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Health & Safety & Infection Control in the Workplace

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    1. Which workplace procedures are relevant to your job to ensure there is a safe working environment and how is this carried out within your workplace? 301.1.1.a.b.c Examples of relevant workplace procedures at a dental practice include: Using hazardous substances safely – e.g. Storing amalgam separately to all other waste until collection, storing lead foil waste from x-rays separately until collection and having a separate bin for clinical waste – the clinical waste is placed in an orange bag and kept in a locked bin ready for collection by authorised personnel. No smoking or drug use on the premises. Eating and drinking should not take place in the surgery. Using working methods and equipment safely – e.g. Sharps which include needles, scalpels etc. should be discarded in appropriate puncture-proof sharps bins. Care should be taken as to not overfill sharps containers and to never re-sheath needles. Working methods to ensure safety should include appropriate personal protective equipment, wearing of disposable gloves, eye protection should be worn when splashing of bodily fluids may occur and the covering of any cuts or abrasions with waterproof plasters is necessary. Understanding emergency procedures is vital – this includes fire procedures, e.g. knowing the fire escape routes, understanding which fire extinguisher to use for each type of fire: Water extinguisher (RED) – can be used on wood, paper, textiles and fabrics.

    Foam extinguisher (CREAM) – can be used on wood, paper, textiles, fabrics and flammable liquids (petrol, oil, paints) CO2 extinguisher (BLACK) – can be used on flammable liquids and electrical fires Powder extinguisher (BLUE) – can be used on wood, paper, textiles, fabrics, flammable liquids, flammable gases, metal fires and electrical fires Wet chemical extinguisher (YELLOW) – can be used on cooking oils and fats. Understanding what to do in the case of a medical emergency is also necessary, this includes knowing the location of the emergency drugs box, defibrillator and oxygen cylinder and being suitably trained to perform CPR. In order to maintain personal presentation, you should always make sure that you are clean and tidy with your hair tied back; rings/bracelets/watches should not be worn. Hand cleaning after each patient and after handling bodily fluids is necessary. When moving non-sterilised equipment from the surgery to the decontamination room, these should be placed in a plastic box with a lid which should not be removed until the instruments are ready to be scrubbed. When handling any sharp objects, extra care should be taken and they should be disposed of in a puncture-proof sharps bin.

    2. What is the difference between workplace legislation and manufactures instructions? 301.1.4 Manufactures instructions act as guide to assemble or use a particular product purchased whereas workplace legislation is a guide put in place by the employer in order to provide their employees with clear, detailed instructions on how to perform tasks at minimal risk ensuring their safety and the safety of others. 3. What workplace legislations are in place for your safety and others? 301.1.4.a.b.c.d.e Healthy and safety at Work Act 1974 – The act sets out the general duties which employers have towards employees and members of the public, and employees have to themselves and to each other. The law requires them to look at what risks the risks are and to take sensible measures to tackle them. Control of Substances Hazardous to Health (COSHH) – Using hazardous substances at work can put people’s health at risk so the law requires employers to control exposure to hazardous substances to prevent ill health. E.g. mercury spillages are poisonous and x-ray chemicals are toxic and flammable. A risk assessment should be put in place for dealing with these kinds of hazardous substances.

    Environmental Protection Act 1990 – The environmental protection act is in place to prevent the pollution from emissions to air, land and water, E.g. you use an amalgam separator so the water doesn’t become contaminated with mercury leading to mercury poisoning. Ionising Radiation (Medical Exposures) Regulations (including local rules) – X-rays must only be taken when clinically necessary to do so. A lead apron can be worn for protection against radiation. All people in the surgery except the patient must leave the room whilst the x-ray is being taken to ensure nobody except the patient is exposed to radiation. Reporting of Injuries, Diseases and Dangerous Occurrences Regulation 1995 (RIDDOR) – This regulation is in place to report: Work related deaths, major injuries, over 3-day injuries, work related diseases. E.g. Acquiring Hepatitis B from a needle-stick injury at work. 4. How would you contribute to Health & Safety Improvements in your workplace? 301.3.3 If you feel unsafe in a particular situation you should alert the principal clinician so a risk assessment can be carried out to ensure safety. If you feel you are not trained well enough to carry out a particular job and believe it would be unsafe for you to do so, you should alert the principal clinician so a risk assessment can be carried out and so additional training can be given.

