Hearing loss is one of the most pervasive occupational health problems in America
today. Approximately 30 million workers are exposed on their jobs to noise levels or
toxicants that are potentially hazardous to their hearing. Fortunately, noise-induced
hearing loss can be reduced, or often eliminated, through the successful application of
occupational hearing loss prevention programs.
A successful hearing loss prevention program benefits both the company and the affected
employee. Employees are spared disabling hearing impairments and evidence suggests that
they may experience less fatigue and generally better health. Ultimately, the company
benefits from reduced medical expenses and worker compensation costs. In some cases there
may be improved morale and work efficiency.
The existence of a hearing loss prevention program (even one that complies with
government standards) does not guarantee the prevention of occupational hearing loss.
Experiences with successful hearing loss prevention programs show that management needs to
develop and adhere to certain policies from the start. These policies cover the
integration of the hearing loss prevention program into the company's safety and health
program, designation of a key individual (a "program implementor") with ultimate
responsibility for the overall conduct of the program, standard operating procedures for
each phase of the program, the proper identification and use of outside services, and the
purchase of appropriate equipment.
This guide, developed by those having long, varied experience in hearing conservation
practices, presents some of the important attributes of successful hearing loss prevention
programs. Concepts and action items are presented in terms of the responsibilities of
three groups of personnel: those representing management, those who implement the hearing
loss prevention programs, and those who are affected by exposure to noise or ototoxic
chemicals. Checklists are provided in the appendices to assist in evaluating hearing loss
prevention programs on a step-by-step basis.
As presented in the original edition of "The Practical Guide," the
seven basic components of a hearing loss prevention program consist of: (1) noise exposure
monitoring, (2) engineering and administrative controls, (3) audiometric evaluation, (4)
use of hearing protection devices, (5) education and motivation, (6) record keeping, and
(7) program evaluation. To these, we now add an eighth: hearing loss prevention program
Hearing Loss Prevention Program Audit
Ideally, a carefully conducted audit should be performed before any program to prevent
hearing loss is put into place, or before any changes in an existing program are made. The
audit should be performed on the system as it exists or doesn't exist. While it is not
difficult to conduct an audit, it may require time to assemble the materials necessary to
fully answer audit questions. The questions in Appendix B, Program Evaluation Check List,
can serve well for an audit, although for an initial audit the check list should be
reordered. It is best to perform the audit from the top down with administrative issues
addressed first. Administrative issues concern corporate responses to regulations, to good
safety and health practices, to the need to develop or modify program policies, to
assuring adequate resources, and to providing the necessary authority to those persons
responsible for the day-to-day operation of the program. Aspects of hearing assessment,
implementation of engineering and administrative controls, and supervisor involvement in
the program should be considered. The system for monitoring audiometry and record keeping
requires close attention since how the records of audiometry and other aspects of the
program are maintained can make or break the program. Employee and management education
should be planned and past successes and failures should be addressed. When noise cannot
be reduced to the point where it is no longer a hearing hazard, a program for providing,
fitting, training in the use of, and maintaining hearing protectors must be established.
The hearing loss prevention program audit should be revisited annually so that strengths
of the program may be identified and weaknesses may be addressed.
Monitoring for Hearing Hazards
As with any health hazard, it is important to characterize the hazard accurately and to
identify the affected employees. Management should define the specific goals of the sound
survey and make sure that operating procedures, as well as resources, are available for
collecting and evaluating measurements of ototraumatic exposures. Since noise is the most
widespread ototraumatic agent, this section will focus on noise exposure monitoring.
However, other agents known to effect the auditory system, or to interact with noise
should also be monitored. In the case of ototoxic chemicals, analytical procedures that
specify the collection media, sample volume and chemicals analysis can be found, for an
extensive number of compounds, in the NIOSH Manual of Analytical Methods (1994). The
results of the noise and other measurements must be reported to the hearing loss
prevention program implementor and to the employees in an understandable format. Hearing
loss prevention program implementors need to coordinate closely with production employees
to make sure that the measurements represent typical production or processing cycles and
that noise and toxicant levels are adequately sampled. The program implementor should see
that those who make the measurements closely follow the policies and procedures
established by management, that the report explains the results clearly, and that
employees are apprised of the results. Employees have the responsibility of sharing their
knowledge about the production environment, the machinery, and specific operations with
those who measure the exposures.
Engineering and Administrative Controls
Ideally, the use of engineering controls should reduce ototraumatic exposure to the
point where the hearing hazard is significantly reduced or eliminated. It is especially
important for companies to specify low noise levels when purchasing new or refurbished
systems and equipment.
Management needs to identify controllable exposure sources, set goals for their
control, and prioritize allocated resources to accomplish these goals. Managers should
also explore potential administrative controls, such as scheduling that will minimize
exposure to noise and other ototraumatic agents, and providing quiet, clean, and
conveniently located lunch and break areas. Program implementors must ensure that
communication channels are open between management, noise control personnel, and
production workers. The workers, in turn, need to communicate their concerns to management
and those in charge of engineering control, and must learn to work safely in their
environment by taking full advantage of the available controls.
