control of substances hazardous to health (coshh) … · 2016. 3. 21. · ii control of substances...

CONTROL OF SUBSTANCES HAZARDOUS TO HEALTH (COSHH) SEPTEMBER 2015

This policy supersedes all previous policies for Control of Substances Hazardous to Health

I CONTROL OF SUBSTANCES HAZARDOUS TO HEALTH (COSHH)_EF04_SEPTEMBER 2015

Policy title Control of Substances Hazardous to Health (COSHH)

Policy reference

EF 04 (Previously RM20)

Policy category Risk Management

Relevant to Health and Safety

Date published September 2015

Implementation date

September 2015

Date last reviewed

July 2015

Next review date

August 2017

Policy lead Gilly Ede, Health and Safety Manager

Contact details Email: [email protected] Telephone: 0203 317 6775

Accountable director

David Wragg, Director of Finance

Approved by (Group):

Health and Safety Committee

Approved by (Committee):

Audit and Risk Committee 29th July 2015

Document history

Date Version Summary of amendments

June 2012

1 Out for consultation to HS Group

September 2012

2 Approved by Audit and Risk Committee and published

June 2014

3 Review and minor changes approved through the HSF Committee

July 2015 4

Introduction of a policy’s statement at the request of the Audit and Risk Committee, Approved at the HSF Committee on 9

th June

2015.

Membership of the policy development/ review team

Gilly Ede, Health and Safety Manager Phil Wisson, Associate Director of Estates and Facilities

Consultation Health and Safety Group

Dennis Griffin, Compliance Manager

DO NOT AMEND THIS DOCUMENT

Further copies of this document can be found on the Foundation Trust intranet.

II CONTROL OF SUBSTANCES HAZARDOUS TO HEALTH (COSHH)_EF04_SEPTEMBER 2015

Contents Page

1 Introduction 3

2 Aims, objectives and policy statement 3

3 Scope of the policy 4

4 Responsibilities

4.1 Chief Executive 4.2 Associate Directors 4.3 Line Managers 4.4 Nominated staff with Health and Safety responsibilities 4.5 Employees 4.6 Health and Safety Manager 4.7 Cofely GDF SUEZ

4.8 Responsibilities for Contractors:

4

5 Definitions 5

6 COSHH Risk Assessment

6.1 The COSHH risk assessment process

6

7 Control Measures 7

8 Body Fluids 7

9 Spill Kits 8

10 Health Surveillance 8

11 Dissemination and implementation arrangements 8

12 Training requirements 8

13 Monitoring and audit arrangements 8

14 Review of the policy 9

15 References 10

16 Associated documents 11

17 Appendices

Appendix 1: COSHH Assessment Form

Appendix 2: COSHH Assessment Form

Appendix 3: COSHH Body Fluid Assessment Form

Appendix 4: COSHH: a brief guide

Appendix 5: COSHH Process Flow Chart

3 CONTROL OF SUBSTANCES HAZARDOUS TO HEALTH (COSHH)_EF04_SEPTEMBER 2015

1. Introduction

Policy statement

The purpose of this policy is to ensure that the Trust meets the requirements of the

Control of Substances Hazardous to Health Regulations (COSHH) 2002.

To ensure that the risk to the health and safety of employee and others who use or are

exposed to COSHH rated products in under taking their work activity or business is

minimised.

The COSHH Regulations 2002 (as amended in 2004) and Health and Safety Executive

Approved Code of Practice (ACoP) require employers to evaluate and control the risks

which employees and others may be exposed to from hazardous substances at work.

This policy applies to all workplaces and includes any substances, materials, processes

or by-products that are hazardous to health e.g. clinical waste, microbiological agents,

dusts of any kind in substantial quantities and all chemicals categorised as hazardous

to health in any form i.e. solid, liquid, gas or vapour.

This policy will outline how that process is met and managed within Camden and

Islington NHS Foundation Trust.

Camden and Islington NHS Foundation Trust (The Trust) recognises its duty to protect

employees, service users and members of the public who might be exposed, by direct contact,

airborne contact or any other method of contamination, to hazardous substances.

It is the policy of the Trust to ensure, so far as is reasonably practicable, the health, safety and

welfare of all it’s employees, service users, contractors and other persons who may be affected

by its operations in accordance with current legislation.

2. Aims, objectives and policy statement

The Trust will take all reasonable steps to secure the health, safety and welfare of its

employees and anyone who may come into contact with substances hazardous to health whilst

on Trust undertakings.

