Occupational Hearing Loss in the Healthcare Setting
By Vince Weber
Occupational hearing loss is something that employers need to take seriously. There are a number of factors that must be taken into consideration when evaluating hearing loss. Given that the average employee is only exposed to their working environment for about 25% of their daily activities, a careful review of work and lifestyle sound exposures should be a part of any evaluation.
Workplace sound exposures, for general industry, fall under OSHA regulation 29CFR1910.95. This regulation sets maximum sound levels and durations. (See MED on the Web below). When an employee is exposed to noise levels in excess of these permissible exposure limits (PELs), the employer is required to implement and enforce mandatory hearing protection practices.
Employers are also subject to additional requirements when noise exposures equal or exceed an 8-hour time weighted average (TWA) of 85 decibels. These requirements include monitoring of the workplace to identify specific operations or activities that may exceed PELs. Employers are also required to establish and maintain an audiometric testing program for all employees whose exposures reach or exceed the TWA of 85 decibels.
This audiometric testing is to be conducted at, or shortly after, the beginning of employment, in order to establish a baseline reading. From this point, the employer is required to conduct annual audiometric testing, to monitor for significant changes or “threshold shifts,” as an indicator of possible injury. Full details of an audiometric testing program can be found in OSHA regulations 29CFR1910.95 (g) & (h).
The need to monitor the work environment is necessary for the employer to fully evaluate any potential exposures to harmful noise. A simple screening of the workplace can be accomplished through the use of hand held “decibel” or sound level meters. It is important to take readings from specific work stations or operator positions that are suspect. Readings should be conducted during various phases of operations or activities. These ambient readings are only a screening method to determine if further monitoring or evaluation is necessary.
A true determination of the employee’s 8-hour TWA can only be accomplished through the use of a personal noise dosimeter. Many small and compact dosimeters are now available for purchase or lease from major scientific equipment vendors. These dosimeters are worn by employees during their normal shift and collect noise exposure data points at specific intervals (usually every 30 – 60 seconds). The final readings will then take into account all noise exposures throughout the employees work shift, including breaks; interruption of process; and changes in operations, activities, or equipment. The findings are then downloaded or taken directly from the unit, and a full report is generated. The report will usually indicate high level “impact” type sounds as well as long duration sounds, to yield a more accurate TWA of the employee’s actual exposures.
Of course other factors, including lifestyle, recreational activities, and the employee’s personal health must also be considered when evaluating hearing loss. It is not unusual for the employee, who routinely wears hearing protection at work, to operate noisy equipment such as lawn mowers, snow blowers, or chainsaws without this protection when working at home. Recreational activities, including loud music, participation in motorized sports, and attendance at many sports venues can also be sources of high noise exposure. Finally, a wide variety of personal health conditions, medical history, and medications are all factors that should be evaluated.
With few exceptions, occupational hearing loss is the result of a lifetime of exposures, both on and off duty. A thorough understanding and evaluation of all of the employee’s exposures is necessary in making a final determination of “occupational” hearing loss.
OSHA PERMISSIBLE NOISE EXPOSURES
Duration per day in hours Sound level dBA slow response
1 1/2 ...................| 102
1/2 ......................| 110
1/4 or less...........| 115
Source: Occupational Noise Exposure, United States Department of Labor
Vince Weber has over 30 years of experience in the health, safety, and loss control field. He is an authorized trainer for a variety of OSHA training courses. Weber is a Loss Control Specialist with RAS.