Annex III of NR-32 Plan for the Prevention of Sharps Injuries

1. Objective and Scope of Application:

    1.1. Establish guidelines for the development and implementation of a plan to prevent accident risks with sharps materials that have the potential for exposure to biological agents, aiming at the protection, safety, and health of workers in health services, as well as those engaged in health promotion and assistance activities in general.

    1.2. Health service is understood to be any building intended for providing health care to the population, and all actions of promotion, recovery, assistance, research, and teaching in health at any level of complexity.

    1.3. Sharps materials are those used in health care that have a point or edge or that can pierce or cut.

    1.4. A safety device is an item integrated into a set that includes the sharp element or a technology capable of reducing the risk of an accident, regardless of the activation mechanism.

    2. Multidisciplinary Management Committee:

      2.1. The employer must establish a multidisciplinary management committee, aimed at reducing the risks of accidents with sharps materials that may expose workers to biological agents, through the development, implementation, and updating of risk prevention plan for sharps materials.

      2.2. The committee should consist, whenever applicable, of the following members:

      a) the employer, their legal representative, or a representative of the health service management;

      b) a representative of the Specialized Service in Occupational Health and Safety (SESMT), in accordance with NR-4;

      c) vice-president of the Internal Committee for Prevention of Accidents and Harassment (CIPA) or the designated person responsible for fulfilling the objectives of NR-5, in cases where the establishment of CIPA is not mandatory;

      d) a representative of the Hospital Infection Control Committee;

      e) nursing management;

      f) clinical management;

      g) person responsible for the development and implementation of the Health Service Waste Management Plan (PGRSS);

      h) representative of the Material and Sterilization Center;

      i) representative of the purchasing sector; and

      j) representative of the material standardization sector.

      3. Analysis of Sharps Injuries

        3.1. The Management Committee should analyze the existing information in the PGR and PCMSO, in addition to those related to occupational accidents involving sharps materials.

        3.2. The Management Committee should not be limited to the existing information within the health service, but should conduct its own analyses of occupational accidents and risks involving sharps materials.

        3.3. The Management Committee should develop and implement procedures for recording and investigating accidents and risks involving sharps materials.

        4. Establishment of Priorities:

          4.1. Based on the analysis of risks and occupational accidents with sharps materials, the Management Committee should establish priorities, necessarily considering the following aspects:

          a) risks and accidents with sharps materials that have a higher probability of transmitting blood-borne biological agents;

          b) frequency of accident occurrences in procedures using a specific sharps material;

          c) cleaning, decontamination, or disposal procedures that contribute to a high incidence of accidents; and

          d) number of workers exposed to risks involving sharps materials.

          5. Control Measures for the Prevention of Accidents with Sharps Materials:

            5.1. The adoption of control measures should follow the following hierarchy:

            a) substitute the use of needles and other sharps where technically possible;

            b) implement engineering controls in the environment (e.g., disposal collectors);

            c) adopt the use of sharps materials with safety devices, where available and technically feasible; and

            d) changes in organization and work practices.

            6. Selection of Sharps Materials with Safety Devices:

              6.1. This selection should be conducted by the Multidisciplinary Management Committee, following these steps:

              a) define priority sharps materials for replacement based on the analysis of risks and occupational accidents;

              b) establish criteria for selecting sharps materials with safety devices and obtain products for evaluation;

              c) plan tests for replacement in selected areas within the health service, based on the analysis of risks and occupational accidents;

              d) analyze the performance of the product replacement from the perspectives of worker health, patient care, and effectiveness, to subsequently decide which material to adopt.

              7. Training of Workers:

                7.1. During the implementation of the plan, workers must be trained before the adoption of any control measures and continuously for the prevention of accidents with sharps materials.

                7.2. Training should be documented, including the date, time, duration, content delivered, name, and qualifications or professional training of the instructor and the workers involved.

                8. Implementation Schedule:

                  8.1. The plan must include a schedule for its implementation.

                  8.2. The schedule should cover the stages of items 3 to 7 described above and their respective deadlines for implementation.

                  8.3. This schedule and proof of implementation must be available for inspection by the Ministry of Labor and Employment and for workers or their representatives.

                  9. Plan Monitoring:

                    9.1. The plan must include systematic monitoring of workers’ exposure to biological agents through the use of sharps materials, using the analysis of risks and occupational accidents before and after its implementation as monitoring indicators.

                    10. Evaluation of the Plan’s Effectiveness:

                      10.1. The plan must be evaluated at least annually, and whenever there is a change in working conditions or when the analysis of risks and accidents so requires.