    Discussing any concern with other employers and the employees contributes to further improvements to health and safety in the work place. 5. How do you use cleaning products and sterilisation equipment in a safe manner? 304.1.3.a.b Wear PPE when using bleach as inhalation could lead to dizziness and feeling unwell. When gloves when using cleaning products to reduce the risk of skins irritation, e.g. dermatitis. Wear heavy duty gloves when scrubbing instruments so as to not get a pin prick injury and therefore be susceptible to cross-infection of blood borne viruses or other diseases. When draining the autoclave beware of the extremely hot water as this could lead to severe burns if a spillage occurred and also be aware of hot instruments when they have just come out of the autoclave as they could also lead to severe burns if not left to cool down for long enough. 6. How could you adjust the following environmental factors to meet the needs of the patient and the procedure? Explain the purpose of adjusting these factors. 304.1.4.a.b.c 304.1.6.a.b.c -Heating

    -Ventilation and Humidity

    Heating – Make sure the heating is adjusted so the patient feels calm. E.g. if it is a hot day and the patient already feels agitated regarding dental treatment, opening windows or using air conditioning will calm the patient down, thus ensuring the patient is calmer and much more relaxing. Lighting – Increase light intensity for certain intricate treatments, e.g. root canal treatment, ensuring the dentist has a very precise view when dealing with the nerve is vital. Ventilation and Humidity – Open the window so any bad odours from the previous surgery are released and the room is ventilated. E.g. after an infected tooth is removed it can leave a bad odour. Opening the window would ensure the bad smell would go and therefore the next patient would feel more at ease. Ventilating the surgery also reduces condensation, thus the chances of damp/mould growth which in the long term could causes serious problems, such as mould spores in the air causing cross infections 7. Explain what decontaminants are effective against the different types of microorganisms. 304.1.5 Decontamination is effective against the microorganisms – fungi, bacteria and viruses. Decontamination is not effective against spores. 8. Give examples of equipment failure and what action you would take in the event of each equipment failure.

    In the event of each of the following pieces of equipment failing, the following actions would be taken: Dental chair – Use another surgery if one is available or if not cancel patients and contact the allocated engineer to come out and fix it as soon as possible. Aspirator – Use another surgery if one is available or if not cancel patients and contact the allocated engineer to come out and fix it as soon as possible. Hand pieces – Put them to one side and use another hand piece. Alert the principal clinician that a new one is needed. Ultrasonic Cleaner – Scrub the instruments by hand, check under magnifier that they are sufficiently clean of any debris and put the instruments through the autoclave. Alert principal clinician of failure. X-ray machine – Alert principal clinician of failure and until fixed don’t process any x-rays. X-ray processing equipment – Alert principal clinician of failure and use another if available. Autoclave – Alert principal clinician and use other autoclave if available. Instrument washer – Alert principal clinician and use other if available. Ultrasonic bath – Scrub the instruments by hand, check under magnifier that they are sufficiently clean of any debris and put the instruments through the autoclave. Alert principal clinician of failure.

