While it is concerned principally with UK Law the situation is similar across Europe and most other developed nations. Irish readers may be aware that Ireland, in common with many countries, undertook a process of reform culminating in the Safety, Health and Welfare Act 2005.1 The 1974 UK legislation might seem outdated by comparison. However, unlike the Opticians Act for example, health and safety law evolves continually with new laws introduced in April and October each year.2 The evidence suggests that an optometric practice is a low risk workplace. There are no outstanding enforcement notices or prosecutions of opticians from around 43,000 UK prosecutions the past five years evident on the Health & Safety Executive website at the time of writing.3 However, it is hoped that the following will convince practitioners that complacency is not an option, and keeping abreast of changing rules is essential.

Disclaimer

Every effort has been made to ensure the accuracy of this article. However, the author does not accept liability for the consequences of relying on its content. Readers are recommended to consult their company health and safety operating procedures and the agency websites appropriate to their location for the most up to date, and comprehensive guidance.

Context 

In the course of providing optical services many aspects of General Law must be taken into account in order to comply with the Standards of Practice expected of opticians by the GOC.  Perhaps the most important of these laws are those relating to Health and Safety, because they concern the wellbeing of employees, and because in the UK at least, the Health and Safety Executive (HSE) is one of the few bodies with the power to close a business without notice if it believes a workplace unsafe. The HSE imposed over 42,000 sanctions on UK businesses in the five years to March 2020. The total fines imposed rose from under £20 million in 2014/15 to a peak of over £70 million in 2017/18. Prosecutions have fallen since, probably due to staff reductions at the HSE, however the average penalty for successful prosecution remains similar at £150,000 in 2018/19 increased from under £16,000 in 2009/10 and £58,000 in 2015/16.

In recent years the responsibilities of practitioners and the behaviours and performance expected of them has been more explicitly stated by both regulators and professional associations. In November 2017 the College of Optometrists (COptom) updated its ‘Guidance for Professional Practice’,4 and the Association of British Dispensing Opticians (ABDO) is known to be undertaking a similar review. 

Standards of Practice

This new guidance is in response to the new Standards of Practice for Optical Businesses (October 2019) which places patient safety at its heart, though it still relies upon the Standards of Practice for Optometrists and Dispensing Opticians (April 2016) for the specific details. Standard 12 urges practitioners to:

  • ‘Ensure a safe environment for your patients’.
  • Standard 12 goes beyond the remit here, concerning itself with professional indemnity insurance etc. However, it is worth noting the detail of standard 12.1.5
  • ‘Ensure that a safe environment is provided to deliver care to your patients, and take appropriate action if this is not the case (see standard 11).’
  • Standard 11 overlaps standard 12 seeking to ‘protect and safeguard patients, colleagues and others from harm’. It is however principally concerned with safeguarding vulnerable patients, raising concerns with employers and whistleblowing.  Health and Safety is specifically mentioned in Standard 12.1, which continues: 

12.1.1 Be aware of and comply with health and safety legislation.

12.1.2 Ensure that the environment and equipment that you use is hygienic.

12.1.3 Ensure that equipment that you use has been appropriately maintained.

12.1.4 Follow the regulations on substances hazardous to health.

12.1.5 Dispose of controlled, clinical and offensive materials in an appropriate manner.

12.1.6 Minimise the risk of infection by following appropriate infection controls including hand hygiene.

Hygiene, waste disposal and infection control, though topical with the recent outbreak of the coronavirus, are to be covered in a separate article and will not be covered here. Similarly, detailed exploration of personal protective equipment, and safety eyewear in particular will not be covered here as this is the subject of a future article in the Fundamentals of Ophthalmic Dispensing Series.

Health & Safety Legislation

The principle law relating to health and safety in the UK is the Health and Safety at Work etc Act 1974. The law is enforced by the Health and Safety Executive (HSE) who develop policy, secure compliance and aim to protect people at work and ensure that all occupational risks are properly controlled (2). In addition to Inspectors from the HSE (who mainly inspect higher risk workplaces such as farms, factories, hospitals and schools) the law is also enforced by Local Authority Environmental Health Officers (EHOs) who inspect retail, office, leisure etc and are the most likely enforcement officers to inspect, or respond to a complaint about, an optometric practice. 