The Trust acknowledges that health and safety risks may arise from the use and/or contact with

substances hazardous to health. It is the intention of the Trust to ensure that so far as is

reasonably practicable that the risk is minimised.

To this end the Trust will:

• Identify what hazardous substances are present in the workplace

• Undertake COSHH assessments for hazardous substances

• Identify what control measures and precautions are required

• Prevent or adequately control exposure so far as is reasonably practicable

• Ensure that control measures are communicated, used and maintained

• Undertake monitoring of staff exposure as required by the COSHH assessment

• Carry out health surveillance as required by the COSHH risk assessment


• Prepare plans to deal with accidents, incidents and emergencies

• Ensure staff are adequately informed, trained and supervised

3. Scope of the policy

This policy applies to all employees as well as those service users, visitors, contractors and members of the public who come into contact with hazardous substances used by or produced by the Trust.

4. Responsibilities

4.1 The Chief Executive is responsible for:

ensuring the effective implementation of this Policy

allocating sufficient resources to enable the Policy to be delivered

monitoring the overall effectiveness of the Policy

4.2 Associate Directors are responsible for ensuring that:

that substances hazardous to health are identified and assessments of the associated risks to health are carried out within their Service by nominated, appropriately trained, competent people.

that appropriate resources are available to support safe working practice and take into account appropriate control measures

that health surveillance is undertaken, as appropriate, in accordance with assessment findings.

that assessments are reviewed annually or more frequently if circumstances change

4.3 Line Managers are responsible for:

ensuring that all hazardous substances within their area are identified and recorded on a COSHH inventory with assistance by the assessor.

ensuring that the hazards of any COSHH rate products use and associated controls in operation are explained during the local induction programme.

to provide/action the control measures as identified as necessary as a result of the COSHH Assessment (refer appendix 1)

supporting the assessment process and its outcome by ensuring that any necessary control measures and / or resource requirement are met.

reporting any health surveillance requirements to the Occupational Health Department

ensuring that any untoward incidents involving hazardous substances are reported, investigated and managed in accordance with the Trust’s Incident Reporting Policy and the Reporting of Injuries, Diseases & Dangerous Occurrences Regulations (RIDDOR) 1995.

4.4 Nominated staff with Health and Safety responsibilities are responsible for:

attending training to enable them to undertake their role as COSHH assessor. (One day Health and Safety training course for Managers)

completing COSHH assessments and developing appropriate control measures and safe systems of work

ensuring material safety data sheets are available for reference

reviewing and revising assessments as necessary and at least annually

recording assessments using COSHH assessment Form ( App 1)

submitting the above documentation to the line manager


raising COSHH related concerns with line manager

4.5 Employees have a responsibility to:

follow the safe system of work identified in the COSHH assessments

make full and proper use of control measures including personal protective equipment

report any compliance failures, digressions, defects or concerns to their line manager

report accidents and incidents

attend training as required

inform their line manager of any health concerns which could reasonably be attributed to exposure

4.6 Health and Safety Manager The Health and Safety Manager will be available to advise all sites on the management of their COSHH risks. They will investigate any serious COSHH related incidents or accidents

4.7 Cofely GDF SUEZ (COFELY) COFELY provide domestic services to the Trust. As such, COFELY will ensure that:

all sites retain a hard copy of the COSHH information appropriate to that site at an accessible location.

all incidents involving COSHH rated products are reported though the Trust accident reporting system.

that all measures will be taken to ensure that all chemicals are not used in the proximity of service users, kept on the trolleys while cleaning is in progress and kept in a locked environment (lockers or cupboard)when not in use.

that no COSHH rated chemicals will be left in service user accessible locations

4.8 Responsibilities for Contractors activities:

as part of the tendering process, reference will be made to the arrangements for

effectively managing the risks associated with hazardous substances, including

risk assessment, training, provision and maintenance of control measures,

communication of information (such as substances used) and record keeping.

if a site instructs a contractor directly, It is the responsibility of that Managers to

liaise with a representative of the contractor on all work involving hazardous

substances, and ensure co-operation and co-ordination.

contractors will reduce the risk as far as is reasonably practicable from

exposure to hazardous substances to Trust employees, visitors, service users

and any other contractors where they anticipate the use of hazardous materials.

Any contractor storing any intrinsically harmful chemicals on to trust property must have the express written permission of the contracts manager. They must also provide suitable secure lockable industry standards storage containers.

a suitable and sufficient risk assessment including Safety Data Sheets will be

provided, and brought to the attention of the Compliance Manager. All

information will be communicated to staff and others likely to be affected.