    9. List hazards in the dental surgery and explain the reporting procedure for each and why they should be reported. 304.2.7.a.b.c.d.e.f

    Blood contamination (Hepatitis C, Hepatitis B, HIV) – RIDDOR, or if a patient reports having either you must update the medical history form. Herpes Simplex – very contagious, therefore alert dentist and rebook appointment. Damaged Instruments – alert principal clinician and list broken instruments so the principal clinician can replace them. Sharps – must be reported in the accident book, alert principal clinician who will then contact occupation health whereby a blood test will be given to ensure no
    cross-infection of any disease has occurred. 10. Explain the reasons why records must be kept in relation the servicing of equipment. 304.2.8 Records must be kept in relation to the servicing of equipment in case there is a fault which no-one is aware of. E.g. if the autoclave was not functioning properly and everyone was unaware due to the autoclave not being serviced, this would mean the instruments would not be sterilised correctly which would therefore lead to cross-infection.

    11. Explain the reason for pre-cleaning instruments prior to sterilisation. 304.3.5 The reason for pre-cleaning instruments prior to sterilisation is because you can remove all debris which the autoclave cannot remove. E.g. Chemfil on a flat plastic must be removed using burr brush and put under the magnifier before going into the autoclave to ensure the instrument is completely clean and sterile. 12. Explain the methods available for testing autoclaves are functioning correctly. 304.3.6 Daily validation checks must be carried out and recorded by the user. Temperature, pressures and timing must be within the manufacturer’s parameter. Water should be drained and refilled daily. Inspect door seals and check the door cannot be opened during cycle. Ensure an annual test is carried out by an engineer to check the autoclave performs to Pressure Systems Regulations’. 13. What different stages of sterilisation is there? And what equipment is used throughout this procedure? Explain the importance of placing equipment and instruments in the correct location relevant to the different stages of sterilisation.

    When moving non-sterilised equipment from the surgery to the decontamination room, these should be placed in a plastic box with a lid which should not be removed until the instruments are ready to be scrubbed. When ready, the instruments must initially be scrubbed (using the burr brush if necessary) to remove all debris. The magnifier should be used to be certain all debris has been removed. The instruments are then cleaned in the ultrasonic bath before being placed in autoclave for sterilisation. Hand pieces are very difficult to clean and must not be immersed in an ultrasonic bath. The ‘N’ type steriliser will not give perfect sterility; therefore they must be oiled and cleaned using a washer disinfector with irrigation adaptions. After sterilisation, instruments must be stored in a way that they remain sterile and minimise any risk of being re-contaminated. Instruments must be stored in dry conditions away from excessive heat and moisture. 14. Explain the potential risks of not decontaminating equipment and instruments. 304.3.8 The potential risks of not decontaminating equipment and instruments are cross infection of blood borne viruses (Hepatitis B, Hepatitis C, HIV) and other diseases. 15. Explain the potential long term effects of using damaged or pre used sterile goods. 304.3.9 Using damaged or pre used sterile goods could lead to recontamination which would lead to cross infection causing possible disease. E.g. if packaging was damaged and the package was then in a place where aerosol contamination could occur this could lead to cross infection. 16. List the different types of waste. 304.4.1.a.b

    Amalgam waste
    Lead foil waste
    Clinical waste
    Non-clinical waste
    17. Explain the dangers of not disposing of waste correctly and promptly. 304.4.3 If waste is not disposes of correctly and promptly this could lead to toxic substances being released to the general public putting them at risk. E.g. not disposing of amalgam correctly – if this got into the water supply it would be extremely dangerous as it is toxic and could lead to fatalities. It would also put the environment at risk. Extreme quantities could kill fish and other sea life having a major effect on the food chain. If a member of the public was exposed to sharps which had not been correctly disposed of, they would not only hurt themselves but they would also be exposed to blood borne viruses and other diseases.

    18. How do you check the following is in good working order prior to use: – x-ray machine
    – x-ray processing equipment
    – instrument washer
    – ultrasonic bath

    X-ray machine – test strip to ensure x-ray chemicals don’t need changing. X-ray processing equipment – check it is in good condition, sterile and in good date. Instrument Washer – ensure it has been serviced and all logs kept meet the manufacturer’s guidelines. Test strip used daiy. Ultrasonic Bath – ensure it has been serviced and all logs kept meet the manufacturer’s guidelines. Test strip used daiy.

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