NR-32 Health and Safety in Health Services

(MTP Ordinance No. 4.219, of Decemer 20, 2022)


32.1 Objective and Scope
32.2 Biological Risks
32.3 Chemical Risks
32.4 Ionizing Radiation
32.5 Waste Management
32.6 Comfort Conditions During Meals
32.7 Laundries
32.8 Cleaning and Maintenance
32.9 Maintenance of Machinery and Equipment
32.10 General Provisions
32.11 Final Provisions
Annex I Classification of Biological Agents
Annex II Classification Table of Biological Agents
Annex III Plan for the Prevention of Sharps Injuries

32.1 Objective and Scope

32.1.1 This Regulatory Standard (NR) aims to establish the basic guidelines for implementing measures to protect the safety and health of workers in health services, as well as those who perform health promotion and care activities in general.

32.1.2 For the purposes of applying this NR, health services are understood to mean any building intended to provide health care to the population, and all actions of promotion, recovery, care, research, and health education at any level of complexity.

32.2 Biological Risks

32.2.1 For the purposes of applying this NR, Biological Risk is considered the probability of occupational exposure to biological agents. Biological Agents are considered to be microorganisms, whether genetically modified or not; cell cultures; parasites; toxins; and prions. The classification of biological agents is found in Annex I of this NR.

32.2.2 Risk Management Program (PGR) The PGR, in addition to what is provided in NR-01, in the hazard identification stage, must include:

I. Identification of the most probable biological agents, based on geographic location and the characteristics of the health service and its sectors, considering:

a) sources of exposure and reservoirs;

b) routes of transmission and entry;

c) transmissibility, pathogenicity, and virulence of the agent;

d) persistence of the biological agent in the environment;

e) epidemiological studies or statistical data;

f) other scientific information.

II. Assessment of the workplace and the worker, considering:

a) the purpose and description of the workplace;

b) the organization and work procedures;

c) the possibility of exposure;

d) the description of activities and functions of each workplace;

e) the applicable preventive measures and their monitoring. In addition to the provisions in sub-item of NR-01, the PGR must be re-evaluated:

a) whenever there is a change in working conditions that may alter exposure to biological agents;

b) when the analysis of accidents and incidents so determines. The documents that make up the PGR must be available to the workers.

32.2.3 Occupational Health Medical Control Program (PCMSO) The PCMSO, in addition to what is provided in NR-07, and observing the provisions of item, must include:

a) recognition and assessment of biological risks;

b) the location of risk areas according to the parameters of item 32.2.2;

c) a list containing the nominal identification of workers, their role, the place where they perform their activities, and the risk to which they are exposed;

d) medical surveillance of potentially exposed workers;

e) the vaccination program. Whenever there is a permanent or occasional transfer of a worker to another work post, which implies a change in risk, this must be immediately communicated to the coordinating or responsible physician of the PCMSO. Regarding the possibility of accidental exposure to biological agents, the PCMSO must include:

a) procedures to be adopted for diagnosis, monitoring, and prevention of seroconversion and diseases;

b) measures for decontaminating the workplace;

c) emergency medical treatment for workers;

d) identification of those responsible for implementing the relevant measures;

e) a list of health establishments that can provide assistance to workers;

f) means of transportation for workers’ care;

g) a list of health care establishments holding immunoglobulins, vaccines, necessary medications, materials, and special supplies. The PCMSO must be available to workers, as well as to labor inspection. In every occurrence of an accident involving biological risks, with or without worker leave, an Accident Notification (CAT) must be issued.

32.2.4 Protection Measures Protection measures must be adopted based on the result of the occupational risk assessment, as provided in the PGR, observing the provisions of item 32.2.2. In case of accidental or incidental exposure, protection measures must be adopted immediately, even if not provided in the PGR. Handling in a laboratory environment must follow the guidelines contained in the Ministry of Health publication (General Guidelines for Containment Work with Biological Material), corresponding to the respective microorganisms. Every place where there is a possibility of exposure to biological agents must have an exclusive sink for hand hygiene provided with running water, liquid soap, disposable towels, and a trash can with a non-manual opening system. Rooms or wards intended for isolating patients with infectious-contagious diseases must contain a sink inside. The use of gloves does not replace the handwashing process, which must occur at least before and after using them. Workers with wounds or lesions on the upper limbs can only start their activities after mandatory medical evaluation with the issuance of a work release document. The employer must prohibit:

a) the use of work sinks for purposes other than those intended;

b) smoking, wearing adornments, and handling contact lenses in workstations;

