Professional Documents
Culture Documents
NR32
HEALTHANDSAFETYATWORKINHEALTHCARE
32.1
32.2
32.3
32.4
32.5
32.6
32.7
32.8
32.9
32.10
32.11
ObjectiveandScope
BiologicalHazards
ChemicalHazards
IonizingRadiation
Wastes
Catering
Laundry
Housekeeping
MaintenanceofMachinesandEquipments
GeneralProvisions
FinalProvisions
Annex1ClassificationofBiologicalAgents
Annex2ClassificationTableforBiologicalAgents
Annex3PlanforPreventionofAccidentswithBlades
32.1
ObjectiveandScope
32.1.1
ThisRegulatoryStandardNRNorma Regulamentadora -hasthe
purposeofestablishingbasicguidelinesfortheimplementationofmeasurestoprotectthe
safetyandhealthofhealthcareworkersandthoseinpositionsofsupportforhealthcare
activitiesingeneral.
32.1.2
ForthepurposeofthisNR,ahealthcarefacilityisanybuilding
employedfortheprovisionofhealthcaretothepopulation,andallactionsforthesupport,
promotion,recovery,care,researchorteachingofhealthandmedicine,atanylevelof
complexity.
32.2
BiologicalHazards
32.2.1
ForthepurposeofthisRegulatoryStandard,thelikelihoodof
occupationalexposuretobiologicalagentsisconsideredaBiologicalHazard.
32.2.1.1
BiologicalAgentscomprisethemicroorganisms,geneticallymodifiedor
not;cellcultures;parasites;toxins;andprions.
32.2.1.2
Aclassification[list]of[themainknown]biologicalagentsfollowsbelow
inAnnexItothisNR.
32.2.2
TheEnvironmentalHazardPreventionProgramPPRA Programa
de Preveno de Riscos Ambientais:
32.2.2.1
ThePPRA,asidefromtherequirementsinNR09,initsHazard
Identificationphase,shallinclude:
I.
Identificationofthemostlikelybiologicalhazards,dependingonthegeographic
locationandcharacteristicsofthehealthcarefacilityanditssectors,considering:
a) sourcesofexposureand[infectingmaterial]reservoirs;
b) meansoftransmissionandpathsofbodilyentry;
c) transmissibility,pathogenicityandvirulenceoftheagent;
d) persistenceofthebiologicalagentintheenvironment;
e) epidemiologicalstudiesorstatisticaldata;
f) otherscientificinformation.
II.
Worksiteandworkerconditions,considering:
a) thepurposeanddescriptionoftheworkplace;
b) theorganizationandworkingprocedures;
c) thelikelihoodofexposure;
d) adescriptionoftheactivitiesandfunctionsateachworkplace;
e) theapplicablepreventiveandmonitoringmeasures.
32.2.2.2
32.2.2.3
32.2.3
ThePPRAshallbereassessedonceayearand:
a) wheneverachangeoccursinworkingconditions,whichmayalterthe
exposuretobiologicalagents;
b) wheneverareviewofaccidentsandincidentssodetermines.
ThedocumentsthatcomprisethePPRAshallremainavailabletothe
workers.
TheOccupationalHealthMedicalControlProgramPCMSO
Programa de Controle Mdico de Sade Ocupacional
32.2.3.1
ThePCMSO,asidefromtherequirementsinNR07,andobservingthe
requirementsinsectionIofitem32.2.2.1above,shallinclude:
a) anidentificationandevaluationofbiologicalhazards;
b) thelocationofhazardousareasaccordingtotheparametersinitem
32.2.2;
c) thelistofworkersbyname,function,workplacewhereactivitiesare
performedandthehazardsandrisklevelstheyareexposedto;
d) themedicalmonitoringofpotentiallyexposedworkers;
e) thevaccinationprogram.
32.2.3.2
Wheneverthereispermanentortemporarytransferofaworkertoanother
jobpost,whichinvolvesachangeinhazardsorrisklevels,thisshallbereported
immediatelytothephysicianorcoordinatorresponsibleforthePCMSO.
32.2.3.3
Withregardtothepossibilityofaccidentalexposuretobiologicalagents,
thePCMSOshallinclude:
a) theprocedurestobeadoptedfordiagnosis,monitoringand
preventionofserumconversionanddisease;
b) measuresforworkplacedecontamination;
c) theemergencymedicaltreatmentforworkers;
d) theidentificationofthepersonsresponsibleforimplementingthe
relevantmeasures;
e) alistof[nearby]healthfacilitiesthatcanassistworkers;
f) formsof[emergency]removalforcareofworkers;
g) alistofhealthcarefacilitiescontainingdepositoriesof
immunoglobulins,vaccines,therequiredmedications,[any
eventuallyrequired]specialmaterialsandsupplies.
32.2.3.4
ThePCMSOshallremainavailableforworkersandLaborOffice
inspection.
32.2.3.5
Aftereveryoccurrenceofaccidentsinvolvingbiologicalhazards,withor
withoutlosttimebytheworker,aWorkAccidentReportCAT Comunicao de
Acidente de Trabalhoshallbeissued.
32.2.4
ProtectiveMeasures
32.2.4.1
Protectivemeasuresshallbetakenbasedontheresultsoftheassessment
providedforinthePPRA,observingtherequirementsinitem32.2.2.
32.2.4.1.1
Intheeventofaccidentalorincidentalexposure,protectivemeasuresshall
betakenimmediately,evenwhen[thisspecificeventwas]notcoveredbythePPRA.
32.2.4.2
Handlingsinalaboratoryenvironmentshallfollowtheguidelinesinthe
publicationoftheMinistryofHealthGeneralGuidelinesforWorkwithContained
BiologicalMaterial,Diretrizes Gerais para o Trabalho em Conteno com
Material Biolgico,correspondingtotheapplicablemicroorganisms.
32.2.4.3
Everylocationwherethereisthepossibilityofexposuretobiological
agentsshallhaveanexclusivelavatory[sink]forhandhygiene,providedwithrunning
water,liquidsoap,disposabletowelsandatrashcanprovidedwithanopeningsystem
withoutmanualcontact[suchasapedal].
32.2.4.3.1
Theroomsorwardsforisolationofpatientswithinfectiousdiseasesshall
containalavatory[sink].
32.2.4.3.2
Theuseofglovesdoesnotreplacetherequirementforthewashingof
hands,whichshalloccur,atleast,beforeandafteruseofthegloves.
32.2.4.4
Workerswithsoresorlesionsintheupperlimbsmayonlystarttheir
activitiesafteramandatorymedicalevaluationwiththeissuanceofadocumentreleasing
forwork.
32.2.4.5
Employersshallforbid:
a) theuseofworkplacesinksforpurposesotherthanthoseintended;
b) smoking,theuseofjewelryoradornments,andthehandlingof
contactlenses,attheworkplace;
c) theconsumptionoffoodandbeveragesattheworkstations;
d) thekeepingoffoodinplacesnotintendedforthispurpose;
e) theuseofopenshoes[orfootgear,suchassandals].
32.2.4.6
Allworkerswithpotentialexposuretobiologicalagentsshallusesuitable
workclothes,underconditionsofcomfort.
32.2.4.6.1
Theworkclothesshallbeprovidedwithoutcosttoworkers.
32.2.4.6.2
Workersshallnotleavetheworkplacewiththepersonalprotective
equipmentandclothingusedintheirworkactivities.
32.2.4.6.3
Theemployershallprovideappropriatelocationsfortheprovidingor
distributionofcleanclothingandthecollectionofusedclothes.
32.2.4.6.4
Thecleaningofclothingusedinsurgicalandobstetriccenters,intensive
careservices,wardsorunitswithpatientsbearinginfectiousdiseases,andwheneverthere
isdirectcontactoftheclothingwithorganicmaterial,shallbeprovidedbytheemployer.
32.2.4.7
ThePersonalProtectiveEquipmentPPE,disposableornot,shallremain
availableinsufficientamountsattheworkplacesoitsimmediatesupplyorreplacement
isguaranteed.
32.2.4.8
Theemployershall:
a) ensuretheconservationandcleaningofmaterialsandtools;
b) provideadequatecontainersandmeansoftransportforallinfectious
materials,fluidsandbodytissues.
32.2.4.9
Theemployershallensuretrainingtoworkerspriortothestartof
activitiesandcontinually,anditshall:
a) be provided whenever there is a change in the exposure conditions
of workers to biological a gents;
b) duringtheworkersregularworkshift;
c) byhealthcareprofessionalsfamiliarwiththehazardsposedby
biologicalagents.
32.2.4.9.1
Thetrainingshallbeadaptedtotheevolutionofknowledgeandthe
identificationofnewbiologicalhazardsandshallinclude:
a) theavailabledataonthepotentialhazardstohealth;
b) thecontrolmeasurestominimizeexposuretoagents;
c) hygieneandsanitarystandardsandprocedures;
d) theuseofcollectiveandpersonalprotectionequipmentandofwork
clothes;
e) themeasuresforthepreventionofaccidentsandincidents;
f) themeasurestobetakenbyworkersintheeventofincidentsand
accidents.
32.2.4.9.2
TheemployershallprovetotheLaborOfficeinspectionthecarryingout
oftraining,throughdocumentsreportingthedate,time,classhours,content,nameand
educationortrainingoftheinstructor,andparticipatingworkers.
32.2.4.10
Ateverylocationwherethereisthepossibilityofexposuretobiological
agents,workersshallbeprovidedwithinstructions,writteninaccessible[clearfor
laymen]language,oftheroutinesperformedintheworkplace,andtheprevention
measuresagainstaccidentandworkrelateddiseases.
32.2.4.10.1
Theinstructionsshallbedeliveredtotheemployee,uponreceipt,which
shallremainavailableforLaborOfficeinspection.
32.2.4.11
Workersshallimmediatelyreporteveryaccidentorincidentinwhich
thereispossibleexposuretobiologicalagents,tothepersonresponsibleforthe
workplaceand,ifany,totheoccupationalhealthandsafetyserviceandtotheinternal
committeeforaccidentpreventionCIPA.ComissoInternadePrevenodeAcidentes
32.2.4.12
Theemployershallreportimmediatelytotheworkersandtheir
representativesanyaccidentorseriousincidentthatmaycausethespreadofabiological
agentlikelytoprovokeseverediseaseinhumans,itscauses,andthemeasuresadoptedor
tobeadoptedtocorrectthesituation.
32.2.4.13
Allmattressesandothercushionsshallbecoveredwithwashableand
waterproofmaterial,allowingeasycleaninganddisinfection.
32.2.4.13.1
Themattressorcushioncoveringshallnothaveholes,tears,groovesor
indentations.
32.2.4.14
Workerswhousecuttingorperforatingobjectsshallberesponsiblefor
theirdisposal.
32.2.4.15
Themanualrecappinganddisconnectionofneedlesisforbidden.
32.2.4.16
TheemployershallestablishaRiskPreventionPlanforAccidentswith
CuttingandPiercingMaterial,accordingtotheguidelinessetoutinAnnexIIIofthis
RegulatoryStandard(asamendedbyOrdinance1,748,ofSeptember30,2011).
32.2.4.16.1
Companiesthatproduceorsellcuttingorperforatingmaterialsshall
providetohealthcareworkerstrainingontheproperuseofsafetydevices(asamended
byOrdinance1,748,ofSeptember30,2011).
32.2.4.16.2
Theemployershallensuretoallhealthcareworkersthetrainingprovided
forinsubsection32.2.4.16.1above(asamendedbyOrdinance1,748,ofSeptember30,
2011).
32.2.4.17
WorkerVaccination
32.2.4.17.1
Everyhealthcareworkershallbeprovided,freeofcharge,withanactive
immunizationprogramagainsttetanus,diphtheria,hepatitisB,andthosesetoutinthe
PCMSO.
32.2.4.17.2
Wheneverthereareeffectivevaccinesagainstotherbiologicalagentsto
whichworkersareormaybeexposed,theemployershallprovidethemfreeofcharge.
32.2.4.17.3
Theemployershallmonitorvaccinationeffectiveness,whenever
recommendedbytheHealthMinistryanditsagencies,andprovide,ifnecessary,its
reinforcement.
32.2.4.17.4
VaccinationshallcomplywithMinistryofHealthrecommendations.
32.2.4.17.5
Theemployershallensurethatworkersareinformedofthebenefitsand
sideeffects,aswellasthehazardstheyareexposedto,bylackorrefusalofvaccination,
andinthesecaseskeepsupportingdocumentationavailableforLaborOfficeinspection.
32.2.4.17.6
Vaccinationshallberecordedintheworkersindividualclinical(health)
record,asprovidedforinNR07.
32.2.4.17.7
Theworkershallbeprovidedwithwrittenproofofreceivedvaccinations.
