AFRICAN COLLEGE OF HEALTH (ACH).

ALL-IN-ONE VOCATIONAL COURSES

FOR HEALTH AND SOCIAL CARE STAFF:
*HEALTH AND SAFETY
*INFECTION CONTROL
*MANUAL HANDLING
*COMPLAINT HANDLING
*INCIDENT REPORTING
*VIOLENCE AND AGGRESSION
*FOOD HYGIENE
*CALDICOTT PROTOCOLS (INFORMATION HANDLING)
*BASIC LIFE SUPPORT
*FIRE SAFETY

*PART OF THE NHS ENGLAND ANNUAL COURSES FOR WORKFORCE.

CONTENTS:
HEALTH AND SAFETY
INFECTION CONTROL
MANUAL HANDLING
COMPLAINT HANDLING
INCIDENT REPORTING
VIOLENCE AND AGGRESSION
FOOD HYGIENE
CALDICOTT PROTOCOLS (INFORMATION HANDLING)
BASIC LIFE SUPPORT
FIRE SAFETY
HEALTH AND SAFETY
It is the duty of your employer to ensure safe and
clean working environments as a preventive measure for
occupational hazards.

Workplace health and safety obligations

Obligations of employers:
*To ensure the workplace health and safety of each of
the employer‟s workers at work.
*To ensure his or her own safety and the workplace
health and safety of others is not affected by the way
the employer conducts the employer‟s undertaking.

General Health and Safety Policies

*Familiarize yourself with fire alarm procedures,
escape routes and assembly point in case of fire
outbreak.
*Report any occupational health hazard to the assigned
personnel immediately. Delays can be dangerous.
*Identify substances that are hazardous to health in
your working place.
*Never pour water on chemicals but the other way
round.
*All sharp objects should be properly disposed of into
sharp box.
*All sharp containers should be properly incinerated.
*Remember your protective clothing while performing
EPPs (Exposure Prone procedures).
*Fire brigades and ambulance team‟s contacts should be
kept at hands all the time.
*Avoid working on slippery floors.
*Women are better off with simple ear studs rather
than long ones.
*Avoid smoking in closed compartments.
*Report personal health issues to your colleagues.
*All electrical appliances must be switch off and
unplugged before closing office.
*A fire policy, regular fire drills and weekly testing
of fire doors are essential safety precautions.
Hospital Health and Safety Policies
*All staff should have a chest X-ray before commencing
work.
*Appropriate vaccination schedules, e.g. hepatitis B,
and tetanus immunization policies should be in place.
*Policies for staff protection when handling patients
with transmittable disease, e.g. hepatitis B or C and
human immunodeficiency virus (HIV; Hand wash in-
between patient contacts.
*Protocols for accident procedure; Cases of needle
stick injury should be reported to occupational health
department immediately.
*Protocols for incident procedure; Alert authority
concerns immediately you spotted unusual occurrences.
*Ionizing irradiation guidelines; all staff that uses
such instruments must be in possession of the
Irradiation Protection Certificate.
*Pregnant staff must not be in the vicinity of
radiation.
*Keep all control drugs in a safe and secured cabinet.
*Never administer opiates in an emergency situation.
*Allergies must be marked on the front of the notes,
on the drug chart and on the anaesthetic form.
*It is ideal to switch your cell phones while in ICU
(Intensive Care Units) unless otherwise stated.

Staff Facilities Health and Safety Policies

*Changing area; this should be adequate inside with
secure lockers, and with clean and adequate supplies
of clean clothing, which should
be of a close-woven colored material with trousers for
both sexes which should have elasticated ankles.
Appropriate disposal bags for dirty
linen, adequate toilets and washing facilities
including hand basins and showers.
*Caps, masks, helmets and aprons should be available.
*Staff should have their own comfortable, regularly
cleaned, antistatic footwear.
*There should be protective eye wears.
*A fire policy, regular fire drills and weekly testing
of fire doors are essential safety precautions.
• Masks and eye wears: These are important for staff
protection and for operations involving splashing,
such as drilling.

Hospital Equipment Health and Safety Policies

* Trolleys should be clean, have safety rails and have
oxygen cylinders with well-fitting tubes and masks,
all of which are regularly checked so
that empty cylinders are replaced. Trollies must be
able to be tipped into the Trendelenburg position in
case of regurgitation of gastric
Contents.
*The operating table should be cleaned with regular
checks to see that it can be raised and lowered
smoothly with the appropriate gears for
Trendelenburg tilt, lateral tilt and an adequate
braking system.
*Accessories should be clean and available and fit
well, and it is particularly important to ensure that
stirrups fit well.
*The operating table lights should be easily movable
by members of the scrubbed team and by other theatre
personnel.
*The suction apparatus should be clean and thoroughly
checked, with spare suction tubes and catheters
available.
*Anaesthetic machines should be in good working order;
They must be regularly serviced and a record of this
must be maintained.
*All electrical equipment should be regularly checked
and marked accordingly, particularly stating the
expected date of next checkups.
*A fire policy, regular fire drills and weekly testing
of fire doors are essential safety precautions.

Patient Movement Safety Procedures

*The patient‟s name and hospital number must be cross
checked before transfer.
*The patient should be transferred from the bed to the
trolley with safety rails raised.
*The patient must be kept comfortable and warm.
*It is important to ensure that the patient‟s dignity
is preserved and that the patient‟s body is not unduly
exposed. Curtains should be drawn and doors closed
where appropriate.
*In surgical cases, ensure the consent form is
completed by the appropriate doctor; The surgeon
performing the operation or senior member of the team.
*In surgical cases, ensure the operating site and side
has been marked appropriately, preferably by the
operating surgeon.
*Ensure the full notes and X-rays are available and
are transported with the patient.
*Transferred patient using a slide or hoist if too
debilitated for self-movement.
*Worn canvasses, which may split, should be discarded.
*The patient should not be lifted but slid on a
special sliding board which is correctly placed using
handles on the canvas. Correct posture
should be adopted by staff to avoid back strain;
*The position of the patient‟s head in relation to the
canvas should be checked.
*If using transferable trolley, the patient should be
placed correctly so that the head end can be rapidly
tipped into the Trendenlenburg position in an
emergency.
*The patient should be positioned so that there is no
pressure against the rails; intravenous lines and
infusions should be correctly attached to the trolley
and the patient‟s covers should be in place. The
notes, investigation results and X-ray should be
stacked under the trolley.
*An appropriate lifting and handling policy can
virtually eliminate back strain amongst staff;
Squatting while attempting to lift from the floor is
safer than bending your back.
The Anaesthetic Room Safety Procedures
*The presence of false teeth must be clarified.
*The presence of prosthesis, especially with metal
components must be clarified.
*The wearing of any jewelry must be clarified.
*Allergies to drugs, plasters, dressings or
disinfectants must be clarified.
*Allergies must be marked on the front of the notes,
on the drug chart and on the anaesthetic form.
*Ensure the care plan is checked; the patient is
watched, observed and engaged in appropriate
conversation.
*Prior to the induction of the anaesthetic, the gowns
are loosened in privacy; the patient is otherwise kept
well covered.
*Ensure electrocardiogram (ECG) electrodes are
applied.
*Ensure the diathermy indifferent electrode is applied
correctly.
*Ensure the induction of the anaesthetic is carried
out by the anesthetist, assisted by the designated
anaesthetic nurse or assistant.
*Ensure the operation site is appropriately exposed.
The covers and drapes are removed and installed in a
warmer.
*Ensure the patient is transferred into the operating
room with all lines well secured and with appropriate
documentation including all drugs given.
*Ensure cross matched blood, if required, is available
and the correct units are in the storage fridge.
*Ensure the limbs are safeguarded, especially if
paralyzed.
*Ensure nerves are protected from pressure.
*Make sure eyes are protected, the lids must be closed
on induction to avoid inversion of the eyelashes and
to protect the cornea against abrasions, drying and
foreign bodies.
*Pneumatic cuffs and tourniquets are usually applied
in the anaesthetic room; they should be regularly
checked against pressure and time and should be
recorded by the nurse or operating theatre assistant.
*The tourniquet width and position must be checked by
the operating surgeon.

Operating Theatre Safety Procedures

*The temperature should range between 19 Centigrade
and 22 Centigrade.
*The lights should be of appropriate design and must
be movable in relation to the operating table.
*Anaesthetic gases and suction should be piped with
different color coding.
*Cables on the floor should be kept to a minimum.
*No reflective or inflammable fixtures or furnishings
must be present in the operating theatre where laser
is to be used.
*Trolleys should be steel with no sharp edges.
*The surgeon should be familiar with raising and
lowering the operating table.
*The circulating nurses must be aware of the
importance of
meticulous counting of swabs, needles and instruments,
and also the handling of samples and specimens.
*It is essential to have an instrument, swab and
needle count prior to closure after laparotomy, and a
final count prior to removal of any equipment from the
theatre. In this respect, swabs, packs,
disposable equipment, instruments, needles and such
items as tapes are to be recorded.
*Dirty swabs should be placed singly in the swab
holders. It is important to stress that all swabs
should be removed from the previous surgery before any
current count is taken.
*Nothing should be removed from the operating theatre
until the incision is closed and the scrub nurse
indicates that all is correct.
*Assistants should not lean on patients, as this may
cause damage, bruising or neuropraxia.
*Those disposables such as drains should be secured to
the patient and checked for patency.
*Those disposables to be discarded such as soiled
linen, drapes and other waste should be disposed of
appropriately, and material of high infectivity needs
to be sealed and marked accordingly.

Specimens Handling Safety Procedures

*The specimens must be identified and, if multiple,
should be placed into separate labeled specimen pots
which should be appropriate for the
study required namely histology, cytology,
microbiology or biochemistry.
*For histology and cytology the appropriate method of
fixation should be selected and checked (all too often
samples for microbiology are
placed in formalin and vice versa).
*All specimens and all request forms should be labeled
fully and clearly, and clinical details must be given.
*The samples should be checked for a good seal prior
to transport.
*Specimens at high risk of infectivity should be
identified and treated securely according to the
policy.
*Formalin splashing when placing a large specimen in a
container must be avoided.
*The record book must be signed with the full
description of the specimen and the time biopsied.
INFECTION CONTROL

To prevent spreading of infections to you and others

around you strict adherence to infection control
procedures must be observed.

General Infection Control Policies

*Regular hand washes before and after all hospital
procedures.
*Hand gloves to be wore when necessary.
*Ideally, your shirt should be rolled up above elbows
if not on short sleeves.
*Your foot wear should be made of hard footings.
*If your hair is long, it is better tied tightly
behind you.
*Face mask when necessary.
*Wrist watch and ring should be removed before
procedures.
*Remember to wash your hands before inserting them
into pockets.
*All sharps to be dropped in sharp bins.
*Never reuse a used syringe.
*Protective goggles and apron to be worn in exposure
prone procedures.
*All highly infective cases should be kept isolated in
a separate nursing room.
*Scrubs, aprons and laboratory coats not allowed in
eating areas.

Decontamination of equipment
Cleaning, disinfection and sterilization are used to
remove micro-organisms from equipment used for patient
care. Safe decontamination of equipment between
patients is an essential part of routine infection
prevention and control.

Methods of decontamination of equipment

*Sterilization: A process that removes or destroys all
micro-organisms, including spores.
*Disinfection: A process that reduces the number of
microorganisms to a level at which they are not
harmful. Spores will not usually be destroyed.
*Cleaning: A process that physically removes
contamination (blood, faeces etc.) and many micro-
organisms using detergent.

NB. Cleaning must precede disinfection/sterilization

Methods of Decontamination
**Cleaning: General purpose detergent is essential for
effective cleaning. It breaks up grease and dirt and
improves the ability of water to remove soil.
Approximately 80% of micro-organisms will be removed
during the cleaning procedure.

*The use of antiseptics e.g. chlorhexidine “Hibiscrub”

or alcohol should not be used for routine cleaning of
equipment/environment.
*Use a clean and disposable cloth for cleaning.
*Thorough drying of equipment after washing is
essential.
*Items must not be left to soak in bowls of detergent.
Gram-negative bacilli can survive in solutions of
detergent.
*Equipment and environmental surfaces must be cleaned
prior to disinfection/sterilization.
*Thorough cleaning with detergent and water removes a
significant proportion of micro-organisms.
*Detergent/disinfectant solutions must not be used
from spray bottles. Micro-organisms can multiply in
detergent/disinfectant solutions and nozzles of sprays
are impossible to clean.
*Commercially produced detergent wipes can be used by
staff to clean equipment in clinical areas.

**Disinfection:
Thermal disinfection;
The following items of equipment maybe disinfected in
ward based disinfectors;
• Bedpans/urine bottles
• Commodes
• Buckets
• Suction jars (used for oro-pharyngeal suction)
• Washbowls
• Vomit bowls

*After disinfection items must be stored dry and wash

bowls etc. must be inverted to ensure that they drain
completely.
*Surgical instruments or items of equipment which come
into contact with mucous membranes must be re-
processed through SSD (Sterile Services Department).

Chemical disinfection:
*Always wear appropriate personal protective clothing
whilst preparing using and disposing of disinfectant
solutions, i.e. gloves, apron, eye protection.
Disinfectants irritate and damage skin, eyes and
mucous membranes.
*Always follow manufacturer's recommendations for
making up and using disinfectants.
*Disinfectants are ineffective if not used at the
correct strength. If used at too great a
concentration it may damage equipment.
*Disinfectants must be used within their shelf life.
*Dilute solutions deteriorate rapidly and may support
the growth of microorganisms.
*Always follow the control of substances hazardous to
health COSHH regulations.
*Chemical disinfectants may be flammable, toxic or
irritant.
*Cleaning of equipment/surfaces must always precede
disinfection.
*Disinfectants have poor penetration of blood and
other organic material. *Disinfectants may be
inactivated by organic material.

Types of disinfectants:
*Chlor-Clean solution; Terminal cleaning following
discharge of a patient from isolation room and during
outbreak of viral gastroenteritis.
*Haz tab solution; Blood spillages.
Precautions;
*Repeated use of haz tab or Chlorclean solution may be
corrosive on metal surfaces or may cause damage to
integrity of other surfaces.
*Haz tab/Chlorclean solution may leave a white residue
on surfaces. This can be removed by wiping over the
disinfected surface with a cloth rinsed in clear
water.

