42

NVQ Level 2 Health and Social Care

What is safety?It sounds very simple and straightforward: make sure that the place in which

you work is safe and secure. However, when you start to think about it

– safe for whom or from whom? Safe from tripping over things? Safe from

hazardous fumes? Safe from infection? Safe from intruders? Safe from work-

related injuries? You can begin to see that this is a wide and complex subject.

It may help if you think about safety and security in respect of the areas of

responsibility shown in the table below.

Responsibilities for safety and security in the workplace

Safety in the workplaceYou share responsibility with your employer for the safety of all the people

who use your service. There are many hazards which can cause injury to

people, especially if they are old, ill or disabled. You need to be aware of the

following types of hazards.

Environmental hazardsThese include:

wet or slippery floors

cluttered passageways or corridors

re-arranged furniture

●

●

●

worn carpets or rugs

electrical flexes.

●

●

Hazards connected with equipment and materialsExamples of such hazards include:

faulty brakes on beds

worn or faulty electrical or gas appliances

worn or damaged lifting equipment

worn or damaged mobility aids

●

●

●

●

incorrectly labelled substances,

such as cleaning fluids

leaking or damaged containers

faulty waste-disposal equipment.

●

●

●

42

HSC 22a Carry out health and safety checks before you begin work activities

Employer’s responsibilities Employee’s responsibilities Shared responsibilities

Planning safety and security Using the systems and procedures correctly

Safety of individuals using the facilities

Providing information about safety and security

Reporting flaws or gaps in the systems, equipment or procedures in use

Safety of the environment

Updating systems and procedures

43HSC 22, Support the health and safety of yourself and individuals

Hazards connected with peopleThis category of hazards includes:

handling procedures

visitors to the building

●

●

intruders

violent and aggressive behaviour.

●

●

Your roleYour responsibility to contribute to a safe environment means more than

simply being aware of these potential hazards. You must take steps to check

and deal with any sources of risk.

You can fulfil your role in two ways: you can deal directly with the hazard, or

you can report it to your manager.

Dealing directly with the hazardThis means that you have taken individual

responsibility. It will probably apply to obvious

hazards such as:

trailing flexes – you can roll them up and store

them safely

wet floors – you can dry them as far as possible

and put out warning signs

cluttered doorways and corridors – you can

remove objects and store them safely or dispose

of them appropriately; if items are heavy, use

assistance or mechanical aids

visitors to the building – challenge anyone you

do not recognise; asking ‘Can I help you?’ is

usually enough to establish whether a person has

a good reason to be there

fire – follow the correct procedures to raise the

alarm and assist with evacuation.

Informing your managerWhen you inform your manager, the hazard becomes an organisational

responsibility. You should report hazards which are beyond your role and

competence, such as:

faulty equipment – fires, kettles, computers, etc.

worn floor coverings

loose or damaged fittings

obstructions too heavy for you to move safely

damaged or faulty aids – hoists, bed brakes, bathing aids, etc.

people acting suspiciously on the premises

fire.

●

●

●

●

●

●

●

●

●

●

●

●

Hazard: Something which could possibly cause harm.

Risk: The likelihood of a hazard causing harm.

Key terms

After washing floors dry them as much as possible, and set out warning signs

44

NVQ Level 2 Health and Social Care

The legal frameworkThe settings in which you provide care are generally covered by the Health

and Safety at Work Act 1974 (HASAWA). This Act has been updated and

supplemented by many sets of regulations and guidelines, which extend it,

support it or explain it. The regulations most likely to affect your workplace

are shown in the diagram below.

The Health and Safety at Work Act is like an umbrella

You and the lawThere are many regulations, laws and guidelines dealing with health and

safety. You do not need to know the detail, but you do need to know where

your responsibilities begin and end.

The laws place certain responsibilities on both employers and employees. For

example, it is up to the employer to provide a safe place in which to work, but

the employee also has to show reasonable care for his or her own safety.

Employers have to:

provide a safe workplace

ensure that there is safe access to and from the workplace

provide information on health and safety

provide health and safety training

undertake risk assessment for all hazards.