5. Definitions

“Substance hazardous to health” means anything:-


listed as dangerous for supply within the Chemical (Hazard Information and Packaging for Supply) Regulations (CHIP Regulations) and which indicates specified dangers as very toxic, toxic, harmful, corrosive or irritant

with a workplace exposure limit approved by the Health & Safety Commission (HSC) as listed in the EH40/2005 Workplace exposure limits publication

which is a biological agent

which is dust of any kind in sufficient quantity (10mg /m3 over 8 hr period for inhalable dust or 4mg/m3 over 8 hr period for respirable dust)

which is present in the workplace and which creates a risk to health e.g. micro-organisms, allergens etc.

6. COSHH Risk Assessment COSHH assessments should take a systematic approach by considering all factors relating to the use of substances hazardous to health. The assessment must also include reference to any emergency plans or procedures e.g. dealing with fire, spillage or first aid. They must clearly show all the control measures put in place either to prevent exposure or to achieve and maintain adequate control of exposure. Assessments must be working documents, copies of which must be kept readily available for reference. Where assessments require further control measures to be put in place, an action plan must be developed with responsibilities clearly allocated and actions timed. Re-assessment must be undertaken whenever there are significant changes to: the substance’s data sheet; the quantity or way in which it is used or if there is reason to suspect that health is being adversely affected. Please refer to appendix 1 for the Trust COSHH risk assessment form.

6.1 The COSHH Assessment Process:

Identify of all hazardous substances within the area being assessed including body fluids.

If the risk is a product, using the contract detail on the product, obtain the (Material Hazard Data Sheet (MHDS). Retain all MHDS in an accessible file. Sheets should be re requested every 2 years.

Using the COSHH risk assessment form and the information from the MHDS, record the risk, referring to the control measures as referred to in section 7. Consider:

o How much of the substance is to be used, what the routes of exposure are; who is likely to be exposed, are they trained to use the product, service user exposure, what the substances potential hazards are

o Existing controls in place, safe systems of workout set out on the MHDS, security and storage arrangements, Personal protective equipment required

o Emergency situations and non-routine tasks (spill kits, flammability)

Inform all those using the product or those who could potentially be exposed to the product or body fluid, of the associated hazardous and control measures required. Manager to formally record this communication process.

Retain a hard copy of the COSHH assessment at site for inspection. Review the assessment annually.

Review COSHH assessments when new products or procedures are introduced to the site.

If there is no risk to health or the risk is trivial, no more action is needed.


7. Control Measures

7.1 Control measures must be determined by the level of risk to health and must take into account:

elimination and/or use of alternative, less hazardous substances and materials where possible

modification of the use or process to eliminate, isolate or reduce exposure

elimination and/or reduction of numbers of people exposed to the hazardous substance

the outcome of any environmental monitoring, as appropriate, which has been undertaken by a competent person

the provision, maintenance and use of any control equipment required

the use of personal protective equipment (PPE) to reduce or control exposure to hazardous substances/materials. PPE should be regarded as a ‘last resort’ in providing protection from exposure to substances hazardous to health

7.2 Failure to comply with the identified control measures may result in disciplinary action.

7.3 Managers are responsible for ensuring that PPE, as required, is suitable for its

intended purpose, appropriately maintained, cleaned, inspected, stored and replaced as required.

7.4 Employees are required to use PPE provided in accordance with the training they

have been given and report any faults/defects or concerns regarding PPE to their manager.

7.5 Any physical control measures put in place as a result of assessments e.g. local exhaust

ventilation systems must be inspected and maintained to ensure their effectiveness.

Cofely, the Trust maintenance contractor will be responsible for the inspection and

maintenance of such systems.

Further information is available; please refer to appendix 3 COSHH a brief guide for further

information

8. Body Fluids

People suffering from certain infections may have the agent of disease present in their body fluids. In some cases the organisms persist for long periods and in sufficient numbers to represent a high risk of transmission. If others are exposed to their body fluids, the infectious agent(s) may be transferred into their body’s and infect them. Body fluids are also hazardous substances and a body fluid COSHH assessment is also required. Please refer to appendix 2 for the Trust Body Fluid Template. Exposure from any contagious/ infectious body fluid can expose those in physical contact and in the immediate area to harm.