32.3 ChemicalsHazards
32.3.1 Themanufacturer'slabeling,ontheoriginalpackaging,shallbemaintained,of
chemicalsusedinhealthcarefacilities.
32.3.2
Everyvesselcontainingmanipulatedorsubdividedandrepacked
chemicalssplitshallbeidentifiedlegiblybylabelwiththeproductname,itschemical
composition,concentration,dateofrepackaging,expirationdate,andnameoftheperson
responsibleforhandlingorrepackaging.
32.3.3
Thereuseofcontainersofchemicalsisforbidden.
32.3.4
TheEnvironmentalHazardPreventionProgramPPRA(Programa de
Preveno de Riscos Ambientais)
32.3.4.1
ThehealthcarePPRAshallincludeaninventorywithallchemicals,
includingintermediatesandwastes,withaclearindicationonthoseposingworkerhealth
andsafetyhazards.
32.3.4.1.1
Thechemicals,includingintermediatesandwastesposinghazardsto
workerhealthandsafety,shallcarryafactsheet[MSDS]containingatleastthe
followinginformation:
a) thecharacteristicsandinstructionsofuseoftheproduct;
b) thehazardstoworkerhealthandsafetyandtotheenvironment,considering
theformsofuse;
c) theappropriatemeasuresforcollectiveandindividualprotection,andfor
medicalcontrolofworkerhealth;
d) conditionsandplaceforproperstorage;
e) emergencyprocedures
32.3.4.1.2
Acopyofthisdatasheetshallbekeptattheplaceswheretheproductis
used.
32.3.5
TheOccupationalHealthMedicalControlProgramPCMSO
(Programa de Controle Mdico de Sade Ocupacional)
32.3.5.1
DuringthedevelopmentandimplementationofaPCMSOtheinformation
containedinthefactsheetsmentionedinsubsection32.3.4.1.1shallbeconsidered.
32.3.6
32.3.6.1
ofchemicals.
32.3.6.1.1
a)
Theemployersshall:
Train,atinductionandcontinually,,allworkersinvolved,inthesafeuse
Trainingshallinclude,atleast:
apresentationofthefactsheetsmentionedinsubsection32.3.4.1.1,with
anexplanationoftheinformationcontainedtherein;
b) safetyproceduresfortheuse;
c) procedurestobefollowedinthecaseofincidents,accidentsand
emergencies.
32.3.7
ProtectiveMeasures
32.3.7.1
Theemployershallallocateanappropriateplace[suchasaroom]forthe
handlingorfractioningofhazardouschemicals.
32.3.7.1.1
Thecarryingoutoftheseproceduresinanylocationotherthanthat
appointedastheappropriateplaceforthispurposeisforbidden.
32.3.7.1.2
Thepreparationandcombinationofdrugsforimmediateadministrationto
patientsisexcludedfromthisprohibition.
32.3.7.1.3
Thisappropriateplaceforhandlingofchemicalsshallbeequippedwith,at
least:
a) graphicalsignforeasyidentificationofthearea[ashavingthispurpose],as
pertherequirementsinNR26;
b) equipmenttoensuretheconcentrationofchemicalsintheairbelowthe
tolerancelimitsestablishedinNR09andNR15andobservingtheaction
levelssetoutinNR09;
c) equipmenttoensuretheexhaustion[forcedventilation]ofchemicals,soas
notminimizetheexposureofanyworker,involvedornotinthework
process,andhoodtypeequipmentshallnotbeused;
d) showersandeyewashsinks[resemblesawaterfountain],openedand
sanitizedweekly;
e) personalprotectiveequipment,asappropriatetoworkerhazards;
f) anappropriatewastedisposalsystem.
32.3.7.2
Thehandlingorfractioningofchemicalsshallbedonebyaqualified
worker.
32.3.7.3
Thetransportationofchemicalsshallbecarriedoutconsideringthe
hazardstoworkerhealthandsafetyandtheenvironment.
32.3.7.4
Facilitiesthatperform,orwhichplantoperform,sterilization,re
sterilization,orreprocessingusingethyleneoxidegas,shallcomplywiththe
requirementsinDecree482/MS/MTE16/04/1999.
32.3.7.5
Facilitieswhereflammableproductsareusedandstoredrequireafire
preventionsystemwhichprovidesspecialsafetymeasuresandemergencyprocedures.
32.3.7.6
Chemicalstorageareasshallbeventilatedandmarked.
32.3.7.6.1
Separatestorageareasshallbeprovidedforincompatiblechemicals.
32.3.8
MedicinalGases
32.3.8.1
Thehandling,transportation,storage,handlinganduseofmedicalor
medicinalgases,andalsothemaintenanceoftheequipment,shallcomplywiththe
manufacturer'srecommendations,providedthesecomplywiththecurrentapplicable
legislation.
32.3.8.1.1
Themanufacturer'srecommendationsshallbemaintained,inPortuguese,
attheworkplaceforworkersandlaborinspection.
32.3.8.2
Thefollowingareforbidden:
a) usingequipmentwheregasleaksarefound;
b) subjectingequipmenttopressuresgreaterthantheyweredesignedfor;
c) usingcylinderswithoutidentification[labeling]ofthegasorasafetyvalve;
d) movingcylinderswithoutusingappropriatepersonalprotectiveequipment;
e) subjectingthecylinderstoextremetemperatures;
f) usingoxygenorcompressedairforpurposesotherthanthattheywere
intended;
g) allowingcontactofoils,greases,orsimilarorganicmaterials,withoxidizing
gas;
h) usingoxygencylinderswithoutacheckvalveorothersafetydevicetoprevent
reverseflow;
i) transferringgasfromonecontainertoanother,regardlessofcylindercapacity;
j) transportingloosecylinders,[or]inahorizontalposition,[or]without
helmets.
32.3.8.3
Cylinderscontainingflammablegases,suchashydrogenandacetylene,
shallbestoredataminimumdistanceofeightmetersfromthosecontainingoxidizing
gasessuchasoxygenandnitrousoxide,orbeyondsealed[airtight]fireresistantbarriers.
32.3.8.4
Forthecentralizedmedicalgasessystem,signsshallbefixedatvisible
locations,withindelibleandlegiblecharacters,withthefollowinginformation:
a) anamelistofpersonsauthorizedtohaveaccesstothesite,whoweretrained
intheoperationandmaintenanceofthesystem;
b) emergencyprocedures;
c) emergencytelephonenumber;
d) graphicsignsindicatingdanger.
32.3.9
MedicationandHazardousDrugs
32.3.9.1
ForpurposesofthepresentNR,arehazardousdrugsarethosethatmay
causegenotoxicity,carcinogenicity,teratogenicityorseriousandselectivetoxicityabout
organsandsystems.
32.3.9.2
ThePPRAshallincludeadescriptionofthedangersinherenttothe
receiving,storage,preparation,distribution,andministration,ofhazarddrugsand
medication.
32.3.9.3
AnestheticGasesandVapors
32.3.9.3.1
Allequipmentusedfortheministrationofanestheticgasesorvaporsshall
undergocorrectiveandpreventivemaintenance,withparticularattentiontoleakagetothe
workenvironment,seekingitselimination.
32.3.9.3.2
Maintenanceshallconsist,atleast,ofverificationofgascylinders,
connectors,fittings,hoses,balloons,tracheas,valves,anesthesiamachines,andfacial
masksforpulmonaryventilation.
32.3.9.3.2.1 Thisprogram,andtheconnectedmaintenancereports,shallbeincludedin
adocumentthatshallremainavailabletodirectlyinvolvedworkersandtoLaborOffice
inspection.
32.3.9.3.3
Theplaces[rooms]whereanestheticgasesorvaporsareusedshallhave
ventilationandexhaustsystems,inordertomaintainacontrolledenvironmental
concentration,asprovidedbylaw.
32.3.9.3.4
Pregnantworkersshallonlybereleasedforworkinareaswiththe
possibilityofexposuretoanestheticgasesorvaporsafterwrittenconsentfromthedoctor
responsibleforthePCMSO,consideringtheinformationinthePPRA.
32.3.9.4
AntineoplasticAgents
2.3.9.4.1
Antineoplasticagents(chemotherapydrugs)shallonlybepreparedinan
exclusivearea,withaccessrestrictedtothedirectlyinvolvedprofessionals.Thearea
[room]shallbeequippedwith,atleast:
a) adoublechamberlockerroom;
b) aroomforchemotherapypreparation;
c) aplaceintendedforadministrativeactivities;
d) astoragefacility[suchasalocker]usedexclusivelyforstorage.
32.3.9.4.2
Thelockerroomshallbeequippedwith:
a) asinkandmaterialforwashinganddryinghands;
b) aneyewashsink[resemblesawaterfountain],whichmaybereplacedbya
hygienicsprayshower;
c) emergencyshower;
d) personalprotectiveequipmentandclothingforuseandreplacement;
e) lockersforpersonalbelongingsandclothes;
f) containersforthedisposalofusedclothing.
32.3.9.4.3
Proceduremanualsshallbedevelopedforthecleaning,decontamination
anddisinfectionofallareas,includingsurfaces,facilities,equipment,furniture,clothing,
PPEandmaterials.
32.3.9.4.3.1 Thesemanualsshallremainavailabletoallworkersandlaborinspection.
32.3.9.4.4
Allworkersdirectlyinvolvedshallwashtheirhandsbeforeplacingand
afterremovalofgloves.
32.3.9.4.5
ThepreparationroomshallbeequippedwithaBiosafetyCabin,ClassII
B2,observing,atleast:
a) airsupplynecessaryforitsoperation;
b) positioningthatwillavoidairturbulence.
32.3.9.4.5.1 Thiscabinshall:
a) inoperationforatleast30minutesbeforethestartofthehandlingworkand
leftonfor30minutesaftercompletionofthework;
b) periodicallyundergomaintenanceandchangesofabsolutefiltersandpre
filters,accordingtoawrittenprogramthatmeetsmanufacturerspecifications,
andshallremainavailableforlaborinspection;
c) keepamaintenancereport,whichshallbekeptavailableforLaborOffice
inspection;
d) keepalabelaffixedinavisibleplace,withthedatesofthelastandthenext
maintenance;
e) besubjectedtotheprocessofcleaning,disinfectionanddecontamination,on
theinnersideofwallsandallworksurfaces,beforethestartofoperations;
f) haveallworksurfacesundergocleaningproceduresattheendofactivities,
andafteraccidentswithspillsorsplashes[beforeworkcontinues].
32.3.9.4.6
Withrespecttoantineoplasticdrugs,employersshall:
a) forbidsmoking,eatingordrinking,usingadornments,andapplyingmakeup;
b) keepawayfromactivitiesallpregnantornursingworkers;
c) forbidexposedworkersfromperformingactivitieswiththepossibilityof
exposuretoionizing[andantineoplastic]agents;
d) provideworkerswithapronsmadeofwaterproofmaterial,withsturdyfront
andclosedintheback,longsleeveswithfittingwrists,whenpreparingand
ministering;
e) provideworkerswithsafetydevicesthatminimizethegenerationofaerosols
andaccidentsduringhandlingandministration;
f) provideworkerswithsafetydevicestopreventaccidentsduringtransport.
32.3.9.4.7
Inadditiontoensuringcompliancewithcurrentlegislation,Personal
ProtectiveEquipmentPPEshallmeetthefollowingrequirements:
a) beevaluateddailyfortheconditionandsafety;
b) bestoredineasilyaccessiblelocationsandinsufficientquantityfor
immediatereplacement,asrequiredbytheprocedure,orintheeventof
contaminationordamage.
32.3.9.4.8
Withrespecttoantineoplasticdrugs,itisprohibitedto:
a) initiateanyactivityintheabsenceofPPE;
b) continuehandlingormanipulationactivitiesduringanydiscontinuationofthe
functioningofthebiologicalsafetycabinet.
32.3.9.4.9
OperationalProceduresforEnvironmentalandPersonalAccidents.
32.3.9.4.9.1 Withrespecttochemotherapy,accidentsare:
a) environmental:contaminationoftheenvironmentdueto[aninvoluntary]
releaseoftheproductfromitspackaging,eitherbyspilling,orbydispersion
ofsolidorliquidaerosols;
b) personal:contaminationcausedbycontactorinhalationofantineoplastic
chemotherapydrugs,atanystageoftheprocess.
32.3.9.4.9.2 Therulesandprocedurestobefollowedintheeventofenvironmentalor
personalaccidentsshallbecompiledinamanual,keptavailableandeasilyaccessiblefor
workersandLaborOfficeinspection.
32.3.9.4.9.3 Intheareasofpreparation,storage,ministrationandfortransportation,a
spillkitshallbekept,identified[clearlymarked]andathand,containingatleast:
examinationgloves,waterproofapron,absorbentpads,respiratoryprotection,eye
protection,soap,identifiedcontainerforwastecollection,writtenprocedure.