Decontamination of foam mattresses

Clean the mattress between each patient occupancy with
general purpose detergent and water using a
clean/disposable cloth. Then dry with disposable
paper towels. Most micro-organisms will not survive in
a clean dry environment.

Disinfection of mattresses;
Mattresses should be disinfected under the following
circumstances only:-
• Contamination with blood or body fluids containing
blood
• After use by an infected patient
Clean the mattress as above. Wipe over surface of
mattress with Chlor-Clean solution. If a „white film‟
is left on the mattress wipe the mattress over with a
disposable cloth rinsed in clear water.

*Repeated unnecessary use of disinfectants on

mattresses may reduce the integrity of the cover.
*A white film residue is sometimes left by NADCC
solutions.
*Foam mattresses must not be cleaned with antiseptic
solution for example, chlorhexidine (Hibiscrub) or
alcohol based solutions, for example alco-wipes.
*Repeated use of antiseptics and/or alcohol may affect
the integrity of the mattress cover and may cause
damage. Alcohol is a flammable liquid.

Standard infection tests for foam mattresses

It is the responsibility of the ward manager to ensure
that all foam mattresses are inspected every three
months. The date of inspection should also be written
on the mattress. Each mattress should be checked using
the following standard tests:-

Checking the mattress and cover;

1. The mattress should be completely stripped
2. The bed should be raised to a comfortable height
3. The cover should be inspected for the following;
• Staining
• Splitting - if the cover is stretched in both
directions you are able to see if the cover is
delaminating which will mean the waterproof properties
are diminished
• Malodor
• Also check the impermeability of the cover using
Standard test 2
If the mattress fails on any of these issues they
should be condemned.

***Standard Test 2:
Impermeability Test (for zipper fastening mattresses
only)
*Place a paper towel beneath the cover, press down on
the mattress for 10 seconds, pour 50mls of water onto
the area, press down for a further 10 seconds, examine
the paper towel beneath for any leakage through the
cover.

Decontamination of bed frames

Clean the following areas of the bed frame between
each patient use;
.Bed head and foot
.Bed rails
.Control panels
These are the areas most likely to become contaminated
during patient use.

*Use clean/disposable cloth and a solution of general

purpose detergent and water.
*Do not use antiseptic/alcohol based solutions to
clean bed frames.

Disinfection of bed frames is only required when:-

• There is contamination with blood/body fluids
containing blood
• After use by an infected patient

*Clean the bed frame with Chlor-Clean solution.

*Repeated use of disinfectants may damage the metal
surfaces of the bed frame.
*Disinfectant may be harmful when used
inappropriately.

Decontamination of dynamic equipment

• Rental equipment must be returned to mattress/bed
rental company after each patient use for
decontamination.
• It is necessary to inform the collection officer if
the system has been used for an infected patient.

Decontamination of equipment whilst in use:

Equipment may be cleaned during patient use if used
for a prolonged period of time or if it becomes
contaminated during use.

Policy for single use items

The item is to be used on an individual patient during
a single procedure and then discarded. It is not
intended to be reprocessed and used on another
patient. The labeling identifies the device as
disposable and is not intended to be reprocessed and
used again. The expression „Single Use‟ on the
packaging of medical devices means that the
manufacturer:
• Intends the device to be used once and then
discarded
• Considers the device is not suitable for use on more
than one occasion
• Has evidence to confirm that re-use would be unsafe

Certificate of Decontamination
A certificate of decontamination must accompany all
items of equipment being sent for repair/servicing.

Policy for the management of spillages

These are the staff that are responsible for dealing
with spillages in the following areas:-
a. Clinical areas – nursing staff.
b. Non clinical areas within the hospital e.g.
corridors – HCAs.
c. Outside/within hospital grounds – Domestics.

**Spillages of blood or body fluids contaminated with

blood and peritoneal, pleural, synovial, amniotic
fluids etc. on hard surfaces:

*Wear disposable apron, non-sterile latex gloves and

eye protection for whole process.
*Protects health care worker from exposure to blood
borne pathogens and exposure to disinfectant.
*Cover the spillage with dry paper towels / absorbent
pad.
*Absorbs some of the spillage; Pour over 10,000 ppm
Haz Tab solution and leave in contact for 2 minutes.
*Kills blood borne pathogens; Gather up the paper
towels etc. and put directly into yellow clinical
waste bag.
*Waste can be incinerated; Clean the surface with
general detergent and warm water; use disposable cloth
or paper towels or use mop.
*Cleans the area; The mop head, if used, should be
rinsed in mop bucket and squeezed dry, placed in pink
water soluble plastic bag and taken to “mop room” by
HCAs for laundering.
*To prevent cross infection by effective
decontamination;
The mop bucket should be preferably washed in a washer
disinfector or thoroughly washed and rinsed with hot
soapy water and dried.
*To prevent cross infection; Remove apron, gloves, eye
protection and wash hands.
*Clean eye protection with detergent and water and
then wipe over with Alcowipe.
*If broken glass or plastic involved in spillage, use
disinfectant on this material before cleaning.
*Do not pick up sharp fragments with hands. The broken
glass must be put directly into sharps bin.

**Small splashes / spots of blood or body fluids

contaminated with blood on hard surfaces:

*Wear disposable gloves, wipe small splash / spots of

blood with Alco wipe.

**Spillages involving sputum, vomit, faeces or urine,

which are not contaminated with blood on hard
surfaces:

*The use of disinfectant with these type of spillages

is unnecessary and can result in the production of
unpleasant fumes which have the potential to be
harmful to staff and patients.
*Wear disposable apron, non-sterile latex gloves (and
eye protection, if splashing anticipated.)
*Protects health care worker and reduces contamination
of health care worker; Clean area with detergent and
warm water and disposable cloth/paper towels.
*Remove excess of spillage, if appropriate with paper
towels, and dispose of spillage (and paper towels)
directly into yellow clinical waste bag.
*Absorbs spillage; Waste can be sent for incineration.
*Many disinfectants damage carpets. Waste can be sent
for incineration.
*Ensure the area is safe. Contact domestic supervisor/
help desk, carpet to be cleaned using carpet shampoo.

**Spillages/disinfection of spillages of blood or body

fluids on mattresses/trolley/couch surfaces:

*Follow instructions as per „Disinfection of Foam

Mattresses‟ as stated above.

Decontamination of electro-medical devices

Procedure:
Prior to decontamination, battery operated/electronic
equipment must be switched off and disconnected from
the mains supply.

*Wipe all surfaces with a disposable cloth rinsed in

general purpose detergent and hot water or detergent
wipe such as Actimax.Dry thoroughly using disposable
paper towels.

Blood Stained Equipment/Equipment used for Patients in

Isolation;
*Clean equipment as above
*Wipe over all non-metallic surfaces with Chlor-Clean
solution
*Metallic parts of equipment must be wiped over with
an alcowipe

Protective Clothing:
Staff must wear the following protective clothing when
decontaminating equipment:
• Disposable plastic apron
• Non sterile vinyl or latex gloves when using
detergent or disinfectant
• Protective eyewear if there is a risk of splash to
the eyes, or if making up and using a disinfectant
solution
*If a large quantity of fluid is spilled on to the
device or further information is required, contact
Medical Engineering.

Decontamination of flexible endoscopes

Endoscopic procedures carry a risk of causing
infection. Infectious agents contaminating a scope can
originate from failures in the decontamination
process, from contamination during storage, or from
previous patients.

*Rigid endoscopes must be re-processed through the

Sterile Services Department.

When to Decontaminate Flexible endoscopes;

Decontamination of the scope must be undertaken before
being used on a patient, as soon as possible after
use, and prior to inspection, service and repair.

Procedure for manual cleaning of flexible endoscopes

Manual cleaning of flexible endoscopes must be
undertaken prior to disinfection;
* Staff must wear appropriate personal protective
equipment i.e. disposable gloves, apron, and eye
protection.
* Use dedicated equipment/receptacles i.e.
sinks/washbowls
* All valves must be dismantled from scope prior to
cleaning and individually cleaned.
* A fresh, warm solution of neutral or enzymatic
detergent must be used.
* Immerse the scope under water to clean to avoid
splashes and aerosols.
* All accessible channels/ports must be brushed
thoroughly with dedicated single use brushes until
visibly clean approximately 3 – 5 times.
* After cleaning scope must be well rinsed in a
separate sink, using tap water, to remove detergent
residues.
* Additional equipment used during the endoscopic
procedure (for example, biopsy forceps), must be
reprocessed through SSD

Ultrasonic Cleaning:
May be used to clean all instrument components and
accessories, (with the exception of telescopes),
according to manufactures recommendations.
The water reservoir must be emptied daily and this
must be documented in the appropriate departmental
records.

Leakage Testing:
Leakage testing must be performed according to
manufacturer‟s guidelines and documented.

Disinfection of Flexible Scopes in an Automated Washer

Disinfector
All flexible scopes must be disinfected in an
Automated Endoscopic Reprocessor (AER).The AER must be
cleaned and disinfected before use;
• Wear appropriate personal protective clothing
• Wash the inside and outside of the processing
chamber, lid and fluid entry bulkheads, using warm
water and general purpose detergent and clean cloth.
• Rinse with fresh water and dry with a clean
disposable cloth.
• Apply a solution of 70% alcohol (or wipe with pre
moist alcohol wipe) and dry any residual alcohol.
• A non-stick pan-cleaning pad can be used to remove
stains. Abrasive scratch pads must be avoided as they
can cause scratching to the stainless steel surface.

Procedure for Disinfection of Flexible Endoscopes

using Sterilox:
• Wear appropriate protective clothing, i.e.
disposable apron, gloves and eyewear.
• A purge cycle, to remove Sterilox from pipes must be
performed on a daily basis. A daily log indicating
that this process has been carried out must be kept
• Fully dismantle all equipment and ensure all lumen
can be perfused. Make sure all lumen are perfused for
the entire disinfection cycle.
• Ensure the scope and accessories are completely
immersed in Sterilox for the required contact time.
The minimum contact time for Sterilox is 5 minutes
(after the washing cycles).
• Details of the disinfection cycle must be recorded
(where available), and kept in the department records

Drying of Endoscopes;
• On completion of disinfection, the endoscope must be
purged with compressed air to facilitate thorough
drying. Alternatively 70% alcohol may be used to dry
internal surfaces and channels.
• Lensed instruments must not be immersed in alcohol
for longer than 5 minutes as this causes damage to
lens cement
• Consideration needs to be given to the quality of
compressed air (microbial and particulate) to prevent
recontamination of the endoscope
• Other fixed and detachable non-autoclavable
components must also be dried

Storage of endoscopes;
• Flexible endoscopes must be stored suspended
vertically in ventilated storage cabinets, to allow
circulation of air. They must not be in contact with
other endoscopes or flat surfaces.
• Control valves, distal hoods, caps and other
detachable components should be stored separately.
However, it may be necessary to store some endoscopes,
e.g. a bronchoscope, fully assembled for out of hour‟s
emergency use.
• Endoscopes must be used within 3 hours of
disinfection with sterilox.

Staff Training
Health care staff designated, as operators of
decontamination equipment must be adequately trained
and competent, and subject to ongoing training
.Records of staff trained in the use of
decontamination equipment must be kept on individual
training records.

Decontamination of Transducers using Tristel Duo Foam

E.g. Trans rectal, transvaginal and trans esophageal
probes;
**All transducer probes must be used with a transducer
cover (latex or latex free as applicable.) To reduce
contamination of transducer.

**Whilst wearing non-sterile gloves the transducer

probe cover should be removed and discarded following
the procedure.

*The “ultrasound gel” should be wiped off the

transducer probe using a wipe compatible with the
transducer.
*Surfaces must be cleaned of organic material, gel or
soil before disinfection can take place.

**Undertake hand hygiene;

*Put on a clean pair of non-sterile gloves.

*Remove the transport locks on the Duo Foamer that
stop the pump being depressed in transit. It is
recommended that these are retained and replaced after
using the Duo Foamer.

**When primed, depress the pump once to dispense one

0.8ml aliquot of chlorine dioxide foam onto the
surface. To dispense required amount for disinfection.

**Use a soft wipe, compatible with the transducer to

disperse the Duo Foam over the surface to be cleaned
and disinfected. To disinfect effectively the foam
must be in contact with all surfaces.

**Discard the wipe into clinical waste. Do not reuse.

**Leave the surface to dry to ensure a 30 second
contact time.

*The foam must be left in contact with the surface for

30 seconds to be an effective virucide, bactericide,
fungicide and sporicide.
MANUAL TASKS INVOLVING HANDLING PEOPLE

Workplace health and safety:

The Workplace Health and Safety is done when persons
are free from the risk of death, injury or illness
created by workplaces, workplace activities or
specified high risk plant.

Ensuring workplace health and safety involves

identifying and managing exposure to the risks at your
workplace. The People Handling Advisory Standard
states ways to prevent or minimize exposure to risk
due to the handling of people that can cause or
aggravate work related musculoskeletal disorders.

What is “PEOPLE HANDLING”?

"People handling" refers to any workplace activity
where a person is physically moved, supported or
restrained at a workplace. Specifically, people
handling refers to workplace activities requiring the
use of force exerted by a worker* to hold, support,
transfer* (lift, lower, carry, push, pull, slide), or
restrain* a person* at a workplace.

NO WORKER SHOULD FULLY LIFT A PERSON, OTHER THAN A

SMALL CHILD, UNAIDED.
(That is, without assistance from, for example,
mechanical aids assistive devices or another
worker/s.).