c) consumption of food and drinks in workstations;

d) storage of food in places not intended for this purpose;

e) the use of open shoes. All workers with the possibility of exposure to biological agents must wear appropriate work clothing in comfortable conditions. The clothing must be provided at no cost to the employee. Workers must not leave the workplace with personal protective equipment and clothing used in their work activities. The employer must provide appropriate places for supplying clean clothing and depositing used ones. The cleaning of clothing used in surgical and obstetric centers, intensive care services, units with patients with infectious-contagious diseases, and when there is direct contact of the clothing with organic material must be the responsibility of the employer. Personal Protective Equipment (PPE), whether disposable or not, must be available in sufficient numbers at workstations to ensure immediate supply or replacement. The employer must:

a) ensure the conservation and cleaning of materials and work instruments;

b) provide appropriate containers and means of transport for infectious materials, fluids, and organic tissues. The employer must ensure training for workers, before starting activities and on an ongoing basis, and it must be provided:

a) whenever there is a change in workers’ exposure conditions to biological agents;

b) during working hours;

c) by health professionals familiar with the inherent risks of biological agents. The training must be adapted to the evolution of knowledge and the identification of new biological risks and must include:

a) available data on potential health risks;

b) control measures that minimize exposure to agents;

c) hygiene standards and procedures;

d) use of collective protection equipment, individual protection, and work clothing;

e) measures for preventing accidents and incidents;

f) measures to be taken by workers in the event of incidents and accidents. The employer must prove to the labor inspection the training through documents that inform the date, time, duration, content provided, the name and professional training or qualification of the instructor, and the involved workers. In every place where there is a possibility of exposure to biological agents, written instructions must be provided to workers, in accessible language, of the routines performed at the workplace and measures to prevent accidents and work-related diseases. The instructions must be given to the worker, upon receipt, and must be available to labor inspection. Workers must immediately report any accident or incident, with possible exposure to biological agents, to the person responsible for the workplace and, when applicable, to the occupational health and safety service and the CIPA. The employer must immediately inform workers and their representatives of any serious accident or incident that may cause the spread of a biological agent likely to cause serious diseases in humans, its causes, and the measures taken or to be taken to correct the situation. Mattresses, mats, and other cushioned items must be covered with washable and impermeable material, allowing disinfection and easy cleaning. The covering must not have holes, tears, grooves, or recesses. Workers who use sharp objects must be responsible for their disposal. Recapping and manual disconnection of needles are prohibited. The employer must develop and implement an Accident Risk Prevention Plan with Sharps, according to the guidelines established in Annex III of this Regulatory Standard. Companies that produce or market sharp materials must provide training on the correct use of the safety device for health service workers. The employer must ensure training for health service workers as provided in item Vaccination of Workers Every health service worker must be provided with a free active immunization program against tetanus, diphtheria, hepatitis B, and those established in the PCMSO. Whenever there are effective vaccines against other biological agents to which workers are or may be exposed, the employer must provide them for free. The employer must control the effectiveness of vaccination whenever recommended by the Ministry of Health and its agencies and, if necessary, provide a booster. Vaccination must comply with the recommendations of the Ministry of Health. The employer must ensure that workers are informed of the benefits and side effects, as well as the risks they will be exposed to due to lack or refusal of vaccination, and in these cases, keep a supporting document and make it available to labor inspection. Vaccination must be recorded in the worker’s individual clinical record, as provided in NR-07. A certificate of the vaccines received must be provided to the worker.

32.3 Chemical Risks

32.3.1 The manufacturer’s labeling on the original packaging of chemical products used in health services must be maintained.

32.3.2 Every container holding manipulated or fractionated chemical product must be identified, legibly, by a label with the name of the product, chemical composition, its concentration, packaging and expiration dates, and the name of the person responsible for the manipulation or fractionation.

32.3.3 The reuse of chemical product packaging is prohibited.

32.3.4 Risk Management Program (PGR) The PGR of health services must include an inventory of all chemical products, including intermediates and residues, indicating those that pose risks to safety and health of workers. Chemical products, including intermediates and residues that pose risks to health and safety of workers, must have a descriptive sheet containing at least the following information:

a) characteristics and forms of use of the product;

b) risks to health and safetyand the environment, considering the forms of use;

c) collective, individual, and medical protection measures for workers’ health;

d) conditions and place of storage;

e) procedures in emergency situations. A copy of the sheet must be kept in the locations where the product is used.

32.3.5 Occupational Health Medical Control Program (PCMSO) In the preparation and implementation of the PCMSO, the information contained in the descriptive sheets mentioned in sub-item must be considered.