●

●

●

●

●

Heal

thand Safety at Work Act

Reporting ofInjuries, Diseasesand Dangerous

OccurrencesRegulations

1995(RIDDOR)

ManualHandling

Regulations1992

Control ofSubstances

Hazardous toHealth

Regulations2002 (COSHH)

Managementof Health and

Safety atWork

Regulations1999

Health andSafety First

AidRegulations

1981

53HSC 22, Support the health and safety of yourself and individuals

How to promote a safe work environmentCare environments are places where accidents can quite often happen,

not because staff are careless or fail to check hazards, but because of the

vulnerability of the people who use the care facilities.

As people become frail or develop physical conditions which affect mobility

such as arthritis or Parkinson’s, they become susceptible to falls and trips

because they are unsteady, and the slightest change in surface or level can

upset their balance. Increasing age can also result in less flexibility of muscles

and joints, meaning that people are less able to compensate for a loss of

balance or a slip and are more likely to fall than younger people, who may be

better able to save themselves by reacting more quickly.

Age is not the only factor to increase risk. Other factors, such as impaired

vision, multiply the risk of accidents from trips, falls, touching hot surfaces

and knocking into objects. Hearing loss can increase the risk of accidents

where people have not heard someone, or perhaps something such as a trolley,

approaching around a corner. Dementia can increase risks because people fail

to remember to take care when they move about. They can also forget where

they have put things down and fail to understand the consequences of actions

such as touching hot liquids or pulling on cupboard doors.

It is important that you develop an awareness of health and safety risks and

that you are always aware of any risks in any situation you are in. If you get into

the habit of making a mental checklist, you will find that it helps. The checklist

will vary from one workplace to another, but could look like the one below.

Checklist for a safe work environment

Hazards Check

Environment

Floors Are they dry?

Carpets and rugs Are they worn or curled at the edges?

Doorways and corridors Are they clear of obstacles?

Electrical flexes Are they trailing?

Equipment

Beds Are the brakes on? Are they high enough?

Electrical or gas appliances Are they worn? Have they been safety checked?

Lifting equipment Is it worn or damaged?

Mobility aids Are they worn or damaged?

Substances such as cleaning fluids Are they correctly labelled? Continued

54

NVQ Level 2 Health and Social Care

One of the other factors to consider in your checklist may be what your

colleagues do about health and safety issues. It is very difficult if you are the

only person following good practice. You may be able to encourage others by

trying some of the following options:

always showing a good example yourself

explaining why you are following procedures

getting some health and safety leaflets from your trade union or

environmental health office and leaving them in the staffroom for people

to see

bringing in any information you can about courses or safety lectures

asking your supervisor if he or she can arrange a talk on health and safety.

What you wearYou may not think that what you wear has much bearing on health and safety,

but it is important. Even if your employer supplies, or insists on you wearing, a

uniform, there are still other aspects to the safety of your work outfit.

There may be restrictions on wearing jewellery or carrying things in your

pocket which could cause injury. This can also pose a risk to you – you could

be stabbed in the chest by a pair of scissors or ball-point pen!

Many workplaces do not allow the wearing of rings with stones. Not only is

this a possible source of infection, but they can also scratch people or tear

protective gloves.

High-heeled or poorly supporting shoes are a risk to you in terms of foot

injuries and very sore feet! They also present a risk to individuals you are

helping, because if you overbalance or stumble, so will they.

●

●

●

●

●

Hazards Check

Containers Are they leaking or damaged?

Waste disposal equipment Is it faulty?

People

Visitors to the building Should they be there?

Handling procedures Have they been assessed for risk?

Intruders Have police been called?

Violent and aggressive behaviour Has it been dealt with?

Keys to good practice: Reducing risk

Simple precautions can often be the most effective in reducing the risk. Always look for the risk and take steps to reduce it.

