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Course 751 - Hearing Conservation Program Management

Safety guides and audits to make your job as a safety professional easier

The Future of Hearing Loss Prevention (Optional)


Present approaches for storing and retrieving hearing loss prevention records work well in some, but not all situations. Many workers (e.g., construction workers) routinely move from job to job. Other workers may do part time work, work that is migratory in nature, or be self-employed. Traditional record management techniques may be impractical for these workers.

Emerging information management hardware and software can provide solutions to the problems associated with managing the records of a mobile or migrant workforce. In particular, optical cards, or memory sticks may be useful in developing hearing conservation programs that serve these workers. Historically, such workers have, at best, had access to personal hearing protective devices. Perhaps a fortunate minority may have even received training in the use and care of their hearing protectors. They almost certainly would not have been served by an audiometric monitoring component of a hearing conservation program.

By its very nature, audiometric monitoring is a long term process. Recall that current hearing conservation programs are site-based; all aspects of the program stay with the site. If a worker leaves, their audiometric and noise exposure records remain at the site. By contrast, an optical card or memory stick will be in the possession of the worker. When the worker changes jobs, the worker will carry their "records" to the next job. The continuity of care for a worker would be assured whether they received hearing health services from one or many occupational health care providers. Such continuity of care would make it reasonable to establish an audiometric baseline and monitor the hearing of a mobile or migrant worker. Finally, optical cards and memory sticks can enable the development of creative approaches in which either the worker or management or both adopt responsibility for procuring audiometric test services.

Holistic Approach: Looking at Factors Other Than Noise

Occupational hearing loss prevention has focused almost entirely on the prevention of disorders due to noise exposure. Since noise has been one of the most widespread occupational hazards, this attention has been justifiable. However, other factors may affect hearing or interact with noise. Many environmental hazards are usually observed in work environments. Combined with other organizational and psychosocial stressors, they are potentially hazardous to health. It has been observed that a worker may be exposed to as many as nine concurrent hazards, and the average worker is exposed to 2 to 3 hazardous agents simultaneously. Even considering only chemicals, the number of agents used and possible combinations is substantial. It may be inappropriate to restrict the term occupational hearing loss to a synonym for noise induced hearing loss, even though the two terms previously have been used as such. Ototoxic (Damage to the ear (oto-), specifically the cochlea or auditory nerve and sometimes the vestibular system, by a toxin.) properties have been identified among at least three classes of industrial chemicals: metals, solvents and asphyxiants. The indication that occupational chemicals could alter auditory function by either ototoxicity, neurotoxicity, or a combination of both processes, has serious implications.

It is plausible to expect that if these chemicals were present in the workplace in sufficiently high concentrations; these could affect hearing despite the lack of occupational exposure to noise. It is important that those involved in hearing loss prevention take into account exposure to chemicals during the various phases of the process (monitoring for hazards, assessing hearing, controlling exposures).

Currently, ototoxic properties of industrial chemicals and interactions between them and noise have only been investigated for a very small number of substances. This poses an obstacle for the appraisal of risk. When specific ototoxicity information is not available on the chemical in question, the program implementer should then gather information on the agent's general toxicity, neurotoxicity and complaints from exposed populations. As the ototoxic properties of chemicals are more thoroughly explored, it may be advisable to derive new hearing damage risk criteria that address the risk associated with exposure to noise and/or chemicals.

Task-Based Exposure Assessment

For many workers, (e.g., those in the construction trades) an 8 hour time-weighted average (TWA) represents a complex mixture of events. While the TWA is an extremely useful metric, it may be of limited use in predicting the exposure of workers with frequently changing environments and/or who perform multiple tasks of variable duration. The Task-Based Exposure Assessment Model (T-BEAM) may prove useful in developing a rational approach for health and safety professionals who must deal with these types of noise exposures. The T-BEAM concept uses work tasks as the central organizing principle for collecting descriptive information on variables used to assess the hearing hazard for a worker. T-BEAM methods are also being developed not only to characterize hazardous noise, but also the hazards associated with occupational exposures to asbestos, lead, silica, and solvents.

To apply the T-BEAM process, the hazardous agent to be studied is first identified - in this case, noise. Next, "experts" (e.g., journeymen), who are familiar with the processes associated with a given occupation, developed a list of tasks associated with each process. This becomes the basis for a hazardous task inventory which may then be used in developing approaches for surveying the tasks. The results of the ensuing task surveys are then applied towards developing intervention strategies. As might be the case with traditional surveys, the results could be used to prioritize candidates for engineering controls as well as for assessing tasks where engineering controls have already been applied. Because a T-BEAM survey is focused on tasks instead of shifts or areas, the survey results can be used to protect workers from hazards associated with specific tasks.

Consider the case of a worker who frequently changes job sites and whose main noise exposure comes from the intermittent use of power tools or machinery. Assume the worker's equipment produces a 100-dB(A) noise level. Under present OSHA guidelines, a two-hour cumulative exposure would equate to a 100% dose. Continuing with this example, assume that some days the worker uses this equipment for two hours or more. A hazard survey conducted on such days would identify this worker for inclusion in a hearing loss prevention program. A hazard survey conducted on other days might not. In situations such as these, the task rather than the shift should be the focus of intervention strategies. This approach is conceptually similar to how other intermittent noise exposures are addressed.

