32.1 Purpose and Scope of Application
32.1.1 This Regulatory Standard aims to lay down basic guidelines for implementing protective measures to safeguard the safety and health of workers engaged in health services, as well as personnel engaged in general health promotion and medical care work.
32.1.2 For the purpose of this standard, health services refer to all premises providing public medical care services, as well as all health promotion, rehabilitation, medical treatment, medical research and medical education activities of all complexity levels.
32.2 Biological Risks
32.2.1 For the application of this standard, biological risk means the probability of occupational exposure to biological agents.
32.2.1.1 Biological agents refer to microorganisms whether genetically modified or not, cell cultures, parasites, toxins and prions.
32.2.1.2 The classification of biological agents is specified in Annex I of this standard.
32.2.2 Risk Management Program - PGR
32.2.2.1 In addition to the provisions stipulated in NR-01, the Risk Management Program shall include the following contents in the hazard identification phase.
I. Identify the most likely biological risks according to geographical location and characteristics of health institutions and their departments, taking into account:
a) Exposure sources and reservoirs
b) Routes of transmission and entry
c) Transmissibility, pathogenicity and virulence of agents
d) Environmental persistence of biological agents
e) Epidemiological studies and statistical data
f) Other scientific information
II. Assess workplaces and workers considering:
a) Purpose and description of workplaces
b) Work organization and operational procedures
c) Possibility of exposure
d) Job activities and duties at each workplace
e) Applicable preventive measures and follow-up supervision
32.2.2.2 In addition to the provisions of Item 1.5.4.4.6 of NR-01, the Risk Management Program shall be reassessed:
a) Whenever working conditions change which may alter exposure to biological agents;
b) As determined by the analysis of accidents and incidents.
32.2.2.3 All documents constituting the Risk Management Program shall be accessible to workers.
32.2.3 Occupational Health Medical Control Program
32.2.3.1 In addition to the provisions laid down in NR-07 and in compliance with Clause I of Item 32.2.2.1, the Occupational Health Medical Control Program shall include:
a) Identification and assessment of biological risks;
b) Division of risk areas in accordance with the criteria specified in Item 32.2.2;
c) A list recording workers' names, positions, workplaces and corresponding exposed risks;
d) Medical surveillance for workers with potential exposure risks;
e) Vaccination schedule.
32.2.3.2 Any permanent or temporary job transfer that leads to change of exposure risks shall be promptly reported to the coordinating physician or person in charge of the Occupational Health Medical Control Program.
32.2.3.3 Regarding accidental exposure to biological agents, the program shall specify:
a) Procedures for diagnosis, follow-up and prevention of seroconversion and related diseases
b) Workplace decontamination measures
c) Emergency medical treatment protocols for workers
d) Personnel responsible for implementing relevant measures
e) List of medical institutions available for worker assistance
f) Means of transportation for medical treatment
g) List of medical institutions storing immunoglobulins, vaccines, essential medicines and special supplies
32.2.3.4 The program shall be accessible to workers and labor inspection authorities.
32.2.3.5 All accidents related to biological risks shall be reported via Work Accident Notification regardless of whether the worker takes sick leave or not.
32.2.4 Protective Measures
32.2.4.1 Protective measures shall be implemented based on occupational risk assessment results in the Risk Management Program and comply with provisions of Item 32.2.2.
32.2.4.1.1 Immediate protective measures shall be taken in case of accidental exposure even if not specified in the Risk Management Program.
32.2.4.2 Laboratory handling shall comply with the General Guidelines for Containment Work with Biological Materials issued by the Ministry of Health according to corresponding microorganisms.
32.2.4.3 All places with possible biological agent exposure shall be equipped with dedicated hand washing stations with running water, liquid soap, disposable towels and touch-free waste bins.
32.2.4.3.1 Isolation wards for infectious disease patients shall be equipped with internal hand washing facilities.
32.2.4.3.1 Wearing gloves does not replace hand washing. Hands must be washed before and after glove use.
32.2.4.4 Workers with wounds or injuries on upper limbs can only resume work after mandatory medical assessment and obtaining official work clearance certificate.