Basic Obligations

In very simple terms an inspector will want to know that both the employer and all employees understand their obligations under health and safety law, that appropriate risk assessments have taken place and have been acted upon, and that there is a means of reporting adverse incidents. 

In the UK they would expect to see a ‘Health & Safety Law; What you need to know’ poster clearly displayed in a staff area, as well as a health and safety policy document, an up to date COSHH assessment, a risk register, and an accident book. They will focus on fire risk, having the right number of appropriate fire extinguishers in the right places, and clearly signed and unobstructed escape routes. Larger premises employing 20 or more people will be expected to comply with more complex requirements (such as having smoke detectors, fire alarms, and emergency lighting) and to demonstrate they have been tested regularly.

The Health & Safety at Work etc Act 1974

The Act 6 applies to anyone in employment including the self-employed. It does not apply to members of the public except in so far as they are guests within a workplace. The Act places a legal duty on the employer and employee, under threat of prosecution, to comply with certain requirements.

  1. The employer is obliged ‘to ensure the health, safety and welfare at work of all employees’ and to provide and maintain a safe and healthy working environment and suitable safety equipment.
  2. The employee is required to ‘take reasonable care for the health and safety of himself and of other persons who may be affected by his actions’.

An employee is also required to ‘co-operate with his employer to ensure compliance with the legal requirements of the Act’. Furthermore, an employee ‘must not misuse or recklessly interfere with any equipment which is provided in the interest of health & safety’ such as removing side shields from safety spectacles. 

Case study

A large practice with over 40,000 patient records struggled for space and decided, as part of a practice refurbishment, to invest in tall filing cabinets, with one metre wide drawers, reaching around three metres to the ceiling, to be accessed by a step ladder or stool. At some point it was noticed that files had been lost down the back of the drawers and needed to be retrieved. An optical assistant, seven months pregnant, undertook with a colleague to remove the ‘awaiting collection’ drawers fourth and fifth from bottom (these weighing far the lightest) to gain access to the area behind the bottom drawers. 

Such cabinets have safety systems that prevent them toppling by ensuring only one drawer can be opened at a time however this was disabled by the action of removing the drawers. When the assistant opened the bottom three drawers and climbed on them to reach the lost files this was sufficient to topple the half-ton cabinet forward with the pregnant staff member inside. 

The situation could have been a lot worse if it was not for the file-store being narrow and the top of the cabinet coming to rest against the cabinet opposite, nevertheless the lady required rescuing by the fire service and sustained serious injuries requiring hospitalisation and considerable anxiety that she might lose her baby. She remained off work for the remainder of her pregnancy and was still undergoing physiotherapy over a year later. 

RIDDOR resulted in the company being prosecuted and held liable because the wall fixings were inadequate, it had no evidence it had trained the employee in health and safety, and since changing to the tall cabinets had failed to train any staff in working at height. The total cost of the incident was tens of thousands of pounds.

Overriding or tampering with failsafe devices and safety features, are contributory factors in most serious workplace accidents. 

Health and Safety Policy

Workplaces with over five employees must have a written statement of safety policy. This should state the company’s intention to provide the safest and healthiest working conditions possible and urge all employees to co-operate with management in order to achieve this aim. A health and safety policy must state who is responsible for carrying it out at both company and local level and state the company’s health and safety objectives to for example:

  • Maintain systems for work that are safe and without risk to health.
  • Ensure safety, and absence of risk to health in connection with the use, handling, storage and transport of articles and
    substances.
  • Provide such information, instruction, training and supervision as is necessary to promote the health and safety of employees.
  • Maintain workplaces in a safe condition and provide safe access to and egress from such workplaces.
  • Provide and maintain a safe working environment and adequate facilities for employee’s welfare at work.

All employees must be made fully aware of health and safety procedures and receive a copy of the company’s policy which must also be displayed or available online. There should be a record that this information has been given and of all training that takes place.