32.3.6 It is the employer’s responsibility: To train workers initially and continuously for the safe use of chemical products. The training must include at least:

a) presentation of the descriptive sheets mentioned in sub-item, explaining the information contained therein;

b) safety procedures related to use;

c) procedures to be adopted in case of incidents, accidents, and emergencies.

32.3.7 Protection Measures The employer must provide an appropriate location for the manipulation or fractionation of chemical products that pose risks to safety and health of workers. These procedures are prohibited in any location other than the one appropriate for this purpose. Exceptions are made for the preparation and association of medications for immediate administration to patients. The location must have at least:

a) easily visible graphical signage for identification of the environment, respecting the provisions of NR-26;

b) equipment that ensures the concentration of chemical products in the air is below the tolerance limits established in NR-09 and NR-15, observing the action levels provided in NR-09;

c) equipment that ensures the exhaust of chemical products in such a way that it does not increase the exposure of any worker, involved or not, in the work process, and the use of hood-type equipment is prohibited;

d) shower and eye wash station, which must be activated and cleaned weekly;

e) personal protective equipment, appropriate to the risks, available to workers;

f) an adequate disposal system. The manipulation or fractionation of chemical products must be done by a qualified worker. The transport of chemical products must consider the risks to safety and health of workers and the environment. All establishments that carry out or intend to carry out sterilization, re-sterilization, or reprocessing by ethylene oxide gas must comply with the provisions of Interministerial Ordinance No. 482/MS/MTE of 16/04/1999. In places where flammable products are used and stored, the fire prevention system must provide special safety measures and emergency procedures. Areas for storing chemical products must be ventilated and signposted. Separate storage areas must be provided for incompatible chemical products.

32.3.8 Medical Gases In the handling, transport, storage, handling, and use of gases, as well as in the maintenance of equipment, the manufacturer’s recommendations must be observed, provided they are compatible with the provisions of current legislation. The manufacturer’s recommendations, in Portuguese, must be kept at the workplace and be available to workers and labor inspection. It is prohibited to:

a) use equipment with detected gas leaks;

b) subject equipment to pressures higher than those for which they were designed;

c) use cylinders that do not have gas identification and a safety valve;

d) move cylinders without the use of appropriate personal protective equipment;

e) subject cylinders to extreme temperatures;

f) use oxygen and compressed air for purposes other than those intended;

g) allow contact of oils, greases, hydrocarbons, or similar organic materials with oxidizing gases;

h) use oxygen cylinders without a check valve or an appropriate device to prevent reverse flow;

i) transfer gases from one cylinder to another, regardless of cylinder capacity;

j) transport loose cylinders, in a horizontal position, and without caps. Cylinders containing flammable gases, such as hydrogen and acetylene, must be stored at least eight meters away from those containing oxidizing gases, such as oxygen and nitrous oxide, or through sealed and fire-resistant barriers. For the centralized medical gas system, signs must be posted in a visible location with indelible and legible characters, with the following information:

a) names of the people authorized to access the location and trained in system operation and maintenance;

b) procedures to be adopted in case of emergency;

c) emergency telephone number;

d) danger signs.

32.3.9 Hazardous Medications and Drugs For the purposes of this NR, hazardous medications and drugs are those that can cause genotoxicity, carcinogenicity, teratogenicity, and serious and selective toxicity on organs and systems. The PGR must include, in addition to the provisions of NR-01, a description of the inherent hazards in activities related to the receipt, storage, preparation, distribution, administration of hazardous medications and drugs. Anesthetic Gases and Vapors All equipment used for the administration of anesthetic gases or vapors must undergo corrective and preventive maintenance, with special attention to leakage points into the work environment, aiming for their elimination. Maintenance consists, at a minimum, of checking gas cylinders, connectors, connections, hoses, balloons, tracheas, valves, anesthesia machines, and facial masks for pulmonary ventilation. The maintenance program and reports must be documented and available to directly involved workers and labor inspection. Locations where anesthetic gases or vapors are used must have ventilation and exhaust systems to maintain ambient concentration under control, as provided in current legislation. Any pregnant worker will only be released to work in areas with potential exposure to anesthetic gases or vapors after written authorization from the physician responsible for the PCMSO, considering the information contained in the PGR. Antineoplastic Chemotherapeutics Antineoplastic chemotherapeutics should only be prepared in an exclusive area with restricted access to directly involved professionals. The area must have at least:

a) a barrier dressing room with double chamber;