32.3.10
Training
32.3.10.1
Workersinvolvedshallreceiveinitialandongoingtrainingthatcontainsat
least:
a) themainroutesofoccupationalexposure;
b) thetherapeuticandtheadverseeffectsofthesedrugs,andthehealthhazards
theymaycauseinthelongandintheshortterm;
c) rulesandstandardizedproceduresforthehandling,preparation,
transportation,ministration,distribution,anddisposalofantineoplasticdrugs;
d) accidentprocedures.
32.3.10.1.1
Trainingshallbegivenbyhealthcareprofessionalsfamiliarwiththe
hazardsinherenttoantineoplasticdrugs.
32.4
IonizingRadiation
32.4.1
CompliancewiththerequirementsunderthisNRwithregardtoionizing
radiationwillnotrelievetheemployerfromobservingtherequirementslaiddownbythe
specificrulesoftheNationalNuclearEnergyCommissionCNENandtheNational
HealthSurveillanceAgencyANVISAintheMinistryofHealth.
32.4.2
ARadiologicalProtectionPlanPPRPlano de Proteo
Radiolgica approvedbyCNEN,shallbekeptattheworkplace,availablefor
inspectionbytheLaborOfficeanddiagnosticradiologyservicesapprovedbytheHealth
Surveillance.
32.4.2.1
TheRadiologicalProtectionPlanshall:
a) bewithinitsperiodofvalidity;
b) identifytheresponsibleprofessional,andhiseventualreplacement,being
fulltimemembersofthestaff;
c) beincludedinthefacilitysPPRAEnvironmentalRiskPreventionProgram;
d) beconsideredinthepreparationandimplementationofthePCMSO
OccupationalHealthMedicalControlProgram;
e) besubmittedtotheCIPAInternalAccidentPreventionCommitteewhen
thiscommitteeexistsinthecompany,withacopyattachedtothecommittee
meetingminutes.
32.4.3
Workerswhocarryoutactivitiesinareaswithionizingradiationsources
shall:
a) remainintheseareastheshortestpossibletimerequiredtoperformthe
procedure;
b) beawareoftheradiologicalhazardsassociatedwiththeirwork;
c) betraineduponadmission,andcontinually[periodically],inradiological
protection;
d) useappropriatePPEtominimizehazards;
e) individuallymonitorionizingradiationdosage,wheretheexposureis
occupational.
32.4.4
Workerswithconfirmedpregnancyshallbeexcludedfromactivitieswith
ionizingradiation,andrelocatedtoactivitiescompatiblewiththeirleveloftraining.
32.4.5
Everyfacilitythatworkswithradiationshallbeequippedwithindividual
andareamonitoring[devices].
32.4.5.1
Individualdosimetersshallbeobtained,calibratedandevaluatedsolelyat
individualmonitoringlaboratoriesaccreditedbyCNEN.
32.4.5.2
Externalindividualmonitoring,fullbodyoroftheextremities,shallbe
donethroughdosimetry,onamonthlybasis,takingintoaccountthenatureandintensity
ofnormalandprojectedpotentialexposures.
32.4.5.3
Intheeventofaccidentalorsuspectedexposure,dosimetersshallbesent
forreadingwithin24hours.
32.4.5.4
Aftertheoccurrence,orsuspectedoccurrence,ofaccidentalexposureto
sealedsources,additionalproceduresshallbeadopted,includingindividualmonitoring,
clinicalevaluation,andcomplementarytests,includingcitogenetic dosimetry,atthe
physician'sdiscretion.
32.4.5.5
After the occurrence, or suspected occurrence, of accidental exposure to
non-sealed sources, subject to external exposure or with internal contamination, including
individual monitoring, clinical evaluation, and complementary tests, including
citogenetic dosimetry, in vivo and in vitro studies, at the physician's discretion.
32.4.5.6
Aprogram,fortheperiodicmonitoringofareascontainedinthe
RadiologicalProtectionPlan,shallbedevelopedandimplementedforallareasof
facilitiesthatworkwithradiation.
32.4.6
Employersshall:
a) ensurecollectiveprotectionmeasuresagainstradiologicalhazards;
b) hireaqualifiedprofessional,toberesponsibleforradiationprotectionineach
specificarea,withaformalrelationwiththefacility[inhouse,notoutsourced
orconsultant];
c) promotetraininginradiationprotection,atinductionandcontinually,forall
workersoccupationallyorparaoccupationallyexposedtoionizingradiation;
d) record,intheworker'sindividualfile,alltraininggiven;
e) providetheworker,inwritinganduponreceipt,instructionsconcerningthe
radiologicalhazardsandradiationprotectionproceduresadoptedinthe
radioactivefacility;
f) informtheresultsof[all]radiationdosimetriccountsofroutine,accidental
andemergencyexposure,inwritinganduponreceipt,toeachworkerandto
thePCMSOscoordinatingphysician,orthephysicianinchargeofthe
medicalexamsprovidedforinNR07.
32.4.7
Eachworkerinfacilitiesthatworkwithradiationshallcarry[be
monitoredthrough]anupdatedindividualrecord,whichshallbekeptforthirty(30)years
aftertheendoftheiroccupation,containingthefollowinginformation:
a) identification(name,dateofbirth,IDnumber,taxIDnumber),addressand
levelofeducation;
b) datesofadmissionanddischargefromemployment;
c) nameandaddressofpersonresponsibleforradiologicalprotectionduring
eachworkperiod;
d) jobfunctionswithradiationsources,specifyingtheirworkareas,radiological
hazards,datesofstartandendofwork,schedulesandperiods;
e) typesofindividualdosimetersused;
f) recordofmonthlyandannualdosesreceived(fortwelveconsecutivemonths)
andtest/monitoringreports;
g) trainingcarriedout;
h) DNAincorporationestimate;
i) emergencyandaccidentexposurereports;
j) prioroccupationalexposuretoradiationsources.
32.4.7.1
Anindividualrecord[file]foreachworkershallbekeptattheworkplace,
availableforLaborOfficeinspection.
32.4.8
TheindividualclinicalhealthrecordasperNR07shallbekeptupdated
andmaintainedforthirty(30)yearsaftertheendofworkactivities[onformerworkers].
32.4.9
Everyfacilitythatworkswithradiationshallbeequippedwitha
RadiologicalProtectionService.
32.4.9.1
Theradiationprotectionserviceshallbelocatedinthesameenvironment
offacilitythatworkswithradiationandareguaranteedworkingconditionsconsistent
withtheactivities,observingtherulesoftheCNENandANVISA.
32.4.9.2
Theradiationprotectionserviceshallbeequippedwith,asspecifiedin
PPR,equipmentfor:
a) monitoringofindividualworkersandofthearea;
b) personalprotection;
c) specificenvironmentalmonitoringofionizingradiationfortheworking
practicesdeveloped.
32.4.9.3
Theradiationprotectionserviceshallbedirectlysubordinatedtothe
holder[topmanagement]ofthefacility.
32.4.9.4
Whenafacilityhasmorethanoneservice,aqualifiedtechnicianshallbe
appointedtopromotetheintegrationofradiologicalprotectionbetweentheseservices.
32.4.10
ThePCMSOscoordinatingphysicianorinchargeofthemedicalexams
providedforinNR07shallbefamiliarwiththeeffectsofandtreatmentforexposure
frombothroutineactivities,andaccidents,withionizingradiation.
32.4.11
Theareasthatemployradiationwithinthefacilityshallbeclassed,and
theiraccesscontroldefinedbythepersonresponsibleforradiationprotection.
32.4.12
Theareasthatemployradiationwithinthefacilityshallbeclearlysignaled
andmarked,asperthelegislationinforce,attendingto:
a) useoftheinternationalradiationsymboloncontrolledaccesses;
b) theradiationsourcesintheseareas,andtheirwastes,shallremaininpackages,
containersorenclosuresthatareclearlyidentifiedandmarked,informingthe
typeofradioactiveelement,levelofactivity,andtypeofemission;
c) doserates,withmeasurementdates,atsignificantspots,closetotheradiation
sources,inplacesofpermanenceortransitofworkers,aspertherequirements
inthePPR;
d) identificationofroutes,entriesandexits,undernormalworkingconditions
andinemergencies;
e) locationofsafetyequipment;
f) accidentandemergencyprocedures;
g) alarmsystems.
32.4.13
NuclearMedicineServices
32.4.13.1
NuclearMedicineServicefacilityareasshallbesupervisedandcontrolled,
withimpermeablefloorsandwalls,allowingdecontamination.
32.4.13.2
Theroom[s]usedforhandlingandstorageofradioactivesourcesinuse
shall:
a) becoatedwithwaterproofmaterial,allowingdecontamination,withfloorsand
wallsprovidedwithroundedcorners;
b) beequippedwithcountertopsorworkbenchesmadeofsmoothmaterial,easy
todecontaminate,coveredwithplasticandpapertowels;
c) beequippedwithasinkatleast40cmdeep,withtap[faucet]openingwithout
manualcontrol[elbowlevers].
32.4.13.2.1
Exclusiveexhaustsystemsaremandatory:
a) local,forhandlingofunsealedvolatilesources;
b) area,forservicesofferinglungventilationstudies.
32.4.13.2.2
Inareaswhereradioactivematerialsortheirwastesarehandledorstored,
itshallbeforbiddento:
a) applycosmetics,eat,drink,smoke,orrest;
b) storefood,beverages,orpersonalproperty.
32.4.13.3
Workersinvolvedinthehandlingofradioactivematerialsandmarking[or
manipulation]ofdrugsshalluseprotectiveequipment,asrecommendedinthePPRAand
PPR.
32.4.13.4
Attheendoftheworkshift,themonitoringofsurfacesshallbecarriedout
accordingtothePPR,usingacontaminationmonitor.
32.4.13.5
Eachtimetheworkactivityisinterrupted,amonitoringoftheextremities
andofthewholebodyshallbemadeonworkershandlingradiopharmaceuticals.
32.4.13.6
Thelocationdestinedforthedecayofradioactivewastesshallbe:
a) locatedinacontrolledaccessarea;
b) clearlymarked;
c) providedwithadequateshielding;
d) madeofcompartmentsthatenablethesegregationofwastesperradionuclide
groupwithsimilarhalflifeandperphysicalstate.
32.4.13.7
Theroomdestinedforministrationofradiopharmaceuticalstopatients
shallbeequippedwith:
a) shielding;
b) wallsandfloorswithroundedcorners,coveredwithwaterproofmaterials,to
allowdecontamination;
c) privatetoilet;
d) shieldedscreenatthebedside;
e) externalsignalingthepresenceofionizingradiation;
f) controlledaccess.
32.4.14
RadiotherapyServices
32.4.15
Radiotherapyservicesshalladoptatleastthefollowingsafetydevices:
a) treatmentroomsequippedwithdoorswithaninterlocksystem,toprevent
unauthorizedaccessofpersonsduringequipmentoperation;
b) indicatorsignallightsforequipmentinoperation,locatedinthetreatment
roomandatitsexternalaccess,inavisibleposition.
32.4.14.2
BrachytherapyServices
32.4.14.2.1
Intheroomdestinedforthepreparationandstorageofsources,isshallbe
forbiddentoengageinanyactivitynotrelatedtothepreparationofsealedsources.
32.4.14.2.2
Thecontainersusedforthetransportofsourcesshallbeidentifiedwiththe
radiationwarningsymbolandtheactivityleveloftheradionuclidebeingtransported.
32.4.14.2.3
Duringthemovementordisplacementofsourcesusedinbrachytherapy,
optimizationshallbepursued,toexposethesmallestpossiblenumberofpeople.
32.4.14.2.4
Duringthetrainingofworkersinthehandlingofsealedsourcesfor
brachytherapy,simulatedsourcesshallbeused.
32.4.14.2.5
Themanualpreparationofsourcesforlowdoseratebrachytherapyshall
beperformedinaspecificroomwithcontrolledaccess,onlybeingallowedthepresence
ofpeopledirectlyinvolvedinthisactivity.
32.4.14.2.6 Thehandlingoflowdoseratesourcesshallbeperformedexclusivelywith
theuseoftools,andtheprotectionofaleadscreen.
32.4.14.2.7
Aftereachdoseapplication,thepatientsgarmentsandbedlinenshallbe
monitoredforthepresenceofsealedsources.
32.4.15
Radiology[MedicalRadiodiagnosticsImaging]Services
32.4.15.1
ThefacilityscurrentBusinessLicense,issuedbythelocalhealth
authority,andQualityAssuranceProgram,shallbekeptintheworkplace,availablefor
LaborOfficeinspection.
32.4.15.2
Thecontrolpanelorcabinshallbepositionedsoasto:
a) enabletheoperator,fromthefiringposition,toeffectivelycommunicateand
visuallyobservethepatient;
b) allowtheoperatortoseetheentryofanypersonsintheroomduringthe
radiologicalprocedure.