While health and safety at work problems are not normally associated with optical practice, there are certain precautions, which can be taken to lessen the risk of an accident or work-related ill health occurring. It is easy to think of optometry as a low risk area, however risks in all fields have been reduced steadily over recent decades, and now the most prevalent work-related health issues are musculoskeletal disorders and stress. It is important to assess the risks in your workplace.

Risk Assessment

Risks need to be assessed in relation to type of work undertaken, working methods or systems used, location of work, and any articles or substances used, which may affect or be affected by the work.

The purpose of the risk assessment of any job is to identify hazard and/or potential hazard areas, evaluate the risk associated with each hazard, identify precautions to prevent hazards, and introduce the precautions to eliminate or minimise the risk.

Assessing risk is not an exact science and it may be preferable to apply a simple analysis of risk to a hazard classifying it low, medium or high. Alternatively there are different models that try to quantify risk such as:

RISK = LIKELIHOOD x IMPACT

Where a score between one and five is applied to each aspect to give a total score out of 25. Another model takes into account the number of occurrences too:

RISK RATING = PROBABILITY x SEVERITY x FREQUENCY

Where a score between one and three is applied to each aspect to give a total score out of 27. 

Both of these models have the fault that they understate the importance of rare and improbable events that are likely to cause death, blindness, or significant financial loss. Before the risk can be assessed however, the potential hazard must be identified.

Identifying Potential Hazards

It is important to look for hazards, which could reasonably be expected to result in significant harm under normal working conditions. However, it may be helpful to consider the most challenging circumstances such as patients who are visually impaired or wheelchair bound in making an assessment.  Common hazards encountered in optical practice include:

  • Slipping (eg hard shop floor during wet weather, after cleaning or spillage).
  • Tripping hazards (eg poorly maintained carpet, obstacles on stairs, deliveries, electric cables).
  • Repetitive strain injury (eg overreaching, stooping, repetitive tasks such as springing in, keyboard use).
  • Fire (eg from flammable materials, coiled electric cables, faulty wiring, covered heaters).
  • Chemicals (eg tint bath liquids, cleaning products, glues and sealants).
  • Moving parts of machinery (eg glazing equipment, buffers, grinders).
  • Working at height (eg on stools or step ladders changing light bulbs, accessing high shelves etc).
  • Ejection of material (eg from glazing or drilling).
  • Electricity (eg poor wiring, damaged fittings, risk of shock or fire).
  • Dust (eg from lens edging).
  • Fumes (eg from lens edging, tint bath, solvents).
  • Manual handling (eg delivery of contact lens solutions).
  • Noise (eg glazing equipment, extractor fans).
  • Poor lighting (eg spectacle repair area).

When the Precaution Becomes the Hazard

Most readers will have experienced thoughtless use of warning signs, several ‘caution wet floor’ signs preceded by several ‘caution cleaning in progress’ signs, which deserve to be preceded by multiple ‘trip hazard ahead’ signs because they are so inappropriately positioned. The first question an investigator should ask if a person trips over a wet floor sign is ‘was the floor wet at the time?’ If not then the victim had been put unnecessarily at risk.

Determining Who Is at Risk

The next stage is to determine who might be harmed and how, and list them by job category such as lab technicians, admin staff etc. Care should be taken to consider people visiting the workplace such as patients, sales representatives, assessors etc and particular attention should be paid to inexperienced staff, lone workers, and staff and customers with disabilities including visual impairment.

Control Measures

Precautions should be taken to mitigate the risks associated with the hazards listed. Employees must have adequate information, instruction and training. Systems and procedures must meet the standards set by law and reflect good practice. The precautions must reduce risk as far as is reasonably practicable.

Risk in a Domiciliary Environment

Question: I run a practice that does a lot of domiciliary work in nursing homes and private houses. How can I assess the risks to my employee’s health and safety if I do not know what hazards they might come across?