b) a preparation room for chemotherapeutics;

c) a place designated for administrative activities;

d) an exclusive storage area. The dressing room must have:

a) sink and materials for washing and drying hands;

b) eye wash station, which can be replaced by a hygienic shower;

c) emergency shower;

d) personal protective equipment and clothing for use and replacement;

e) lockers for storing personal belongings;

f) containers for disposing of used clothing. Manuals of procedures for cleaning, decontamination, and disinfection of all areas, including surfaces, installations, equipment, furniture, clothing, PPE, and materials must be developed. The manuals must be available to all workers and labor inspection. All directly involved professionals must wash their hands properly before and after removing gloves. The preparation room must be equipped with a Class II B2 Biological Safety Cabinet, and its installation must provide, at a minimum:

a) air supply necessary for its operation;

b) location and positioning to avoid the formation of air turbulence. The cabinet must:

a) be in operation for at least 30 minutes before starting manipulation work and remain on for 30 minutes after work is completed;

b) be subjected to periodic maintenance and filter replacements according to a written program that complies with the manufacturer’s specifications and must be available for labor inspection;

c) have maintenance reports, which must be available for labor inspection;

d) have visible labels with the dates of the last and next maintenance;

e) undergo cleaning, decontamination, and disinfection processes on the internal side walls and work surface before starting activities;

f) have its work surface cleaned at the end of activities and in case of spills and splashes. Regarding antineoplastic chemotherapeutics, the employer must:

a) prohibit smoking, eating, or drinking, as well as wearing adornments or makeup;

b) remove pregnant and nursing workers from activities;

c) prohibit exposed workers from performing activities with potential exposure to ionizing agents;

d) provide workers with an impermeable apron, with a resistant front and closed back, long sleeves, and tight cuffs, during preparation and administration;

e) provide workers with safety devices that minimize aerosol generation and accident occurrence during manipulation and administration;

f) provide workers with safety devices for accident prevention during transportation. In addition to complying with current legislation, Personal Protective Equipment (PPE) must meet the following requirements:

a) be evaluated daily for conservation and safety status;

b) be stored in easily accessible locations and in sufficient quantity for immediate replacement, as required by the procedure or in case of contamination or damage. Regarding antineoplastic chemotherapeutics, it is prohibited to:

a) start any activity without PPE;

b) continue manipulation activities when there is any interruption in the operation of the biological safety cabinet. Operational Procedures in Case of Environmental or Personal Accidents. Regarding chemotherapeutics, an accident is understood as:

a) environmental: contamination of the environment due to the release of the drug from the container in which it is packaged, either by spillage or by solid or liquid aerosols;

b) personal: contamination generated by contact or inhalation of antineoplastic chemotherapeutic drugs at any stage of the process. The norms and procedures to be adopted in case of environmental or personal accidents must be included in a manual available and easily accessible to workers and labor inspection. In preparation, storage, and administration areas and for transport, a spill kit must be identified and available, containing at least: procedure gloves, impermeable apron, absorbent pads, respiratory protection, eye protection, soap, identified container for waste collection, and a description of the procedure.

32.3.10 Training Involved workers must receive initial and continuous training that includes, at a minimum:

a) the main routes of occupational exposure;

b) the therapeutic and adverse effects of these drugs and the possible health risks in the long and short term;

c) standardized norms and procedures for handling, preparation, transportation, administration, distribution, and disposal of antineoplastic chemotherapeutics;

d) norms and procedures to be adopted in case of accidents. The training must be provided by health professionals familiar with the risks inherent to antineoplastic chemotherapeutics.

32.4 Ionizing Radiation

32.4.1 Compliance with the requirements of this NR, regarding ionizing radiation, does not exempt the employer from observing the provisions established by the specific standards of the National Nuclear Energy Commission (CNEN) and the National Health Regulatory Agency (ANVISA), of the Ministry of Health.

32.4.2 It is mandatory to keep at the workplace and available to labor inspection the Radiation Protection Plan (RPP), approved by CNEN, and for radiodiagnostic services approved by Health Surveillance. The Radiation Protection Plan must:

a) be within the validity period;

b) identify the responsible professional and their eventual substitute as permanent members of the service team;

c) be part of the establishment’s PGR;

d) be considered in the preparation and implementation of the PCMSO;

e) be presented to the CIPA, if present in the company, with a copy attached to the minutes of this committee.