Sample task
Showering person sequence;
(a) Transfer person from bed
(i) Assist person to sit up on to shower chair the
edge of the bed
(ii) Transfer person to standing position
(iii) Transfer pivot from standing (and lower) into
shower chair

(b) Convey person to shower

(i) Unlock brakes of shower chair
(ii) Push shower chair to shower
(iii) Manoeuvre shower chair into cubicle

(c) Undress person

(i) Remove clothes from upper part of person‟s body
supporting upper limbs as necessary
(ii) Loosen clothes on lower limbs
(iii) Assist person‟s partial rise to stand
(iv) Remove clothes from lower part of person‟s body
supporting lower limbs as necessary
(v) Lower person into shower chair

(d) Shower person

(e) Dry person

(f) Dress person

(g) Convey person to bedroom

(h) Transfer person from chair to bed

Injuries associated with people handling

The most frequently injured body parts from people
handling activities undertaken without assistance are
the back, shoulders and wrist. People handling
activities can contribute to a number of work-related
musculoskeletal disorders (WRMDs) including:

• Low Back Disorders (injuries to muscles, ligaments,

inter-vertebral discs and other structures in the
back)
• Tendon Disorders (injuries affecting the tendons in
the wrist, and elbows particularly)
• Nerve Disorders (injuries affecting the wrist, neck
and shoulder)
• Upper limb muscle strains (injuries affecting the
rotator cuff and forearm particularly).
WRMDs occurs in two ways:
• Gradual wear and tear (cumulative trauma) caused by
frequent periods of muscular effort involving the same
body parts
• Sudden damage caused by unexpected movements,
intense or strenuous activity, for example, when
people being handled move suddenly or when the worker
is handling a load beyond their capacity.

*Gradual wear and tear is the most common way WRMDs

occur. Even when an injury seems to be caused by
overload, the triggering event might just be the final
trauma to tissues already damaged by previous
exposures to people handling and other manual
activities.

Common work-related actions within people handling

tasks which contribute to WRMDs include:
• Unaided lifting or supporting weight
• Frequent and repetitive lifting with a bent and/or
twisted back regardless of weight
• Pushing or pulling actions, particularly on slopes
or surfaces that are uneven, or are resistant to
wheels, for example, carpeted floors, wheeled
equipment that is not maintained
• Unexpected force for example, catching a person who
is falling to prevent the person injuring themselves
or others
• Static working positions with the back bent, for
example, holding a limb during a surgical procedure or
providing stability while a person stands
• Lowering in restricted spaces, for example, into a
vehicle or onto a toilet

Risk factors
Risk factors can be grouped into two distinct
categories:
• Direct risk factors – which directly stress/injure
the worker‟s body.
• Contributing risk factors and modifying risk factors
which affect how the task or action is done.

There are three direct risk factors:

• Forceful exertion
• Working postures (awkward, static)
• Repetition and duration.
It is important to note that if none of these direct
risk factors are found to be associated with the
people handling task or action, there is no risk and
no need to assess the task or action.

There are six contributing risk factors and modifying

risk factors. These risk factors are the causes of the
direct risk factors.

The contributing risk factors are:

• Work area design,
• Work environment,
• Handling procedure, and
• Characteristics of the person being handled.

The modifying risk factors are:

• Characteristics of the worker, and
• Work organization.

It is the contributing and modifying risk factors that

are controlled to manage the risk of injury.

The Risk Management Process - An Overview

Risk management is an ongoing process. It should be
undertaken:
• Now, if it has not been undertaken before
• When changes occur at, or are planned for, the
workplace
• When there are indications for potential injury
• After an incident (or „near miss‟) occurs
• At regularly scheduled times appropriate to the
workplace.
**Identification
• Consult with workers and observe the tasks.
• Make a list of all the people handling tasks.
• Make a list of the actions within each of these
tasks.
• For each action, determine which of the direct risk
factors are present.
• For each action, identify the contributing and
modifying factors

**Assessment
• Consult with the workers.
• Determine the level of risk associated with each
action.
• Prioritise actions for control.

**Control
• Consult with workers.
• Determine solutions that will manage the
contributing and modifying risk factors.
• Implement chosen control measures

**Review
• Consult with workers.
• Review people handling actions and tasks to
determine the effectiveness of measures.

Identification:
The first step in the process of managing exposure to
people handling risks is identification. This step
involves identifying people handling tasks, actions
within each task, direct risk factors, and,
contributing and modifying risk factors.

List the people handling tasks;

The first part of identification is to make a list of
those tasks undertaken at the workplace that involve
handling people.

Common work-related people handling tasks include:

• Raising a person who is at ground level
• Assisting with toileting
• Bathing/showering a person
• Dressing/undressing a person
• Transferring a person from a bed into a chair or
from a chair into a bed
• Assisting a person from a restricted space, such as
a car or bus
• Repositioning a dependent person, such as in a bed
or chair
• Moving or conveying a person from one location to
another, for example, in a wheelchair
• Supporting/being ready to support a person/child,
such as during rehabilitation or when the child climbs
on playground equipment
• Rescuing or retrieving an injured or deceased person
• Restraining a person, for example, to prevent
movement in a person with cognitive or behavioral
problems.

Identify the actions in each task:

The second part of identification involves identifying

the actions involved in each of the tasks. Breaking
the task into its actions allows all the components of
the task to be considered. Analysing these actions
helps to identify those aspects of the task that might
place the worker and/or person at risk. This process
facilitates the selection of appropriate and targeted
control measures.

The task of raising a person who is at ground level,

could involve the following people handling actions:
*Action 1 – repositioning the person (for example,
putting them in the recovery position)
*Action 2 – administer first aid, if required
*Action 3 – position the person in a sitting
position
*Action 4 – position a chair close to the person
*Action 5 – assist the person as they rise to sit
on the chair
*Action 6 – assisting the person as they rise to
stand.

Hoisting:
**Alternatively, the task of raising a person who is
at ground level could involve the use of a hoist, as
follows:
*Action 1 – assist the person to roll to their side
*Action 2 – position the sling on/under the person
*Action 3 – position hoist close to the person
*Action 4 – attach the sling to the hoist
*Action 5 – follow the operating instructions,
use the hoist to lift the person.

A number of people handling tasks will have actions in

common. The action of raising a person to stand from
a seated position will be required when:
• Toileting a person
• Transferring a person from a wheelchair to a bed
• Removing a child from a high-chair
• Assisting a person out of a car or bus.

Identify the direct risk factors:

The next part of the identification step is to
identify the direct risk factors associated with each
of the actions. It is expected that most people
handling actions will involve at least one of the
direct risk factors, and, therefore, all actions
should be considered. However, if none of the direct
risk factors are found to be associated with the
action, there is no need to proceed with assessing the
action.

The three direct risk factors are:

• Forceful exertions
• Working postures (awkward, static)
• Repetition and duration.

Forceful Exertions
Forceful muscular exertions place high loads on body
tissues and so are associated with a large percentage
of WRMDs.The level of muscular effort needed for an
action is affected by a number of factors, such as;

• Awkward working postures –A higher level of muscular

exertion is needed when a body part is in an awkward
posture.
• Static positions - Holding a body part, such as the
back or shoulder in a fixed position, for example,
when supporting a person, places a considerable load
on the body part. Continuous standing, for example,
can also be a problem if it needs to be maintained for
a prolonged period. The load is increased
significantly if the posture is static and awkward.
• Sudden movement - Responding to sudden movement in
people being handled who faint, fall or are
uncooperative (because of cognitive or behavioral
problems), can lead to large forceful exertions.

Forceful exertions are caused by the following

contributing and modifying risk factors;

• Characteristics of the person being

handled, for example, needing to respond to sudden
movement or to apply restraint.
• The handling procedure, for example, whether it is
carrying, lifting or pulling
• The work area design, for example, whether bending
and reaching are needed because of the location of
work items
• Work organization, for example, lack of maintenance
of equipment.
Forceful exertions are also caused by working
postures, (awkward, static) for example, reaching
across a bed and lifting a person.

Working Postures
Working postures affect the level of muscular effort
needed to perform an action, and how quickly muscles
fatigue.

Working postures can be:

• Dynamic or static
• Awkward or neutral

It is the static working postures and the awkward

working postures that represent a risk.

Dynamic postures involve movement. A static posture

refers to a posture where a body part is held in a
fixed position. Static postures lead to earlier
fatigue than dynamic postures because, with static
postures, blood flow to the muscle is restricted and
the energy supply to the muscle can run out.

Many people handling activities involve both types of

working postures, for example, a worker using his/her
arms to dress a person, while having the back bent in
a fixed posture. Awkward postures are postures where
joints of the body are away from the midline or from
the neutral position.

Neutral positions include:

• Back and head upright with normal spinal
alignment
• Arms by the sides of the body with the shoulders
relaxed
• Forearms hanging straight, or at a right angle to
the upper arm when working
• Legs straight.

Awkward working postures while handling people are not

always harmful in themselves. However, an awkward
posture is likely to cause damage to body tissues in
combination with another awkward posture - The back
being both bent forward and bent sideways or twisted
increases the stresses on the spine. For example;
• Transferring a person from bed to chair, when the
worker needs to bend or twist sideways
• Assisting a dependent person into a vehicle or bus
• Rescuing or retrieving a person from a restricted
area.

*Static positions: Maintaining a fixed position for a

prolonged period accelerates the fatigue in muscles,
such as when having the back bent or shoulders tensed
when holding a load or working with the hands. For
example;
• Supporting a person‟s limb during a surgical
procedure
• Bending over a bath while tending to a person.

*Forceful exertions; the muscular effort to perform an

action increases as the body part moves further away
from the neutral position.
• Lifting a person from a low bed, the floor or out of
a low chair
• Positioning a person in a bed from lying to sitting
up
• Responding to sudden movement in people such as
fainting or falling
• Restraining a difficult person during a transfer

*Repetitive tasks; people handling tasks which use

awkward postures and are performed repeatedly without
breaks increase the likelihood of tissue damage. For
example toileting or bathing people during peak
periods

Awkward working postures addressed in this standard

include the following high-risk awkward working
postures:

Back
• Bent forward, for example, tending to a person on a
low bed
• Bent sideways, for example, using a shoulder lift to
assist a person to sit up in bed
• Twisted, for example, settling a person into a car
or maneuvering a person in a shower, where space is
limited.
• A combination of the above awkward postures.

Neck
• Bent backwards, for example, looking up
• Twisted for example, looking over the shoulder
• Bent downwards
• A combination of the above awkward postures

Arms and shoulders

• Reaching up above the shoulder for example, removing
children from play equipment
• Reaching away from the body (including behind) for
example, having an obstacle in the way when trying to
grasp a person

Hands and wrist

• Pinching an unsupported object weighing 1 kg or more
• Gripping with a pinch grip for example, pulling a
slide sheet holding the sheet between the thumb and
index finger, or with the wrist in an awkward posture

Legs
• Squatting for more than a total of 2 hours per day
• Kneeling for more than a total of 2 hours per day

The following contributing and modifying risk factors

cause high-risk working postures:

• The work area design in which the task/action is

performed
• The characteristics of the person being handled, the
special way the person might have to be handled
because of a particular problem or individual
characteristic
• The method of people handling - lift, carry, pull
etc.

Repetition and Duration

Repetition - is a major risk factor for WRMDs. It
usually means the same muscles and joints are being
moved continuously and this can result in:

• Increased "wear and tear" of body tissues because of

the limited opportunity for them to recover during
repetitive work; and/or
• Muscle fatigue, which could be followed by an
inflammatory response and tissue damage.

The frequency of a repetitive people handing task or

action (how many times it is done) is critical in
causing adverse health effects. Examples of common
repetitive tasks include:

• Handling people into and out of vehicles at arrival

or departure times in an educational facility
• Assisting people with activities of daily living at
routine times such as meals, toileting or getting in
or out of bed
• Recreational activities in child care centers
involving moving children on and off equipment

Duration; refers to the length of time a people

handling task is done during a shift. This is
important when the worker is exposed to risk factors
such as forceful exertions, repetitive movement, and
static awkward postures.

Tasks that are repetitious or of long duration can

generally be controlled through changing the modifying
risk factor of work organization, by reducing task
frequency or exposure time, and or implementing
policies to ensure the availability and correct use of
handling aids.
Contributing and modifying risk factors
The relevant contributing and modifying risk factors
associated with people handling actions are:

*Contributing risk factors

• Work area design
• Workplace environment
• The handling procedure
• Characteristics of the person, as a load

*Modifying risk factors

• Individual characteristics of the worker
• Work organization

Work area design:

The work area is that part of the workplace where a
particular people handling task or action is based.
It includes furniture and fittings, vehicles, and the
equipment used by the worker in performing the action.

The design/layout of a work area and the risk of

injury are linked, because the relative positions of
work items and the worker affect the;
• Working postures, and
• Level of muscular exertion.

The design of the workplace should allow the worker as

far as possible to;
• Be upright and facing forward
• Have a clear view of the task
• Perform the action between hip and shoulder height
and without reaching forward and or twisting.

Problems with the design/layout of work areas include:

Dimensions of furniture and equipment; if the surface
on which the person to be handled is not height
adjustable (e.g. too low or too high) or too wide, the
worker might have to bend and reach, for example;

• Bathing a person in a conventional bath.

• Tending a person in a low, queen-size bed
• The caring/rehabilitation of a disabled child on a
floor mat

Location of items in the work area; can result in

awkward postures (dynamic and static) such as reaching
or bending, for example;
• Having furniture which is not moveable or limits
workable space so workers have to reach over to handle
a person.
• Using the area under furniture for storage so there
is insufficient space for the feet.

Access ways; Insufficient space for moving handling

equipment or mobile furniture can result in awkward
postures and additional force being used, for example
pushing equipment through a standard doorway.

Space constraints; can prevent the worker standing

close to a person being handled, or standing up
straight. This can result in awkward postures and an
increased level of muscular effort, for example;
• Toilet cubicles or other constricted or crowded
spaces with insufficient room to stand beside the
person being assisted
• Maneuvering mechanical aids around beds
• Vehicles with limited head room into which people
are required to be assisted and/or lifted and
positioned.

Floor levels: Different floor levels, steps, lips, and

lack of suitable ramps can result in awkward postures
and an increased level of muscular effort, for
example, moving/ maneuvering wheeled equipment and
mobile furniture into lifts.

Work environment
Aspects of the work environment that increase the
risks associated with undertaking people handling
actions include:
Surfaces: Floors and other surfaces underfoot that are
uneven, slippery or sloping, add to the level of
exertion required to perform people handling
activities.

Housekeeping: Poor housekeeping can contribute to

awkward postures, for example, reaching or bending
over obstacles, and can result in an increase in the
level of forceful exertion required to perform an
action.