32.4.15.3
TheXrayroomshallbeequippedwith:
a) avisiblesignontheoutsideoftheaccessdoors,containingtheinternational
symbolforionizingradiation,withthetextXrays,restrictedentryorX
raytheaccessofunauthorizedpersonsforbidden.
b) aredwarninglightsignalabovetheoutsideoftheaccessdoors,accompanied
bythefollowingwarningnotice:whentheredlightisonentryisforbidden.
Thelightsignalshallbetriggeredduringradiologicalprocedures.
32.4.15.3.1
TheaccessdoorsofroomswithfixedXrayequipmentshallbekept
closedduringirradiations.
32.4.15.3.2
TheinstallationofmorethanoneXrayequipmentperroomisnot
allowed.
32.4.15.4
Thedarkroomshallbeequippedwith:
a) alocalairexhaustsystem;
b) asinkwithfaucet.
32.4.15.5
Radiologydiagnosticmedicalequipmentshallbeequippedwitha
diaphragmandcollimator,inoperatingconditionsforradiography.
32.4.15.6
Mobileequipmentshallbeequippedwithatriggercontrolcablewitha
minimumlengthof2meters.
32.4.15.7
Duringradiologicalprocedures,onlythepatientandthenecessarystaff
shallremainintheroom.
32.4.15.8
Fluoroscopyequipmentshallbeequippedwith:
a) animageintensifiersystemwithattachedvideomonitor;
b) leadcurtainoraprontoprotecttheoperatorfromscatteredradiation;
c) asystemtoensurethattheradiationbeamiscompletelyrestrictedtothe
imagereceptorarea;
d) analarmindicatorsystemofacertainlevelofdoseorexposure.
32.4.15.8.1
Ifthefluoroscopicequipmentisnotequippedwiththisalarmsystem,it
shallbeinstalledintheenvironment.
32.4.16
DentalRadiologyServices
2.4.16.1
Intraoralradiologyservicesshallobservethat:
a) allworkersshallbekeptawayfromtheirradiationheadandthepatient,ata
minimumdistanceof2meters;
b) noworkershallholdthefilmduringexposure;
c) ifthepresenceofaworkerisnecessarytoassistthepatient,heorsheshall
usePPE.
32.4.16.2
Forprocedureswithextraoralradiographyequipment,thesame
requirementsshallbefollowedasinmedicaldiagnosticradiology.
32.5
ResiduesandWastes
32.5.1
Theemployershalltrain,atinductionandcontinually,workersonthe
followingsubjects:
a) segregation,packagingandtransportationofresidue;
b)
c)
d)
e)
f)
g)
h)
definitions,classification,andpotentialhazardofresidues;
themanagementsystemusedinternallyinthefacility;
waystoreducethegenerationofresidue;
knowledgeoftheirresponsibilitiesandduties;
identificationofthesymbolsfortheclassesofwastes;
knowledgeoftheuseofcollectionvehicles;
guidanceontheuseofPersonalProtectiveEquipmentPPE.
32.5.2
Plasticbagsusedinthepackagingofmedicalwastesshallmeetthe
requirementsinNBR9191andalsobe:
a) filledupto[nomorethan]2/3oftheircapacity;
b) closedsafelyinsuchawayastonotallowpouring,evenwhenturnedwith
theopeningfacingdownward;
c) immediatelyremovedfromthegenerationsite,afterfillingandclosing;
d) keptintactuntilthetreatmentordisposalofthewaste.
32.5.3
Thesegregationofresidueshallbecarriedoutattheplacewheretheyare
generated,observingthat:
a) recipients[trashcans]areusedthatcomplywithABNTstandard
requirements,inamountsufficientforstorage;
c) therecipientsarelocatednearthegeneratingsource;
d) therecipientsaremadeofwashablematerial,resistanttopuncture,rupture
andleakage,withalidprovidedwithanopeningsystemnomanualcontact,
withroundedcorners,andresistanttotipping;
e) therecipientsareidentifiedandmarkedaccordingtoABNTstandard
requirements.
32.5.3.1
Recipients[trashcans]usedinoperatingand[baby]deliveryroomsdonot
requirelids.
32.5.3.2
Recipientsforthecollectionofcuttingorperforatingmaterialshallbe
fillednomorethan,atmaximum,alevellocated5cmbelowcapacity.
32.5.3.2.1
Recipientsforthecollectionofcuttingorperforatingmaterialshallbe
keptuponastandalonesupport,ataheightthatallowsseeingclearlythedisposal
opening.
32.5.4
Themanualtransportationofsegregationrecipientscontainershallbe
doneinamannerthatthereisnocontactbetweenitandanypartsofthebody[otherthan
thehands]anddraggingisforbidden.
32.5.5
Whenthetransportofsegregationcontainersmayjeopardizethesafety
andoccupationalhealthofworkers,appropriatetechnicalmeansshallbeusedtopreserve
theirhealthandphysicalintegrity.
32.5.6
Thetemporarystorageareafortransportcontainersshallcomplywithat
leastthefollowingrequirements:
Ibeprovidedwith:
a) washablefloorsandwalls;
b) asiphoneddrain;
c) awaterpoint[faucet];
d) anelectricsocket;
e) adequateventilation;
f) largeenoughopeningtoallowtheentryofcontainers.
IIbekeptcleanandfreeofvectors[pests,insects,rodents];
IIIcontainonlythecontainers[trashcans]forcollection,storageortransport;
IVtobeusedonlyforthepurposesforwhichitwasintended;
Vbesignaledandclearlyidentified.
32.5.7
Thetransportofwastetoexternalstorageareasshallmeetthefollowing
requirements:
a) bemadeusingwagonsmadeofrigidmaterial,washable,waterproof,fitted
withahingedlid,andwithroundedcorners;
b) becarriedoutoneway,withaplannedroute,attimesscheduledtoavoid
thosewithdistributionofclothing,foodormedicine,visitinghours,and
periodswithincreasedflowofpeople.
32.5.7.1
Transportationcontainersofover400litersshallhaveadrainvalveatthe
bottom.
32.5.8
Healthcarefacilitiesshallbeequippedwithanappropriateexternal
outdoorlocationforthestorageofwastesuntilcollectionbytheexternalcollection
service.
32.5.8.1
Thislocationshallcomplywiththerequirementsdescribedinsection
32.5.6,andlargeenoughtoallowtheseparationofthecontainersbytypeofwaste.
32.5.9
RadioactiveresiduesshallbetreatedaspertherequirementsinResolution
CNENNE6.05.
32.6
CateringConditions
32.6.1
Thecateringordiningareas[cafeteriaordininghall]inhealthcare
facilitiesshallmeettherequirementsinNR24.
32.6.2
Facilitieswithupto300workersshallbeprovidedwithplacesformeals
meetingthefollowingminimumrequirements:
a)
b)
c)
d)
e)
f)
g)
locationoutsideofthejobarea;
washablefloor;
beprovidedwithcleaning,ventilationandgoodlighting;
tablesandseatsenoughforthenumberofworkersatrestandmealintervals;
sinksinstallednearbyorinthelocation;
supplyofdrinkingwater;
appropriateandsafeequipmentforheatingmeals.
32.6.3
Thesinksforhandhygieneshallbeprovidedwithpapertowels,liquid
soapandtrashcanwithlidandfootswitch.
32.7
Laundry
32.7.1
Thelaundryshallhavetwodistinctareas,oneconsidereddirtyandone
clean.Thefirstareashallcontainthereceiving,sorting,weighingandwashingofclothes,
andthesecondarea,thehandlingofwashedclothes.
32.7.2
Regardlessofthesizeofthelaundry,washingmachinesshallbeequipped
withadoubledoororbarrier,wherethedirtyclothingisinsertedintoaportonthedirty
areabyanoperatorand,afterwashed,removedinthecleanarea,byanotheroperator.
32.7.2.1
Communicationbetweenthetwoareasisonlyallowedthroughvisors
[closedwindows]orintercoms.
32.7.3
Theironershallbeequippedwith:
a) athermometerforeachheatingchamber,indicatingthetemperature
oftherailsorheatedcylinder;
b) thermostat;
c) protectiondevicethatpreventstheinsertionofworkerbodypartsinto
therollersormovingparts.
32.7.4
Thewashingmachines,centrifugesanddryersshallbeequippedwith
electromechanicaldeviceswhichinterruptoperationupontheopeningofcompartment
doors.
32.8
Housekeeping
32.8.1
Workerswhoperformthecleaningofhealthcarefacilitiesshallbetrained,
atinductionandcontinually,ontheprinciplesofpersonalhygiene,biohazards,chemical
hazards,signs,labels,PPE,CPE,andemergencyprocedures.
32.8.1.1
Proofoftrainingshallbekeptattheworkplace,availableforLaborOffice
inspection.
32
Regardinghousekeepingandcleaningactivities,employersshall:
a) provideafunctionalcartforthestorageandtransportofmaterialsand
productsessentialfortheactivities;
b) providematerialsandcleaningutensilsthatpreservethephysicalintegrityof
theworker[arenonhazardousasfaraspossible];
c) forbiddrysweepingininternalareas;
d) forbidtheuseof[personal]adornments[suchasjewelry].
32.8.3
Housekeepingservicecompaniesoperatinginhealthcarefacilitiesshall
complywith,atleast,therequirementsinitems32.8.1and32.8.2.
32.9
MaintenanceMachineryandEquipment
32.9.1
Theworkerswhoperformmaintenance,inadditiontospecifictrainingfor
theiractivity,shallalsobeundergoinitialtrainingandongoingbasisinordertokeep
themacquaintedwiththeprinciplesof:
a) personalhygiene;
b) biologicalhazards(universalprecautions),physicalandchemicalhazards;
c) signsandtheirmeaning;
d) preventivelabeling;
e) typesofPPEandCPE,accessibilityandcorrectuse.
32.9.1.1
Companiesprovidingtechnicalassistanceandmaintenanceinhealthcare
shallcomplywiththerequirementsinsection32.9.1above.
32.9.2
Allequipmentshallundergodecontaminationpriortoperforming
maintenance.
32.9.2.1
Themaintenanceofequipmentwherethediscontinuityofitsusewould
entailhazardtoapatient'slifeshallrequiresafetyproceduresforthepreservationofthe
workers'health.
32.9.3
Machinery,equipmentandtools,includingthoseusedbymaintenance
crews,shallbeundergopriorinspectionandpreventivemaintenanceaccordingtothe
manufacturersinstructions,theapplicableofficialtechnicalstandard,andlegislation.
32.9.3.1
Inspectionandmaintenanceshallberecorded,andtherecordskept
availablefortheworkersinvolvedandsupervisionbytheLaborOffice.
32.9.3.2
Companiesprovidingtechnicalassistanceandmaintenanceinhealthcare
shallcomplywiththerequirementsinsection32.9.3.
32.9.3.3
Employersshallestablishapreventivemaintenancescheduleofthegas
supplyandexhaustorfumehoodsystems,andshallmaintainanindividualrecordofit,
signedbytheprofessionalwhomadeit.
32.9.4
Theequipmentandmechanicalmeansusedfortransportshallundergo
periodicmaintenanceinordertokeepthewheels[andeverythingelse]inworkingorder.
32.9.5
Thebed[heightandposition]adjustmentdevicesshallundergopreventive
maintenance,includinglubrication,toensuretheiroperationwithoutoverloadfor
workers.
32.9.6
Airconditioningsystemsshallbeundergoproceduresforpreventiveand
correctivemaintenancetopreservetheintegrityandefficiencyofallcomponents.
32.9.6.1
Compliancewiththerequirementsinitem32.9.6doesnotexemptfrom
simultaneouscompliancewithOrdinanceGM/MS3523of28/08/98andotherrelevant
legalprovisions.
32.10
32.10.1
GeneralRequirements
a)
b)
c)
d)
Healthcarefacilitiesshall:
meetthecomfortconditionsregardingnoiselevels,asperNB95ABNT;
meetthelightingconditions,asperNB57ABNT;
meettheconditionsforthermalcomfort,asperRDC50/02ANVISA;
keeptheworkenvironmentinaclean,tidyandconservedcondition.
32.10.2
DuringthepreparingandimplementationofthePPRAandPCMSO,the
activitiesoftheHospitalInfectionControlCommitteeCCIH,Comisso de
Controle de Infeco Hospitalar atthefacility,orequivalentcommittee,shallbe
considered.
32.10.3
Priortousinganyequipment,operatorsshallbetrainedastothemodeof
operationanditshazards.
32.10.4
Themanufacturersmanualsofallequipmentandmachinery,printed[in
hardcopy]andinPortuguese,shallremainavailablefortheworkersinvolved.