The Infection Control Team will provide expert advice on the risk from microbiological agents


9 Spill Kits

If a site uses COSHH rated products and/or has exposure to body fluids then an appropriate spill response kit must be purchased. These can be purchased through procurement. The Health and Safety manager can also advise on selection In the event of a chemical spill, the individual(s) who caused the spill is responsible for prompt and proper clean-up. Staff should carefully note the correct use of chlorine based disinfection agents

10. Health Surveillance

COSHH places a duty on the Trust to provide suitable health surveillance where employees are exposed to a substance linked to a particular disease or adverse health effect and there is a reasonable likelihood, under the conditions of the work, or that disease or effect occurring and it is possible to detect the disease or health effect. Health surveillance will be managed by Occupational Health (Camden Provider Services). The Occupational Health Service will maintain appropriate COSHH health surveillance records as required by legislation. Individual health surveillance health records will be made available to the individual employee should they wish to access them.

11. Dissemination and implementation arrangements

This document will be circulated to all team managers who will be required to cascade the information to members of their teams. They should confirm receipt of the procedure and destruction of previous procedures/policies which this supersedes. It will be available to all staff via the Trust intranet. Team Managers will ensure that all staff are briefed on its contents and on what it means for them.

12. Training requirements

The Trust will ensure that those with Health and Safety responsibilities receive the necessary level of training for them to fulfil their individual responsibilities identified in this policy. COSHH will be taught in the one day “health and safety training course for managers”.

Wherever employees are exposed to hazardous substances they must receive whatever information, instruction and training is required, from their manager, so that they are aware of the following:

The risks to health created by their exposure

The precaution, which should be taken

Control measures, their purpose and how to use them;

How to use personal protective equipment and clothing provided

Results of any exposure monitoring and health surveillance (without giving names)

Emergency procedures

Employees should also be informed of the results of any monitoring carried out in the workplace.

13. Monitoring and audit arrangements


14. Review of the policy

This policy will be reviewed in August 2017 or if a change in legislation requires revision. The policy will also be reviewed as a result of any serious incidents relating to COSHH risk management within the Trust. The review will be undertaken by the Health and Safety manager.

Element to be monitored See list of NHSLA minimum requirements if relevant

Lead How Trust will monitor compliance

Frequency Reporting arrangements Which committee or group will the monitoring report go to?

Acting on recommendations and Lead(s)

Which committee or group will act on recommendations?

Change in practice and lessons to be shared

How will changes be implemented and lessons learnt/ shared?

Compliance with the policy (the maintenance of COSHH risk assessments)

GE Health and Safety site inspections

Six monthly Health, Safety and Fire Committee

Required actions will be identified and completed in a specified timeframe.

Required changes to practice will be identified and actioned within a specific time frame. A lead member of the team will be identified to take each change forward where appropriate. Lessons will be shared with all the relevant stakeholders.

COFELY Compliance with the policy (the maintenance of COSHH risk assessments)

SM Performance monitoring

Six monthly Health, Safety and Fire Committee


15. References

Control of Substances Hazardous to Health 2002 (COSHH) (as amended by the Control of Substances Control of Substances Hazardous to Health (COSHH) Policy V2:1 Hazardous to Health (Amendment) Regulations 2004 (COSHH 2004) • HSE Control of Substances Hazardous to Health (fifth edition 2005) Approved Code of Practice and guidance (HSE Books) • Health & Safety at Work etc Act 1974 • Management of Health & Safety at Work Regulations 1999 (as amended) • Personal Protective Equipment at Work Regulations 1992 • Chemicals (Hazard Information and Packaging Supply) Regulations 1996 (CHIP 96) http://www.hse.gov.uk/chip/index.htm

The CLP Regulation (EC) No 1272/2008 • HSE COSHH Website: http://www.hse.gov.uk/coshh/ • HSE COSHH A Brief Guide to the Regulations: http://hse.gov.uk/pubn/indg136.pdf • NHS Estates Alert (2004) 13 Chemical hazardous at Health: http://dh.gov.uk/assetRoot/04/12/2873/04122873.pdf • HSE A short guide to the Personal Protective Equipment at Work Regulations 1992 http://www.hse.gov.uk/pubns/indg174.pdf • Health Protection Agency web page on Chemicals and poisons http://www.hpa.org.uk/ • Advisory Committee on Dangerous Pathogens (ACDP) website is: http://www.hse.gov.uk/aboutus/meetings/ • HSE information and guidance on biological hazards at work http://www.hse.gov.uk/biosafety/information.htm • HSE Workplace Exposure Limits EH40/2005 ISBN:9780717664467 http://www.hse.gov.uk/pubns/books/eh40.htm.