Ambient conditions:
• Thermal Comfort - Heat/humidity, cold and wind
contribute to the physical demands placed on workers
during handling, and can lead to the earlier onset of
fatigue, for example, when undertaking rescue
procedures during extremes of heat, cold, wind or
humidity.

• Noise – Both the level and the type of noise can

interfere with communication, such as giving
instruction or warnings, especially during team
handling and between the worker(s) and the person
being handled.

• Lighting - People handling actions performed in an

area with low lighting can result in visual compromise
which can lead to awkward postures, such as leaning
forward. Further, poor lighting can limit the
visibility of obstacles.

Working in people‟s homes: In people‟s homes, the work

environment is unpredictable and there is generally a
limit to what the worker can control.

The handling procedure

The handling procedure refers to the way a task or
action is carried out. Different handling procedures
result in different working postures and different
levels of muscular effort needed to perform an action.
Lifting, lowering, holding and carrying:
These handling actions can involve a worker supporting
part or all of the body weight of the person being
handled. These actions are a primary cause of WRMDs
in workers.

When lifting/carrying, the force exerted on the spine

by the load is an important factor contributing to
injury. This is affected by the weight of the person
combined with the distance of the center of gravity of
the person relative to the worker‟s spine. An
increase in this distance greatly increases the load
on the spine.

Distance is increased when;

• The person is bulky
• The person has to be held away from the body,
because of, for example, attachments, equipment or
behavioral patterns of the person
• Extended reach is needed because of, for example, an
obstacle in the way.

The following aspects also increase the physical

demands of the handling action:

The vertical distance the person has to be lifted or

lowered increases the load, through awkward postures
of the back or arms, for example;
• Lifting a person from a low chair to a standing
position
• Lowering a child from play equipment

This force is measured as the „bending moment‟ and is

calculated as Weight X Distance. The center of gravity
of a regular object is situated at its center. In an
object of uneven weight distribution, it is towards
the heavier side.

Asymmetry of the load: Weight is not distributed

evenly in a person with the upper half generally being
heavier than the lower half. This can affect team
handling. For example, for workers carrying a
stretcher, the worker at the head end will support
more of the weight.

Asymmetric lifting; causes more stress on one side of

the worker‟s body than the other, for example, lifting
a person out of a bath that is located against a wall
or pulling a person from the water into an Inflatable
Rubber Boat (IRB).

Location: The starting and finishing positions of a

person during a transfer affects whether the worker
has to lift or lower or to twist, for example,
transferring a person from a bed to a trolley which is
higher, or a chair at right angles.

Distance moved; generally, the greater the distance

the person is moved, the longer the load is on the
body.

Working while seated: Less weight can be handled when

the worker is seated than when the worker is standing.

Constricted work space; limiting the ability to man

oeuvre or stand up straight for example, positioning a
person in a vehicle or working in a hostel room or
person‟s home with too much furniture.

Sliding, pushing and pulling

Sliding, pushing and pulling are actions that allow
people to be moved across surfaces with the weight of
the person supported by the assistive device, for
example;

• A slide sheet to reposition people in bed

• A slide board to transfer at level
• A wheelchair, stretcher, or trolley for moving
people.
Restraining
The need to restrain a person or body part can occur
with another handling task. This can increase the
effort needed and the risk associated with performing
the people handling task or action.

Characteristics of the person being handled

Unlike other general load handling activities, with
people handling, the health and safety of the load,
that is, the person being handled, has to be
considered as well as the health and safety of the
worker(s) and others.

Both the physical and the non-physical, including

cognitive and behavioral, characteristics of the
person (the load) will affect how the people handling
activity is undertaken and the risk(s) involved.

Physical characteristics
One of the main problems with people handling is that
the weight of the person (the load) is often more than
the weight of an object considered acceptable for an
unaided worker to manually handle. In an office
environment, for example, a service person would not
be expected to move a photocopier, weighing
approximately 70 kilograms, without the assistance of
a trolley.

If the task also involves the handling of a stretcher

or coffin, the level of risk will be increased because
of the additional weight of these items to the weight
of the load.

Other physical characteristics of the person can

increase the risk of injury by causing the direct
stressors, which places demands on the worker(s) and
limits handling controls. These characteristics
include:
• The type of injuries a person may have (for example,
fractures, spinal injuries, contractures)
• The „infectious state‟ of the person (for example,
the need to wear specific personal protective
equipment)
• The physical flexibility of the person
• Whether the person is attached to any medical
equipment and can be held close to the worker‟s body
during a transfer
• Whether the person has any physical disabilities
• Whether it is suspected or known that the person is
under the influence of drugs or alcohol
• Whether the person is (or is likely to) make sudden,
uncontrolled movements (for example, slip, convulse,
loss of balance)
• Whether the person is physically capable of
assisting the worker(s).

Non-physical including cognitive and behavioral

characteristics of the person (the load):

As well as the physical condition of the person, non-

physical, including cognitive and behavioral,
characteristics of the person can affect the handling
activity and the level of risk. This includes the
person‟s:

*State of arousal: A person, not in a fully conscious

state, for example, if the person is asleep,
unconscious or has fainted, will be totally dependent
on the worker and, in effect, heavier to handle.

*Predictability of behavior: Unpredictable behavior,

for example, when it is suspected or known that a
person is under the influence of drugs or alcohol or
suffers from dementia, head injury or a psychological
condition, can hinder the handling activity. Any
sudden and/or uncontrolled movement by the person
being handled can require the worker to use high
muscle forces and can result in overloading of body
tissues, for example, a worker moving suddenly to
restrain a person.
*willingness to assist: Handling can be easier if the
person is willing to assist and cooperates with the
worker(s). If the person has behavioral problems
and/or is aggressive, the handling procedure is likely
to require more force from the worker(s). Even the
person moving independently of the worker can hinder
the handling activity. Procedures should be designed
so that minimum reliance is placed on the person‟s
assistance and alternative controls are used.

*Ability to communicate and understand: A person can

assist a handling procedure, if they can understand
what is intended/required for the procedure. Effective
communication can be difficult, however, when the
person does not speak the same language as the worker,
or their condition limits their ability to understand
instructions, for example, if the person has an
intellectual disability.

*Need for dignity and privacy: Handling methods used

to preserve the dignity and privacy of the person
(including deceased persons) can increase the risk of
injury, for example,
• Closing the toilet door while assisting the person,
which can restrict space
• Dressing and undressing a person in the shower
rather than beside the bed, which can increase the
number of handling tasks and actions required to
perform the activity.

Characteristics of the individual worker

Characteristics of the individual worker, such as
those outlined below, can influence the level of risk
associated with performing the action:

*Competency: A lack of competency by the worker can

contribute to the level of risk associated with
performing a task.
*The physical capabilities; of the worker is a
significant factor. For example,
• Workers with an existing back injury, (for example,
a ruptured disc, which might be pain free) have a
greater chance of re-injury.
• Young workers can be at greater risk than adult
workers because they are still developing physically.
Older workers with a reduced physical capacity or
previous work–related injuries can be at greater risk
of injury. However, older workers might be able to
compensate for any physical loss by their skill in
performing an action or task.
• Workers in the last stages of pregnancy can be at
greater risk of injury. Pregnancy can affect the risk
of back pain because of a number of factors, including
the changing shape of the body. Loading stress can be
increased in some handling situations because the
worker cannot get as close to the person. Hormonal
changes also cause softening of tissues and laxity of
joints in pregnancy. The ligaments of the lower back
and pelvis, and the muscles of the pelvic floor
regions are particularly at risk when moving a person.
• Workers who are new, are returning from long
absences and whose functional capacity for the
physical demands of the work may not be back to
normal, or are on workplace rehabilitation programs
can be at greater risk of injury.

*Clothing and footwear: Wearing inappropriate items of

clothing and footwear can increase the level of risk
associated with performing a handling action, for
example;
• Tight-fitting and/or short skirts, dresses etc.
which do not allow workers to adopt optimal working
postures because of restrictions in the clothing or
modesty concerns
• Footwear lacking stability and good traction with
the floor to prevent slipping.
*Personal protective equipment (PPE): Items of PPE can
increase the level of risk by increasing demands of
the actions. For example;
• Gloves can add to the difficulty in grasping and
holding a person, particularly if the gloves do not
fit well.
• Heavy clothing to protect against heat (fires) or
cold can cause restrictions in movement.

Work organization
The way work is organized, or procedures are
administered can affect the level of risk by;
• Increasing the frequency with which repetitive tasks
are performed
• Increasing the duration of exposure to the risk
• Reducing the time for recovery between tasks
• Increasing the level of forceful exertion required.

Organizational aspects that increase the level of risk

include:

*Staffing levels: Too few workers for people handling

tasks can result in increased work demands being
placed on the existing workers, for example, increased
number of transfers (repetition) and longer duration
on handling tasks. This can lead to fatigue and
reduced work capacity. This is a common experience
during peak times, for example, during bathing and
dressing activities, or assisting dependent people
into cars. When working in isolation, for example,
when caring for a dependent person in their own home,
a worker generally does not have the opportunity to
call for assistance and/or use team-handling. The
availability of assistance to a worker will affect the
level of risk associated with performing people
handling actions.

*Lack of variability: Can increase the load on body

tissues due to lack of changes in posture and the
reduced chance for recovery, for example;
• Performing one action repeatedly, such as
positioning people in bed
• Performing people handling actions with similar
requirements.

*Inadequate rest breaks; might not allow enough time

between people handling tasks and so contribute to
fatigue and overexertion, for example, busy work
schedules leading to missed work breaks.

*Extended workdays: Long work hours (more than 8

hours) can lead to increased exposure to the risk of
injury, for example;
• Overtime due to workers on the next shift suddenly
being unavailable.
• 12-hour shifts in work units catering for dependent
people.

*Administrative policies and procedures: A lack of

policies and procedures, inadequate policies and
procedures, or policies and procedures which are not
followed can increase the level of risk associated
with performing a people handling task/action, for
example;
• A procedure for use of shared equipment which is not
followed.
• Lack of consultation with workers when purchasing
new equipment or vehicles.

Compiling the lists

In a small workplace, an individual might be familiar
with all the activities undertaken and so is able to
prepare the lists of people handling tasks and
actions, and to identify the risk factors.

At a larger workplace, it may be necessary to develop

the lists through a workplace health and safety
committee or at a staff meeting. People handling
tasks, actions and associated risk factors can also be
identified through:
• Further consultation with workers
• Regular observation of work processes
• Minutes of previous Workplace Health and Safety
committee meetings and staff meetings
• Diaries or activity reports
• Incident reports, including hazard reports and
improvement logs
• Industry statistics, including workers compensation
data.

A summary of the identification process:

• Consult with workers
• List the workplace tasks that involve people
handling.
• Record the people handling actions involved in each
task.
• Identify the direct risk factors associated with
each action.
Note, if none of the direct risk factors exist, there
is no need to proceed with assessing the action.
• Identify the contributing and modifying risk
factors.

Questions to ask:

• What do the workers think?

• What tasks involve people handling?
• What are the main actions in each task?
• What are the direct risk factors?
• What are the contributing and modifying risk
factors?

Assessment
Assessment involves determining the level of risk
associated with each of the people handling actions
identified. The desired outcome of the assessment
step is a prioritized list of people handling actions
requiring control.
Further, when more than one people handling task is
assessed, then the overall risk estimate for the task
can be used to develop a prioritized list of tasks
requiring control.

Consult with workers throughout this process to assist

with determining the level of risk associated with
each of the people handling actions and the priority
of each task.

Estimating the level of risk associated with each

action:
In order to prioritize the people handling actions,
the risk associated with performing each action should
be assessed. It is up to the assessor how this
assessment is done. The assessor can choose any
method of risk assessment as long as a prioritized
list of actions is achieved.

A way of assessing risk is to consider the likelihood

and consequences of an incident occurring at the
workplace.

*Likelihood
To estimate the likelihood of an incident occurring at
the workplace, the following aspects can be
considered:
• How often the action is undertaken
• The number of workers performing the same or a
similar action
• The duration of time that the action is performed
• Distractions
• The effectiveness of existing control measures
• Capacity and characteristics of the workers
• Environment
• Availability and use of equipment
• Condition of equipment
• Injury data/history

*Consequences
To estimate consequences, the severity of a potential
injury or illness that could result from performing a
people handling action can be considered. Reference
can also be made to injury records and statistics, and
information on injuries from people handling in
related industries for an indication of the potential
severity of injury.

Prioritizing actions
Use your likelihood and consequence estimates to rank
and then list the people handling actions requiring
control. You might decide that some actions, for
example, those for which it is very unlikely that an
incident would occur and for which the consequences
are minor, may not require control.

A summary of the assessment process:

• Consult with workers
• Estimate the likelihood of an incident occurring at
the workplace.
• Estimate the consequences of an incident occurring
at the workplace.
• List the people handling actions in the order of
they require control.

Questions to ask:
• What do the workers think?
• What is the likelihood and potential severity of
injury associated with each action?
• What should be fixed? ?
• What should be fixed first?

Note, an absence or lack of recorded incidents does

not necessarily mean that there is no risk associated
with performing the people handling action.

*Control
Risk control involves:
• Making decisions about the best measure(s) to
control exposure to the contributing and modifying
risks identified; and
• Implementing the chosen controls.

Consultation with workers is an important part of this

process. Due to their experience in undertaking the
task/action, workers are likely to be able to offer
valuable suggestions about how to manage the risk. In
addition to the positive effect on worker morale,
consultation should enhance "ownership" of the
measures and facilitate the implementation process.
This will help to achieve better health and safety
outcomes.

Methods of risk control –Overview

Control measures for people handling can be grouped
into two major categories: “design" and
"administrative" controls.

Design controls involve the arrangement, or alteration

of:
• Physical aspects of the work area such as equipment
or furniture/fittings, or
• The work procedure.

Design controls are preferred because they:

• Can eliminate or at least minimize exposure to risk
factors
• Have the advantage of being relatively permanent
(compared with administrative controls).

For these reasons, implement design controls wherever

possible.

*Job design and redesign: The aim of job redesign is

to make sure that all components of a task are
arranged to reduce the risk of injury. It includes
consideration of factors such as:
• The design of the work area
• The work postures required to carry out the action,
how often it is repeated and for how long.