Answer: You can complete a generic risk assessment covering broad risks and common hazards. In nursing homes, while you retain responsibility for the health and safety of your employees, you can ask the manager for their risk assessment and ensure your workers are able to familiarise themselves in advance, and on attendance are given time to liaise with management and make themselves aware of specific risks and procedures such as locations of fire exits, assembly points and the like.

It is not practical at a business level to assess every risk involved in visiting patients’ houses, however the risks must be assessed, and some can only be assessed by being there. Employees working in patients’ homes should be trained until competent to do on-site risk assessments specific to each working environment. In the author’s experience dogs and cats can provide multiple risks from acting as mobile trip hazards, to the risk of bites from fleas or indeed the pet itself that are best identified at the time of appointment booking.

Further Action Necessary to Control the Risk

It is always necessary to ask what more could reasonably be done for those risks which are not found to be adequately controlled. Priority should be given to those risks which affect large numbers of people and/or could result in serious harm. Further action should be considered in the following order:

  • Remove the risk completely.
  • Try a less risky option.
  • Prevent access to the hazard (eg by guarding).
  • Organise work to reduce exposure to the hazard.
  • Issue personal protective equipment.
  • Provide welfare facilities (eg washing facilities for removal of contamination and first aid).

A risk assessment record might look like the one in table 1, however wherever possible it is best to use a system supplied by the employer who will have thought carefully about the common risks involved and how they might be mitigated.

Table 1: Record of risk assessment

Fire Safety

Fire presents the greatest risk of fatality in optical practice, and is a particular risk for those on upper floors. Many opticians’ premises also have residential property above which may impose more onerous fire precautions. The main legislation for workplace fire safety in England and Wales is the Regulatory Reform (Fire Safety) Order 2005. It comprises three main areas:

  1. Assess the fire risks
  2. Identify the precautions needed
  3. Inform, instruct and train employees

The risk assessment should be recorded and reviewed annually. It should identify fire escape routes, which doors are fire exits, how escape routes can be safely used at all relevant times, type and location of firefighting equipment and alarms, any flammable material stored on premises. Fire alarms, fire detectors, fire-fighting equipment and emergency lighting must be maintained and tested regularly.  

Employees must receive appropriate training on use of fire prevention equipment and fire procedures in a fire drill at least once a year.  This should include what action staff should take if fire breaks out, evacuation procedures, meeting point, arrangements for calling fire brigade and informing them of any special risks, supervisors for action and/or drills. A suitable record must be kept. Employees should only use fire extinguishers to facilitate exit from the building, or to fight the fire if their exit is known for certain to be clear. Buildings can be replaced, lives cannot. Put simply employees must get out and stay out.

Safety Around the Workplace

It is imperative that all staff are aware of the risk posed by slips and trips, especially with elderly patients, as they are the most common cause of serious injury in retail workplaces. Deliveries should be unpacked and stored immediately upon receipt and public areas, stairs and passageways must be kept clear of trip hazards at all times. Particular attention should be paid to hard floors during wet weather or after cleaning, additional barrier mats, regular mopping to dry floors, and the use of warning signs should all be considered. Provisions for visually impaired patients, such as high contrast stair/step edges will also benefit all other patients and staff.

Electrical Safety

Poorly maintained/damaged electrical equipment can cause fire and injury through electrocution. Users should check leads and appliances for damage before use. Suspect or faulty equipment must be taken out of use until checked and passed for use. Each portable appliance should be tested (so called PAT testing) at regular intervals. When fuses blow they must be replaced with the correct rating for the appliance, and the same applies to light bulbs.

Electric Spaghetti

Optical practices have more portable electric appliances than most similar small businesses that can lead to tangles of wires that represent a number of health and safety hazards. Poorly designed pre-screening areas can create trip hazards especially given the low light levels that are typical in this environment.

However, cable spaghetti is better than neat coils. The author has witnessed IT contractors installing PCs requiring a four-gang extension lead, and only able to purchase a 10-metre cable locally left it coiled in its casing within the desk cupboard. Coiled cables act like heating elements and it was fortunate that the smell of melting plastic was noticed in time. This risk could have been avoided had the warnings on the extension lead been heeded. Where extensions must be used they should be as short as possible without putting them under physical strain and taking care not to overload the electrical circuit. 