16. Associated documents

The Mandatory Training Policy

Learning and Development Guide

Infection Control Manual (please do not print this document as it is very long)

http://www.hse.gov.uk/chip/index.htm

http://www.hse.gov.uk/coshh/

http://hse.gov.uk/pubn/indg136.pdf

http://dh.gov.uk/assetRoot/04/12/2873/04122873.pdf

http://www.hse.gov.uk/pubns/indg174.pdf

http://www.hpa.org.uk/

http://www.hse.gov.uk/aboutus/meetings/

http://www.hse.gov.uk/biosafety/information.htm


Appendix 1

Equality Impact Assessment Tool

Yes/No Comments

1. Does the policy/guidance affect one group less or more favourably than another on the basis of:

Race NO

Ethnic origins (including gypsies and travellers) NO

Nationality NO

Gender NO

Culture NO

Religion or belief NO

Sexual orientation including lesbian, gay and bisexual people

NO

Age NO

Disability - learning disabilities, physical disability, sensory impairment and mental health problems

NO

2. Is there any evidence that some groups are affected differently?

NO

3. If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable?

N/A

4. Is the impact of the policy/guidance likely to be negative?

NO

5. If so can the impact be avoided? N/A

6. What alternatives are there to achieving the policy/guidance without the impact?

N/A

7. Can we reduce the impact by taking different action?

N/A


Appendix 2

COSHH ASSESSMENT

Department: Completed by: Location: Date:

No. Name of substance Location of use Frequency of use

Duration of exposure

Hazard index 1 - 5

Likelihood of exposure 1 - 5

Overall risk 1 - 25

Controls required

1. 2. 3.

e.g. FLASH ALL PURPOSE CLEANER

Kitchen

Daily (Daily/weekly/monthly)

20 minutes a day (give the exposure in time units, total minutes or hours a day)

e.g.

2 Please refer to C&I risk matrix below

e.g.

2 Please refer to C&I risk matrix below

e.g.

4 Hazard score x Likelihood score

e.g. Dilute in bucket with water as directed on the instructions for cleaning to be undertaken. Store in locked cupboard when not in use Wear gloves during use Wash hands after use


C&I Foundation Trust The Risk Matrix

Likelihood

Likelihood score 1 2 3 4 5

Rare Unlikely Possible Likely Almost certain

5 Catastrophic 5 10 15 20 25

4 Major 4 8 12 16 20

3 Moderate 3 6 9 12 15

2 Minor 2 4 6 8 10

1 Negligible 1 2 3 4 5

Control of Substances Hazardous to Health (COSHH)_EF04_September 2015

Appendix 3

BODY FLUIDS COSHH ASSESSMENT

POLICY FOR SPILLAGE OF BLOOD AND OTHER BODY FLUIDS INTRODUCTION Dealing with spills of blood or other body fluids may expose the health care worker to blood-borne viruses or other pathogens (Wilson 2002). This Coshh Assessment outlines a safe procedure for dealing with spillages and should be read in conjunction with other policies as directed. Employers have a duty to protect workers from hazards encountered during their work: this includes microbiological hazards (COSHH 2002). Department: Your department title goes here Completed by: Your name goes here Location: Your location address goes there Date: The date the assessment is completed goes here

No. Name of substance Location of use Frequency of use

Duration of exposure

Hazard index 1 - 5

Likelihood of exposure 1 -

5

Overall risk 1 - 25

Controls required

1. 2. etc.

Body fluids include • Blood • Respiratory and oral secretions • Vomit • Vaginal secretions • Amniotic fluid • Faeces • Urine • Wound drainage • Semen • Cerebrospinal fluid • Pleural fluid • Gastric • Aspiration • Breast milk Delete those that do not apply

Your location address goes here

Infrequent exposure of body fluids

Up to 30 minutes

To be completed by

the site dependant

on the health of the service

users in residence/attending the

site

To be completed by

the site dependant

on the health of the service


site

To be completed by

the site dependant on the health of the service


site

ROUTINE SAFETY PROCEDURES GENERAL Deal with any spillage of blood/body fluids immediately. Avoid skin, eye, and mucous membrane contamination during the cleaning and disinfection of spillages. Protective clothing must be worn (see additional information) Follow Infection Control policies and procedures when dealing with blood and body fluids Apply standard precautions and spillage controls. Cover cuts and lesions with a waterproof dressing whilst on duty.


Ensure that all Staff dealing with spillages of blood/body are vaccinated against hepatitis B virus .Refer to Occupational Health Department for advice.