32.10.5
Theuseofmedicalandhospitalsuppliesormaterialsatoddswiththe
recommendationsofuse,ortechnicalspecifications,definedintheirmanualor
packaging,isprohibited.
32.10.6
Healthcarefacilitiesshallensureasynanthropic[ecologicallyassociated
withhumans]animalcontrolprogram,withproof,whichshallbeprovedwhenever
requiredbytheLaborOfficeinspection.
32.10.7
Kitchensshallbeequippedwithexhaustsystemsandotherequipmentto
reducethedispersionofgreaseandsteam,asestablishedinNBR14518.
32.10.8
Jobsstationsshallbeorganizedsoastoavoidunnecessarydisplacement
andeffort.
32.10.9
Jobsstationsshallbeprovidedwithsecurelystabilizeddevices,enabling
workerstoaccesshighplaceswithnoadditionaleffort.
32.10.10
Duringthemovingandtransportationofpatients,theuseofdevicesthat
minimizeworkereffortshallbepreferred.
32.10.11
Thetransportationofmaterialsthatmayjeopardizeworkerhealthorsafety
shallbecarriedoutwiththeaidofmechanicalorelectromechanicalmeans.
32.10.12
Healthcarefacilityworkersshallbe:
a) trainedinproperbodypositionsandmechanics,forthemovementofpatients
ormaterials,inordertopreservetheirhealthandphysicalintegrity;
b) instructedastoprocedureswithpatientsshowingbehavioraldisorders.
32.10.13
Environmentsinwhichproceduresareperformedthatcausefoulodors
shallbeequippedwithanexhaustsystem,oranotherdevice,tominimizeodors.
32.10.14
Mouthpipettingisprohibited.
32.10.15
Washbasinsandsinksshall:
a) beequippedwithfaucetsoractivators[elbowleversorsensors]thatdonot
requirethecontactofhandstoclosethewater;
b) beprovidedwithliquidsoapanddisposabletowelsfordryinghands.
32.10.16
HealthcarefacilitybuildingsshallmeettherequirementsinANVISA
RDC50,ofFebruary21,2002.
32.11
Finalprovisions
32.11.1
CompliancewiththerequirementsinthisNRdoesnotrelieveorexempt
companiesfromsimultaneouscompliancewithotherapplicablerequirements,eventually
includedinhealthregulationsbystates,municipalitiesortheFederalDistrict,orderived
fromlaborconventionsandcollectiveagreements,orcontainedinotherapplicableNRs
andfederallegislation.
32.11.2
AlllegislationandnormativeactsmentionedinthisNR,whenreplacedor
updatedbynewacts,shallbedeemedautomaticallyupdatedregardingthisreference.
32.11.3
TheNationalPermanentTripartiteCommissionfortheNR32,called
CTPNNR32,andthePermanentTripartiteRegionalCommissionsfortheNR32within
theFederativeUnits,calledNR32rCTP,areherebycreated.
32.11.3.1
Doubtsanddifficultiesencounteredduringtheimplantationandcontinued
developmentoftheNRshallbeforwardedtotheCTPN.
32.11.4
Thereshallbejointresponsibilityamongemployers,contactorcompanies
andworkersinthecomplianceofthisNR.
ANNEXI
BIOLOGICALAGENTRISKCLASSES
Biologicalagentsareclassifiedinto:
RiskGroup1:lowindividualriskfortheworkerandforthecommunity,unlikelytocause
diseaseinhumans.
RiskGroup2:moderateindividualrisktoworkersandlowprobabilityofspreadingto
thecommunity.Cancausediseasesinhumans,forwhicheffectivemeansofprophylaxis
ortreatmentareavailable.
RiskGroup3:highindividualriskforworkersandlikelytospreadtothecommunity.
Cancausediseasesandseriousinfectionsinhumans,forwhicheffectivemeansof
prophylaxisortreatmentarenotalwaysavailable.
RiskGroup4:highindividualriskforworkersandhighprobabilityofspreadingtothe
community.Thepathogenhashighcapacityoftransmissionfromoneindividualto
another.Cancauseseriousillnessinhumans,forwhichnoeffectivemeansof
prophylaxisortreatmentareavailable..
ANNEXII
BIOLOGICALAGENTCLASSIFICATIONTABLE
1.Thisannexlistsbiologicalagentsclassifiedunderriskgroups2,3and4,accordingto
thecriterialistedinAnnexI.Foradditionalinformation,weusethefollowingsymbols:
A:
possibleallergiceffects
E:
emergentandopportunisticagent
O:
oncogenicagent,lowrisk
O+: oncogenicagent,moderaterisk
T:
productionoftoxins
V:
effectivevaccineavailable
(*): usuallynottransmittedthroughtheair
spp:otherspeciesofthegenus,inadditiontothoseexplicitlyspecified,may
poseahazardtohealth.
Intheclassificationbygenusandspecies,thefollowingsituationsmayoccur:
a)
inthecaseofmorethanonespeciesofaparticulargenretobepathogenic,the
mostimportantwillbemarked,followedby"spp",indicatingthatother
speciesofthegenusmayalsobepathogenic.Forexample:Campylobacter
fetus,Campylobacterjejuni,Campylobacterspp.
b)
whenasinglespeciesappearsinthetable,forexample,Rochalimaea
Quintana,thisindicatesthatspecificallythisagentisapathogen.
2.
Theclassificationofagentsconsideredthepossibleeffectsonhealthyworkers.
Theparticulareffectsonemployeeswhosesusceptibilitymaybeaffected,asinthecase
ofpreviouspathology,medication,immunologicaldisorders,pregnancyorlactation,
werenotconsidered.
3.
Forthecorrectclassificationofagentsusingthistable,considerthat:
a)
thefailuretoidentifyaparticularagentinthetabledoesnotimplyits
automaticinclusioninthehazardcategory1.forthis,ariskassessmentshallbe
conducted,basedontheseagentsknownorpotentialproperties,andthoseof
otherrepresentativesofthesamegenusorfamily.
b)
geneticallymodifiedorganismsarenotlistedinthetable.
c)
inthecaseofagentsinwhichonlyitsgenusislisted,speciesandstrains
[eventuallyknownas]nonpathogenictoman,shallbeconsideredexcluded.
d)
allvirusesisolatedinhumans,butnotincludedinthetable,shallbe
classifiedasofHazardClass2untilclassificationstudiesarecompleted.
BIOLOGICAL AGENTS
Bacteria
Acinetobacter baumannii (formerly Acinetobacter calcoaceticus)
Actinobacillus spp
Actinomadura madurae
Actinomadura Pelletieri
Actinomyces gerencseriae
Actinomyces israelii
Actinomyces pyogenes (formerly Corynebacterium pyogenes)
Actinomyces spp
Aeromonas hydrophyla
Amycolata autotrophica
Archanobacterium haemolyticum (Corynebacterium haemolyticum)
Bacillus anthracis
Classification
(Groups)
Notes
2
2
2
2
2
2
2
2
2
2
2
Bacteroides fragilis
Bartonella (Rochalimea) spp
Bartonella bacilliformis
Bartonella henselae
Bartonella quintana
Bartonella vinsonii
Bordetella bronchiseptica
Bordetella parapertussis
3
2
2
2
2
2
2
2
2
Bordetella pertussis
Borrelia anserina
Borrelia burgdorferi
Borrelia duttonii
Borrelia persicus
Borrelia recurrentis
Borrelia spp
Borrelia theileri
Borrelia vincenti
Brucella abortus
Brucella canis
Brucella melitensis
Brucella suis
Burkholderia mallei (Pseudomonas mallei)
Burkholderia pseudomallei (Pseudomonas pseudomallei)
Campylobacter coli
Campylobacter fetus
Campylobacter jejuni
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
2
2
2
Campylobacter septicum
Campylobacter spp
Cardiobacterium hominis
Chlamydia pneumoniae
Chlamydia trachomatis
Chlamydia psittaci (avian strains)
Clostridium botulinum
Clostridium chauvoei
Clostridium haemolyticum
Clostridium histolyticum
Clostridium novyi
Clostridium perfringens
Clostridium septicum
Clostridium spp
Clostridium tetani
Corynebacterium diphtheriae
Corynebacterium equi
Corynebacterium haemolyticum
Corynebacterium minutissimum
Corynebacterium pseudotuberculosis.
Corynebacterium pyogenes
Corynebacterium renale
Corynebacterium spp
Coxiella burnetii
Dermatophilus congolensis
Edwardsiella tarda
Ehrlichia sennetsu (Rickettsia sennetsu)
Ehrlichia spp
Eikenella corrodens
Enterobacter aerogenes / cloacae
Enterococcus spp
Erysipelothrix rhusiopathiae
Escherichia coli (all enteropathogenic, enterotoxigenic, enteroinvasive
strains, or carrying K1 antigens)
Escherichia coli strains verocitotxicas (e.g. O157: H7 and O103)
Francisella tularensis (type A)
Haemophilus ducreyi
Haemophilus equigenitalis
Haemophilus influenzae
Helicobacter pylori
Klebsiella oxytoca
Klebsiella pneumoniae
2
2
2
2
2
3
3
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
3
2
2
2
2
2
2
2
2
Klebsiella spp
Legionella pneumophila
Legionella spp
Leptospira interrogans (all serotypes)
Listeria monocytogenes
Listeria ivanovii
Moraxella spp
Mycobacterium asiaticum
2
2
2
2
2
2
2
2
T, V
T, V
2
3
3
2
3
2
2
2
2
(*), T
2
3
2
2
2
2
2
2
2
2
2
2
3
2
2
2
2
2
2
2
2
2
2
2
2
2
3
2
2
2
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
3
3
3
3
3
2
(*)
(*)
(*)
Salmonella enteritidis
Salmonella typhimurium
Salmonella paratyphi A, B, C
Salmonella typhi
Salmonella spp
Serpulina spp
Shigella boydii
Shigella dysenteriae
Shigella flexneri
Shigella sonnei
Staphylococcus aureus
Streptobacillus moniliformis
Streptococcus pneumoniae
Streptococcus pyogenes
Streptococcus suis
Streptococcus spp
Treponema carateum
Treponema pallidum
Treponema pertenue
Treponema spp
Vibrio cholerae (01 and 0139)
Vibrio parahaemolyticus
Vibrio vulnificus
Vibrio spp
Yersinia enterocolitica
Yersinia pestis
Yersinia pseudotuberculosis
Yersinia spp
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
3
2
2
Virus
Herpesvirus of guinea pigs
Shope fibroma virus of rabbits
Haemorrhagic disease of rabbits
Viral enteritis virus of ducks, geese and swans
Malignant catarrhal fever virus of cattle and deer
Viral hepatitis virus types 1, 2 and 3 of duck
Leukemia virus of hamsters
Enzootic leucosis virus of cattle
Lumpy skin virus
Sarcoma virus of dogs
Mammary Tumor virus of mice
Lucke virus of frogs
Adenoviridae
Adenovirus 1, Aviary - CELO virus
Adenovirus 2 Simian virus 40 (Ad 2 - SV40)
Adenovirus 7 Simian virus 40 (Ad 7 - SV40)
Arenaviradae:
* LCM-Lassa viral complexes (Old World arena viruses)
Lassa virus
Lymphocytic choriomeningitis virus (neurotropic strains)
2
2
4
4
4
4
2
2
4
2
2
2
2
2
2
2
4
3
V
(*), V
O
O
O
O
O
O
O
O
O+
O
2
2
2
4
4
2
4
2
2
4
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
Apeu virus
Caraparu virus
Itaqui virus
Marituba virus
Murutucu virus
Nepuyo virus
Oriboca virus
* Capim Group
Acara virus
Benevides virus
Benfica virus
Grass virus
Guajar virus
Moriche virus
* Guama Group
Anantapur virus
Bimiti virus
Cat virus
Guama virus
Mirim virus
Moju virus
Timboteua virus
* Simbu Group
Jatobal virus
Oropouche virus
Utinga virus
Calciviridae`:
Hepatitis E virus
Norwalk virus
other Calciviridae`
Coronaviridae:
Human virus, swine gastroenteritis , murine hepatitis [of mice], bovine
coronavirus of cattle, feline infectious peritonitis, avian infectious
bronchitis, canine, rat and rabbit Coronavirus
Filoviridae:
Ebola virus
Marburg virus
Flaviviridae:
Bussuquara virus
Cacipacor virus
Dengue virus types 1-4
Japanese B Encephalitis virus
Australian Encephalitis virus (Murray Valley Encephalitis)
Russian spring-summer encephalitis virus
St. Louis Encephalitis virus
Central Europe Encephalitis virus
Yellow Fever virus
Omsk Haemorrhagic Fever virus
Kyasanur Forest virus