*Provide mechanical aids; provide any aid or

mechanical device that will assist workers to carry
out the actions.

Administrative controls are achieved primarily by

modifying existing personnel arrangements.
Administrative controls do not remove the root cause
of potential problems. These controls can only reduce
exposure to the risk of injury.

They might also be forgotten or not followed under

stressful or other conditions as they are behavior
based, for example, coping with staff reductions.

*Work organization; examine opportunities to reduce

exposure by rotating workers, and avoiding peaks in
the workload.

*Task-specific training; training in work methods for

specific tasks or actions helps workers to carry out
these tasks/actions in a safe and effective way.

*Maintenance; on a regular basis helps ensure

equipment works well and is available when needed.

Select controls
The next step in the risk management process is to
decide how the risks associated with the actions can
be managed or controlled. When deciding on control
measures, consult with workers for their suggestions.

Control Strategy
It is useful to think of control in terms of a total
strategy, which can include design controls or
administrative controls (or some combination of both).
For example, a solution to a problem might involve a
design control, such as a mechanical device, in
combination with administrative controls, such as
training to use the device, plus use of a „no lift‟
policy.

In developing the control strategy, consider both

short-term (or interim) measures and long-term
measures. If, in the above example, the device is not
immediately available, or funds are not immediately
available to purchase the device, measures must still
be put in place to manage the risk in the short term
(even if such measures are temporary), until longer
term measures can be implemented. For example,
administrative controls, such as team-handling with
training might be used until the mechanical device
(which represents a better solution), is acquired.

In developing the control strategy, preference should

be given to design controls over administrative
controls.

Administrative controls should only be used:

• Where it is not possible to design problems out of
tasks or actions,
• To supplement design controls; such as when training
is provided with the introduction of a new mechanical
device, or a maintenance schedule drawn up
• When waiting to implement design based controls due
to funding or other delays.

Use the following criteria to choose the control

measures:

• Effectiveness; the degree to which the solutions

control the risk.
• Timeliness; the overall time to fully implement a
solution which works effectively to eliminate or
minimize the risk of injury.
• Controls do not create other risks; the solutions do
not result in a transfer of risk, for example,
incorrect use of a handling aid, such as a transfer
sheet can create forceful exertions on the workers
forearms.
• Efficiency; the solutions have benefits not only for
health and safety, but also for productivity,
efficiency and worker moral.
• Cost effectiveness; the outlay for the solution(s)
should justify the potential risks and injury
outcomes. Ensure that funds allocated to the chosen
solutions suitably control the risks. For example,
the cost outlaid on a hoist will be justified if
training, in isolation, does not adequately control
the risk.

Implement controls
Implementation generally involves the following:

Trialing solutions before making them permanent. Some

ideas do not work as well in practice as on paper. It
can be useful to do a "mock-up" of a room to determine
whether control options, such as workplace design or
use of a mechanical device, will work. It is also
important to consult with workers before setting up
the trial and during this testing period. This assists
in determining how well the proposed solution(s)
actually work, and identifying any additional
modifications that are required.

*Revising controls: After the initial testing period,

the proposed solution might need to be revised. Make
modifications where necessary. Conduct further testing
to see that the appropriate changes have been made.

*Developing work procedures: Develop work procedures

in relation to the new control measures selected, to
make sure they are effective. Part of this process is
to prepare a plan outlining the most appropriate
procedure for handling the person.

Management, supervision and worker responsibilities

should be clearly defined in the procedures developed.
*Communication: The reasons for the changes should be
clearly communicated to workers and others. Any
concerns raised should be evaluated.

*Training: Provide training to ensure the competency

of workers, supervisors and others in relation to the
new control measures.

*Supervision: Adequate supervision should be provided

to verify that the new control measures are being
followed and used correctly.

*Maintenance: Maintenance of tools and equipment

(including personal protective equipment) relating to
control measures is an important part of the
implementation process. Work procedures should
include maintenance requirements to ensure the ongoing
effectiveness of the new control measures.

*Setting time frames: Time frames should be set for

controls to be implemented and evaluated.

Preparing an implementation plan

Planning is critical to make sure controls for problem
actions are implemented in a timely fashion. Keep a
written record for use during the implementation and
evaluation phases, and for future reference.

The following is a guide to preparing a written

„control implementation plan‟, a document which can be
used to facilitate the implementation process:

(a) Note the risk factor(s) and the control measures

selected.
(b) Decide on the activities necessary to implement
the selected control(s).
(c) Allocate staff member(s) to be responsible for
carrying out the activities.
(d) Set a date for completing each activity.
(e) Specify the date for evaluation of the control
options and any other follow-ups.
(f) Review the control implementation plan regularly
to assess progress.

The plan should include the proposed dates and people

responsible for undertaking the activities required to
implement the control measures.

A summary of the control process:

*Consult with workers.

Develop a control strategy, which includes design

and/or administrative controls and short-term and
long-term measures, as necessary.

*Implement the chosen control measures, using the

following steps:
• Trial the control measures
• Revise the control strategy, if necessary
• Develop supporting policies and procedures
• Advise workers and others about the new control
measures
• Provide training and supervision in relation to the
new control measures
• Ensure maintenance in relation to the new control
measures will be undertaken
• Set time frames to put the control measures in place
• Document information in an implementation plan.

Questions to ask:
• What do the workers think?
• How do you fix the problems?
• How do you put selected control measures in place?

Review
The final step in the process of managing exposure to
the risks associated with people handling is to
monitor and review the effectiveness of measures.
This step is necessary to make sure the implementation
process is complete and to assess whether the
implementation of control measures has achieved
appropriate control of the risk.

It is important to consult with workers and others and

particularly those who have worked with the new
control measures.

A review should be undertaken immediately after

implementing the controls and again a short period of
time after the measures have been in place (for
example, 3 months after implementation). In addition,
a formal review should be undertaken annually or as
required.

If problems are discovered, determine what might have

prevented the control measure(s) working as planned,
and decide what needs to be changed to make them
operate more effectively.

Review is an ongoing process. Consult with workers and

supervisors regularly, observe work activities during
walk through surveys, and monitor injury reports to
ensure problems have been resolved.

A summary of the review process:

• Consult with workers.
• Make sure selected controls have been implemented,
as planned.
• Check to see that introduced controls are working
and are being used correctly.
• Check to see that the introduced controls have
resulted in elimination or minimization of the risk.
• Make sure no new risk has been introduced, or any
existing problems made worse.

Questions to ask:
• What do the workers think?
• Are the measures in place?
• Are the measures working?
• Are there any new problems?

Control Options
Control measures are directed at contributing and
modifying risk factors to manage the risk. The control
options are arranged, where possible, in line with
their priority as a control. For example, design
control options are placed before administrative
control options.

Work area design

Consider the following:
*Height of furniture and fixtures
• Fixed work heights should be set within a
comfortable working range for the people handling task
for the majority of workers, that is, handling in a
hip to shoulder range with neutral postures, where
possible.
• Height adjustable items allow handling at the best
height for the worker.

Suitable items include:

• Height-adjustable beds with lockable castors on all
legs, which allow access and operation of brake
control
• Height-adjustable trolleys for moving/transferring
people
• Height-adjustable tables for dressing children and
other dependent persons
• Mobile hoist bath seats with mechanically adjustable
seat height for showering, toileting and bathing
• Height adjustable bath trolleys on wheels,
tilting/reclining shower chairs and commodes
• Armchairs with an elevating seat for people who have
to be regularly transferred in and out of easy chairs
• Block raisers on beds and other furniture in a
person‟s home.

*Width of furniture
• The worker and the person handled should be
positioned to have a comfortable reach, for example,
the worker has one leg kneeling on the bed instead of
standing beside the bed, to reduce reach to the
person.
• People who are tended to or transferred regularly
should have:

• Armchairs that are not too wide, particularly if

they are also low
• A single rather than a larger bed. Items to aid
independence of persons can reduce handling needs -

• Locate attachments/aides where they can be reached

from chair height to enable some people to undertake
activities of daily living, for example, showering
themselves with minimal assistance.
• Add safety aids such as bath seats, safety bars and
grab rails to existing facilities.
• Locate night lights in the work areas where people
handling will occur.
• For children who have reached the early walking age,
purpose built furniture, such as appropriately
dimensioned steps can be an effective way of raising a
child to a change table or bench and reduce handling
needs. Note, with such equipment, the child must be
supported and guided while on the steps and moving
from the steps to the table or bench.

*Work space; make sure there is enough space in each

critical location, including work areas such as
classrooms or dining rooms, to safely perform the
actions needed.
• Design rooms to accommodate furniture, equipment and
functional movement space.
• Position furniture so that there is sufficient room
for the worker to manoeuvre. Careful placement of
furniture, equipment and fittings minimizes dangerous
handling conditions and facilitates the safe use of
assistive devices and lifting equipment.
• Provide furniture, which is easily moved to allow
access, for example, lightweight chairs with wheeling
attachments.
• Increase functional space with privacy curtains,
sliding doors or curtains and mobile equipment, such
as a mobile shower trolley.

Workplace environment
Access ways; make sure there is enough space in each
critical location to safely perform the actions
needed:
• Through doorways and along corridors and round
corners when furniture or equipment needs to be moved
even on rare occasions or on an emergency basis
• Adjacent to beds (three sides) toilets, showers,
baths

*Handling equipment: Make sure all items of handling

equipment are;
• Suited to the task or action
• Easy to manoeuvre and do not require excessive force
by the worker in any aspect of use
• Designed to allow good posture when assembling,
positioning or using
• Stored close to the work area in which used
• Are kept in good working order with regular
proactive maintenance
• Do not cause an obstruction
• Do not create any other risks in use.

*Access in vehicles; to allow sufficient room for

people handling, select vehicles with:
• A tail-gate/ramp for wheelchair access
• Wide doorways on both sides to facilitate access
• Sliding doors or doors that stay open without having
to be held open by the worker
• Sufficient room inside the vehicle for positioning
and securing the person in a short time, for example,
head room and sufficient space between the driver‟s
and passengers‟ seats .
• Implement policies and procedures which promote the
use of suitable transport, for example, maxi taxis
which are fitted with an hydraulic lifting platform or
a family vehicle suitable to the handling requirement.

*Consider the following:

Floor surfaces (in general)
• Use non-slip materials on floor surfaces.
• Keep floors dry and free from contaminants, such as
spills.
• Keep floor surfaces clean.
• Wet-clean floors when there is time for them to dry
before they need to be walked on. Keep a "wet floor"
sign displayed until the floor is dry.

Floor surfaces for wheeled equipment

Make sure floor surfaces on routes for example,
corridors, ramps, lift doorways, over which equipment
will be pushed/ pulled have hard smooth surfaces (not
carpet) where possible. This will reduce the
resistance, and the muscular effort needed, and better
suit the equipment‟s steering characteristics.

Working outdoors;
• Remove obvious obstacles and avoid steep inclines or
slippery ground when working outside the regular
workplace.
• In grounds outside buildings, keep access ways well
maintained and free of litter.
• Provide cover from rain where people handling
activities are carried out, for example, transport
drop-off areas at schools with dependent students.

Housekeeping;
• Keep work areas clean, tidy and free of clutter and
obstacles.
• Do not use corridors or other access ways for
storage of packages or other items.
• Make sure items or other equipment which can cause
slips and trips is put away immediately.
*Ambient Conditions;
• Thermal Comfort
• Ensure workers wear appropriate clothing that is not
too bulky or restrictive.
• Reduce temperature and humidity where possible by
providing fans or air conditioning.
• When working outdoors, for example, rescues, reduce
the shift time of workers working in hot, humid, cold
or windy situations, where possible.
• Encourage workers to work at a sensible pace and for
shorter periods in temperature extremes.
• In hot conditions, it is essential to provide
adequate rest periods and allow for replenishment of
body fluids.
• Where possible, minimize extraneous noise.
• Ensure those communicated with have heard or
understood the communication. It may be necessary to
communicate visually.
• Improve the layout of existing lights by lowering or
raising them or changing their position in the work
area.
• Use screens, visors, shields, hoods, curtains,
blinds or external louvers to reduce glare.

The handling procedure

Before deciding on control options to address this
risk factor, consider what is the most appropriate way
of handling a person.

In addition, consider the following:

Provide mechanical handling equipment; including
mechanical handling equipment, lifting devices, mobile
and fixed hoists with rigid seats, slings or lifting
frames.

Mechanical handling equipment should be:

• Easy to use
• Designed to suit the load
• Readily available and accessible during ordinary
activities and emergencies
• Regularly serviced, including maintenance of
castors.

Consider the following when selecting mechanical

hoists and hoist systems:
• The typical handling tasks/actions for which the
equipment is likely to be used, for example, transfers
between bed, chair, bath, toilet and vehicle.
• The characteristics of people to be lifted, for
example, size, weight, disabilities and behavior
• The work environment, for example accessibility,
floor surfaces, layout
• The design of hoists, for example, load capacity,
range of lift, stability, accessibility, clearance,
maneuverability, reliability, attachments, control and
safety mechanisms, ease of use, compatibility with
other equipment
• The design of slings, for example, safety,
stability, style, comfort and acceptability to users,
ease of attachment and removal, access for toileting.

Note, the provision of mechanical handling equipment

should be accompanied by training in its use and a
maintenance schedule for the equipment. This training
should be provided to all users.

Provide assistive handling devices; a range of aids is

available to assist with particular tasks/actions:
• Carrying a person; spine boards, scoop stretcher,
basket stretcher, drop sheet stretcher, emergency back
board

(Note, while 2 workers would be required to assemble

the stretcher, at least 4 workers would be required to
undertake the transfer.)

• Lifting a person; lifting frame

• Transferring a person; transfer belt, rigid slide
board (fiberglass board which can be used to form a
bridge between bed and trolley, bed and bath trolley,
wheelchair and car)
• Repositioning a person; PVC transfer board, patient
slide, slide sheet/cushion and drawsheet
• Pivoting a person; turning disk, turntable
• Positioning a person in bed; a fabric sliding aid
and slip sheet
• A person changing position themselves; pull ropes,
monkey pole, patient hand or foot blocks, rope ladder
and hand rails.