32.4.3 The worker performing activities in areas with ionizing radiation sources must:

a) stay in these areas for the minimum time necessary to perform the procedure;

b) be aware of the radiological risks associated with their work;

c) be initially and continuously trained in radiological protection;

d) use appropriate PPE to minimize risks;

e) be under individual monitoring of ionizing radiation dose, in cases where exposure is occupational.

32.4.4 Any worker with confirmed pregnancy must be removed from activities involving ionizing radiation and reassigned to a task compatible with their level of training.

32.4.5 Every radiation facility must have individual and area monitoring. Individual dosimeters must be obtained, calibrated, and evaluated exclusively in CNEN-accredited individual monitoring laboratories. External individual monitoring, of the whole body or extremities, must be carried out through dosimetry with monthly frequency, taking into account the nature and intensity of the expected normal and potential exposures. In the event or suspicion of accidental exposure, dosimeters must be sent for reading within a maximum of 24 hours. After the occurrence or suspicion of accidental exposure to sealed sources, additional procedures for individual monitoring, clinical evaluation, and complementary examinations, including cytogenetic dosimetry, must be adopted at medical discretion. After the occurrence or suspicion of accidents with unsealed sources, subject to external exposure or internal contamination, additional procedures for individual monitoring, clinical evaluation, and complementary examinations, including cytogenetic dosimetry, in vivo and in vitro analysis, must be adopted at medical discretion. A periodic area monitoring program, as outlined in the Radiation Protection Plan, must be developed and implemented for all areas of the radiation facility.

32.4.6 The employer must:

a) implement collective protection measures related to radiological risks;

b) maintain a qualified professional responsible for radiological protection in each specific area, with a formal link to the establishment;

c) promote initial and continuous radiological protection training for workers occupationally and para-occupationally exposed to ionizing radiation;

d) keep a record of the training provided in the worker’s individual file;

e) provide the worker with written instructions, with a receipt, regarding radiological risks and radiological protection procedures adopted in the radiation facility;

f) inform each worker and the coordinating physician of the PCMSO or the physician responsible for the medical examinations required by NR-07, in writing and with a receipt, of the results of doses from routine, accidental, and emergency exposures.

32.4.7 Each worker at the radiation facility must have an updated individual record, which must be kept for 30 (thirty) years after the end of their employment, containing the following information:

a) identification (Name, DOB, Registration, CPF), address, and level of education;

b) dates of admission and termination of employment;

c) name and address of the person responsible for radiological protection for each period worked;

d) functions associated with radiation sources, respective work areas, radiological risks, start and end dates of radiation activity, schedules, and periods of occupation;

e) types of individual dosimeters used;

f) records of monthly and annual (twelve consecutive months) doses received and dose investigation reports;

g) training conducted;

h) incorporation estimates;

i) reports on emergency and accident exposures;

j) previous occupational exposures to radiation sources. The individual record of workers must be kept at the workplace and available for labor inspection.

32.4.8 The individual clinical record required by NR-07 must be kept updated and preserved for 30 (thirty) years after the end of the occupation.

32.4.9 Every radiation facility must have a radiological protection service. The radiological protection service must be located in the same environment as the radiation facility, ensuring working conditions compatible with the activities developed, observing CNEN and ANVISA standards. The radiological protection service must have, as specified in the RPP, equipment for:

a) individual and area monitoring of workers;

b) individual protection;

c) environmental measurements of specific ionizing radiation for work practices. The radiological protection service must be directly subordinate to the head of the radiation facility. When the establishment has more than one service, a technical manager must be appointed to promote the integration of radiological protection activities of these services.

32.4.10 The coordinating physician of the PCMSO or the physician responsible for the medical examinations required by NR-07 must be familiar with the effects and treatment associated with exposure from routine activities or accidents involving ionizing radiation.

32.4.11 Areas of the radiation facility must be classified and have access control defined by the radiological protection officer.

32.4.12 Areas of the radiation facility must be properly signposted in accordance with current legislation, especially regarding the following aspects:

a) use of the international radiation presence symbol at controlled access points;

b) sources present in these areas and their waste must have their packaging, containers, or shielding identified with the type of radioactive element, activity, and type of emission;

c) dose rate values and measurement dates at significant reference points near radiation sources, at worker stay and transit locations, in accordance with the RPP;

d) identification of circulation routes, entry, and exit for normal working conditions and emergency situations;

e) location of safety equipment;

f) procedures to be followed in accident or emergency situations;

g) alarm systems.