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
(*)
2
4
4
2
2
2
3
3
4
2
4
3
4
4
V
Go)
(*), V,
(a)
V
(The)
Go)
Hepatitis C virus
West Nile virus
Ilheus virus
Kunjin virus
Powassan virus
Rocio virus
Sal Vieja virus
San Perlita virus
Spondweni virus
Hantavirus:
Andes virus
Dobrava (Belgrade) virus
Hantaan virus (Korean hemorrhagic fever)
Juquitiba virus
Prospect Hill virus
Puumala virus
Seoul virus
Sin Nombre virus
Hepadnaviridae:
Hepatitis B virus
Hepatitis D (delta)
Herpesviridae:
Cytomegalovirus
Herpes simplex virus types 1 and 2
Herpesvirus paniscus (Rhadinovirus)
Herpesvirus Saimiri (Rhadinovirus)
Human herpesvirus 7 (HHV7)
Human herpesvirus 8 (HHV-8)
Herpesvirus simiae (B virus)
Herpesvirus varicellazoster
Marek's Disease virus
Epstein-Barr virus
Human B-lymphotropic virus (HBLV-HHV6)
Nairovirus:
Haemorrhagic Fever, Crimean / Congo
Hazara virus
Oncornavirus C and D virus
Orthomyxoviridae:
Influenza virus types A, B and C
Orthomyxovirus transmitted by ticks: Dhori virus and Thogoto
Papovaviridae:
Polyoma virus
Shope papilloma virus
BK virus and JC
Papillomaviruses
Human Papilloma virus
Simian virus 40 (SV40)
Paramyxoviridae:
Pneumovirus
2
2
2
2
3
3
3
3
3
(*)
3
3
3
3
2
2
3
3
2
2
(*), V
(*), V,
(b)
2
2
3
3
2
2
4
2
2
2
2
4
2
3
2
2
You)
2
2
2
2
2
2
O
O
Mumps virus
Newcastle Disease virus (non-Asian samples)
Parainfluenza virus types 1 to 4
Measles virus
Nipah virus
Respiratory Syncytial virus
Parvoviridae:
Human Parvovirus (B 19)
Phlebovirus:
Uukuvirus
Alenquer virus
Ambe virus
Anhang virus
Ariquemes virus
Belterra virus
Bujaru virus
candiru virus
Toscana virus
Icoaraci virus
Itaituba virus
Itaporanga virus
Jacund virus
Joa virus
Morumbi virus
Munguba virus
Naples virus
Oriximina virus
Pacu virus
Sierra Norte virus
Calabash virus
Tuscany virus
Turuna virus
Uriurana virus
Urucuri virus
Picornaviridae:
Poliovirus
Rhinovirus
Coxsackie virus
FMD virus, with its various types and variants
Acute Hemorrhagic Conjunctivitis virus (AHC)
Hepatitis A virus (human enterovirus type 72)
ECHO virus
Poxviridae:
Parapoxvirus
Poxvirus of goats, pigs and poultry
Buffalopox virus
Cotia virus
Cowpox virus (and related virus es isolated from domestic cats and wild
animals)
Smallpox virus (major, minor)
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
4
2
2
2
2
2
2
2
2
4
(D)
4
4
2
4
3
2
2
4
2
2
V
O+
2
2
2
2
2
2
2
2
3
2
2
2
2
2
2
2
2
2
3
2
3
2
3
2
2
2
2
2
2
2
2
2
2
2
2
2
(*)
O
O+
O
O
O+
O
O
O+
O+
(*)
O
(*), (e)
V (*)
* Mussuril Group
Cuiaba virus
Marco virus
* Timbo Group
Chaco virus
Sena Madureira virus
Timbo virus
Togaviridae:
* Alphavirus
Aur virus
Bebaru virus
Chikungunya virus
Western equine encephalitis virus
Eastern equine encephalitis virus
Venezuelan equine encephalitis virus
Semliki Forest virus
Ross River virus
Mayaro virus
Mucambo virus
Onyongnyong virus
Pixuna virus
Una virus
Other known alphaviruses
* Rubivirus: Rubella Virus
* Pestivirus: Bovine Diarrhoea virus
Prions: Unconventional agents associated with transmissible spongiform
encephalopathies
Agent of Bovine Spongiform Encephalopathy (BSE), scrapie and other
diseases
Agent of Creutzfeldt-Jakob disease (CJD)
Family of Fatal Insomnia Agent
Agent Gerstmann-Strussler-Scheinker syndrome
Agent Kuru
Parasites
Acanthamoebacastellani
Ancylostoma ceylanicum
Ancylostoma duodenale
Angiostrongylus cantonensis
Angiostrongylus costaricensis
Angiostrongylus spp
Ascaris lumbricoides
Ascaris suum
Babesia divergens
Babesia microti
Balantidium coli
Brugia malayi
Brugia pahangi
Brugia timori
Capillaria philippinensis
Capillaria spp
Clonorchis sinensis
2
2
2
2
2
2
2
2
2
2
3
2
2
2
2
2
2
2
2
2
2
3
3
3
3
3
(*) (f)
(*) (f)
(*)
(*)
(*)
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
(*)
A
A
Clonorchis viverrini
Coccidia spp
Cryptosporidium parvum
Cryptosporidium spp
Cyclospora cayetanensis
Cysticercus cellulosae (hydatid cyst, sollium T. Larvae)
Dactylaria galloped (Ochroconis gallopavum)
Dipetalonema streptocerca
Diphyllobothrium latum
Dracunculus medinensis
Echinococcus granulosus
2
2
2
2
2
2
2
2
2
2
2
Echinococcus multilocularis
Echinococcus vogeli
Emmonsia parva var. Crescens
Emmonsia parva var. Parva
Entamoeba histolytica
Enterobius spp
Exophiala (Wangiella) dermatitidis
Fasciola gigantica
Fasciola hepatica
Fasciolopsis
Fonsecaea compact
Fonsecaea pedrosoi
Giardia lamblia (Giardia intestinalis)
Giardia spp
Heterophyes spp
Hymenolepis diminuta
Hymenolepis nana
Isospora spp
Leishmania brasiliensis
Leishmania donovani
Leishmania major
Leishmania mexicana
Leishmania peruviana
Leishmania spp
Leishmania tropica
Leishmanla ethiopica
Loa loa
Madurella grisea
Madurella mycetomatis
Mansonella ozzardi
Mansonella perstans
Microsporidium spp
Naegleria fowleri
Naegleria gruberi
Necator americanus
Onchocerca volvulus
Opisthorchis felineus
Opisthorchis spp
Paragonimus westermani
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
(*)
(*)
(*)
(*)
(*)
Plasmodium cynomolgi
Plasmodium falciparum
Plasmodium malariae
Plasmodium ovale
Plasmodium spp (human and simian)
Plasmodium vivax
Sarcocystis suihominis
Scedosporium apiospermum (Pseudallescheria boidii)
Scedosporium prolificans (inflatum)
Schistosoma haematobium
Schistosoma intercalatum
Schistosoma japonicum
Schistosoma mansoni
Schistosoma mekongi
Strongyloides spp
Strongyloides stercoralis
Taenia saginata
Taenia solium
Toxocara canis
Toxoplasma gondii
Trichinella spiralis
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
Trichuristrichiura
Trypanosoma brucei brucei
Trypanosoma brucei gambiense
Trypanosoma brucei rhodesiense
Trypanosoma cruzi
Wuchereria bancrofti
Fungi
Acremonium sickle
Acremonium kiliense
Acremonium potronii
Acremonium recifei
Acremonium roseogriseum
Alternaria anamorph of Pleospora Infectoria
Aphanoascus fulvescens
Aspergillus amstelodami
Aspergillus caesiellus
Aspergillus candidus
Aspergillus carneus
Aspergillus flavus
Aspergillus fumigatus
Aspergillus glaucus
Aspergillus oryzae
Aspergillus penicillioides
Aspergillus restrictus
Aspergillus sydowi
Aspergillus terreus
Aspergillus unguis
Aspergillusversicolor
Beauveria bassiana
Blastomyces dermatitidis (Ajellomyces dermatitidis)
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
(*)
(*)
(*)
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
A
Candida albicans
Candida lipolytica
Candida pulcherrima
Candida ravautii
Candida tropicalis
Candida viswanathii
Chaetoconidium spp
Chaetomium spp
Chaetosphaeronema Larense
Cladophialophora bantiana (bantiana Xylophora, Cladosporium bantianum
or C. Trichoides)
Cladophialophora carrioni (Cladosporium carrioni)
Cladosporium cladosporioides
Coccidioides immitis
Conidiobolus incongruus
Coprinus cinereus
Cryptococcus neoformans
Cryptococcus neoformans var. Gattii (Filobasidiella bacillispora)
Cryptococcus neoformans var. Neoformans (Filobasidiella neoformans var.
neoformans)
Cunninghamella geniculata
Curvularia pallescens
Curvularia senegalensis
Cylindrocarpon tonkinense
Drechslera spp
Emmonsia parva var. Crescens
Emmonsia parva var. Parva
Epidermophyton floccosum
Epidermophyton spp
Exophiala (Wangiella) dermatitidis
Exophiala moniliae
Fonsecaea compact
Fonsecaea pedrosoi
Fusarium dimerum
Fusariumnivale
Geotrichum candidum
Hansenula polymorpha
Histoplasma capsulatum duboisii
Histoplasma capsulatum (Ajellomyces capsulatus)
Lasiodiplodia theobramae
Madurella grisea
Madurella mycetomatis
Madurella spp
Microascus desmosporus
Microsporum aldouinii
Microsporum canis
Microsporum spp
Mucor rouxianus
Mycelia sterilia
Mycocentrospora Acerina
Neotestudina rosatii
2
2
2
2
2
2
2
2
2
2
2
2
3
2
2
2
2
A
E
E
E
E
E
E
E
E
A
E
E
A
2
2
2
2
2
2
2
2
2
2
2
A
E
E
E
E
E
2
2
2
2
2
2
2
3
3
2
2
2
2
2
2
2
2
2
2
2
2
E
E
E
E
E
A
A
A
E
E
E
Oidiodendron cerealis
Paecilomyces lilacinus
Paecilomyces variotti
Paecilomyces viridis
Paracoccidioides brasiliensis (in the sporulation phase at higher risk of
infection)
Penicillium chrysogenum
Penicillium citrinum
Penicillium commune
Penicillium expansum
Penicillium marneffei
Penicillium spinulosum
Phialophora hoffmannii
Phialophora parasitica
Phialophora repens
Phoma hibernica
Phyllosticta ovalis
Phyllosticta spp
Pneumocystis carinii
Pyrenochaeta unguis-hominis
Rhizoctonia spp
Rhodotorula pilimanae
Rhodotorula rubra
Scedosporium apiospermum (Pseudallescheria boidii)
Scedosporium prolificans (inflatum)
Schizophyllum commune
Scopulariops acremonium
Scopulariops brumptii
Sporothrix schenckii
Stenella araguata
Taeniolella stilbospora
Tetraploa spp
Trichophyton rubrum
Trichophyton spp
Trichosporon capitatum
Tritirachium oryzae
Volutella cinerescens
2
2
2
2
2
E
E
E
E
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
2
E
E
E
E
A
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
E
Sources:
1.Brazil(2004)GeneralGuidelinesforworkincontentionwithbiologicalmaterial.
SeriesA:StandardsandTechnicalManuals.MinistryofHealth,SecretaryforScience,
TechnologyandStrategicInputs,Brasilia:MinistryofHealth,60p.
2.EU(2000)CouncilDirective2000/54/EC.OJL262,17.10.2000,21p.
3.ABSA(2005)RiskGroupClassificationforInfectiousAgents.
http://www.absa.org/riskgroups/accessedJuly11,2005[confirmedMay9,2016]
(a)encephalitistransmittedbyticks.
(b)HepatitisDvirusispathogeniconlyonthepresenceofsimultaneousorsecondary
infectioncausedbyhepatitisB.Thus,vaccinationofpersonswhoarenotcarriersof
hepatitisBvirusalsoimmunizeagainsthepatitisD(delta).
(c)OnlyfortypesAandB.
(d)Twovirusesareidentified:oneisbuffalopoxtypeandtheotherisavariantof
vacciniavirus.
(e)Todatethereisnoevidenceofdiseaseinhumanscausedbyretrovirusesofsimian
origin.Asaprecaution,itisrecommendedto3containmentlevelforworkingwiththis
agent.
(f)Todatethereisnoevidenceofhumaninfectionscausedbytheagentsresponsiblefor
bovinespongiformencephalitis.However,itisrecommendedcontainmentlevel2atleast
toworkwithinthelaboratorythisagent.[Note;ThisappliesonlytoCJD,notthe
humaninfectingvCJD177people(asofJune2014)contractedanddiedofadisease
withsimilarneurologicalsymptomssubsequentlycalled(new)variantCreutzfeldtJakob
disease(vCJD).[5][61]Thisisaseparatediseasefrom'classical'CreutzfeldtJakob
disease,whichisnotrelatedtoBSEandhasbeenknownaboutsincetheearly1900s.
https://en.wikipedia.org/wiki/Bovine_spongiform_encephalopathy]
ANNEXIII
RISKPREVENTIONPLANFORACCIDENTSWITHCUTTINGAND
PIERCINGMATERIAL
1.