32.2.4.5 Employers shall prohibit the following acts:
a) Improper use of work sinks beyond designated purposes;
b) Smoking, wearing ornaments and handling contact lenses at work posts;
c) Eating and drinking at work stations;
d) Storing food in non-designated areas;
e) Wearing open-toe footwear.
32.2.4.6 All workers exposed to biological agents shall wear suitable and comfortable work uniforms.
32.2.4.6.1 Work uniforms shall be provided free of charge by employers.
32.2.4.6.2 Workers are not allowed to leave the workplace wearing personal protective equipment and work clothes.
32.2.4.6.3 Employers shall arrange proper places for distributing clean uniforms and storing used ones.
32.2.4.6.4 Employers shall be responsible for the sanitization of work uniforms used in surgical centers, obstetric departments, intensive care units, infectious disease wards and uniforms directly in contact with organic substances.
32.2.4.7 Sufficient disposable and reusable personal protective equipment shall be available at workplaces to ensure timely supply and replacement.
32.2.4.8 Employers shall:
a) Ensure proper maintenance and disinfection of working tools and instruments;
b) Provide qualified containers and transport means for infectious materials, body fluids and organic tissues.
32.2.4.9 Employers shall provide pre-job and regular ongoing training for workers:
a) Retraining is mandatory when workers' biological exposure conditions change;
b) Training can be arranged during working hours;
c) Training shall be delivered by medical professionals familiar with biological risks.
32.2.4.9.1 Training shall be updated in line with latest research and newly identified biological risks, covering:
a) Available data on potential health hazards;
b) Exposure minimization control measures;
c) Hygiene regulations and operating procedures;
d) Use of collective protection facilities, personal protective equipment and work uniforms;
e) Prevention measures for occupational accidents and incidents;
f) Emergency response measures for workers in case of accidents.
32.2.4.9.2 Employers shall submit training records to labor inspection authorities, including date, time, class hours, training contents, instructor qualifications and trainee information.
32.2.4.10 Written guidelines with plain language on daily working procedures and occupational disease prevention measures shall be provided to all staff in biologically exposed working areas.
32.2.4.10.1 Workers shall sign for receipt of the guidelines, and relevant documents shall be kept for labor inspection.
32.2.4.11 Workers shall immediately report all accidents and incidents involving potential biological exposure to site supervisors, occupational safety and health departments and internal safety committees.
32.2.4.12 Employers shall promptly inform all workers and their representatives of any serious incident that may lead to the spread of disease-causing biological agents, including causes and corrective measures adopted or to be taken.
32.2.4.13 Mattresses, cushions and padding shall be covered with washable and waterproof materials for easy disinfection and cleaning.
32.2.4.13.1 The covering shall be free of holes, tears, grooves and depressions.
32.2.4.14 Users of sharp instruments shall be responsible for their proper disposal after use.
32.2.4.15 Manual recapping and manual disconnection of needles are strictly prohibited.
32.2.4.16 Employers shall formulate and implement a prevention plan for sharp instrument injuries in accordance with guidelines laid down in Annex III of this standard.
32.2.4.16.1 Manufacturers and sellers of sharp instruments shall provide training on correct use of safety devices for health staff.
32.2.4.16.2 Health service employers shall ensure relevant training is provided for their employees.
32.2.4.17 Worker Vaccination
32.2.4.17.1 All health workers shall be provided free active immunization including tetanus, diphtheria, hepatitis B and other vaccines specified in the occupational health medical control program.
32.2.4.17.2 Effective vaccines against other biological agents that workers are exposed to or may be exposed to shall be provided free of charge by employers.
32.2.4.17.3 Employers shall check vaccination efficacy as recommended by health authorities and arrange booster shots when necessary.
32.2.4.17.4 All vaccination shall comply with official health ministry recommendations.
32.2.4.17.5 Employers shall fully inform workers of vaccine benefits, side effects and occupational risks arising from non-vaccination or refusal to vaccinate. Relevant signed documents shall be kept available for labor inspection.
32.2.4.17.6 Vaccination records shall be entered into workers' individual medical files as required by NR-07.
32.2.4.17.7 Certificates of received vaccines shall be issued to relevant workers.
NR 32 - Occupational Safety and Health Standard for Health Services