32.4.13 Nuclear Medicine Service Supervised and controlled areas of the Nuclear Medicine Service must have impermeable floors and walls that allow decontamination. The room for handling and storing radioactive sources in use must:

a) be covered with an impermeable material that allows decontamination, with floors and walls having rounded corners;

b) have benches made of smooth, easy-to-decontaminate material, covered with plastic and absorbent paper;

c) have a sink with a bowl at least 40 cm deep and non-manual tap control. Installation of exclusive exhaust systems is mandatory:

a) local, for handling volatile unsealed sources;

b) area, for services conducting pulmonary ventilation studies. In places where radioactive materials or waste are handled and stored, it is not permitted to:

a) apply cosmetics, eat, drink, smoke, or rest;

b) store food, drinks, and personal belongings. Workers involved in handling radioactive materials and marking drugs must use the protective equipment recommended in the PGR and RPP. At the end of the workday, surface monitoring must be performed according to the RPP, using a contamination monitor. Whenever work activity is interrupted, extremity and whole-body monitoring of workers handling radiopharmaceuticals must be performed. The site designated for the decay of radioactive waste must:

a) be located in a controlled access area;

b) be signposted;

c) have adequate shielding;

d) consist of compartments allowing segregation of waste by radionuclide groups with similar physical half-lives and by physical state. The room for patient hospitalization for radiopharmaceutical administration must have:

a) shielding;

b) walls and floors with rounded corners, covered with impermeable materials allowing decontamination;

c) private bathroom;

d) shielded screen by the bed;

e) external sign indicating the presence of ionizing radiation;

f) controlled access.

32.4.14 Radiotherapy Services Radiotherapy Services must adopt at least the following safety devices:

a) treatment rooms with interlocking door systems to prevent unauthorized access during equipment operation;

b) light indicators of equipment operation, located in the treatment room and at its external access, in a visible position. Brachytherapy In the preparation and storage room for sources, no activities unrelated to the preparation of sealed sources are allowed. Containers used for transporting sources must be identified with the radiation presence symbol and the activity of the radionuclide to be moved. When moving sources for use in brachytherapy, the principle of optimization must be observed to expose the fewest number of people possible. Simulators of sources must be used in the training of workers for handling sealed sources used in brachytherapy. Manual preparation of sources used in low-dose-rate brachytherapy must be carried out in a specific room with controlled access, allowing only the presence of people directly involved in this activity. Handling of low-dose-rate sources must be done exclusively with instruments and under lead shielding protection. After each application, patient clothing and bedding must be monitored to check for the presence of sealed sources.

32.4.15 Medical Radiodiagnosis Services It is mandatory to keep at the workplace and available for labor inspection the valid Operating Permit granted by the local health authority and the Quality Assurance Program. The control booth must be positioned to:

a) allow the operator, in the shooting position, to effectively communicate with and visually observe the patient;

b) allow the operator to see the entry of any person during the radiological procedure. The X-ray room must have:

a) visible signage on the exterior side of the access doors, containing the international ionizing radiation symbol, accompanied by the inscriptions: “X-rays, restricted entry” or “X-rays, entry prohibited to unauthorized persons”.

b) red light signage above the exterior side of the access door, accompanied by the following warning: “When the red light is on, entry is prohibited”. The light signal must be activated during radiological procedures. The access doors of rooms with fixed X-ray equipment must be kept closed during exposures. Installation of more than one X-ray device per room is not allowed. The darkroom must have:

a) a localized air exhaust system;

b) a sink with a tap. All medical radiodiagnostic equipment must have a functioning diaphragm and collimator for radiographic imaging. Mobile equipment must have a firing cable with a minimum length of 2 meters. Only the patient and necessary staff should remain in the location of the radiological procedure. Fluoroscopy equipment must have:

a) an image intensification system with an attached video monitor;

b) lower and lateral lead curtains or skirts for operator protection against scattered radiation;

c) a system to ensure the radiation beam is completely confined to the image receptor area;

d) an alarm system indicating a certain dose or exposure level. If the fluoroscopy equipment does not have the mentioned alarm system, it must be installed in the environment.

32.4.16 Dental Radiodiagnosis Services In intraoral radiology:

a) all workers must stay away from the headpiece and the patient at a minimum distance of 2 meters;

b) no worker should hold the film during exposure;

c) if the presence of a worker is necessary to assist the patient, they must use PPE. For procedures with extraoral radiography equipment, the same requirements as medical radiodiagnosis must be followed.

32.5 Waste Management

32.5.1 It is the employer’s responsibility to train workers initially and continuously on the following topics:

a) segregation, packaging, and transportation of waste;

b) definitions, classification, and potential risks of waste;

c) the internal management system adopted in the establishment;

d) ways to reduce waste generation;

e) understanding responsibilities and tasks;

f) recognition of the identification symbols for waste classes;

g) knowledge about the use of collection vehicles;

h) guidelines on the use of Personal Protective Equipment (PPE).