THINK RISK ➞ ASSESS ➞ REDUCE ➞ AVOID

✓

55HSC 22, Support the health and safety of yourself and individuals

How to contribute to infection controlThe very nature of work in a care setting means that great care must be taken

to control the spread of infection. You will come into contact with a number

of people during your working day – an ideal opportunity for infection

to spread. Infection which spreads from one person to another is called

‘cross-infection’. If you work in the community, cross-infection is difficult to

control. However, if you work in a residential or hospital setting, infection

control is essential. There are various steps which you can take in terms of the

way you carry out your work (wherever you work) which can help to prevent

the spread of infection.

You do not know what viruses or bacteria may be present in any individual,

so it is important that you take precautions when dealing with everyone. The

precautions are called ‘universal precautions’ precisely because you need to

take them with everyone you deal with.

Wear gloves

How

When Any occasion when you will have contact with body fluids (including body waste, blood, mucus, sputum, sweat or vomit), or when you have any contact with anyone with a rash, pressure sore, wound, bleeding or any broken skin. You must also wear gloves when you clear up spills of blood or body fluids or have to deal with soiled linen or dressings.

Why Because gloves act as a protective barrier against infection.

1 Check gloves before putting them on. Never use gloves with holes or tears. Check that they are not cracked or faded.

2 Pull gloves on, making sure that they fit properly. If you are wearing a gown, pull them over the cuffs.

3 Take them off by pulling from the cuff – this turns the glove inside out.

4 Pull off the second glove while still holding the first so that the two gloves are folded together inside out.

5 Dispose of them in the correct waste disposal container and wash your hands.

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NVQ Level 2 Health and Social Care

Wash your hands

How

Wear protective clothing

When Before and after carrying out any procedure which has involved contact with an individual, or with any body fluids, soiled linen or clinical waste. You must wash your hands even though you have worn gloves. You must also wash your hands before you start and after you finish your shift, before and after eating, after using the toilet and after coughing, sneezing or blowing your nose.

Why Because hands are a major route to spreading infection. When tests have been carried out on people’s hands, an enormous number of bacteria have been found.

How Wash hands in running water, in a basin deep enough to hold the splashes and with either foot pedals or elbow bars rather than taps, because you can re-infect your hands from still water in a basin, or from touching taps with your hands once they have been washed. Use the soaps and disinfectants supplied. Make sure that you wash thoroughly, including between your fingers. This should take between 10 and 20 seconds.

When You should always wear a gown or plastic apron for any procedure which involves bodily contact or is likely to deal with body waste or fluids. An apron is preferable, unless it is likely to be very messy, as gowns can be a little frightening to the individual you are working with.

Why Because it will reduce the spread of infection by preventing infection getting on your clothes and spreading to the next person you come into contact with.

How The plastic apron should be disposable and thrown away at the end of each procedure. You should use a new apron for each individual you come into contact with.

1 Wet your hands thoroughly under warm running water and squirt liquid soap onto the palm of one hand.

2 Rub your hands together to make a lather.

3 Rub the palm of one hand along the back of the other and along the fingers. Then repeat with the other hand.

4 Rub in between each of your fingers on both hands and round your thumbs.

5 Rinse off the soap with clean water. 6 Dry hands thoroughly on a disposable towel.

57HSC 22, Support the health and safety of yourself and individuals

Tie up hair

Clean equipment

Deal with waste

Take special precautions

How to maintain personal safetyThere is always an element of risk in working with people. There is little

doubt that there is an increase in the level of personal abuse suffered

by workers in the health and care services. There is also the element of

personal risk encountered by workers who visit people in the community,

and have to deal with homes in poor states of repair and an assortment of

domestic animals!

However, there are some steps which you can take to assist with your own

safety.

Why Because if it hangs over your face, it is more likely to come into contact with the individual you are working with and could spread infection. It could also become entangled in equipment and cause a serious injury.

When Because infection can spread from one person to another on instruments, linen and equipment just as easily as on hands or hair.

Why By washing large items like trolleys with antiseptic solution. Small instruments must be sterilised. Do not shake soiled linen or dump it on the floor. Keep it held away from you. Place linen in the proper bags or hampers for laundering.