PurposeandScope:
1.1
Establishguidelinesforthepreparationandimplantingofariskpreventionplan
foraccidentswithsharpcuttingandpiercingmaterialswithlikelihoodofexposureto
biologicalagents,aimingattheprotection,safetyandhealthofhealthcarefacility
workers,aswellasthosewhoexercisehealthcareactivitiesingeneral.
1.2
Healthcarefacilitiesareallbuildingsemployedfortheprovisionofhealthcareto
thepopulation,andallactivitiesforthepromotion,recovery,care,researchandteaching
ofhealthandmedicine,atanylevelofcomplexity.
1.3
Cuttingandpiercingmaterialsarethoseusedinhealthcarefacilitiesthathavea
perforatingtip[suchasneedles]orcuttingedge[suchasblades]orwhichcanperforate
orcut.
1.4
Safetydevicesareanitemsintegratedtoaunitwhereacuttingorperforating
element,oratechnology,capableofreducingtheriskofaccidents,whatevertheunits
activationmechanism.
2.
Multidisciplinarymanagingcommittee:
2.1
Employersshallconstituteamultidisciplinarycommitteewiththepurposeof
reducingtheriskofaccidentswithsharpandpiercingmaterials,withlikelyexposureto
biologicalagents,throughthedevelopmentandupdatingofaeriskpreventionplan
againstaccidentswithcuttingorperforatingmaterials.
2.2
Thecommitteeshallbeformed,whereapplicable,withthefollowingmembers:
a) theemployer,hisorherlegalrepresentative,oratopmanagement
representativeofthehealthcarefacility;
b) arepresentativeoftheServiceinSafetyEngineeringandOccupational
MedicineSESMT,accordingtoRegulatoryStandardNo.4;
c) thevicepresidentoftheInternalAccidentPreventionCommissionCIPAor
thepersonappointedasresponsibleforthefulfillmentofrequirementsunder
NormNo.5,whereaCIPAisnotrequired;
d) arepresentativeoftheHospitalInfectionControlCommittee;
e) nursingmanagementorheadnurse;
f) chiefphysician;
g) personresponsibleforthepreparationandexecutionofthePGRSSWaste
ManagementPlan;
h) arepresentativeoftheCentralSupply/SterileSupply/SterileProcessing;
i) arepresentativeofthepurchasingdepartment;and
j) arepresentativeofthematerialsstandardizationsector.
3.
Reviewofoccurredaccidentsandhazardoussituationswithcuttingorperforating
materials:
3.1
TheManagementCommitteeshallreviewthePPRA,thePCMSO,andthelabor
accidentswithcuttingorperforatingmaterials.
3.2
TheManagementCommitteeshallnotberestrictedtopreexistinginformation
availableatthehealthcarefacilityandshallcarryoutindependentanalysesof
occupationalaccidentsandhazardoussituationswithcuttingorperforatingmaterials.
3.3
TheManagementCommitteeshallprepareandensureproceduresforthe
recordingandinvestigationofaccidentsandhazardoussituationsinvolvingcuttingor
perforatingmaterials.
4.
Establishingpriorities:
4.1
Fromtheanalysisofhazardoussituationsandworkingaccidentswithcuttingor
perforatingmaterials,theManagementCommitteeshallsetprioritiesconsideringthe
followingaspects:
a) hazardoussituationsandaccidentswithcuttingorperforatingmaterialsthat
havehighprobabilityoftransmissionofbiologicalagentscarriedinblood;
b) frequencyofoccurrenceofaccidentinprocedureswithuseofaspecific
cuttingorperforatingequipment;
c) cleaning,decontaminationordisposalproceduresthatcontributetoahigh
occurrenceofaccidents;and
d) amountofworkersexposedtohazardoussituationswithcuttingorperforating
materials.
5.
Controlmeasuresforthepreventionofaccidentswithcuttingorperforating
materials:
5.1
Theadoptionofcontrolmeasuresshallcomplywiththefollowinghierarchy:
a) replacingtheuseofneedlesandothercuttingorperforatingwhentechnically
possible;
b) adoptingengineeringcontrolsintheenvironment(e.g.disposalcollectors);
c) adoptingsafetydevicesoncuttingorperforatingmaterial,ifanyareavailable
andtechnicallyfeasible;and
d) changingtheworkorganizationandpractices.
6.
Selectionofcuttingorperforatingmaterialswithsafetydevices:
6.1
ThisselectionshallbeconductedbytheMultidisciplinaryManagement
Committee,throughthefollowingsteps:
a) definitionofprioritycuttingorperforatingmaterialsforreplacement,fromthe
analysisofhazardoussituationsandworkaccidents;
b) definitionofcriteriafortheselectionofcuttingorperforatingmaterialswith
safetydevices;obtainingproductsamplesforevaluation;
c) planningoftestsforreplacementinselectedareasinthehealthcarefacility,
fromtheanalysisofhazardoussituationsandworkaccidents;and
d) analysisoftheproductreplacementperformance,fromtheperspectivesof
workeroccupationalhealth,andpatientcareeffectiveness,forsubsequent
decisiontoadoptwhichmaterial.
7.
Workertraining:
7.1
Whenimplementingtheplan,workersshallbetrainedpriortotheadoptionofany
controlmeasure,andcontinually,topreventaccidentswithcuttingorperforating
materials.
7.2
Thistrainingshallbeproventhroughdocumentstoreportthedate,time,
workload,content,nameandqualificationofinstructorandworkersinvolved.
8.
Planschedule
8.1
Theplanshallcontainatimetableforitsexecutionandimplementation.
8.2
Thescheduleshallincludethestepsinitems3to7above,anddeadlinesforits
implementation.
8.3
Thisschedule,andproofofexecution,shallremainavailableforsupervisionby
theLaborOfficeandbytheworkersortheirrepresentatives.
9.
Planmonitoring
9.1
Theplanshallincludesystematicmonitoringofworkerexposuretobiological
agentsintheuseofcuttingorperforatingmaterials,usingtheanalysisofhazardous
situationsandworkaccidentsbeforeandaftertheirimplementation,suchasmonitoring
indicators.
10.
Planeffectivenessreview:
10.1 Theplanshallbeevaluatedeveryyear,atleast,andwheneveroccursachangein
workingconditionsorwhenanalysisofthehazardoussituationsandaccidentsdeemsit
advisable.
NR32
GLOSSARY
ABNT:BrazilianNationalStandardsOrganization
Accident:asuddenandunexpectedeventthatinterfereswiththenormaloperation,and
canresultindamagetotheworker,facilityortheenvironment.
OperationalLicense:licenseoroperatingpermitfortheservice,providedbythelocal
healthauthority.Alsocalledsanitarylicenseorhealthpermit.
Invitroanalysis:anindirectmethodfordeterminationofradionuclideactivityina
personsbodythroughtheanalysisofbiologicalmaterial,especiallyurineandfeces.
Invivoanalysis:adirectmethodofmeasuringtheemittedradiation,usedtoassessbody
contentorradionuclideactivityinspecificbodyorgans.Inthisanalysis,wholebody
countersaregenerally,usedwherethegammaorXraysemittedbyincorporated
radioactiveelementsaredetectedatstrategicpointsofthemonitoredindividual'sbody.
Ssynanthropicanimals:specieswhichcohabitundesirablywithmanandcantransmit
diseaseorcauseharmtohumanhealth,suchasrodents,cockroaches,flies,mosquitoes,
pigeons,ants,fleas,andothers.
Antineoplastic:drugsthatinhibitorpreventthegrowthandspreadofsometypesof
cancercells.Theyareusedinthetreatmentofpatientswithmalignancies.Theyare
highlytoxicandcancauseteratogenesis,mutagenesisandcarcinogenesiswithdifferent
risklevels.
ANVISA:NationalHealthSurveillanceAgency.
Controlledarea:areaunderspecialsafetyrules,forthepurposeofcontrollingnormal
exposure,preventingthespreadofradioactivecontamination,andpreventingorlimiting
theextentofpotentialexposures.
Supervisedarea:anareaforwhichtheconditionsofoccupationalexposuretoionizing
radiationarekeptundersupervision,evenifspecificprotectionandsafetymeasuresare
notnormallynecessary.
ExternalStorage:Consistsofareatokeepwastecontainersuntiltheyarecollectedbyan
externalwastecollectionservice,inaseparateareawitheasyaccesstowastecollection
vehicles.
TemporaryStorage:Consistsinthetemporarystorageofcontainerswithwastesalready
bagged,inaplacenexttotheirpointofgeneration,inordertospeedupthecollection
withinthefacilityandoptimizemovementfromtheirlocalofgenerationtothelocalfor
externalcollection.Temporarystoragecannotbemadewithdirectcontactofdisposal
bagsonthefloor,theconservationofbagsincontainers[trashcans]beingmandatory.
Shieldedscreen:screenormobilepartition,withasurfacecoatedwithmaterialthat
shieldsfromionizingradiation[suchaslead]todemarcateanareaandcreateasheltered
area.
Shielding:materialordeviceplacedbetweenaradiationsourceandhumanbeingsorthe
environmentforthepurposeofsafetyandradiationprotection.
Brachytherapy:radiationthroughoneormoresealedsourcesofgammaorbetarays,used
forsurface,intracavitaryorinterstitialapplications.
Biologicalsafetycabinet,classIIB2:Cabintoprovideprotectiontoworkersandthe
environmentfromchemicals,radionuclidesandbiologicalagentsthatfallunderthe
criteriaofBiosafetyLevel3.Italsoprotecttheproductortestruninsidethecabinfrom
contaminantsintheroomwhereitisinstalled,andfromcrosscontaminationinsidethe
cabinitself.
BiosafetyCabin,ClassIITypeB2(accordingtotheconceptsofNSF49):Cabin
equippedwithabsolutefilter(HEPA)withfiltrationefficiencyandairexhaustfrom
99.99%to100%,averageairvelocity(m/s)0.4510%,inletairvelocitythroughthe
frontwindowof0.50.55m/s.Allairenteringthecabinandallairthatisexhaustedtothe
outsidepreviouslypassthroughtheHEPAfilter.Thereisnoairflowrecirculation,the
exhaustiscomplete.Thecabinhasnegativepressurerelativetotheroomwhereitis
installed,giventhedifferencebetweentheairintakeanditsexhaust(flow1500m3/hand
suctionpressure@35m.m.c.a.).
Carcinogenicity:abilitysomeagentshavetoinduceorcausecancer.
CCIH:HospitalInfectionControlCommittee.
CNEN:NationalNuclearEnergyCommission.
Collimator:adevicecoupledtoaradiationsource,whichallowslimitingtheradiation
fieldandimprovingtheimageexposureconditions,ortoobtainadiagnosisorfor
therapy,throughtheshapeandsizeofaholegivingpassagetoradiation.
Externalcollection:aserviceprovidingtheremovalofwastefromahealthcarefacility
(placedinanexternalstoragearea)toatreatmentplantorfordisposal,usingtechniques
thatensurethepreservationofstorageconditionsandthehealthofworkers,thepublic
andtheenvironment,asperurbansanitationagencyguideline.
Vectorcontrol:operationsorprogramsdevelopedinordertoreduce,eliminateorcontrol
theoccurrenceofvectorsinagivenarea.
Cellculturesinvitro:growthofcellsderivedfromorgansortissuesofmulticellular
organisms,inanutrientmedium,understerileconditions.
Radioactivewastedecay:aspontaneoustransformationthatcausestheactivityofa
radioactivematerialtoreduceovertime.Thisprocessresultsinthedecreaseofthe
numberofradioactiveatomsintheoriginalsample.Thetimeforradioactivitytobe
reducedbyhalf[inasubstance]iscalled[thesubstances]radioactivehalflife.
Decontamination:removingachemical,physicalorbiologicalcontaminant.
Disinfection:aprocessofeliminationordestructionofmicroorganismsinvegetative
state,whetherornotpathogenic,inarticlesandinanimateobjects.Disinfectionmaybe
low,mediumorhigh.Itcanbedonethroughtheuseofphysicalorchemicalagents.
Diaphragm:adevicethatallowscontrolofanopeningandthusthesizeofanionizing
radiationbeam.
Finaldisposal:thedisposalofwastesintothesoil,inanareapreviouslypreparedto
receivethem,accordingtotechnicalcriteriaforconstructionandoperation,andbearing
environmentallicensingasperCONAMAResolution237/97.
