Health, Safety &
Ergonomic Bulletin
October 2013 Edition
This bulletin provides an overview of current
developments in the field of health & safety,
both internal to the organisation and externally
that may have an impact on NUH. We hope
you find it both useful and informative.
completed and uploaded to the shared area by
Monday 30th September.
The Compliance Review validations took place
across the Trust during May, June and July and
some of the themes identified were as follows:

General Hot Topics
Incident Investigation Training

From January 2014 the Health, Safety &
Ergonomics Team will be offering a new
training session. The Incident Investigation
Training is aimed at staff who investigate
moderate and low level incidents within NUH.
It will highlight the important of investigating
these types of incident and will provide staff
with simple root cause analysis techniques.
There are two sessions planned for January
which
you
may
book
onto
via
hsbtraining@nuh.nhs.uk or by ringing the
Health, Safety & Ergonomics Team on extension
62316.
Wednesday 8th January 10am-12 noon H&S
Training Room 1, St Francis Building, City
Campus
Friday 17th January 2pm-4pm H&S Training
Room, D Floor, QMC

Compliance Review
The Health and Safety Compliance Review has
been updated to include new sections on sharps
safety and links to CQC health and safety
standards.
All Health and Safety Link staff have been sent
the new spread sheet which should have been



Risk assessments should be specific to
each area of work and have control
measures in place that can be applied by
staff working in that area
Link staff and Managers need to be able
to view their risk assessments on Datix
Risk assessments must be shared with
staff in the area
Some areas still need to identify and train
DSE assessors
Some areas need to complete the
Psychological Wellbeing assessment
All staff should be encouraged to engage
with health and safety in the areas
A full report has been shared with the Trust
Health and Safety Committee during October
2013.
The Health and Safety Compliance Review
continues to be an important part of health and
safety and risk management across the Trust.
Actively taking part in it and completing actions
will ensure that health and safety remains a
priority within NUH.
“G” Sized Gas Cylinders
In July 2010 an Estates & Facilities Alert was
issued regarding unsecured medical gas
cylinders, including cylinders on trolleys. All
clinical areas where informed via the Central
Alerting System (CAS) network of the need to
assess the need for the larger sized cylinders and
reduce to smaller ones where possible or ensure
they are adequately secured to prevent toppling
over.
The alert has not been fully implemented across
the trust therefore the Trust Board are seeking
assurances that the issues are addressed as soon
as possible. The CQC Inspection team are in the
Trust in November therefore we need to ensure
compliance as soon as possible. Please review
the gas cylinders within your area and if “G”
size cylinders are required from a clinical point
of view this must be risk assessed and the
cylinder appropriately secured. As per the
original alert wherever possible replace the
larger size cylinders with smaller ones.
Sharps
The Health and Safety (Sharp Instruments in
Healthcare) Regulations 2013 were introduced
on 11th May this year. As you will be aware, the
Sharps Management Assurance Group has been
working towards the implementation of these
Regulations for the past 18 months.
There is currently a change programme in place
to introduce safety cannula across NUH. The
product by BBraun was trialled and evaluated in
several areas across the Trust before being
chosen as the most suitable device. We are
moving to an excellent product which will allow
us to maintain clinical excellence in this area;
improve our corporate practice by refreshing
skills and messages about how to cannulate
properly and at the same time improving safety
for staff as well as patients because the devices
chosen automatically shield the sharp point of
the cannula upon use – the activation cannot be
avoided. The devices must still be disposed of in
the correct manner in the sharps disposal bins
provided but the risks of injury are markedly
reduced.
Our needlestick injury levels from cannula are
high at present and through collaborative
working with clinical colleagues, Trade Union
Representatives, Infection, Prevention and
Control, Occupational Health, Anaesthetic
colleagues, staff trainers and Procurement we
have begun a programme of work to support the
NUH response to the legislation which was
specific to health providers – we must minimise
the risk of sharps injuries to our colleagues and
ourselves.
Corridor Clutter
This issue was reported in the last Health and
Safety bulletin and continues to be a problem
across both sites.
Please ensure that you use the correct process
for notifying Estates and Facilities of items that
need collecting and utilise the ‘dump the junk’
days to get rid of any unwanted items.
http://nuhnet/estates_facilities/Pages/Furnitu
re_Removal_Transfer_Form.aspx
Leaving clutter on the corridor affects both staff
and patient safety.
online Infection Prevention and Control
scorecard allows wards and departments who
are able to access this facility to confirm they
have completed the daily flushing of these
outlets for the previous week.
As you are aware there has been a Fire Service
strike recently and internal guidance was issued
by the NUH Fire Safety and Security Manager
regarding the urgent need to be even more
vigilant regarding our surroundings and
practices to prevent fire incidents and managing
the environment was a main aspect of this
guidance.
From 2nd September please use the declaration
on the scorecard as this process means that a
copy of the flushing sheet is no longer required
by Estates. An updated flushing sheet reflecting
these changes has been uploaded onto the
intranet along with a sample completed sheet.
All areas that cannot access the scorecard should
use the new form and continue to return a copy
of their flushing sheet to:
Estates Department (flushing records)
Facilities Building,
City Campus
Alternatively a scanned signed copy may be sent
to flushingrecords@nuh.nhs.uk. Please note that
this email address can also be used if you have
any questions.
Central Alerting System (CAS) procedure
Legionella – Flushing of Water Outlets
Water outlets which aren’t in regular use must
be flushed each working day as an effective
prevention of legionella growth.
A new way to record the flushing of little-used
water outlets (taps, showers etc) has been
allocated for all wards and departments. The
The Organisational Quality, Risk & Safety
section of the Integrated Governance website is
undergoing a re-vamp and as a result the
Central Alerting System page has a few new
features including an email link to notify the
CAS Officers of any externally reported
incidents and all Field Safety Notices received
from September 2013 are available for viewing
and printing.
Ergonomics Internal Alert – transfer sheets
Following information received the Ergonomics
Manager recently sent an Internal Alert to all
managers asking them to make staff aware that
we currently use 2 different types of 6 handled
transfer sheet for patient movement.
The first fee for intervention bills went out in the
week commencing 21 January 2013 and the
following summarises the amounts:
The transfer sheet with 6 black handles can be
used for both lateral/patslide transfer & the lift
of a person from the floor in an emergency.