Noise Control

Most optical practices in the UK supply hearing aids, and audiologists are well aware of the perils of excessive noise levels. Excessive noise is stressful, and can actively damage hearing. Noise levels can easily be measured with smartphone apps. Sources include glazing machinery, frame heaters, fans, tools, contractors at work, etc. Glazing equipment is usually designed to be used without personal protective equipment, however poor maintenance, operator abuse (eg failure to deploy safety guards), vibration due to poor siting etc may cause noise to be excessive.  

In busy labs with multiple pieces of equipment it is quite likely noise levels will be excessive and personal protective equipment (ear defenders) should be considered. Placing machines on anti-vibration mats also helps as do absorbent wall and floor coverings to help deaden sound. Foam floor matting has the additional benefit of reducing musculoskeletal disorders related to standing on hard floors all day.

Stress

Stress is a major cause of employee absence and can be caused by noise, change, job insecurity, long hours, personality clashes, lack of training or information, work-loads, lack of resources, poor management support, bullying, management style, violence – physical or verbal, or personal problems.  

Stress can be alleviated by regular and open communication, reviewing work systems and the working environment, and providing training in time management, stress management, self-awareness of stress and relaxation. Employers should foster a fun environment and train managers in how to deal with stressed colleagues, especially in terms of staff reviews, and might consider referring stressed individuals to a counsellor or their GP. Employees should be encouraged to adopt stress release techniques such as exercise, mindfulness, meditation and social activity. 

Control of Substances Hazardous to health

Companies will normally make an assessment of the most likely substances which may be hazardous to health which should be reviewed every six months to add any new or different substances that may have been taken into the practice. A COSHH assessment might look something like table 2. With the appropriate precautions there is little risk from any product commonly found in optical practice.  The apparently badly named Safe Clean (given its list of precautions) is perfectly safe under normal use, especially for the polycarbonate lenses and cellulose propionate frames it was designed to prevent damage to. It should be noted that though there may be special precautions relating to the practice environment, standard precautions for each product can be found on the label or packaging.

Table 2: Control of Substances Hazardous to Health (COSHH) assessment (keep all substances out of children’s reach)

Healthy Computing

Optical practitioners will be aware of the Health & Safety (Display Screen Equipment) Regulations 1992 (amended 2002) through the provision of eye examinations and spectacles specific to patients who are ‘users’ of computer equipment. It is debatable whether optometrists and dispensing staff can be classified as ‘users’ according to the Act as they do not usually carry out work at a computer for an hour or more continuously each day. However, it can be argued that all personnel involved in the provision of optical services should be treated as users under the Act.

Adverse effects associated with VDU (visual display unit) use include eye strain; headaches; neck, shoulder or back pain; and wrist problems, and are common in optical practice, especially given the difficult ergonomics of wanting to interact with a patient face on, and requiring to also sit squarely in front of a computer monitor and keyboard for optimum comfort. 

The visual problems associated with VDU use, especially for presbyopic staff, are very similar to the problems associated with carrying out near and intermediate tasks at head height such as measuring a patient’s PD or heights with either a ruler or tablet computer. Workstation spectacles (enhanced readers or occupational progressives for presbyopes, and low add progressives, so called digital lenses, for pre-presbyopes), are of great benefit to virtually all colleagues involved in dispensing, optometry or contact lens fitting. An additional benefit of offering such spectacles to dispensing staff is that they will have a first-hand understanding of such lenses and be better able to communicate the benefits of them to patients.

Employers should take ergonomics of computer use seriously as it is a major cause of lost work days each year and simply searching ‘healthy computing’ online will yield a wealth of useful information that is beyond the space available here.

Recording, Investigating and Reporting Accidents

The official way of recording accidents is via an accident book. Since changes to the Data Protection Act in 2003 (and continuing with the 2018 Act that brought into force the requirements of the EU General Data Protection Regulations) accident books must not divulge the identity anyone involved in a listed accident to anyone reading them. Compliant books are available from HSE with tear off slips to be included on personnel records. Larger employers might prefer an electronic system, perhaps within a wider system for reporting adverse incidents in general. All accidents no matter how trivial should be recorded, including the perennially popular screwdriver stick injury that although easily preventable remains common in optical practice. 