Why Because it can then be processed correctly, and the risk to others working further along the line in the disposal process is reduced as far as possible.

How By placing it in the proper bags. Make sure that you know the system in your workplace. It is usually:

clinical waste – yellow

soiled linen – red

recyclable instruments and equipment – blue

●

●

●

When There may be occasions when you have to deal with an individual who has a particular type of infection that requires special handling. This can involve things like hepatitis, some types of food poisoning or highly infectious diseases.

How Your workplace will have special procedures to follow. They may include such measures as gowning, double gloving or wearing masks. Follow the procedures strictly. They are there for your benefit and for the benefit of the other individuals you care for.

Make notes of three ways in which infection can be spread. Then note down three effective ways to reduce the possibility of cross-infection. Keep your notes as evidence.

Evidence indicator

58

NVQ Level 2 Health and Social Care

Keys to good practice: Steps to personal safety

If you work alone in the community, always leave details of where you are going and what time you expect to return. This is important in case of accidents or other emergencies, so that you can be found.

Carry a personal alarm, and use it if necessary.

Ask your employer to provide training in techniques to combat aggression and violence. It is foolish and potentially dangerous to go into risky situations without any training.

Try to defuse potentially aggressive situations by being as calm as possible and by talking quietly and reasonably. But if this is not effective, leave.

If you work in a residential or hospital setting, raise the alarm if you find you are in a threatening situation.

Do not tackle aggressors, whoever they are – raise the alarm.

Use an alarm or panic button if you have it – otherwise yell – very loudly.

✓

✓

✓

✓

✓

✓

✓

K was a home-care assistant on her first visit to a new service user, Mr W. She had been warned that his house was in a poor condition and that he had a large dog. She also knew that he had a history of psychiatric illness and had, in the past, been admitted to hospital compulsorily under the Mental Health Act.When K arrived on her first morning, the outside of the house was in a very poor state – the garden was overgrown, and it was full of rubbish and old furniture. The front door was half open and she could see that half the floorboards in the hallway appeared to be missing – there were simply joists and a drop into the cellar below. Mr W’s dog was in the hallway growling and barking, and Mr W was at the top of the stairs shouting ‘Who are you? You won’t get me out of here – I’ll kill you first!’

1 Q What should K do?

A Leave! She should leave the house at once and report the situation to her manager.

2 Q When should she go back?

A Only after a risk assessment has been carried out.

3 Q What sort of risks need to be assessed?

A a Mr W’s mental health and whether any treatment or support is required.

b The safety of the house. Mr W will have to be consulted about whether he is willing for his house to be made safe and the floorboards repaired.

c The dog and whether it is likely to present a risk of attack on a visitor to the house.

4 Q If Mr W refuses to allow a risk assessment, or his house to be repaired, should K go back in anyway?

A No. K’s job is to provide care, but not at the risk of her own safety.

5 Q Who should carry out the risk assessment?

A K’s employer.

Case study: Risk in the community

59HSC 22, Support the health and safety of yourself and individuals

How to help people to move safelyHandling and moving service users is dealt with in detail in Unit HSC 223,

but the implications for the safety of both you and the service user are

examined in this unit.

The Manual Handling Operations Regulations 1992 require employers

to avoid all manual handling where there is a risk of injury ‘so far as it is

reasonably practical’. Everyone from the European Commission to the Royal

College of Nurses has issued policies and directives about avoiding lifting

wherever possible. Make sure you check out the policies in use in your

workplace and that you understand them.

There is almost no situation in which manual lifting and handling could be

considered acceptable.

On the rare occasions when it is still absolutely necessary for manual lifting

to be done, the employer has to make a risk assessment and put procedures

in place to reduce the risk of injury to the employee. This could involve

ensuring that enough staff are available to lift or handle someone safely,

which can often mean that four people are needed.

Use the aids which your employer is obliged to provide

Your employer should arrange for you to attend a moving and handling

course. You must attend one each year, so that you are up to date with the

safest possible practices.

Your employer is required to carry out a risk assessment of any moving

and handling which is necessary and to supply the correct equipment, and

enough people, to carry out the move.