32.5.2 The plastic bags used for health waste packaging must comply with NBR 9191 and also be:

a) filled up to 2/3 of their capacity;

b) closed in such a way that they do not spill, even if turned upside down;

c) immediately removed from the generation site after filling and closing;

d) kept intact until the waste is treated or finally disposed of.

32.5.3 Waste segregation must be carried out at the point of generation, ensuring that:

a) containers meeting ABNT standards are used, in sufficient number for storage;

b) containers are located near the source of generation;

c) containers are made of washable material, resistant to puncture, rupture, and leakage, with a lid equipped with a non-manual opening system, rounded corners, and resistant to tipping;

d) containers are identified and signposted according to ABNT standards. Containers in surgery and delivery rooms do not need a sealing lid. For containers intended for collecting sharp materials, the maximum filling limit should be located 5 cm below the mouth. The container for sharp materials must be kept in an exclusive holder at a height that allows visibility of the disposal opening.

32.5.4 Manual transport of the segregation container must be done in such a way that there is no contact with other parts of the body, and dragging is prohibited.

32.5.5 Whenever the transport of the segregation container may compromise health and safety of workers, appropriate technical means must be used to preserve health and physical integrity.

32.5.6 The temporary storage room for transport containers must have at least the following characteristics:

I. be equipped with:

a) washable floors and walls;

b) a siphoned drain;

c) a water point;

d) a light point;

e) adequate ventilation;

f) an opening sized to allow the entry of transport containers.

II. be kept clean and with vector control;

III. contain only collection, storage, or transport containers;

IV. be used only for its intended purpose;

V. be properly signposted and identified.

32.5.7 The transport of waste to the external storage area must meet the following requirements:

a) be done using carts made of rigid, washable, waterproof material, with a lid hinged to the body of the equipment and rounded corners;

b) be carried out in a one-way direction with a defined route at times not coinciding with the distribution of clothes, food, and medications, visitation periods, or peak traffic times. Transport containers with a capacity of more than 400 liters must have a drain valve at the bottom.

32.5.8 All health services must have an appropriate location for external waste storage until collected by the external collection system. The location, in addition to meeting the characteristics described in item 32.5.6, must be sized to allow the separation of containers according to the type of waste.

32.5.9 Radioactive waste must be treated according to resolution CNEN NE-6.05.

32.6 Comfort Conditions During Meals

32.6.1 The dining rooms of health services must comply with NR-24.

32.6.2 Establishments with up to 300 workers must have meal areas that meet the following minimum requirements:

a) located outside the work area;

b) washable floor;

c) cleanliness, ventilation, and good lighting;

d) tables and seats sized according to the number of workers per rest and meal interval;

e) sinks installed nearby or in the same location;

f) provision of potable water;

g) appropriate and safe equipment for heating meals.

32.6.3 Handwashing sinks must be equipped with paper towels, liquid soap, and pedal-operated trash cans.

32.7 Laundries

32.7.1 The laundry must have two distinct areas, one considered dirty and the other clean, with the dirty area used for receiving, sorting, weighing, and washing clothes, and the clean area for handling washed clothes.

32.7.2 Regardless of the size of the laundry, washing machines must have double doors or barriers, where the used clothes are inserted through the door in the dirty area by one operator and removed in the clean area by another operator after washing. Communication between the two areas is only permitted through viewers or intercoms.

32.7.3 The calender must have:

a) a thermometer for each heating chamber, indicating the temperature of the troughs or the heated cylinder;

b) a thermostat;

c) a protective device to prevent the insertion of workers’ body parts near the cylinders or moving parts of the machine.

32.7.4 Washing machines, centrifuges, and dryers must have electromechanical devices that stop their operation when their compartments are opened.

32.8 Cleaning and Maintenance

32.8.1 Workers performing cleaning in health services must be trained initially and continuously on personal hygiene principles, biological risk, chemical risk, signage, labeling, PPE, EPC, and emergency procedures. Proof of training must be kept at the workplace and be available for labor inspection.

32.8.2 For cleaning and maintenance activities, it is the employer’s responsibility, at a minimum, to:

a) provide a functional cart for storing and transporting materials and products essential for the activities;

b) provide cleaning materials and utensils that preserve the worker’s physical integrity;

c) prohibit dry sweeping in indoor areas;

d) prohibit the use of adornments.

