Why is it important to tackle slips and trip risks?

Slips and trips resulting in falls are the most common cause of major injuries in all workplaces in Great Britain and the second biggest cause of over-3-day injuries. Over 48% of all major injuries to employees in healthcare are attributed to slips and trips (HSE Slips and Trips Workplace Newsletter). They also account for three times more major injuries than manual handling and assault/violence.

Recent evidence suggests that slips are also indirectly responsible for many fatal accidents, as:

• Slips are often the 'first event' in falls from heights; and
• Simple slip injuries (broken bones etc) often lead to complications such as thromboses or embolisms, which may be fatal.

Slips and trip risks are especially important in healthcare because:

• Injuries to healthcare workers and members of the public are frequent
• Trips account for almost 62% of major injuries to members of the public. Generally trips are believed to account for between 25% and 30% of all slips, trips and falls
• 8% of fatal accidents to members of the public in the healthcare industry are caused by slips and trips.

The National Audit Office, in their report of April 2003, highlighted slips and trips as a main type of accident to workers and patients. The report includes recommendations that NHS Trusts should review their health and safety risk management policies and improve accident reporting systems.

The cost of accidents could affect the delivery of high quality patient care and viability of the business. For example:

• Patients being seriously injured through falls lead to additional medical costs and an increased stay in hospital with implications for waiting lists and service delivery.
• Staff sickness absence due to slips, trips and falls at work, and other associated costs, such as staff replacement costs, will have a detrimental effect on budgets
• The total estimated cost of civil claims for slips and trip injuries to employees and the public in or on NHS premises in England, reported to the NHS Litigation Authority over the last four years, exceeds £25 million. Typical claims average around £5000 but some in the healthcare sector have been as high as £6000, 000. Increased insurance costs and enforcement of criminal liability can be a further consequence.
• People may experience hardship as a result of loss of wages, as well as pain and suffering.

These accidents can be cut dramatically through planning and positive management during refurbishment and new build, together with good housekeeping. Employees should be consulted at an early stage, as they will have useful experience of areas where problems arise. Accidents are not an inevitable part of the healthcare industry - they can and should be prevented.

Understanding how risks can be controlled

The four main causes of slips and trip accidents in healthcare are:

• Slippery/wet surfaces - caused by water and other fluids
• Slippery surfaces caused by dry or dusty floor contamination, such as plastic, lint or talcum powder
• Obstructions both temporary and permanent
• Uneven surfaces and changes of level, such as unmarked ramps.

Other causes include factors such as poor level of lighting and external glare; human factors such as employees rushing; running or carrying heavy/cumbersome items; the wearing of unsuitable footwear or the use of improper cleaning regimes.

Managing the control of slips and trip risks

What practical measures you can take will vary in different situations. You will need to assess each situation, identify what factors cause slip and trips and match practical control measure to these factors.

You will need management arrangements to identify and implement the necessary control measures for each situation. The five steps to achieve this are listed below:

Plan your overall arrangements to manage slips and trip risks. In most cases, the risks will justify setting these slips and trips arrangements out separately and specifically within the overall safety policy document. Assess the risks and identify what more you need to do by looking at the tables. Get the commitment and support of others, especially senior management.

Organise so that staff know what to do; establish systems for inspection, maintenance, training and consultation with safety representatives.

Control the risks by taking the measures you identify

Record all incidents involving slips and trips and ensure appropriate injuries are reported to HSE as required by the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995

Monitor your achievements to ensure you are making progress, e.g. from accident information, inspections, audits and reports from employees. Review your plan regularly.

Preventative measures

When dealing with the causes of slips, trips and falls, health and safety managers and staff should be aware of where the risks arise, such as floor contamination or inherent slip resistance not adequately maintained. They should also be able to identify the measures to control the risks. Examples of measures that could be taken are:

• maintain equipment and clear liquid leakages as soon as possible
• maintain resistance of floor surfaces by using appropriate cleaning methods and 'cleaning in progress' signs
• maintain adequate lighting in all areas of the hospital
• ensure that environmental conditions, such as glare, shadows and temperature extremes, do not distract the attention of staff, patients and visitors
• train and re-train staff on a regular basis so that they understand the dangers of lifting heavy loads, restricted views and other moving and handling issues, and ensure staff operate within their individual capacity.

Legal requirements

Although previous health and safety legislation had always required action against slips and trips risks, recent regulations have re-emphasised the importance of these measures and shown how to take them.

The Management of Health and Safety at Work Regulations 1992 (amended in 1999) specify the five steps required for effective risk control arrangements and employee duties, as well as training and consultation with safety representatives,

The Workplace (Health, Safety and Welfare) Regulations 1992 require the floor surface to be suitable by not being 'slippery so as to expose any person to a risk to their safety' and for the floor to have 'effective drainage'. Preventing contamination rather than increasing the slip resistance to counteract it clearly preferable. However, very small levels of contamination (a single drop in many circumstances) can lead to drastic increases in slipperiness. Prevention of contamination must therefore be very thorough.

There are also duties on suppliers of equipment, floor treatment substances and slip-resistant shoes to ensure, so far as reasonably practicable, the inherent safety of their products and to provide information to users.

The Workplace Regulations also require the floor construction to:

• have no holes, or slope or be uneven so as to expose a person to risk;
• so far as reasonably practicable keep floors 'free of obstructions and from any article which may cause a person to trip
• not have accumulated waste materials except in suitable receptacles.

Suppliers of equipment

Under the Provision and Use of Work Equipment Regulations 1998, suppliers of equipment provided for use at work (including machinery) have a duty to ensure the safety of their products, so far as is reasonably practicable, and to provide information to users.

STEP Slips & Trips eLearning Package

Available January 2009

STEP is an eLearning package produced by the Health and Safety Executive, providing slip and trip guidance through interactive learning.

It is an easy way to learn about slips and trips, how they are caused, why preventing them is important and how to tackle them. Step includes quizzes, videos, animations and interactive sequences to enhance the learning experience.

It is suitable for anyone at any level such as workers, supervisors, managers, safety representatives, health and safety professionals and health and safety trainers. This is because it contains three levels of information - introductory, intermediate and advanced.

STEP contains generic courses suitable for different industries and courses specifically designed for the health services as well as hospitality & catering.

It is designed to be used online and at no cost. It will also be available on DVD for a small charge.

For more information on STEP and to register your interest visit the HSE slips and trips website