We also have white handled transfer sheets –
these can ONLY be used for a lateral/patslide
transfer & MUST NOT be used to lift a person
from the floor.



Managers should raise awareness in their area in
relation to this issue & ensure that each clinical
area has at least one black 6 handled transfer
sheet.
NUH has not been subject to any FFI as the two
areas the HSE are currently involved in;
Mobility Centre Ventilation & Sonography, were
underway prior to the scheme and therefore not
subject to FFI.
Rotunda incident
Care should be taken when assessing patients
suitability for transfer using a rotunda following
an incident on a ward when a patient’s legs
became caught in the bars of the rotunda
causing injury to the patient’s legs & requiring
the Fire brigade to attend the ward to ‘cut’ the
patient free from the equipment.
Forthcoming / Recent legislation
RIDDOR 2013
The Reporting of Injuries, Diseases and
Dangerous
Occurrences
Regulations
are
changing slightly which will simplify the
mandatory reporting of workplace injuries for
businesses, while ensuring that the data
collected gives an accurate and useful picture of
workplace incidents.
If the patient is at risk of sudden collapse or has
a history of their legs ‘giving way’ on standing
please consider an alternative form of transfer.
Fee For Intervention (FFI) Invoices
The Fee for Intervention scheme, introduced in
October 2012, saw the Health and Safety
Executive (HSE) become able to recover costs for
inspection, investigation and taking enforcement
action, under The Health and Safety (Fees)
Regulations 2012.
the total sum invoiced for the two months
from October to November was
£727,644.81 which arose from 1418 FFI
Invoices
10. 10% of invoices are for values greater
than £1K
70% of the invoices are for less than £500
30% are for less than £200.
The main changes are to simplify the reporting
requirements in the following areas:



The classification of ‘major injuries’ to
workers is being replaced with a shorter list of
‘specified injuries’.
The existing schedule detailing 47 types
of industrial disease is being replaced with
eight categories of reportable work-related
illness.
Fewer types of ‘dangerous occurrence’
will require reporting.
1st Aid at Work regulations
It is anticipated that during October 2013 the
"The Health and Safety (First Aid) Regulations
1981” will be amended to remove the
requirement for the HSE to approve the training
and qualifications of appointed first-aid
personnel.
Removing the HSE approval process will give
businesses greater flexibility to choose a training
provider and first aid training that is right for
their work place, and based on their individual
business needs. The provider will be required to
meet a certain standard, set by HSE.
The legal requirement for employers to ensure
they have an adequate number of suitably
trained first aiders (or appointed persons) in
accordance with their first aid needs assessment
will remain unchanged.
Health & Safety related Policies &
Procedures
Recently approved Health and Safety related
policies are as follows:
Waste Handling & Management Policy
Restraint policy
Infection Prevention & Control Policy
Risk Management Policy
Hazard Identification, Assessment &
Management Procedure
As with all policies and procedures these are
available via the intranet:
http://nuhnet/nuh_documents/Documents/Fo
rms/Staff%20View.aspx
Learning from Incidents
Incident Report – contact with moving object
IP was moving a large yellow bin along the
corridor. IP saw a tug towing two empty cages
coming towards him and moved himself and the
bin out of the way. As the tug came past, the
back cage caught the yellow bin and crushed the
IP between the bin and a cupboard. IP reported
back pain and attended the Emergency
Department.
Action taken
An investigation has taken place and
Departments have been asked to remove clutter
form the corridors. Additional training will be
provided to the driver of the tug. All drivers
have been reminded of the safe system of work
for driving tugs..
Lessons learned
Corridors need to be kept clear to allow for the
safe movement of pedestrian and vehicular
traffic. When driving on corridors the drivers
need to take into consideration the condition of
their route i.e. other traffic pedestrians or
vehicle.
Recent Health & Safety Cases / Claims
An NHS Trust has been fined for two separate
health & safety matters
The trust was ordered to pay £350,000 in fines
and costs for serious safety failings.
The first concerns at least seven patients being
infected with legionella, the bacterium that
causes Legionnaires’ disease, from the hospitals
water system.
One patient died as a result of developing
Legionnaires Disease; it also contributed to the
death of another patient. A further five patients
were infected at the hospital as was a hospital
visitor.
The HSE identified a catalogue of failures
including failing to monitor the hot and cold
water systems adequately or ensure that key
parts of the system, such as shower heads and
hoses, were kept clean. The Trust had been
advised previously from regulators and
consultants bought in to give the hospital advice
and support, but these were not fully heeded.
The trust had failed to learn lessons from a
previous prosecution after a death in 2002.
The second incident involved an elderly
Alzheimer’s disease patient who was injured
following a fall from a window. The incident
was investigated by the HSE which identified
failings relating to ineffective window
restrictors, lack of window safety checks and
staff not trained to undertake safety checks..
According to NHS Guidance in place since 1989,
the Trust should have undertaken a risk
assessment and devised a window safety policy
to ensure no window other than those on the
ground floor should open by more than 10
centimetres.
Patient died as a result of fall from window at
Hospital
An NHS Trust has been prosecuted for serious
safety breaches after a vulnerable patient fell
from a third floor window to his death. The
patient died after falling nine metres through a
window that was fitted only with a single
restrictor. He had only recently been moved to a
separate room for his own safety after becoming
confused and agitated.
The patient fell through the window opening in
his third floor room. He sustained serious
injuries and was treated in the hospital’s
emergency department where he died the same
evening.
An investigation by the HSE identified that the
Hospital’s arrangements for managing the risk
of patients falling from windows were
inadequate.
HSE found the window of the room was fitted
only with a single, angle bracket restrictor,
which was bent to one side allowing the
window to be fully opened.
The court was told that the hospital reviewed its
window restrictors following a previous
incident in 2007 when a patient broke an ankle
after jumping from a first floor window. A
report carried out by the Trust in 2009 made a
recommendation that ‘…chain link restrictors or
similar should be fitted to all metal casement
windows…’. However this was not followed
through and at the time the patient died the
window was still fitted with a single, inadequate
restrictor.
After the hearing, the HSE inspector said:
"The tragic death was entirely preventable. Had
a suitable window restrictor been provided, as it
should have been by the Hospital Trust, he
would not have been able to defeat it and open
the window wide enough to fall out.
"Where there is any risk of vulnerable people