Handling aids should be:

• As light as their function will permit
• Well balanced, with the angle between handle and
working parts designed to avoid extreme bending of the
wrists and arms
• Designed to allow comfortable and secure grasp
• Suitable for both right and left-handed workers and
for hands of different sizes
• Designed for two handed use where appropriate.

Avoid double handling:

• Eliminate or reduce multiple handling actions by
introducing equipment like tilting/ reclining chairs,
shower chairs/ trolleys, trolleys or mechanical
lifting devices.

• Provide lightweight chairs with wheeling attachments

on the legs to allow the chair to be moved to the
desired location, to avoid having to transfer the
person from one chair to another.
• Use easy to manoeuvre hospital beds instead of
trolleys for relocations to the operating theatre.
• Eliminate the need to use awkward handling
environments, for example, the choice of classroom for
a disabled student to eliminate the need to use
stairs.
*Modify the handling procedure; lifting and lowering
• Encourage the person to assist, when possible
• Convert to pushing or pulling by use of transfer
systems like wheelchairs, trolleys and hoists.
• Transfer at level by adjusting furniture in starting
or finishing locations so they are at the same height.
• Reduce the weight to be lifted or lowered, for
example, by removing a blanket
• Improve access to bring the person close to the
worker's body
• Move a person to the same level or from a higher to
a lower level rather than the reverse.

Modify the handling procedure; holding and carrying

Use furniture or mechanical equipment to eliminate or
minimize holding time, for example, pushers, chairs,
beds or tables.

Modify the handling procedure; pushing and pulling

• Eliminate the need to push or pull by using
hydraulic-powered mechanical equipment, for example,
hoists, or mechanical pushers, pullers, bedmovers,
detachable load transporters, tugs.
• Use wheels or castors appropriate to transfer
surfaces.

• Design the work method so that the worker does not

have to:

• Push, pull or slide a person sideways

• Apply these forces from a sitting position.

• Use equipment with pushing/pulling applied at about

waist level.
• Provide good maintenance of equipment, wheels and
castors, and floor surfaces.

*Avoid manual lifting and carrying of a person.

Manual lifting and carrying should only be used as a
last resort where lifting aids are unavailable or
impractical, and only:
• In emergency or exceptional circumstances
• After a risk assessment is done, and
• If other workers are available for team handling and
they have been suitably trained.

Transferring the risk to another worker is not

acceptable. The handling procedure should be able to
be controlled without having to call on another worker
with exceptional capacity, or a worker from another
organization (for example, Ambulance).

Design procedures for people falling suddenly.

There is no choice but to deal with this situation

manually. However, workers will be at risk and it is
necessary to train them in the following, prior to
working with people:

• Technique to assist people to the ground so as to

avoid injury to the worker and the person. Specialist
advice will be needed for this.
• What the procedure is for seeking assistance,
administering first aid etc.
• How to make the person comfortable
• How to call for assistance, for example how and when
to use a mechanical aid, to transfer the person from
the ground.

Team handling should only be used where no other

solution is available. Team handling is inherently a
risk as it is impossible to ensure equitable load
sharing and/or to prevent sudden transfer of load.

Risks in team handling include:

• Inexperience in one or some of the team members,
which may mean the load is not shared equally
• Different physical dimensions (such as height) of
team members and different capacity of individual
members, which can also mean the load is not shared
equally
• Team members not exerting force simultaneously
• Coordination loss by individual team members,
because of the adjustments they make, for example,
hand and foot placement to fit in with other team
members
• If operating on steps or a slope, most of the weight
being borne by team members at the lower end
• Unexpected increased loading and/or change in
balance because one team member loses his/her grip
• "social loafing", where some team members are forced
to carry the bulk of the load because others choose to
use minimal effort.

For team handling, decide on;

(a) The handling procedure, and
(b) The number of workers needed.

Before starting, make sure;

• One person is appointed to co-ordinate the lift and
instruct the others
• The team members are of similar capacity and stature
and know their responsibilities during the lift
• Aids to assist with handling (stretcher, slings,
straps, lifting bars, lifting tongs, trolleys, hoists)
are used where possible
• There is enough space for the handlers to manoeuvre
as a group
• Appropriate training in team handling has been
provided
• The lift has been rehearsed, including what to do in
case of emergency.

Training for team handling should include the

following elements:

• Assessing the load; the physical characteristics of

the person (such as their weight, type of injuries the
person might have etc.) and the non-physical
characteristics of the person (such as the person‟s
state of arousal, their predictability of behavior
etc.).
• Assessing the lift; type of lift, number of people,
where they should stand etc.
• Preparing to lift; clear the area of potential
hazards and obstacles.
• Timing and coordination of team members; using a
countdown to minimize unexpected movement.
• A worker giving warning to other team members if
s/he is not ready to commence the lift and/or needs to
rest temporarily while carrying the load.
• Dealing with unexpected loading, for example, one
team member suddenly lets go of the load.
• Using lifting aids.
• Practicing team lifting.

Team handling outside the regular workplace: In

situations where a worker is at a workplace outside
his/her control, for example, a rescue scene, or a
person‟s home, it may be necessary to seek assistance
from bystanders or carers. In such circumstances, the
worker should;
• Be trained in how to instruct others in assisting
with team handling
• Give clear directions to the helper/s, before the
transfer.

Characteristics of the person being handled

The characteristics of the person being handled need
to be considered in planning a handling method that is
safe for the person and the worker/s. Consider the
following:

Change the presentation of the person, such as, the

posture of the person and the positioning of any
attached items so that the person is easier to grip
and can be held close to the worker.

For example:
• Person being handled might grasp one wrist with the
other hand or cross their arms
• The hands of a person being rescued can be tied
together to assist being carried by rescuers

*Plan for unpredictable movement:

When you have identified people who might make
involuntary or unexpected movements or be
uncooperative, select the handling method accordingly
with sufficient workers to support the person and to
react to sudden movements of the trunk or limbs.

Consider attachments to the person which can promote

instability:
• Plan how to deal with tubes, splints, braces, casts,
monitoring devices which also need to be handled with
the person
• Lighten the weight on stretchers to be carried by
removing any unnecessary items such as blankets.

Improve grip by considering clothing;

• Modify the person‟s clothing so it does not
interfere with a secure grip by the handler.
• For people with a fragile skin, grip clothing if it
is sturdy enough instead of the person.

Communicate with the person where possible. Seek

maximum assistance and cooperation from the person
being handled by ensuring, as far as possible, that
the person is fully prepared and understands the
procedure to be used.

Individual characteristics of the worker

Consider the following:
*Competency: Make sure workers receive training and
supervision in;
• Performing all the routine handling tasks and
actions to be done in their work unit, and acquire an
understanding of the risks they might be exposed to,
particularly if these tasks/actions are not performed
correctly.
• Doing a risk assessment of actions they are required
to perform.
• Working with new equipment or work procedures that
have been introduced.

*Physical capacity: Assess the needs of workers who

are younger, older, pregnant, or with an existing back
injury when deciding;
• Who should do specific tasks/actions
• How many workers are needed in a team handling
situation involving the worker
• On the duration of a particular task/action
• On longer working hours.

Note: In making decisions about individual workers, it

may be necessary to seek assessment through a health
professional in relation to the specific duties of a
job.

Unaccustomed work can affect workers new to the area,

or returning from extended absences for example
maternity leave, recovering from an operation, or
other medical problems such as a hernia.

Provide a gradual adjustment process to physically

demanding work activities through;
• Allocation to tasks with lighter physical demands
• A gradual introduction to the full number of people
handling tasks normally performed
• More frequent rest breaks
• Job rotation.

Clothing; including uniforms and other specialist

clothing worn by workers involved in people handling
activities, should allow for easy functional movement.
For example;
• Freedom of hip and knee movement so that the worker
can kneel, have one knee up on a bed close to the
person, squat with the legs widely spread, or assume a
semi-squat or half kneeling position. Trousers and
culottes, for example, generally enable unrestricted
working postures, while allowing for modesty and
comfort.
• No upper limb restriction when placing the arms
around a person. This can be done by designing
garments with an "action back" to give extra room when
needed, or making them in a fabric that stretches, for
example, knit materials
• No restriction due to excess material being caught
in equipment or being knelt on.

Note: A conventional straight-skirted short dress is

generally not suitable for many people handling tasks.

Footwear; should offer good support and stability and

have non-slip soles and heels to prevent slips and
falls, and allow the best postures for forces applied.

PPE; use PPE appropriate to the particular demands of

the action;

• Gloves should not hinder the worker's ability to

gain and maintain a secure grip on the person.
• In areas where foot-covers are worn, make sure the
floor surface is non-slip.
• Consider a reduced shift length or increased rest
periods when workers are wearing heavy protective
clothing, which increases the physical demands of
working in hot or cold conditions.

Work organization
Consider the following:
*Work load: Plan resources and organize tasks to
facilitate work during peak periods by;
• Arranging staff levels so that there are sufficient
workers available to complete tasks at peak periods.
• Rescheduling tasks so that physically heavy
workloads are spread throughout a shift or shared
throughout the day by workers on different shifts
instead of being concentrated in one shift.
• Providing sufficient staff, or a procedure for
accessing help when a dependent person is being
transferred.
• Arranging tasks so that additional rest breaks will
be available to workers beyond set breaks or
negotiated arrangements, if required.

Working in isolation: To overcome a lack of ready

assistance from other workers;
• If the person being handled is able to bear their
own weight, they can assist the worker.
• If the person is unable to bear weight, the worker
should use mechanical assistance.
• There are many new products available which might be
useful, such as the fitting of portable overhead
tracking systems and various hoists.

*Task variation; to help prevent problems with

repetitious activity;
• Combine two or more tasks to be done by one worker.
It is preferable if the second task does not involve
people handling, for example, administrative work.
• Allow rotation of tasks within a certain number of
workers so that each worker can have frequent changes
of tasks.

Extended hours; determine whether the type of work is

suitable for shifts longer than eight hours.
Repetitive and/or physically demanding work might not
be suitable for long work hours.

In general;

• Reschedule tasks when overtime is worked so that the

amount of heavy or repetitive work is not increased
• Provide additional or longer rest breaks when
overtime is worked
• Do not require workers recovering from injury to
work overtime unless part of a prescribed workplace
rehabilitation program.

*Purchasing specifications; when purchasing equipment,

it is necessary to specify the;
• Uses or functions of the equipment
• General performance characteristics required
• Need to accommodate a range of physical
characteristics of workers and/or people.

Maintenance and servicing; establish procedures for

the routine maintenance and regular servicing of
equipment as per the manufacturer‟s specification.

List which equipment requires servicing and

specify for each:
• Who is responsible for the servicing (some might be
suitable for servicing by workers, and others only by
qualified personnel)
• The nature of the servicing needed
• Frequency of servicing (the frequency might need to
be increased with increasing age of the equipment).

Reporting procedures; put systems in place for workers

to report;
• Problems with equipment (or any other aspects of
work organization) needing attention. Early
reporting is desirable, otherwise these items could be
causing unnecessary muscular strain and might lead to
injury.
• The need for assistance with undertaking a people
handling task/action.

Specify clear guidelines to

(a) Workers on how and to whom to report in either
circumstance; and
(b) to supervisors on how to respond to a worker‟s
report.

Emergency procedures: When designing procedures for

evacuation of a building during an emergency, consider
the effect of people handling on the health and safety
of workers.

Consult workers; who do the everyday work in a work

area, before changes are made to facilities or new
equipment is purchased.

DEFINITIONS:

Cognitive; faculty of knowing or perception.

Hazard; something with the potential to cause harm.

Incident; an accident or event which results in death,

injury or illness.

Person or people; person/s being handled and include

babies and children, people with disabilities and
deceased people.

People handling; workplace activities requiring the

use of force exerted by a worker to hold, support,
transfer (lift, lower, carry, push, pull, slide), or
restrain another person at a workplace.

People handling actions; individual elements of the

people handling task and refer to movements which are
undertaken.

People handling activities; any movement where a

person is handled.

People handling tasks; specific pieces of work

undertaken at the workplace, which involve the
physical movement of a person.
Proper diligence; the opposite of negligence and
requires taking reasonable care. It refers to making
sure that selected control measures are actually
implemented at the workplace.

Reasonable precautions; having a risk management

process in place at the workplace.

Restraint; restraint needed as an adjunct to a people

handling activity such as when transferring or
assisting a person. It does not cover handling
aggression, where aggression is the major hazard (e.g.
in the Police Service).

Risk; likelihood that death, injury or illness might

result because of the hazard.

Rotator; muscles and tendons that surround the

shoulder joint to form a musculotendinous cuff.

Transfer; physical moving of a person from one

position to another. It includes lifting, lowering,
carrying, pushing, pulling and sliding.

Work area; part of the workplace where a particular

people handling action is based. It includes furniture
and fittings, vehicles, and the equipment used by
workers in doing the action.

Work-Related Musculoskeletal Disorders (WMSDs);work-

related disorders that involve soft tissues such as
muscles, tendons, ligaments, joints, blood vessels and
nerves. Examples include: Muscle strains and tears,
ligament sprains, joint and tendon inflammation,
pinched nerves, degeneration of spinal discs, carpal
tunnel syndrome, tendinitis, rotator cuff syndrome.

Worker; anyone in a carer situation, involved in a

rescue or involved in moving a deceased person.
Workplace health and safety obligations
Obligations of employers:
*To ensure the workplace health and safety of each of
the employer‟s workers at work;

*To ensure his or her own safety and the workplace

health and safety of others is not affected by the way
the employer conducts the employer‟s undertaking.

To help in eliminating or minimizing risks from people

handling activities, workers should also;

Take part in activities to identify, assess and

control the risk of WRMDsreport to the employer or
supervisor;
• Any problems with the performance of a people
handling action
• Any pain or discomfort, for example, low back pain
during or following performance of people handling
actions that indicate a problem with an action.
• Any product or equipment that could provide an
alternative way of doing a task or action and reducing
some of the health and safety problems
• If training has not been provided for particular
people handling activities, or for using specific
handling aids
• If specific pieces of equipment need maintenance or
servicing
PRINCIPLES OF GOOD COMPLAINT HANDLING

Good complaint handling means:

*Getting it right
*Being client focused
*Being open and accountable
*Acting fairly and proportionately
*Putting things right
*Seeking continuous improvement

Everyone has the right to expect a good service and to

have things put right if they go wrong. When things do
go wrong, service providers should manage complaints
properly so clients‟ concerns are dealt with
appropriately.