Audiometric evaluation is crucial to the success of the hearing loss prevention
program, since it is the only way to determine whether occupational hearing loss is being
prevented. Management must allocate sufficient time and resources to the audiometric
program to allow accurate testing; otherwise, the resulting audiograms will be useless.
Management should also select audiometric technicians and professional consultants with
demonstrated competence in relating to employees as well as in performing their duties in
the audiometric program. The program implementor must monitor the audiometric program
including scheduling, testing, equipment maintenance and calibration, audiogram review,
feedback to the employee, and referral. Effective communication and coordination among
company personnel, health services, and employees are of utmost importance. Employees need
to disclose information about ear problems and prior noise or toxicant exposures, or
problems encountered in taking the audiometric test. They also need to follow up on any
recommendations for treatment or further medical or audiologic evaluation.
Personal Hearing Protection Devices
In the absence of feasible engineering or administrative controls, personal hearing
protection devices (often referred to as hearing protectors) remain the only means of
preventing hazardous noise levels from damaging one's hearing. Unless great care is taken
in establishing a hearing protector program, employees will often receive very little
benefit from these devices. Each employee can react differently to the use of such
devices, and a successful program should respond to individual needs. The primary
managerial responsibilities are: to facilitate the procurement of appropriate hearing
protection devices, to demonstrate commitment to the program (e.g., by modeling the use of
these devices in appropriate situations), to provide the personnel and facilities to train
employees in the proper and optimum use and care of hearing protection devices, and to
enforce the use of hearing protectors. Program implementors need to be knowledgeable in
the details of hearing protector evaluation, selection, and use, and must be able to
impart this information and enhanced daily use skills to employees. Implementors need to
encourage employees to ask questions and must help them solve any problems that may arise.
Program implementors also should perform periodic on-site checks of the condition and
performance of hearing protectors including availability of replacement devices as well as
component elements that tend to deteriorate with use (such as earmuff cushions).
Employees must take responsibility for being fully informed about the need for hearing
protection, wearing their hearing protectors correctly at all times, seeking replacements
as necessary, encouraging co-workers to use these devices, and communicating problems to
Education and Motivation
Education and motivation sessions are valuable for both management and employees so
they will understand that a successful hearing loss prevention program takes commitment,
communication, and cooperation. Management should set a high priority on regularly
scheduled training sessions, and select articulate, knowledgeable, and enthusiastic
instructors. The program implementor, or those who present the sessions, need to make
their presentations short, simple, and highly relevant to employees and management. They
need to encourage questions and open communication, and they must make sure that all
problems receive prompt attention. Employees must contribute to their own education by
raising questions and concerns, and by informing program implementors when specific
procedures are impractical, suggesting alternatives when possible. If hearing loss
prevention program personnel fail to provide adequate consideration or follow-up,
employees should communicate their concerns to higher levels of management.
Effective record keeping requires a committed and consistent approach. Each element of
the hearing loss prevention program generates its own type of record (e.g., noise survey
forms, audiograms, and medical histories), and much of this information needs to be
integrated into the employee's health record. Historical record keeping is vital because
injuries to hearing due to over exposures are rarely as evident as other types of
occupational events; i.e., noise-induced hearing loss takes place very slowly over time.
Therefore, complete documentation becomes vitally important when evaluators attempt to
construct longitudinal records that pertain to an individual's long-term exposures to
noise and effectiveness questions concerning prevention and control measures.
Management's responsibility is to provide adequate resources for efficient record
processing, review, and storage in addition to training program implementors and procuring
outside services if necessary. Management must ensure that confidentiality of personal
data is maintained, that hearing loss prevention program records are available to program
implementors and government inspectors, and that each employee has access to his or her
own files. Program implementors must see that the information entered into the records is
accurate, legible, complete, and self-explanatory. They also should ensure that records
are standardized, cross-referenced, and properly maintained. Employees should take
advantage of the record keeping system by inquiring about their hearing status, especially
at the time of the annual audiogram.
A thorough evaluation of all the hearing loss prevention program's components is
necessary to determine the extent to which the hearing loss prevention program is really
working, or if there are problems, which elements or departments need improvement. There
are two basic approaches: (1) to assess the completeness and quality of the program's
components, and (2) to evaluate the audiometric data. The first approach may use
checklists, such as those found in Appendices A and B, and the second consists of
evaluating the results of audiometric tests, both for individuals and for groups of
employees exposed to hearing hazards. Management should dedicate resources for hearing
loss prevention program evaluation (i.e., trained individuals and computer facilities). In
addition, managers must be willing to acknowledge and solve problems that arise. If
program implementors are not knowledgeable in the mechanics of database analysis, the
company should obtain training for the implementor or hire someone with these skills.
Program implementors must also be committed to seeking out elusive information, and
interacting with all members of the hearing loss prevention program team to identify and
correct any deficiencies. As with many other aspects of the hearing loss prevention
program, the employee's responsibility with respect to program evaluation is to provide
feedback on the program's merits or shortcomings to the program implementor and management
and to participate in the implementation of the improvements.
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