All moving and handling should be carried out using appropriate aids and

sufficient people. Manual lifting is not something to be undertaken in the

Lifting and handling individuals is the single largest cause of injuries at work in health and care settings. One in four workers take time off because of a back injury sustained at work.

Did you know?

Always use lifting and handling aids.

There is no such thing as a safe manual lift.

Use the aids which your employer is obliged to provide.

●

●

●

Remember

Many workers in care still lift people manually. It seems quicker and easier than going to all the trouble of using a hoist – it isn’t.

Manual lifting is now actively discouraged throughout the profession.

Manual lifting presents unnecessary and unacceptable risks to the service user and to you.

A back injury can end your career. It’s not worth the risk.

●

●

●

●

Remember

✓ ✗

60

NVQ Level 2 Health and Social Care

normal course of events and you should use mechanical lifting aids and

hoists wherever possible.

Your employer is required to supply the necessary equipment, such as hoists

If you do have to consider lifting, what should you do?Encourage all individuals to help themselves – you would be surprised how

much ‘learned helplessness’ exists. This is largely brought about by care

workers who find it is quicker and easier to do things themselves rather than

allowing a person to do it for himself or herself! Does this sound familiar?

It is also essential that the views of the person being moved are taken into

account. While your employer, and you, need to make sure that you are not

put at risk by moving or lifting, it is also important that the person needing

assistance is not caused pain, distress or humiliation by the policies in place.

Groups representing people with disabilities have pointed out that policies

which exclude any lifting may infringe the human rights of an individual

needing mobility assistance. For example, individuals may in effect be

confined to bed unnecessarily and against their will by a lack of lifting

assistance.

A High Court judgement (A & B vs East Sussex County Council 2003) found

in favour of two women with disabilities who had been denied access to

lifting because the local authority had a blanket ban on lifting regardless of

the circumstances. Such a ban was deemed unlawful. It is likely that similar

cases will be brought under the Human Rights Act, which gives people

protection against humiliating or degrading treatment.

There is more detailed information in Unit HSC 223 about maintaining

mobility and helping people to move themselves.

Your employer has a statutory requirement to install lifting equipment, but it is your responsibility to use the equipment that is there.

Remember

61HSC 22, Support the health and safety of yourself and individuals

How to help maintain securityMost workplaces where care is provided are not under lock and key. This

is a necessary part of ensuring that people have choice and that their rights

are respected. However, they also have a right to be secure. Security in a care

environment is about:

security against intruders

people’s right to privacy and to make decisions about unwanted visitors

security of property

protection against abuse.

Security against intrudersIf you work for a large organisation, such as an NHS trust, it may be that

all employees are easily identifiable by identity badges with photographs.

This makes it easier to identify people who do not have a right to be on the

premises. Some of these identity cards even contain a microchip which allows

the card to be ‘swiped’ to gain access to secure parts of the building.

In a smaller workplace, there may be a system of issuing visitors’ badges to

visitors who have reasons to be there, or the workplace may simply rely on

the vigilance of the staff.

The more dependent individuals are, the greater the risk. If you work with

babies, high-dependency or unconscious patients, people with a severe

learning disability or multiple disabilities, or people who are very confused,

you will have to be extremely vigilant in protecting them from criminals.

Protecting peopleIf very dependent individuals are living in their own homes, the risks are far

greater. You must try to impress on them the importance of finding out who

people are before letting them in. If they are able to use them, the ‘password’

●

●

●

●

Keys to good practice: Security against intruders

Be aware of everyone you come across. Get into the habit of noticing people and thinking, ‘Do I know that person?’

Challenge anyone you do not recognise.

The challenge should be polite. ‘Can I help you?’ is usually enough to find out if a visitor has a reason to be on the premises.

If a person says that he or she is there to see someone:

Don’t give directions – escort him or her.

If the person is a genuine visitor, he or she will be grateful. If not, he or she will disappear pretty quickly!

✓

✓

✓

✓

✓If you find an intruder on the premises, don’t tackle him or her – raise the alarm.