falling from windows in a healthcare setting, it is
vital that measures are taken to restrict the
window opening to no further than 10cms."
Health Board fined for failing to protect
worker from AVH incident
An NHS Health Board has been fined for safety
failings after a worker was attacked while
making a home visit to a patient with mental
health issues.
The community psychiatric nurse was visiting a
female patient who had been suffering from
psychiatric illnesses for more than 30 years
when the attack happened.
"We have concluded our investigation into the
death of Gillian Astbury at Stafford Hospital
and have decided there is sufficient evidence
and it is in the public interest to bring criminal
proceedings in this case.
"HSE will be charging Mid Staffordshire NHS
Foundation Trust under Section 3(1) of the
Health and Safety at Work Act.
HSE’s investigation found that the injured
person was an experienced nurse whose role
involved visiting patients in the area who were
receiving community treatment for mental or
psychiatric illnesses.
"Gillian Astbury died on 11 April 2007, of
diabetic ketoacidosis, when she was an inpatient at the hospital. The immediate cause of
death was the failure to administer insulin to a
known diabetic patient.
During the incident the nurse was forced to the
floor, threatened and had her hair pulled so
violently that several clumps were pulled out.
Since the incident, she has been understandably
apprehensive about undertaking home visits
and has experienced unwelcome ‘flashbacks’.
"Our case alleges that the Trust failed to devise,
implement or properly manage structured and
effective systems of communication for sharing
patient information, including in relation to shift
handovers and record-keeping."
It was found that at the time of the incident
there were no risk assessments in place for
Community Health team workers dealing with
client violence or aggression, or for lone
working in clients’ homes. The Health Board
had further failed to provide such information,
instruction, training and supervision as was
necessary for this work, and failed to provide a
safe system of work for home visits to such
patients.
Mid Stafford NHS Trust prosecution
In the last edition of the Health, Safety &
Ergonomics Bulletin we featured The HSE
formal investigation into Mid Staffordshire NHS
Foundation Trust over the death of Gillian
Astbury. The latest update from the HSE is as
follows:
This decision highlights the impact of clinical
actions on Health & Safety legislation and the
consequences of getting it wrong.
Mid Staffordshire NHS Foundation Trust is due
to appear before Stafford Magistrates’ Court on
9 October 2013 for the first hearing in this case.
Health Board fined for failing to control
asbestos
An NHS health board has been fined for safety
failings that led to several workers and
contractors being potentially exposed to deadly
asbestos fibres because they had failed to
properly manage the risks of asbestos in a
basement plant room of the Hospital.
The court heard that a survey in February 2009
had identified the presence of asbestos
containing materials (ACMs) in various
locations within the plant room and noted that
they were in good condition and presented a
low risk. The survey recommended the ACMs
should be labelled and their condition
monitored so any future deterioration could be
managed.
In January 2011 a survey of the plant room was
carried out prior to the installation of a new MRI
scanner at the hospital. This found that some of
the ACMs were in a poor condition and now
posed a high risk. It recommended removal and
environmental cleaning of the area.
Air and swab samples for asbestos fibres came
back positive, the plant room was then sealed off
and the matter reported to the Health and Safety
Executive (HSE).
An investigation by the HSE found that the
health board had taken no action since the 2009
survey to monitor the ACMs within the plant
room. No labelling of the ACMS had taken place
and nothing had been done over the following
two years to maintain the materials in good
condition.
The 2011 survey showed their condition had
deteriorated, from good and low risk to poor
and high risk, but it was not known precisely
how or when the ACMs had been damaged.
The court also heard that employees of the
health board and outside contractors regularly
had to access the plant room and could have
potentially been exposed to the harmful asbestos
fibres in the plant room when carrying out
maintenance work.
Following the case, HSE Inspector said:
"The dangers posed by the presence of asbestos
are clear. There is no known ‘safe limit’ and it is
often many years after exposure before asbestosrelated diseases appear – so it is important that
exposure to asbestos fibres is kept to an absolute
minimum.
"The Health Board failed in its duty to properly
manage the risks of asbestos in its premises and
as a result a number of employees and external
contractors have potentially been exposed to
harmful fibres."
Your Contacts
Neil Mart, Head of Organisational Quality, Risk &
Safety (QRS) ext 76018
Heather Churchill, Health & safety manager, ext
62748
Locksley McPherson, Health & safety adviser, ext
59629
Margaret Stone, Ergonomics Manager, ext 62745 /
57616
Lisa Davies, QRS Manager, ext 59093
James Saxton, DATIX Manager, ext 62743
Micheal Woodward , Union Health & Safety
Chairperson
See
our
webpage
at
http://nuhnet/medical_director/integrated_gove
rnance/orgqrs/healthandsafety/Pages/default.as
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