Dispose of the fluid, soiled cleaning products and soiled proactive clothing in a clinical waste bin or bag First THEN use the body fluid spill kit to sanitise the contact area. Spill kits can be ordered through Procurement. ) HAND WASHING Always wash hands after dealing with spillages or contaminated waste. Please refer to specific information below:


Appendix 4 Further information INCIDENT REPORTING Accidental exposure to blood/body fluids must be reported through the Datix system using the category: 05 HEALTH AND SAFETY the code 9HANDS Exposure to Hazardous Substance.

PROTECTIVE CLOTHING Wear plastic disposable apron. Wear disposable gloves. Protect eyes and mouth with goggles and mask (or full-face visor) if splash or spray is anticipated.

DISINFECTION OF BLOOD AND BODY FLUID SPILLS Disinfection aims to reduce the number of micro organisms to a safe level. Whilst a variety of chemical disinfectants are available, high concentration chlorine-releasing compounds provide an effective method of treating body fluid spills with activity against a range of bacteria and viruses. For clarity Actichlor has been used throughout this policy, but other chorine releasing agents may be available/introduced. Points about Chlorine based disinfectants: The disinfection solution is expressed as parts per million (ppm) of available chlorine. 10,000 ppm for blood spillages. 1,000 ppm for general disinfection. • Caution must be taken when using chlorine based disinfectants as they can cause irritation to the eyes, skin or mucous membranes if used in poorly ventilated areas. • Use cold water only to dilute the solution. • Chlorine based disinfectants must not be applied directly to acidic bodily fluids such as urine or vomit as chlorine vapour will be released. • COSHH regulations apply to chlorine disinfectants and to the microorganisms that may be present in the spillage. COSHH assessments should be available in every ward and department. • Chlorine may corrode metals unless residual disinfectant is rinsed off afterwards. • Chlorine will bleach and damage fabrics and carpets. • Whilst the granules and tablets are stable when stored dry, they are unstable when in solutions. Solutions of chlorine must be made up as needed and any remaining solution discarded. • Chlorine based disinfectants e.g. Actichlor are inactivated by organic matter and it is necessary for any soiling to be removed by cleaning prior to the application of the disinfectant.


The exception is where a blood spillage can be treated with hypochlorite granules which will penetrate organic matter due to its strength of 10,000 ppm and can be applied directly to the spill.

METHODS OF TREATING BODY FLUID SPILLS Type of Spill: - Blood and visibly blood stained fluid (except urine and vomit) For a small spillage: - • Wear disposable gloves and apron. Where there is a risk of splash, wear face protection. • Use Actichlor granules (or similar) 10,000 ppm. • Sprinkle granules over the blood spill and leave for 2 minutes. • Remove granules using paper towels or spillage kit and dispose of into clinical waste bag. • Clean the area with neutral detergent and water. For a large blood spillage: - • Wear disposable gloves, apron and where there is a risk of splash, wear face protection. • Prepare a solution of Actichlor plus (or similar) at 10,000 ppm, cover the spill with paper towels. • Pour the solution over the paper towels and where possible leave for 2 minutes. • Discard the paper towels into clinical waste bag. • Clean the area with neutral detergent and water. Body fluid spills not visibly blood stained • Wear disposable gloves and apron. Where there is a risk of splash, wear face protection. • Cover the spill with paper towels to absorb the matter. • Dispose of paper towels into clinical waste bag. • Disinfect the area using a suitable solution. Urine or Vomit spill • Wear disposable gloves and apron. Where there is risk of splash, wear face protection. • Absorb the spill using paper towels. • Remove paper towels and discard into clinical waste bag. • Disinfect area using suitable solution. Always clean the equipment used to deal with the spillage. Dispose mop- heads and cleaning cloths into clinical waste bag


Buckets – disinfect using a solution of Actichlor plus. After use, personal protective equipment must be removed and disposed of according to the waste policy. Always wash your hands after dealing with spillages. Carpeted Areas Where spillage has occurred in a carpeted area, treat according to the type of spillage outlined above. Contact the COFELY help desk on 0203 317 3484 as soon as possible in order that the carpet can be domestically cleaned using a carpet suction cleaner/stream cleaner after the spillage has been treated. Note that chlorine based disinfectants may bleach carpets. Responsibility For Dealing With Spillages For spillages, whether caused by patients, staff or visitors, the responsibility is as follows: • Wards/residences/day hospitals – Clinical staff • Main entrance, main corridors, communal areas outside ward and departments –Cofley Staff, contact the COFELY help desk on 0203 317 3484 • Outdoor areas, waste trolleys, vans – Cofley Staff, contact the COFELY help desk on 0203 317 3484 Spillages Of Blood And Body Fluids In Vehicles (day trips with service users) Where it is a likely occurrence that there may be a spillage of body fluids while transporting service users, a spillage kit should be carried, the kits containing disinfectant, detergent wipes, personal protective clothing, absorbent material and a clinical waste bag References

Wilson, J (2002). Infection Control in Clinical Practice. 2nd Edition. Bailliere Tindall,London.

