSHH mandates that dental practices evaluate and control exposure to all hazardous chemical and biological agents:

• COSHH File: Must contain individual risk assessments and manufacturer Safety Data Sheets (SDS) for every chemical in the building.
• Elemental Mercury & Dental Amalgam:
  • Governed by the EU/UK Mercury Regulations 2018: Dental amalgam is banned for treatment of primary teeth, children under 15 years, and pregnant or breastfeeding women (except where strictly deemed clinically necessary).
  • Practices must use pre-dosed encapsulated amalgam only (bulk elemental mercury is illegal).
  • Dental units must be fitted with amalgam separators with a certified retention efficiency of at least 95%.
  • Practices must maintain an emergency Mercury Spill Kit (containing sulfur/calcium hydroxide powder, mercury-absorbent sponges, and dedicated vapor-tight containers).
• Other Hazardous Agents: Methyl methacrylate monomer (skin sensitization, requiring nitrile gloves and adequate ventilation); sodium hypochlorite (corrosive, eye protection mandatory); acid etch (phosphoric acid $37%$).

Reporting of Injuries, Diseases & Dangerous Occurrences Regulations 2013 (RIDDOR)

Employers must notify the Health and Safety Executive (HSE) of specified workplace incidents:

• Reportable Workplace Deaths and Major Specified Injuries: Fractures (other than fingers/toes), amputations, crush injuries, loss of sight.
• Over-7-Day Incapacitation: Accidents resulting in an employee being unable to work for more than seven consecutive days.
• Occupational Diseases: Occupational dermatitis (e.g., from latex or methacrylates), occupational asthma.
• Reportable Biological Exposures & Inoculation Injuries: A sharps or needlestick injury is reportable under RIDDOR ONLY IF it is known that the source patient carries a bloodborne virus (HIV, Hepatitis B, or Hepatitis C) AND the healthcare worker subsequently seroconverts (contracts the infection).

Health and Safety (Sharp Instruments in Healthcare) Regulations 2013

Enacted under European Directive 2010/32/EU to eliminate percutaneous injuries among healthcare staff:

1. Use of Safer Sharps: Employers must eliminate unnecessary sharps and provide medical devices incorporating safety-engineered protection mechanisms (e.g., self-sheathing local anesthetic syringes).
2. Ban on Recapping Needles: The manual, two-handed recapping (resheathing) of contaminated dental needles is strictly prohibited. Needles may only be resheathed if an approved single-handed recapping block, bayonet device, or passive guard is utilized.
3. Sharps Disposal Containers: Sharps bins must be placed at the point of clinical use, mounted securely, never filled beyond the indicated manufacturer fill line ($3/4$ full), and properly color-coded:
   • Yellow Lid: Sharps contaminated with medicinal products (e.g., anesthetic cartridges, needles).
   • Orange Lid: Sharps not contaminated with medicines (e.g., scalpel blades, suture needles).
   • Purple Lid: Sharps contaminated with cytotoxic/cytostatic drugs.

Percutaneous Inoculation Injury Protocol

If a sharps injury occurs with a contaminated needle or instrument:

Sharps Inoculation Injury Emergency Action Plan

  Step 1: Immediate First Aid at Point of Injury
    │
    ├── Encourage free bleeding under warm running water (DO NOT squeeze, press, or suck wound)
    ├── Wash thoroughly with soap and warm water (DO NOT scrub with abrasive brushes or caustic agents)
    └── Cover puncture wound with a sterile, waterproof adhesive dressing
    │
  Step 2: Immediate Incident Reporting & Source Assessment
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    ├── Inform Practice Principal / Health and Safety Lead
    └── Identify source patient; discreetly check medical history for BBVs (HIV, HBV, HCV)
    │
  Step 3: Rapid Occupational Health / Emergency Department Referral
    │
    ├── Attend within 1 HOUR for risk assessment and baseline blood screening
    ├── Post-Exposure Prophylaxis (PEP) for HIV:
    │     └── Must be initiated as rapidly as possible (ideally within 2 hours; window closes at 72 hours)
    └── Hepatitis B Management:
          └── Accelerated vaccine booster ± Hepatitis B Immunoglobulin (HBIG) if non-responder

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Risk Assessment as the Common Thread

Every piece of UK health and safety legislation applied to dentistry rests on the same mechanism: identify the hazard, assess who might be harmed and how, decide on and implement control measures, record the assessment, and review it. The Management of Health and Safety at Work Regulations 1999 make suitable and sufficient risk assessment an explicit duty, and require that any practice with five or more employees records it in writing. Dental-specific assessments include sharps and inoculation injury, mercury and amalgam, chemical agents under COSHH, ionising radiation under IRR17, nitrous oxide exposure, legionella in dental unit waterlines, manual handling, display screen equipment, fire, and lone working.

Specific Duties Candidates Are Expected to Name

The Health and Safety at Work etc. Act 1974 places duties on employers so far as is reasonably practicable and, importantly, on employees to take reasonable care of themselves and others and to cooperate with the employer. The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 require reporting to the Health and Safety Executive of deaths, specified injuries, injuries causing more than seven days' incapacity, certain occupational diseases, and dangerous occurrences — and, relevant to dentistry, an injury from a sharp that leads to a diagnosed blood-borne infection. The Sharps Regulations 2013 require the avoidance of unnecessary sharps, the use of safer devices where reasonably practicable, a ban on recapping needles unless a safe device or technique is used, safe disposal into a compliant container close to the point of use, and a written procedure for exposure incidents. The Regulatory Reform (Fire Safety) Order 2005 requires a fire risk assessment and a responsible person. Practices must also display the health and safety law poster or provide equivalent leaflets, hold employers' liability insurance and display the certificate, and keep an accident book compliant with data protection.