Remember

62

NVQ Level 2 Health and Social Care

schemes from the utilities (water, gas and electricity companies) are helpful.

Information record cards like those provided by the ‘Safe as Houses’ scheme

can be invaluable in providing basic information to anyone who is involved

in helping in an emergency.

Choosing who to seePeople have a right to choose who they see. This can often be a difficult

area to deal with. If there are relatives or friends who wish to visit and an

individual does not want to see them, you may have to make this clear. It is

difficult to do, but you can only be effective if you are clear and assertive. You

should not make excuses or invent reasons why visitors cannot see the person

concerned. You could say something like: ‘I’m sorry, Mr P has told us that he

does not want to see you. I understand that this may be upsetting, but it is

his choice. If he does change his mind we will contact you. Would you like to

leave your phone number?’

Do not allow yourself to be drawn into passing on messages or attempting

to persuade – that is not your role. Your job is to respect the wishes and the

choices of the person you are caring for. If you are asked to intervene or to

pass on a message, you must refuse politely but firmly: ‘I’m sorry, that is not

something I can do. If your uncle does decide he wants to see you, I will let you

know right away. I will tell him you have visited, but I can’t do anything else.’

Security of propertyProperty and valuables belonging to individuals in care settings should be

safeguarded. It is likely that your employer will have a property book in

which records of all valuables and personal possession are entered.

There may be particular policies within your organisation, but as a general

rule you are likely to need to:

make a record of all possessions on admission

record valuable items separately

describe items of jewellery by their colour, for example ‘yellow metal’,

not ‘gold’

ensure that individuals sign for any valuables they are keeping, and that

they understand that they are liable for their loss

●

●

●

●

Every time you visit, you may have to explain again what the individual should do when someone knocks on the door.

Give the individual a card with simple instructions.

Obtain agreement to speak to the local ‘homewatch’ scheme and ask that a special eye is kept on visitors.

Speak to the local police and make them aware that a vulnerable individual is living alone in the house.

●

●

●

●

Remember

You need to work with a colleague or friend to try this role play. One of you should play the person who has come to visit, and the other the care worker who has to say that a friend or relative will not see him or her. Try using different scenarios – the visitor could be angry, upset, aggressive, and so on. Try at least three different scenarios each. When you have practised a few times, you may feel better equipped to deal with the situation when it happens in reality.

If you cannot find anyone to work with you, it is possible to do a similar exercise by imagining three or four different scenarios and then writing down the words you would say in each of the situations.

Check it out

63HSC 22, Support the health and safety of yourself and individuals

inform your manager if an individual is keeping valuables or a significant

amount of money.

It is always difficult when items go missing in a care setting, particularly if

they are valuable. It is important that you check all possibilities before calling

the police.

Action stages when property goes missing

Protecting people from abuseAbuse is dealt with in depth in Unit HSC 24, but it can never be repeated

often enough that individuals have a right to be protected from abuse, and

you must report immediately any abuse you see or suspect.

●

Find out where the property book is in your workplace, and how it is filled in. Check who has the responsibility to complete it.

If you are likely to have to use the book at any time, make sure you know exactly what your role is. Do you have to enter the property in the book, then give it to someone else to deal with the valuables? Do you have to make sure the valuables are safe? Do you have to give the individual a copy of the entry in the book? Ask the questions in advance – don’t leave it until you have to do it.

Check it out

1 Why are there precautions about the kind of clothing and jewellery you wear?

2 Why do you need to wash your hands?

3 How should you wash them?

4 What are the different ways of disposing of waste?

5 What should you do if you find an intruder on the premises?

6 What type of manual lifting is encouraged?

Test yourself

Notify policeNotify police

Look for possible break-inLook for possible break-in

Quietly check any confused individualsQuietly check any confused individuals

Speak to other staffSpeak to other staff

Check with relatives in case they have the itemsCheck with relatives in case they have the items

Check laundryCheck laundry

Search the individual’s room/lockerSearch the individual’s room/locker

Search the area where the item was last seenSearch the area where the item was last seen

Inform your manager