Cytogeneticdosimetry:anassessmentoftheradiationdoseabsorbed,througha
frequencycountofchromosomalaberrationsinanirradiatedlymphocytecultureofthe
individual.Itismainlyusedtoconfirmhighdosesrecordedinindividualdosimeters.
Individualdosimeter:adeviceusedne4xttothebodypartsofanindividual,inorderto
evaluatetheeffectivedoseortheequivalentdoseaccumulatedoveragivenperiod.
Constructedofatissueequivalentmaterial,withawellestablishedcalibrationfactorand
traceabletonationalandinternationalmetrology,asperISO40371andIEC731.Also
calledindividualmonitor.
Accidentalexposure:involuntaryandunpredictableexposurearisingfromanaccidental
situationoraccident.
Emergencyexposure(IonizingRadiation):deliberateexposurebyacompetentauthority
occurredduringtheresponsetoemergencysituations,intheinterestof:
a) savinglives;
b) preventingtheescalationofaccidentsthatmaycausedeaths;
c) savingafacilityofvitalimportanceforthecountry.
Routineexposure(IonizingRadiation):theexposureofworkersundernormalworking
conditions,interventions,ortraininginauthorizedpractices.
Fluoroscopy:examininganorganbymeansofanimageformedonafluorescentscreen
withapplicationofXrays
Radiationsource:equipmentormaterialthatemitsoriscapableofemittingionizing
radiationorreleasingradioactivesubstancesormaterials.
Exposuresource:person,animal,object,orsubstancefromwhichabiologicalagent
passestoahostortoenvironmentalreservoirs.
Unsealedsources:thoseinwhichtheradioactivematerialisinsolidform(powder),
liquidor,morerarely,gas,incontainersthatallowthesubdividingofcontentunder
normaluseconditions.
Sealedsources:radioactivematerialshermeticallyencapsulatedinordertopreventleaks
andcontactwiththematerial,underspecificapplicationconditions.
Genotoxicity:abilityofsomeagentshavetocausedamagetotheDNAofexposed
organismsWhenmutationsareinduced,theseagentsarecalledmutagens.
Immunoglobulin:asolutioncontainingantibodiesagainstoneormorebiologicalagents,
usedforthepurposeofgivingimmediateandtransientimmunity.
Incident:asuddenandunexpectedeventthatinterfereswiththenormalactivityatwork,
butwithoutharmtotheworker,facilityortheenvironment.
Incorporation:theuptakeofradioactivematerialstothehumanbodybyingestion,
inhalationorskinpenetrationorinjury.
INMETRO:NationalInstituteofMetrology.
Radioactivefacility:afacilitywhereradiationsourcesareproduced,used,transportedor
stored.Excludedfromthisdefinitionare:
a)nuclearfacilities;
b)vehiclescarryingradiationsources,whennotanintegralpartthereof.
Lavatory:sanitarysinkintendedexclusivelyforwashinghands.
Radioactivematerial:materialcontainingsubstancesorelementsthatemitionizing
radiation.
Microorganisms:Lifeformsofmicroscopicdimensions.Organismsindividuallyvisible
onlyunderamicroscope,includingbacteria,fungi,protozoaandviruses.
Geneticallymodifiedmicroorganisms:thoseinwhichthegeneticmaterial(DNA)has
beenchangedbymodernbiotechnology,inparticularrecombinantDNAtechnology.
Modernbiotechnologycoversartificialmethodsofalterationofgeneticmaterial,i.e.not
involvingbreeding,graftingorothernaturalgeneticrecombination.
ContaminationMonitor:aninstrumentcapableofmeasuringradiationlevels,inunits
establishedbylimitsderivedfromsurfacecontamination,accordingtoCNENStandard
NE3.01.
RadiationMonitor:ameasuringdeviceofquantitiesandparameters,forcontrolpurposes
ortoassessexposuretoradiationpresentinpersonsoronthesurfaceofobjects,which
hasthefunctionofprovidingwarningsoralarmsignalsunderspecificconditions.
EnvironmentalMonitoring:continuous,periodicorspecialmeasurementofradiological
amountsintheenvironmentforradioprotectivepurposes.
Areamonitoring:theevaluationandcontrolofradiologicalconditionsofanareaina
facility,includingthemeasuringofvariablesrelatingto:
a)
externalradiationfields;
b)
contaminationofsurfaces;
c)
airpollution.
Individualmonitoring:monitoringthroughindividualdosimeters,placedonthe
individual'sbody,forcontrolpurposesofoccupationalexposures.Theindividual
monitoringhastheprimaryfunctionofevaluatingthedoseonthemonitoredindividual.
Itcanalsobeusedtochecktheadequacyofradiationprotectionplanforfacility
activities.
Radiologicalmonitoring(orsimplymonitoring):themeasurementofvariablesand
parametersforpurposesofradiationprotection,fortheevaluationandcontrolofthe
radiologicalconditionsoftheareasofafacilityortheenvironment,regardingexposition
toradioactiveandnuclearmaterials,includinganinterpretationoftheattainedresults.
Mutagenicity:abilityofsomeagentstoinducemutationsinorganismsexposedtothem.
MutationsareausuallypermanentchangeintheDNAnucleotidesequence,andmay
causeoneormorephenotypicchanges.Mutationscanbehereditary.
NB:BrazilianstandarddevelopedbyABNT.
NBR:BrazilianstandarddevelopedbyABNTandregisteredinINMETRO
Parasite:organismthatsurvivesanddevelopsattheexpenseofahost,andwhichcanbe
locatedinsideoroutsideitsbody.Usuallycausessomedamagetothehost.
Pathogenicity:theabilityofabiologicalagenttocausediseaseinasusceptiblehost.
Cuttingorperforatingmaterial(sharps):objectsequippedwithapointedtip[suchasa
needle]orsharpedge[suchasablade],usedforpiercingorcutting.
Persistenceofabiologicalagentintheenvironment:theabilityofthebiologicalagentto
remainoutsidethehost,retainingthepossibilityofcausingdisease.
Washingsink(orsimplysink):asinkintendedpreferablyforthewashingofutensils
whichcanalsobeusedforhandwashing.
RadiologicalProtectionPlan:adocument,requiredforthelicensingofafacility,
establishingaradiationprotectionsystemtobeimplementedbytheradioprotection
service.
Optimizationprinciple:theprinciplethatadesign,planning,andoperationofafacility
withradiationsourcesshallbemadesoastoensurethatoperationsareasreducedas
reasonablyachievable,takingintoaccountsocialandeconomicfactors.
Prions:infectiousproteinparticlesthatlacknucleicacid[typicallyimmunetoheat
sterilization]
QualityAssuranceProgram:asetofsystematicandplannedactionstoensureadequate
reliabilityregardingtheoperationofastructure,system,componentorsetofprocedures,
accordingtoanapprovedstandard.Indiagnosticradiology,theseactionsshallresultin
continuedproductionofhighqualityimageswithminimalexposuretopatientsand
operators.
Antineoplasticchemotherapy:drugsusedinthetreatmentandcontrolofcancer.
Ionizingradiation(orsimplyradiation):anyparticlesorelectromagneticradiationwhich,
wheninteractingwithmatter,directlyorindirectlyionizesitsatoms.
Radiopharmaceutical:aradioactivesubstancewhosephysical,chemicalandbiological
propertiesmakeitsuitableforuseinhumans.
Radionuclide:anunstableisotopeofanelementthatdecaysordisintegrates
spontaneously,emittingradiation.
Radioprotection:setofmeasuresaimedatprotectingthehumanbeing,hisorher
descendants,andtheenvironment,frompossibleunwantedeffectscausedbyionizing
radiation,accordingtotheprinciplesestablishedbyCNEN.
Radiotherapy:themedicalapplicationofionizingradiationfortherapeuticpurposes.
Radioactivewaste:Anymaterialresultingfromhumanactivities,whosereuseis
inappropriateornotforeseeable,andthatcontainsradionuclidesinquantitiesabovethe
exemptionlimitsestablishedinCNENstandardNE6.5,oritsreplacement.
Reservoir:person,animal,objectorsubstance,inwhichabiologicalagentcanpersist,
maintainviability,orgrowandmultiply,andfromwhichitcanbetransmittedtoahost.
Healthcarewaste:residuesresultingfromactivitiescarriedoutinhealthcarefacilities
that,bytheircharacteristics,requiredifferentprocessesintheirhandingand
management,whetherornotrequiringtreatmentpriortofinaldisposal.
Segregation:theseparationofwasteatthetimeandplaceofitsgeneration,accordingto
itsphysical,chemical,biological,orphysicalcharacteristics,andthehazardsinvolved.
NuclearMedicineService:specificmedicalfacilityforradiopharmaceuticalapplication
inpatientsfortherapeuticand/ordiagnosticpurposes.
RadiologicalProtectionService:entityspecificallysetupfortheimplementationand
maintainingofaradioprotectionplaninafacility.Thisdesignationisnotmandatory,
servingsimplyasareference.
Medicalradiologyservice:facility,orsectorinafacilityorinstitution,forthemedical
specialtythatusesionizingradiationfordiagnosisbyradiologicaland/orXrayimages.
Dentalradiologyservices:facility,orsectorinafacilityorinstitution,forthedental
specialtythatusesionizingradiationfordiagnosisthroughradiologyimagesand/orX
rays.ThisdefinitionincludesdentalclinicswithdiagnosticXrayequipment.
Radiotherapyservice:aspecificfacilityformedicalapplicationofionizingradiationfor
therapeuticpurposes,withtheuseofsealedsourcesorradiationbeams.
InternationalsymbolforIonizingRadiation:symbolusedinternationallytoindicatethe
presenceofionizingradiation.Itshallbeaccompaniedbyatextwarningabouttheuseof
ionizingradiation.
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Sealedsourcesimulators:emptyradioactivematerialcapsules,usedinbrachytherapy
training.
Teratogenicity:capacityofachemical,physicalorbiologicalagenttoinduceabnormal
development,duringgestationorinthepostnatalperiod,expressedbymortality,birth
defects,developmentaldelayoraberrationalfunctional.
Titularofradiationfacility:personwhoislegallyresponsibleforafacility,forwhicha
licenseorotherauthorizationwasgranted.
Toxins:chemicalssynthesizedbyorganismsthatexertadversebiologicaleffectsin
humans.
Workeroccupationallyexposedtoionizingradiation:aworkerwho,asaresultof
workingintheserviceofafacilitythatemploysradiation,islikelytoreceive,overa
year,higherdosesthantheprimarylimitsforpublicindividuals,asestablishedinCNEN
StandardNE3.01BasicGuidelinesforRadioprotection.
Workerparaoccupationallyexposedtoionizingradiation:aworkerwhoseactivitiesare
notdirectlyrelatedtoionizingradiation,butoccasionallymayalsocometoreceivedoses
higherdosesthantheprimarylimitsforpublicindividuals,asestablishedinCNEN
StandardNE3.01BasicGuidelinesforRadioprotection.
QualifiedWorker:aworkerthatprovestotheemployerandLaborOfficeinspectionone
ofthefollowingconditions:
a)
havingincompanytraining,asprovidedinNR32;
b)
havingatrainingcourse,ministeredataprivateorpublicinstitution,
conductedbyaqualifiedprofessional.
Transmissibility:capacityofbeingtransmitted(carriedacross)fromanagenttoahost.
Thetransmissionperiodcorrespondstothetimeintervalduringwhichanorganism
releasesabiologicalagentintoareservoirorhost.
Airturbulence:analterationintheuniformityofaunidirectionallaminarairflow(inthis
case,insidetheBiologicalSafetyCabinClassIITypeB2).
Vaccination:processtoobtainactiveandlastingimmunityofanorganism.Active
immunityistheprotectionaffordedbytheantigenicstimulationoftheimmunesystem
withthedevelopmentofcellularandhumoralimmunity(antibodyproduction).
Vector:vectorisanorganismthattransmitsabiologicalagentfromasourceofexposure
orreservoirtoahost.
Routesofentry:tissuesororganswhereanagententersanorganism,whichmaycausea
disease.Entrymaybethroughtheskin(bydirectcontactwithskin),percutaneous
(throughtheskin),parenteral(intravenousinoculation,intramuscular,subcutaneous),by
directcontactwithmucousmembranes,respiratoryroute(inhalation)andorally
(swallowed).
Transmissionroutes:routetakenbyabiologicalagentfromthesourceofexposuretothe
host.Transmissioncanoccurinthefollowingways:
1.Direct:Transmissionofthebiologicalagentwithouttheintermediationofvehiclesor
vectors.
2.Indirect:transmissionofthebiologicalagentbymeansofvehiclesorvectors.
Virulence:Thedegreeofpathogenicityofaninfectiousagent.
Source:
http://www.famema.br/assistencial/nr32/docs/NR-32_.pdf