According to RIDDOR (The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013) specified accidents and injuries that employees and others are subject to must be reported to the HSE within 15 days. This includes the death, serious injury (eg loss of sight, amputations, unconsciousness, stays in hospital of over 24 hours), and anything that causes the employee to have greater than seven-days off work. 

Employers must also report dangerous occurrences, or near miss incidents, where no harm or injury took place but could have done so. Additionally, they must also report some diseases and work-related ill health such as occupational dermatitis or asthma that has been confirmed by a doctor.

Whether or not an accident is reportable under RIDDOR it is important that it is investigated and any learnings acted upon to improve health and safety in the future. The investigator (practice owner/manager/HR department) should identify what happened, how it happened, and speak to any witnesses, interview staff, take photographs etc. Machinery and operating procedures should be checked, as well as accident book and sickness records. The investigator should reflect on the impact of the accident, the likelihood of it happening again and make recommendations accordingly.

Conclusion

An article of this size cannot possibly cover everything an optical business or practitioner needs to know about health and safety. Every practice is laid out differently with varying work activities and new legislation is frequently introduced, but it is hoped it
will form a useful starting point to understanding the hazards, and mitigating the risks posed by such hazards, in optical practice. 

Peter Black MBA FBDO FEAOO is senior lecturer in ophthalmic dispensing at the University of Central Lancashire, Preston, and is a practical examiner, practice assessor, exam script marker, and past president of the Association of British Dispensing Opticians.

Bibliography

  1. Irish Health & Safety Authority. Safety Health and Welfare Act 2005 (No 10 of 2005). www.hsa.ie. [Online] 2017. [Cited: 8 March 2020.] http://www.hsa.ie/eng/Legislation/Acts/Safety_Health_and_Welfare_at_Work/.
  2. Walker, Samantha. The Straightforward Guide to Health & Safety Law. The Essential handbook For Businesses Large or Small. sl: Straightforward Guides, 2017. 978-1-84716-733-0.
  3. Health & Safety Executive. HSE Enforcement Action Home Page. www.hse.gov.uk. [Online] [Cited: 8 March 2020.] https://resources.hse.gov.uk/notices/default.asp.
  4. College of Optometrists. Guidance for professional practice. [Online] 22 November 2017. [Cited: 8 March 2020.] http://guidance.college-optometrists.org/guidance-contents/safety-and-quality-domain/.
  5. General Optical Council. Standards for optometrists and dispensing opticians. www.optical.org. [Online] April 2016. [Cited: 8 March 2020.] https://www.optical.org/en/Standards/Standards_for_optometrists_dispensing_opticians.cfm.
  6. Health & Safety Executive. The Health & Safety at Work etc Act 1974. [Online] [Cited: 8 March 2020.] http://www.hse.gov.uk/legislation/hswa.htm.

Useful Reading

A number of books have been read during the compilation of this article that may be useful further reading. In addition to those quoted and cited above these have included:

  • AOP. The Optometry Red Book. Non-clinical, legal and regulatory aspects of optometric practice in the UK. Association of Optometrists, 2001.  ISBN: 0-9541272-0-X
  • Taylor, S. Law in Optometric Practice. Butterworth Heinemann, 2002. ISBN: 0-7506-4578-4
  • Pierscionek, B. Law & Ethics for the Eye Care Professional. Butterworth Heinemann Elsevier, 2008. ISBN: 978-0-08-045033-9
  • Tay, C and Au Eong, KG. Medico-Legal and Ethical Issues in Eye Care. McGraw Hill Medical, 2010. ISBN 978-007-126994-0
  • Alaszewski, A, et al. Managing Risk in Community Practice: Nursing, Risk and Decision Making. Bailliere Tindall/Royal College of Nursing, 2000. ISBN: 0-7020-2603-4