A police officer may only be exposed to hazardous noise in the course of periodic weapons training. Nevertheless, during weapons training the officer is provided hearing protectors, instructed in their proper use and may well be enrolled in an audiometric monitoring program. Many manufacturing operations require persons walking through hazardous noise areas to wear hearing protectors. The point is, a singular focus on the time-weighted average should not be the sole basis for decisions regarding hearing loss prevention measures. Workers engaged in tasks in which they are routinely exposed to hazardous noise or ototoxic agents should be included in hearing loss prevention activities.

Task-Based Exposure Assessment (Continued...)

The above examples point to the need for an alternate method for use in situations where current dosimetry or area monitoring may not identify workers exposed to hazardous noise. Current studies are assessing approaches for developing hazardous task inventories for individual occupations and crafts within the construction industry. To be effective, a hazardous task inventory must classify distinctive tasks, should quantify time-to-task parameters, and be able to account for the effects of adjacent noise. If research demonstrates T-BEAM methods are effective, hazardous task inventory's can be used to establish databases representing the occupational hazards associated with many trades. Such databases would enable one to characterize a worker's exposure profile without requiring an individual hazard assessment survey.

Although, at least for noise, the exposure profile may not be able to predict the specific exposure for an individual worker, it still may be possible to categorize a worker as having no risk, having some risk, or having substantial risk of hazardous noise exposure. Such categorization could be used to select an efficient intervention strategy based on and tailored to the degree of risk predicted for the worker.

New Directions in Theories about Self-Protective Behavior

With a wealth of research and published information available to guide the development of effective hearing conservation programs, why do some workers in apparently quality programs simply fail to protect themselves? In the past, popular models of health behavior such as the Health Belief Model and the Theory of Reasoned Action have tried to explain this phenomenon by tending to emphasize characteristics and beliefs of the individual worker.

For example, a particular worker might hold attitudes or beliefs that conflict with the principles of the safety program, e.g., "I'm not susceptible to noise-induced hearing loss, so why bother with protectors" or "Protectors interfere with warning signals...better to be deaf than dead!" While still useful as integral parts of newer models, these person-centered models have not adequately addressed many other factors now known to contribute to safe work behavior.

Newer models of health behavior currently under development stress interdisciplinary viewpoints and may contain parameters that focus on the interaction of environmental, psychological, and social determinants of behavior. Social aspects such as shared values and beliefs, the social relationship in which a specific behavior occurs, and the physical context of the behavior have taken on new importance. In particular, the issue of "safety climate" in the workplace is receiving renewed interest. Safety climate can be broadly defined as the general level of safety awareness and commitment among management and workers in the organization. The safety climate guides relevant behavior in the workplace by serving as a central point of reference for decision-making by workers and management about safety concerns.

One recent report has attempted to incorporate safety climate into a model of employee adherence to safety precautions. In this model, organizational safety climate depends upon such factors as explicit company safety policies and organizational attitudes and responses toward safety concerns. Worker characteristics (such as knowledge about health risks), availability of personal protective equipment in the work area, provision of employee feedback with respect to adherence to the safety program, and the social and physical environment of the workplace also contribute to worker adherence to safety practices.

New Directions in Theories about Self-Protective Behavior (Continued...)

In a study of medical personnel and adherence to universal precautions (to protect against HIV transmission), it was noted that providing extensive knowledge-based training and adequate supplies of personal protective equipment was not enough to lead to greater adherence to universal precautions (DeJoy, et al., 1995). Maximal adherence depended upon establishing an organizational safety climate, embraced by the workers as well as management that supported and fostered strict adherence to safety precautions.

Such a climate develops when management and workers take ownership for their safety program, and thereby facilitate and reinforce its provisions. Many prior studies designed around the health belief/promotion models have noted that perceived barriers or job hindrances have a strong influence on worker adherence to safety rules. In this new model, it was reported that "Job hindrances was the strongest predictor of adherence to universal precautions, and safety climate was the best predictor of job hindrances."

New Directions in Theories about Self-Protective Behavior (Continued...)

Most hearing loss prevention professionals agree that passive protection of workers from hearing loss by applying engineering controls to diminish hazards in the workplace is a preferred approach. However, in many occupational settings, protecting the workforce from hearing loss and other occupational hazards ultimately depends upon personal protective equipment (e.g., personal hearing protectors) and the voluntary actions of the hazard-exposed workers.

Training programs for these workers will continue to be very important, but the expanding research findings suggest that such programs may need to include more than factual presentations about mechanisms involved in hearing loss and how to properly wear personal protective equipment. Training programs in the future may increasingly concentrate on 1) modifying the organizational climate, and 2) providing workers with the skills and strategies they need to take responsibility for managing their own health by collectively uncovering and reducing barriers to safe work behavior.

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