32.8.3 Cleaning and maintenance companies operating in health services must comply, at a minimum, with the provisions in items 32.8.1 and 32.8.2.

32.9 Maintenance of Machinery and Equipment

32.9.1 Workers performing maintenance must receive specific training for their activities and initial and continuous training to familiarize them with the principles of:

a) personal hygiene;

b) biological (universal precautions), physical, and chemical risks;

c) signage;

d) preventive labeling;

e) types of EPC (collective protective equipment) and PPE (personal protective equipment), accessibility, and correct use. Companies providing technical assistance and maintenance services in health services must comply with item 32.9.1.

32.9.2 All equipment must be decontaminated before maintenance. When equipment maintenance involves discontinuation of use that poses a risk to the patient’s life, safety procedures must be adopted to preserve the worker’s health.

32.9.3 Machines, equipment, and tools, including those used by maintenance teams, must be subject to prior inspection and preventive maintenance according to the manufacturer’s instructions, official technical standards, and current legislation. Inspection and maintenance must be recorded and available to the workers involved and labor inspection. Companies providing technical assistance and maintenance services in health services must comply with item 32.9.3. The employer must establish a preventive maintenance schedule for the gas supply system and fume hoods, keeping an individual record signed by the professional who performed it.

32.9.4 Equipment and mechanical means used for transport must be periodically maintained to keep the rotation systems in perfect working order.

32.9.5 The adjustment devices of beds must undergo preventive maintenance, ensuring permanent lubrication to guarantee their operation without overloading the workers.

32.9.6 Air conditioning systems must undergo preventive and corrective maintenance procedures to preserve the integrity and efficiency of all their components. Compliance with item 32.9.6 does not exempt compliance with GM/MS Ordinance No. 3,523 of 08/28/98 and other relevant legal provisions.

32.10 General Provisions

32.10.1 Health services must:

a) comply with the comfort conditions regarding noise levels as provided in NB 95 of ABNT;

b) comply with the lighting conditions according to NB 57 of ABNT;

c) comply with the thermal comfort conditions provided in RDC 50/02 of ANVISA;

d) keep work environments clean and well-maintained.

32.10.2 In the process of developing and implementing the PGR and the PCMSO, the activities carried out by the Hospital Infection Control Commission (CCIH) or equivalent commission of the establishment must be considered.

32.10.3 Before using any equipment, operators must be trained on the mode of operation and its risks.

32.10.4 Manufacturer manuals for all equipment and machines, printed in Portuguese, must be available to the workers involved.

32.10.5 The use of medical-hospital material in disagreement with the usage recommendations and technical specifications described in its manual or packaging is prohibited.

32.10.6 Every health service must have a synanthropic animal control program, which must be proven whenever required by labor inspection.

32.10.7 Kitchens must be equipped with exhaust systems and other equipment that reduce the dispersion of grease and vapors, as established in NBR 14518.

32.10.8 Workstations must be organized to avoid additional displacements and efforts.

32.10.9 All workstations must be equipped with safe and stable devices that allow workers to access high places without additional effort.

32.10.10 Procedures for moving and transporting patients should prioritize the use of devices that minimize the effort made by workers.

32.10.11 The transport of materials that may compromise health and safety of workers must be carried out with the assistance of mechanical or electromechanical means.

32.10.12 Health service workers must be:

a) trained to adopt correct body mechanics when moving patients or materials to preserve their health and physical integrity;

b) instructed on measures to be taken when dealing with patients with behavioral disorders.

32.10.13 The environment where procedures causing foul odors are performed must be equipped with an exhaust system or other device to minimize them.

32.10.14 Workers are prohibited from pipetting by mouth.

32.10.15 All sinks must:

a) have taps or controls that do not require hand contact to close the water;

b) be equipped with liquid soap and disposable towels for hand drying.

32.10.16 Health service buildings must comply with Anvisa RDC 50 of February 21, 2002.

32.11 Final Provisions

32.11.1 (Revoked by SEPRT Ordinance No. 915, of July 30, 2019)

32.11.2 (Revoked by SEPRT Ordinance No. 915, of July 30, 2019)

32.11.3 The Tripartite Permanent National Commission of NR-32, called CTPN of NR-32, and the Regional Tripartite Permanent Commissions of NR-32, in the context of the Federation Units, called CTPR of NR-32, are created. Doubts and difficulties encountered during the implementation and continued development of this NR should be referred to the CTPN.

32.11.4 (Revoked by SEPRT Ordinance No. 915, of July 30, 2019)