2. Managing the risk of slips and trips in health and social care
You must control the risks in your workplace, this includes the risks of a slip, trip or fall and do everything reasonably practicable to protect people from harm.
Identify the risks
Your assessment should consider who has access, the physical and environmental factors that may give rise to a slip, trip or fall and how these can be minimised and controlled.
Factors to consider include:
- slippery or wet surfaces caused by water and, or other fluids (for example residue left from cleaning, or body fluids)
- slippery surfaces caused by dry or dusty floor contamination (for example dust, lint or talcum powder)
- slippery flooring in areas prone to regular contamination (for example kitchens, bathrooms, main entrances) where slip-resistant flooring would be expected
- obstructions, both temporary and permanent (for example trolleys, cables, items not stored away)
- trip hazards, uneven surfaces and changes of level (for example unmarked ramps or steps)
- lack of handrails (for example along corridors, in stairwells or at doorways)
- poor levels of lighting
- poor contrast between adjacent objects, particularly between furniture and flooring (for example dark furniture on dark floors)
- whether footwear is suitable for the type of tasks being carried out on your premises
The STEP eLearning package developed by HSE provides slips and trips guidance through interactive learning.
Completing this package will help your understanding of slips and trips. In addition, the Slips Assessment Tool may help with your assessment.
Controlling the risks
In order to effectively control risk, you should consider the following factors:
- individual factors
- organisational factors
- environmental factors
- people or human factors
You should identify what factors could cause slips and trips and then put suitable and adequate control measures in place. There are many practical ways to control slips and trips risks and prevent accidents.
Individual factors
Employees, and in particular those being cared for, may have conditions that put them at increased risk of falls. Factors include:
Age-related physiological changes
Age can increase the risk of falls, such as deteriorating vision, impaired judgement and memory, altered mobility and increased frailty and dependence. Falls may arise from weight shifting, trips or stumbles.
Medical conditions
Certain conditions may increase the risk of falls, such as strokes, dementia, fits and faints, low blood pressure, and urinary infections.
Medication
Certain medications may increase the risk of falling. Older people may have increased sensitivity to medications such as psychotropic drugs, sedatives, analgesics, beta-blockers, antidepressants, diuretics and antihypertensive drugs, which can all cause particular problems.
Those patients and service users who are identified as being at higher risk of falls should have an assessment as part of the care planning. Further information is provided in guidance on assessment and prevention of falls in older people from the National Institute of Clinical Excellence (NICE).
Organisational factors
Management – It is vital that organisations demonstrate good leadership with a clear management commitment to controlling the risks from slip and trips. This could be embedded within wider risk management systems to set out co-ordination between departments, estates, cleaning teams and the responsibilities of staff at all levels.
Planning and design of new build or refurbishment work should ensure that safe walkways are provided and adequately cleaned and, or maintained. Arrangements should be monitored to ensure employees carry out their responsibilities.
Footwear – Provide suitable footwear for staff where this has been identified as a way of controlling the slip risk. For example, where floors are likely to be slippery (for example kitchens or wet rooms), staff may require slip-resistant footwear. For further information see our slips and trips page on footwear.
Cleaning – Decide how and when floors should be cleaned and how spillages can be quickly and effectively dealt with. You need to decide on the most effective cleaning method and avoid introducing more slip or trip risks. For example, many floors are only wet during cleaning and smooth floors left damp by a mop are likely to be extremely slippery so access to these areas is likely to need restricting until dry.
Where traditional mopping takes place, there should be adequate segregation until the floor is dry. Spillages or localised contamination should be spot cleaned to reduce the risk of widening the contaminated area. Effective training and supervision is often overlooked, but is essential. For further information see our slips and trips page on cleaning.
Environmental factors
Floors – Slip-resistant flooring should be used in bathrooms, kitchens or where surface contamination cannot be effectively controlled. The use of safer floors does not impact negatively on hygienic cleaning (according to HSE's research report into slip resistance). The condition of the floor, and changes in floor surface, for example stepping from carpet to a smooth floor or vice versa can cause stumbles and slips, especially for people with impaired vision or mobility.
Where floor levels change and they present a risk, they should be clearly identified and handrails should be considered. It should be noted that highly reflective materials may be a barrier for people with dementia. This may sometimes be a desired outcome if it helps to ensure their safety. There is further information in our slips and trips page on flooring.
Contamination – this can include food, liquids, urine, talcum powder, leaves and dirt from outside, cleaning substances. Consider how you can prevent contamination getting on to the floor wherever possible. Design tasks to minimise spillages and if they cannot be prevented, control the contamination, There is more information on contamination and slips and trips.
Work environment – Consider environmental issues that may increase the risk of slips and trips. These include lighting (natural or otherwise), noise distractions, the weather, humidity, and condensation. In order to assist people with limited mobility, ensure there are sufficient handrails at the correct height. It is also important to ensure there is continuity in handrail provision, particularly at doorways and that the handrail can be gripped effectively. Sufficient contrast between walls, handrails, floors and mobility aids will help ensure that they are used and help reduce falls.
Obstacles – Floors should be free from trip hazards and obstructions, for example, avoid trailing wires and ensure equipment is stored away when not in use, rather than left in walkways. Where everyday furniture or equipment is present, and is a potential trip hazard, try to ensure that there is sufficient contrast between the equipment and the floor. One simple technique to help with this is to use black and white photographs of the environment to get an idea of how effective contrast is between surfaces and objects.
Human factors
Have a positive attitude towards health and safety, a 'see it, sort it!' mentality can reduce the risk of slip and trip accidents, for example dealing with a spillage instead of waiting for someone else to do it.
When assessing the risk, consider how work is organised and involve employees in decision making, for example:
- when choosing the most appropriate protective footwear
- when there is a proposed change in cleaning methods
- when devising cleaning schedules, or
- when finding ways to separate people from wet floors
For further information see our slips and trips page on human factors.