Department of Health (1974) Health and Safety at Work Act. HMSO. London.

Control of Substances Hazardous to Health, Regulations. COSHH (2002).

Department of Health (1998). Guidance of Clinical Health Care Workers: Protection against infection with Blood-Borne Viruses. Recommendations of the Expert Advisory

C&IFT Infection Control Manual which can be located on Trust intranet.


Appendix 5 COSHH: A brief guide

What you need to know about the Control of Substances Hazardous to Health Regulations 2002 (COSHH)

Using chemicals or other 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. Hazardous substances include: ■ substances used directly in work activities (e.g., cleaning agents, adhesives, paints); ■ substances generated during work activities (e.g. fumes and dust); ■ naturally occurring substances (e.g. grain dust); ■ biological agents such as bacteria and other micro-organisms. A 'hazardous substance' is anything classified as dangerous to health under the current CHIPs (Chemical Hazards Information and Packaging) regulations, or substances which have a Workplace Exposure Limit (WEL) (as given in the Health and Safety Guidance Note EH40) OR dust of any kind when present in quantity, or micro-organisms, or any substance that creates a comparable hazard to the above. Effects of hazardous substances Examples of the effects of hazardous substances include: ■ skin irritation or dermatitis as a result of skin contact; ■ asthma as a result of developing allergy to substances used at work; ■ losing consciousness as a result of being overcome by toxic fumes; ■ cancer, which may appear long after the exposure to the chemical that caused it; ■ infection from bacteria and other micro-organisms (biological agents). How do the substances enter the body ? If someone should breathe it in (inhalation) If someone should swallow it (ingestion) If someone should touch it or get it onto their skin (absorption If some one receives a wound (laceration) If it should get into someone's eyes (eye contact) What COSHH requires: A written recorded Assessment To comply with COSHH you need to follow these eight steps to record the risk to health and the actions to be taken to remove or reduce that risk. Step 1 Assess the risks Assess the risks to health from hazardous substances used in or created by your workplace activities.


To do this you must: ■ identify the hazardous substances present in your workplace; ■ consider the risks these substances present to people’s health Step 2 Decide what precautions are necessary You must not carry out work which could expose any persons to hazardous substances without first considering the risks created and the necessary precautions needed. Step 3 Prevent or adequately control exposure You must prevent person being exposed to hazardous substances. Where preventing exposure is not reasonably practicable, then you must adequately manage the risks and put the appropriate controls into place to minimise the risks. Consider changing the process or activity so that the hazardous substance is not needed or generated; replace it with a safer alternative or use it in a safer form, eg pellets instead of powder. Step 4 Ensure that control measures are used maintained properly Ensure that control measures are used and maintained properly and that safety procedures are followed. COSHH sets specific intervals between examinations for local exhaust ventilation equipment, and you must retain records of examinations and tests carried out (or a summary of them) for at least five years. Step 5 Monitor the exposure Monitor the exposure of employees to hazardous substances, if necessary. Step 6 Carry out appropriate health surveillance Carry out appropriate health surveillance where your assessment has shown this is necessary or where COSHH sets specific requirements. You must keep and maintain a record of any exposure monitoring you carry out for at least five years. Step 7 Prepare plans and procedures to deal with accidents, incidents and emergencies. Prepare plans and procedures to deal with accidents, incidents and emergencies involving hazardous substances, where necessary. Step 8 Ensure employees are properly informed, trained and supervised. You should provide your employees with suitable and sufficient information, instruction training and supervision. Which should include: ■ the names of the substances they work with or could be exposed to and the risks created by such exposure, and access to any safety data sheets that apply to those substances; ■ the main findings of your risk assessment;


■ the precautions they should take to protect themselves and other employees; ■ how to use personal protective equipment and clothing provided; ■ results of any exposure monitoring and health surveillance (without giving individual employees’ names); ■ emergency procedures which need to be followed. You should update and adapt the information, instruction and training to take account of significant changes in the type of work carried out or work methods used. You should also ensure that you provide information etc that is appropriate to the level of risk identified by the assessment and in a manner and form in which it will be understood by employees. Consider the risks these substances present to people’s health Assessing the risk involves making a judgement on how likely it is that a hazardous substance will affect someone’s health. You need to ask yourself:

How much of the substance is in use or produced by the work activity and how could people be exposed to it?.