Good complaint handling matters because it is an

important way of ensuring clienteles receive the
service they are entitled to expect. Complaints are a
valuable source of feedback for the service providers
; they provide an audit trail and can be an early
warning of failures in service delivery.

When handled well, complaints provide an opportunity

for service providers to improve their service and
reputation.

Good complaint handling should be led from the top,

focused on outcomes, fair and proportionate, and
sensitive to complainants‟ needs. The process should
be clear and straightforward, and readily accessible
to clients.

It should be well managed throughout so that decisions

are taken quickly, things putright where necessary and
lessons learnt for service improvement.
*Putting things right;
• Signposting to the next stage of the complaints
procedure, in the right way and at the right time.

• Providing prompt, appropriate and proportionate

remedies.

•Acknowledging mistakes and apologizing where

appropriate.

•Considering all the relevant factors of the case when

offering remedies.

*Being customer focused;

• Taking account of any injustice or hardship that
results from pursuing the complaint as well as from
the original dispute.

•Ensuring that complainants can easily access the

service dealing with complaints, and informing them.

*Seeking continuous improvement;

•About advice and advocacy services where appropriate.
Dealing with complainants promptly and sensitively,
bearing in mind their individual circumstances.

•Listening to complainants to understand the complaint

and the outcome they are seeking.

•Having systems in place to record, analyse and report

on the learning from complaints.
Using all feedback and the lessons learnt from

•Complaints to improve service design and delivery.

• Responding flexibly, including co-coordinating

responses with any other bodies involved.

•Regularly reviewing the lessons to be learnt from

complaints.
•Where appropriate, telling the complainant about the
lessons learnt and changes made to services.

*Being open and accountable;

•Publishing clear, accurate and complete information
about how to complain, and how and when to.

•Providing honest, evidence-based explanations and

giving reasons for decisions.

•Keeping full and accurate records.

Good complaint handling requires strong and effective

leadership. Those at the top should take the lead in
ensuring good complaint handling, with regard to both
the practice and the culture.

*Senior managers should:

• Set the complaint handling policy, and own both the
policy and the process.

• Give priority and importance to good complaint

handling, to set the tone and act as an example.

• Develop a culture that values and welcomes

complaints as a way of putting things right and
improving service.

• Be responsible and accountable for complaint

handling.

• Ensure that effective governance arrangements

underpin and support good complaint handling.

• Ensure the policy is delivered through a clear and

accountable complaint handling process.

• Ensure learning from complaints is used to improve

service.
Staff should be properly equipped and empowered to put
things right promptly where something has gone wrong.
They should be supported by clear lines of authority
and decision making that are flexible enough to respond
to complaints effectively and authoritatively.

Complaint handling should focus on the outcomes for

the complainant and, where appropriate, others
affected. Public bodies should put in place policies
and procedures to ensure complainants are treated
fairly, to aid decision making and to ensure fair
outcomes. Those policies and procedures should allow
staff the flexibility to resolve complaints promptly
and in the most appropriate way while still learning
from complaints.

*Service providers should do the following:

•Ensure their complaints procedure is simple and
clear, involving as few steps as possible.

•Ensure that their complaint handling arrangements are

easily accessible to their clients.

•Let their clients know about any help or advice that

may be available to them if they are considering
making a complaint.

•Deal with complaints promptly, avoiding unnecessary

delay, and in line with published service standards
where appropriate.

•Resolving problems and complaints as soon as possible

is best for both complainants and public bodies.

•Acknowledge the complaint and tell the complainant

how long they can expect to wait to receive a reply.

•Service providers should keep the complainant

regularly informed about progress and the reasons for
any delays, and provide a point of contact throughout
the course of the complaint.

•Treat complainants sensitively and in a way that

takes account of their needs.

•Use language that is easy to understand, and

communicate with the complainant in a way that is
appropriate to them and their circumstances. For
example, making arrangements for complainants with
special needs or those whose first language is not
English.

•Listen to and consider the complainant‟s views,

asking them to clarify where necessary, to make sure
the authority understands clearly what the complaint
is about and the outcome the complainant wants.

•Respond flexibly to the circumstances of the case.

This means considering how the public body may need to
adjust its normal approach to handling a complaint in
the particular circumstances.

•Ensure, where complaints raise issues about services

provided by more than one public body, that the
complaint is dealt with in a co-ordinated way with
other providers. If a public body cannot respond, it
should refer the complainant quickly to other sources
of help.

•Ensure that information about how to complain is

easily available.

•Be open and honest when accounting for their

decisions and actions. They should give clear,
evidence-based explanations, and reasons for their
decisions. When things have gone wrong, public bodies
should explain fully and say what they will do to put
matters right as quickly as possible.
•Create and maintain reliable and usable records as
evidence of their activities. These records should
include the evidence considered and the reasons for
decisions.

• Public bodies should manage complaint records in

line with recognized standards to ensure they are kept
and can be retrieved for as long as there is a
statutory duty or business need. This can include the
need to respond to complaints or to provide relevant
information to the Supervisory body.

• Handle and process information properly and

appropriately, in line with the law and relevant
guidance.

•So while their policies and procedures should be

transparent, public bodies should also respect the
privacy of personal and confidential information, as
the law requires.

•Take responsibility for the actions of their staff

and those acting on behalf of the public body.

•Understand and respect the diversity of their

customers and ensure fair access to services
regardless of background or circumstances.

•Investigate complaints thoroughly and fairly, basing

their decisions on the available facts and evidence,
and avoiding undue delay.

•Public bodies should deal with complaints

objectively, fairly and consistently, so that similar
circumstances are handled similarly. Any different
decisions about two similar complaints should be
justified by the circumstances of the complaint or
complainant.
• Seek to ensure, where a complaint relates to an
ongoing relationship between the public body and
complainant, that staff do not treat the complainant
any differently during or after the complaint.

• Avoid taking a rigid, process-driven, „one-size-fits-

all‟ approach to complaint handling, and ensure the
response to an individual complaint is proportionate
to the circumstances. This means taking into account
the seriousness of the issues raised, the effect on
the complainant, and whether any others may have
suffered injustice or hardship as a result of the same
problem.

•Ask a member of staff who was not involved in the

events leading to the complaint to review the case.

•The public body can still put things right quickly

for the complainant where appropriate.

•Act fairly towards staff as well as customers. This

means ensuring members of staff know they have
been complained about and, where appropriate, have an
opportunity to respond.

•A minority of complainants can be unreasonably

persistent or behave unacceptably in pursuing their
complaints. Public bodies should have arrangements for
managing unacceptable behavior.

Providing fair and proportionate remedies is an

integral part of good complaint handling. Where a
public body has failed to get it right and this has
led to injustice or hardship, it should take steps to
put things right.

That means, if possible, returning complainants and,

where appropriate, others who have suffered the same
injustice or hardship as a result of the same
maladministration or poor service, to the position
they were in before this took place. If that is not
possible, it means compensating complainants and such
others appropriately.

In many cases, a prompt explanation and an apology

will be a sufficient and appropriate response and will
prevent the complaint escalating.

Apologizing is not an invitation to litigate or a sign

of organizational weakness.

There is a wide range of appropriate responses to a

complaint that has been upheld.

These include:
•An apology, explanation and acknowledgement of
responsibility

•Remedial action, which may include reviewing or

changing a decision on the service given to an
individual complainant; revising published material;
revising procedures, policies or guidance to prevent
the same thing happening again; training or
supervising staff; or any combination of these

•Financial compensation for direct or indirect

financial loss, loss of opportunity, inconvenience,
distress, or any combination of these.

When deciding the level of financial compensation,

public bodies should consider:
•The nature of the complaint
•The impact on the complainant
•How long it took to resolve the complaint
•The trouble the complainant was put to in pursuing
it.

Remedies may also need to take account of any

injustice or hardship that has resulted from pursuing
the complaint as well as from the original dispute.
Good complaint handling is not limited to providing an
individual remedy to the complainant:

Public bodies should ensure that all feedback and

lessons learnt from complaints contribute to service
improvement.

Learning from complaints is a powerful way of helping

to improve public service, enhancing the reputation of
a public body and increasing trust among the people
who use its service. Public bodies should have systems
to record, analyse and report on the learning from
complaints. Public bodies should feed that learning
back into the system to improve their performance.

It is good practice for public bodies to report

publicly on their complaint handling performance. This
should include reporting on the number of complaints
received and the outcome of those complaints. Where
complaints have led to a change in services, policies
or procedures, public bodies could report those
changes.

*Reporting on complaint handling performance can help

to:

•Motivate staff
•Promote achievement
•Drive improvement in service delivery
•Boost public confidence in the complaint process
•Encourage potential complainants to access the scheme
properly
•Enable public bodies to identify patterns in
complaints.

*Public bodies should ensure they:

•Tell the complainant when lessons have been learnt as
a result of their complaint.
•State any changes they have made to prevent the
problem recurring.
INCIDENT REPORTING

Prompt reporting of an incident is a critical

component to a risk management program. An incident is
an unplanned occurrence that resulted or could have
resulted in injury to people or damage to property. An
incident may also be considered an accident or near
miss.

When an incident is reported promptly, injured persons

receive timely medical care, unsafe conditions are
quickly corrected, and evidence is preserved for
administration of potential claims. Incidents should
be reviewed to identify trends, effectiveness of
current safety programs, and to prevent similar
incidences from reoccurring.
VIOLENCE AND AGGRESION

Intentional behavior aimed at doing harm or causing

pain to another person.

*Violence and aggression triggers

.Arousal; It is a physiological and psychological

state of being awake or reactive to stimuli.

.The Media; The more TV violence individuals watch as

children, the more violence they exhibit later as
teens and young adults.

.Pain;Pain heightens aggressiveness in individuals.

.Heat;Aggression is related warmer atmospheric

conditions

.Attack;Defense mechanisms against assaults.

.Crowding; Crammed in the back of the bus, trapped in a

slow moving freeway traffic, or living in a small
room in a college dorm diminishes one‟s sense of
control.

*How to Reduce Aggression

.Catharsis

.A social Learning Approach

Catharsis:
.A catharsis is an emotional release.
.According to psychoanalytic theory, this emotional
release is linked to a need to release unconscious
conflicts. Example: Work stress and physical activity
stress relieving activity.

Social Learning Approach:

.According to the social learning theory of
aggression, people learn aggressive behaviors from
watching other people and exhibit same behavior.

.This approach elaborates on watching nonviolent

people as a model of behavior.
FOOD HYGIENE

Food borne illness and food borne injury are

unpleasant; they can be fatal.

Primary Production
Primary production should not be carried on in areas
where the presence of potentially harmful substances
would lead to contamination. Care should be taken to
manage wastes and store harmful substances
appropriately.

Establishment: Design and Facilities

*Location:
The establishments should normally be located away
from environmentally polluted areas and industrial
activities which pose a serious threat of
contaminating food, areas subject to flooding unless
sufficient safeguards are provided, areas prone to
infestations of pests and areas where wastes, either
solid or liquid cannot be removed effectively.

*Equipment:
They should be located so that it permits adequate
maintenance and cleaning, functions in accordance with
its intended use and facilitates good hygiene
practices.

*Premises and rooms:

Where appropriate the internal design and layout of
food establishments should permit food hygiene
practices including protection against cross
contamination between and during operations by
foodstuffs.

*Internal structures and fittings:

The surface of walls, partitions and floors should be
made of waterproof materials with no toxic effect in
intended use. The walls and partitions should have a
smooth surface up to a height appropriate to the
operation.

The floors should be constructed to allow adequate

drainage and cleaning. The ceilings and overhead
fixtures should be constructed and finished to
minimize the buildup of dirt and condensation and
shedding of particles.

The windows should be easy to clean, be constructed to

minimize the buildup of dirt where necessary be fitted
with removable and cleanable insect proof screens.
Where necessary the windows should be fixed. The doors
should have smooth, non-absorbent surfaces and is easy
to clean and where necessary disinfect.

The working surfaces that come into contact with food

should be in sound condition, durable and easy to
clean, maintain and disinfect. They should be made of
smooth, non-absorbent materials and inert to food, to
detergents and disinfectants under normal operating
conditions.

*Facilities:

Water supply:
An adequate supply of potable water with appropriate
facilities for its storage, distribution, and
temperature control should be available where
necessary to ensure the safety and suitability of
food.

Potable water should be of higher standard as per FAO

specifications or BIS. Non-potable water shall have
separate system. They should be identified and shall
not connect with or allow reflux into potable water
systems.

Drainage and waste disposal:

Adequate drainage and waste disposal systems and
facilities should be provided. They should be designed
and constructed so that the risk of contaminating food
or the potable water supply is avoided.

Cleaning:
Adequate facilities suitably designed should be
provided for cleaning food, utensils, and equipment.
Such facilities should have an adequate supply of hot
and cold potable water where appropriate.

Personal hygiene:
Where appropriate facilities should include adequate
means of hygienically washing and drying hands,
including washbasins and a supply of hot and cold
water. Should have lavatories of appropriate hygienic
design and adequate changing facilities for personnel.

Temperature control:
Adequate facilities should be available for heating,
cooling, cooking, refrigerating and freezing food, for
storing refrigerated or frozen foods, monitoring food
temperatures and when necessary controlling ambient
temperatures to ensure the safety and suitability of
food.

Air quality and ventilation:

Adequate means of natural or mechanical ventilation
should be provided.

Lighting:
Adequate natural or artificial lighting should be
provided to enable the undertaking to operate in a
hygienic manner. Where necessary lighting should not
be such that the resulting color is misleading.

The intensity should be adequate to the nature of the

operation. Lighting fixtures should where appropriate
be provided to ensure that food is not contaminated by
breakages.
Storage:
Where necessary adequate facilities for the storage of
food, ingredients and non-food chemicals should be
provided. The storage facilities should be designed
and constructed to permit adequate maintenance and
cleaning, avoid pest access and harborage and enable
food to be effectively protected from contamination
during storage and provide environment, which
minimizes the deterioration of food.

*Control of Operation

Control Food hazards:

The food hazards should be controlled. They should
identify any steps in their operations critical to the
safety of food, implement effective control procedures
at those steps, monitor control procedures to ensure
their continuing effectiveness and review control
procedures periodically and whenever the operations
change.

*Key aspects of hygiene control systems:

Time and temperature control:

Adequate food temperature control should be adopted.
The controls should take into account the nature of
food, the intended shelf life, the method of packaging
and processing and how the product is intended to be
used.

Specific process steps:

Other steps such as chilling, thermal processing,
irradiation, drying, chemical preservation and vacuum
or modified packaging may be included.

Microbiological and other specifications:

Where microbiological and chemical or physical
specifications are used in any food control system,
such specifications should be based on sound
scientific principles and state where appropriate,
monitoring procedures, analytical methods and action
limits.

Microbiological cross contamination:

Pathogens can be transferred from one food to another,
either by direct contact or by food handlers, contact
surfaces or the air. Raw and unprocessed food may be
separated either physically or by time from ready to
eat foods with effective intermediate cleaning and
appropriate disinfections. Access to processing areas
may need to be restricted or controlled.

Physical and chemical contamination:

Systems should be in place to prevent contamination of
foods by foreign bodies such as glass or metal shards
from machinery, dust, harmful fumes and unwanted
chemicals. In manufacturing and processing, suitable
detection or screening devices should be used where
necessary.

Incoming material requirements:

Raw materials or ingredients should where appropriate
be inspected and sorted before processing. Where
necessary laboratory tests should be made to establish
fitness for use. Only sound, suitable raw materials or
ingredients should be used.

Packaging:
Packaging design and materials should provide adequate
protection for products to minimize contamination,
prevent damage and accommodate proper labeling. Where
appropriate reusable packaging should be used.

Water:
Only potable water should be used in food handling and
processing except for steam production and chilling.

Management and supervision:

Managers and supervisors should have enough knowledge
of food hygiene principles and practices to be able to
judge potential risks, take appropriate preventive and
corrective action and ensure that effective monitoring
and supervision takes place.

Documentation and records:

Where necessary appropriate records of processing,
production and distribution should be kept and
retained for a period that exceeds the shelf life of
the product.

Recall procedures:
Managers should ensure effective procedures are in
place to deal with any food safety hazard and to
enable the complete, rapid recall of any implicated
lot of the finished food from the market.

Recalled products should be held under supervision

until they are destroyed, used for purposes other than
human consumption, determined to be safe for human
consumption or reprocessed in a manner to ensure their
safety.

*Establishment: Maintenance and sanitation

Maintenance and Cleaning:

Establishments and equipment should be kept in an
appropriate state of repair and condition to
facilitate all sanitation procedures and prevent
contamination of food e.g. from metal shards, debris,
chemicals etc.

Cleaning should remove food residues and dirt, which

may be source of contamination. Disinfections may be
necessary after cleaning. Cleaning chemicals should be
handled and used carefully and in accordance with
manufacturers‟ instructions and stored.

Cleaning procedures and methods:

Cleaning procedures will involve where appropriate in
removing gross debris from surfaces, applying
detergent solution to loosen soil and bacterial film
and hold them in solution or suspension, rinsing with
water to remove loosened soil and residues of
detergents, dry cleaning or other appropriate methods
for removing and collecting residues and debris and
where necessary, disinfections with subsequent rinsing
unless the manufacturers‟ instructions indicate on a
scientific basis that rinsing is not required.

Cleaning programs:
Cleaning and disinfections programs should be
continually and effectively monitored for their
suitability and effectiveness and where necessary
documented.

Where written cleaning programs are used, they should

specify areas, items of equipment and utensils to be
cleaned, responsibility for particular tasks, method
and frequency of cleaning and monitoring arrangements.

Pest control systems:

Good hygiene practices should be employed to avoid
creating an environment conducive to pests. Good
sanitation, inspection of incoming materials and good
monitoring can minimize the likelihood of infestation.

Buildings should be kept in good repair and condition

to prevent pest access and to eliminate potential
breeding sites. Holes, drains and other places where
pests are likely to gain access should be kept sealed.

Wire mesh screens on open windows, doors and

ventilators will reduce the problem. Animals should be
excluded from the grounds of factories and processing
plants.

Areas both inside and outside food premises should be

kept clean. Where appropriate refuse should be stored
in covered pest proof containers. Establishments and
surroundings should be regularly examined. Pest
infestations should be dealt with immediately.

Waste management:
Suitable provision must be made for the removal and
storage of waste. It must not be accumulated in food
handling, food storage and other working areas.

Monitoring effectiveness:
Sanitation systems should be monitored for
effectiveness, periodically verified by means such as
audit pre operational inspections or where appropriate
microbiological sampling of environment and food
contact surfaces and regularly reviewed and adopted to
reflect changed circumstances.

*Establishment: Personal hygiene

Health status:
People known or suspected to be suffering from
jaundice, diarrhea, vomiting, fever, sore throat with
fever, visibly infected skin lesions, discharges from
the ear, eye, nose etc. or to carriers of a disease or
illness likely to be transmitted through food, should
not be allowed to enter any food handling area if
there is a likelihood of their contaminating food.

Personal cleanliness:
Personnel should always wash their hands at the start
of food handling activities, immediately after using
the toilets and after handling raw food or any
contaminated material when personal cleanliness may
affect food safety.

Personal behavior:
People engaged in food handling activities should
refrain from smoking, spitting, chewing or eating and
sneezing or coughing over un protected food in the
processing areas.
Visitors:
Where appropriate the visitors should wear protective
clothing and adhere to the other personal hygiene
provisions.

Transportation:
Food must be adequately protected during transport.
Where necessary conveyances and bulk containers should
be designed and constructed so that they do not
contaminate foods or packaging, can be effectively
cleaned, permit effective separation of different
foods, provide effective protection from contamination
including dust and fumes, can effectively maintain the
temperature, humidity, atmosphere and other conditions
necessary to protect food from harmful or undesirable
microbial growth and allow any necessary temperature,
humidity and other conditions to be checked.

Conveyances and containers for transporting food

should be kept in an appropriate state of cleanliness,
repair and condition. Where appropriate, particularly
in bulk transport, containers and conveyances should
be designated and marked for food use only and be used
only for that purpose.

*Product information and consumer awareness

Lot identification is essential in product recall and
also helps effective stock rotation. All products
should be accompanied by or bear adequate information
to enable the next person in the food chain to handle,
display, store and prepare and use the product safely
and correctly.

Prepackaged foods should be labeled with clear

instructions to enable the next person in the food
chain to handle carefully. Consumers should be given
the information on the health benefits of the
products, nutritional profile, its shelf life and
other instructions in using the product safely.
*Training
Food hygiene training is fundamentally important. All
personnel should be aware of their role and
responsibility in protecting food from contamination
or deterioration. Food handlers should have the
necessary knowledge and skills to enable them to
handle food hygienically.

Systems should be in place to ensure that food

handlers remain aware of all procedures necessary to
maintain the safety and suitability of food. All
personnel involved in the food chain must be given
training on all the aspects of food hygiene to produce
food with safety. Training programs should be
routinely reviewed and updated where necessary.
HANDLING INFORMATION IN HEALTH AND SOCIAL CARE
SETTINGS

*Indentify the legislation that relates to the

recording, storage and sharing of information
in health and social care.
. Data Protection Act
. Freedom of Information Act
. Caldicott Principles
. Information Commissioner‟s Office

*Explain why it is important to have secure system for

recording and storing information in health and care
setting. Current legislation requires everyone working
in social care to maintain certain records and keep
them secure.

Different employers will keep different records and in

different ways. Most of the information is sensitive
and therefore not available to the general public so
it is important that information is stored securely so
it cannot be accessed by people who have no right to
see it.

Information that is sensitive is called “Confidential”

*Describe how to access guidance, information and

advice about handling information. The guidance could
be seen on the data protection act, freedom of
information act, caldicott principles and from the
direction of the company you are working at.

*Explain what actions to take when there are concerns

over recording, storing and sharing information. You
have a duty of care to report the situation
immediately to your manager or supervisor.

*Explain how to keep records up to date, complete,

accurate and legible. Information that needs to be
recorded should always be written in a legible manner.
Legible means clear, readable and understandable.

It could be harmful to an individual if other people

cannot read what you have written, for example in a
care plan about the way the individual is feeling.

Records must always be factual and not an opinion.

They should include the correct date and a full
signature of the person writing the record. It is also
recommended to use black ink. Some documents will only
accept black ink.

Information must not be crossed out or covered using

correction fluid. Always record any information
given to you by an individual even if you think it is
trivial because it might help someone else.

Always check an individual‟s care and support plan

before working with them as there may have been
changes since you last worked with the individual,
even if it was only a short time ago.

*Explain how you follow agreed ways of working for

recording, storing and sharing information. Following
the employers protocol in handling of information
Basic Life Support

Basic Life Support is the technique of chest

compressions combined with rescue breathing.

The purpose is to temporarily maintain a circulation

sufficient to preserve brain function until
specialized treatment is available.

Rescuers must start Basic Life Support if the victim

is unresponsive and not breathing normally. Even if
the victim takes occasional gasps, rescuers should
start.

Compression ventilation ratio

Current consensus is that a universal compression-
ventilation ratio of 30:2 (30 compressions followed by
two ventilations) is recommended for all ages
regardless of the numbers of rescuers present.

Steps
*Check for danger
*Check for response (if unresponsive)
*Send for help
*Open the airway
*Check breathing (if not breathing / abnormal
breathing)
*Give 30 chest compressions (almost two
compressions/second) followed by two breaths

If rescuers are unwilling or unable to do rescue

breathing they should do chest compressions
only.

The rescuer should continue until:

1. The victim responds or begins breathing normally
2. It is impossible to continue (e.g. exhaustion)
3. A health care professional arrives and takes over.
The risk of disease transmission during training and
actual Basic Life Support performance is very low.
FIRE SAFETY

The Fire Triangle: Fuel, oxygen and heat are required

to start a fire. The oxidation process will not be
possible without any one of these elements.

Fire is a rapid oxidation process accompanied by the

evolution of heat, light, flame and the emission of
sound.

*Fire Growth:
Stage 1: Pre-flashover or growth phase
Stage 2: Flashover
Stage 3: Fully developed fire (Stable phase)
Stage 4: Decay (Cooling Period)

*Fire Safety Designs:

Aims:
A. To prevent fire
B. To safeguard the lives of occupants and
firefighters
C. To reduce damage on the building, its contents, and
on surrounding buildings

*Basic Principles Fire Safety:

1.Fire Avoidance
2.Fire Detection
3.Fire Growth Restriction
4.Fire Containment
5.Fire Control
6.Smoke Control
7.Escape Provisions

*Fire Detection
Fire alarm systems must be accessible in all zones
especially in fire-prone areas.

Aimed at ensuring that the growing fire is

extinguished immediately and at providing adequate
time for firemen to arrive, control the fire and
evacuate the occupants.

Actively extinguishing or slowing down the development

of a fire before the full involvement of the room.
Means:
1. Fire Extinguisher
2. Water Supply
3. Fire Blanket
4. Bucket of Sand

*Classification of Fire Extinguishers:

.Class A Extinguishers will put out fires in ordinary

combustibles, such as wood and paper. The numerical
rating for this class of fire extinguisher refers to
the amount of water the fire extinguisher holds and
the amount of fire it will extinguish.

.Class B Extinguishers should be used on fires

involving flammable liquids, such as grease, gasoline,
oil, etc. The numerical rating for this class of fire
extinguisher states the approximate number of square
feet of a flammable liquid fire that a non-expert
person can expect to extinguish.

.Class C Extinguishers are suitable for use on

electrically energized fires. This class of fire
extinguishers does not have a numerical rating. The
presence of the letter “C” indicates that
the extinguishing agent is non-conductive

.Class D Extinguishers are designed for use on

flammable metals and are often specific for the type
of metal in question. There is no picture designator
for Class D extinguishers. These extinguishers
generally have no rating nor are they given a multi-
purpose rating for use on other types of fires.

*Composition of Fire Extinguishers:

.Dry Chemical extinguishers are usually rated for
multiple purpose use. They contain an extinguishing
agent and use a compressed, non-flammable gas as a
propellant

.Halon extinguishers contain a gas that interrupts the

chemical reaction that takes place when fuels burn.
These types of extinguishers are often used to protect
valuable electrical equipment.

.Carbon Dioxide (CO2) extinguishers are most effective

on Class B and C (liquids and electrical) fires. Since
the gas disperses quickly, these extinguishers are
only effective from 1.0 to 2.4 feet.

Definitions

*Fire Avoidance:
Reducing the possibility of accidental ignition of
construction materials, as well as fittings and
fixtures.

This implies:
(a). keeping separate heat sources and materials which
might ignite readily through proper planning and
zoning
(b). need to specify materials to reduce the risk of
fire starting
(c). reducing fire load.

*Fire Zoning:
1. Life Risk Areas; areas in which all occupants are
ambulant and able to move unaided away from a fire
e.g. Outpatient department; Service Zone

2. High Fire Risk Areas; areas which, due to their

function, are more usually susceptible to an outbreak
of fire, or to a rapid spread of fire or smoke. e.g.
Kitchen or Boiler Room
3. High Fire Load Areas; areas which, because of their
construction or contents, contain large amounts of
combustible materials, thereby constituting a fire
load in excess of that normally found e.g. Gas
Storage, Linen Closets

4. High Life Risk Areas; areas in which persons may

reside and are not able to move unaided away from a
fire.eg. Intensive Care Unit, Operating Department

*Choice of Materials:
Steel:
- Does not burn
- May buckle in fire
- High conductivity spreads heat
- Loses half its strength in 550°C

Timber:
- Combustible
- Little loss of strength as charcoal formed insulates
wood core
- Spreads flames

Masonry:
- High fire resistance
- Cracks at 575°C
- Are subject to high temperatures during manufacture

Calcium Silicate:
- Excellent thermal shock resistance
- Up to 1000°C
- Suitable for cladding structural members

Glass:
- Standard float, toughened and laminated glass panes
do not provide any fire resistance
- Monolithic fire-rated glass is available

Concrete:
- High fire resistance
- Disintegrates at 400-500°C
- Holes in concrete will expose steel structural
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