Who could be exposed to the substance and how often? You must remember to include all groups of people who could come into contact with the substance, ie contractors, visitors and members of the public, as well as your employees.

Do not forget those involved in cleaning and maintenance tasks – high exposures can occur during this type of work. Also, certain groups of people could suffer more from exposure than others, eg pregnant women, individuals with a suppressed immune system. Is there a possibility of substances being absorbed through the skin or swallowed (eg as a result of a substance getting into the mouth from contaminated hands during eating or smoking)?

Are there risks to your employees at other locations if they work away from your main workplace? Who should do the assessment? Those who have health and safety responsibility for their site/team and have attended the one day health and safety course The assessment should be a ‘living’ document, which should be revisited if circumstances change. It should definitely be reviewed when: ■ there is reason to suspect the assessment is no longer valid; ■ there has been a significant change in the work; ■ the results of monitoring employees’ exposure The assessment should state when the next review is planned. Adequately control exposure If prevention is not reasonably practicable, assessors must adequately control exposure. They should consider and put in place measures appropriate to the activity and consistent with the risk assessment, including, in order of priority, one or more of the following: Choosing control measures In order of priority: 1 Eliminate the use of a harmful product or substance and use a safer one. 2 Use a safer form of the product, e.g. re diluted. 3 Change the process to emit less of the substance.


4 Enclose the process so that the product does not escape. 5 Extract emissions of the substance near the source. 6 Have as few workers in harm’s way as possible. 7 Provide personal protective equipment (PPE) such as gloves, coveralls and a respirator. PPE must fit the wearer. Adequate control of carcinogens, mutagens and asthmagens COSHH acknowledges the particular hazards of substances which cause cancer, heritable genetic damage or asthma by requiring that exposure to these is reduced to as low a level as is reasonably practicable. The HSE website contains guidance on suitable controls. Eight principles of good COSHH practice

Design and operate processes and activities to minimise emission, release and spread of substances hazardous to health.

Take into account all relevant routes of exposure – inhalation, skin absorption and ingestion – when developing control measures.

Control exposure by measures that are proportionate to the health risk.

Choose the most effective and reliable control options, which minimise the escape and spread of substances hazardous to health.

Where adequate control of exposure cannot be achieved by other means, provide, in combination with other control measures, suitable personal protective equipment.

Check and review regularly all elements of control measures for their continuing effectiveness.

Inform and train all employees on the hazards and risks from the substances with which they work and the use of control measures developed to minimise the risks.

Ensure that the introduction of control measures does not increase the overall risk to health and safety. Safety data sheets Products can be dangerous for supply and use. If so, they will have a label that has one or more hazard symbols. Some examples are given here.


These products include common substances in everyday use such as paint, bleach, solvent or fillers. When a product is ‘dangerous for use or supply’, by law, the supplier must provide you with a Material safety Data hazard sheet. (MHDS). Safety data sheets can be hard to understand, with little information on measures for control. However, to find out about health risks and emergency situations, concentrate on: Part 15 of the sheet, which tells you what the dangers are; Parts 4 to 8, which tell you about emergencies, storage and handling. International symbols have replace the European symbols in 2009.


Some of them are similar to the European symbols but there is no single word describing the hazard. Read the hazard statement on the packaging and the safety data sheet from the supplier.

Acute toxicity, Very toxic (fatal), Toxic etc.

Gasses under pressure

Harmful skin irritation, serious eye irritation

Flammable gasses, flammable liquids, flammable solids, flammable aerosols, organic peroxides, self-reactive,

pyrophoric, self-heating, contact with water emits flammable gas

Explosive, self-reactive, organic peroxide

Harmful to the environment


oxidising gases, oxidising liquids, oxidising solids

Respiratory sensitiser, mutagen, carcinogen, reproductive toxicity, systemic target organ toxicity, aspiration

hazard

Corrosive (causes severe skin burns and eye damage), serious eye damage

Appendix 4 is currently on a separate sheet, thank you

control of substances hazardous to health (coshh) … · 2016. 3. 21. · ii control of substances...

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