1. Hearing Conservation Program Best Practices
Bryan Beamer, PhD, PE, CSP
Research Engineer – Noise and BioacousticsTeam
NRASP Annual Safety Conference 2019
DEC
NIOSH and my team
Work in industry as IE and at UW-Stout

2. Outline Practical Approach for Safety Professionals
Regulatory requirements for a hearing conservation program (HCP)
Monitoring
Buy Quiet & Noise Control
Hearing protection
Training
Fit testing overview and demo
Audiometry basics
Recordkeeping best practices
Source: Getty Images

3. What’s wrong in this photo?
Source: Getty Images
Which hazards do you see?
Which are most important in terms of severity/probability?
Some organizations manage Occupational Safety and Health by striving to minimize overall Risk
Risk is the chance that harm will occur or an accident will happen.
Out of many workplace hazards, the harm from occupational hearing loss can be:
Long term
Permanent
In the future
The chance that workers will get hearing loss is quite high compared to other, more obvious hazards.
Therefore the overall Risk for hearing loss is relatively high
Other possible hazards due to noise
Lack of awareness/accidents
Hypertension
Cardio-vascular disease
Point – for construction:
About 51% of all workers in Construction have been exposed to hazardous noise.1
31% of noise-exposed Construction workers report not wearing hearing protection.2
About 25% of noise-exposed tested Construction workers have a material hearing impairment.4 Hearing impairment is hearing loss that impacts day-to-day activities.
Point – Noise might not be the highest hazard, but it a) needs to be addressed from a regulatory standpoint and b) it presents a real, permanent, NOT LOW risk to workers
Ototoxic exposure
In the United States, hearing loss is the third-most common chronic physical condition among adults after hypertension and arthritis.
About 12% of the U.S. working population has hearing difficulty.
About 24% of the hearing difficulty among U.S. workers is caused by occupational exposures.
About 8% of the U.S. working population has tinnitus (‘ringing in the ears’) and 4% has both hearing difficulty and tinnitus.

4. Picture credit – OSHA Technical Manual

5. Practical Approach for Safety Professionals
Create a quieter workplace if possible, and introduce hearing conservation program (HCP) best practices
Make sure, most of all, that your employees understand that noise may cause serious harm.
Work through the steps and implement HCP best practices.
If you assess noise and find that you don’t technically need an HCP, you should still consider that there may be a benefit in implementing simple noise controls for a quieter workplace.
You can’t just establish a hearing conservation program and solve the problem. Instituting a program is only the first step.
A hearing conservation program and noise control strategies must be re-evaluated with regularity. It’s an ongoing process.

6. Searching for regulatory requirements for hearing conservation programs
Google search results
34M hits
U.S. government sources, including OSHA, NIOSH, MSHA, for example
Environmental and occupational health and safety publications
Wikipedia
Many for-profit courses and programs
A web search for “regulatory requirements for HCP” will result in an overwhelming number of options.
Do you know which sources you should trust?
Source: Google.com

7. Regulatory requirements for hearing conservation programs
OSHA Regulation
29 CFR Occupational noise exposure
29 CFR (c) - Hearing conservation programs
OSHA - Hearing Conservation
Monitoring
Audiometric testing and audiograms
Hearing protection
Training
Recordkeeping

8. Some differences for other industries
Construction - 29 CFR Subpart D
Workers to be protected over 90 dBA (PEL)
1) Engineering, 2) Administrative, 3) PPE (hearing protection)
At PEL hearing conservation program required
(NOT 85 dBA)
HCP details not laid out explicitly
Impulse noise mentioned
Construction - 29 CFR Subpart E
VERY little info here: 1) use PPE when over PEL, 2) PPE fitted by competent persons, 3) NOT plain cotton
Mining – 30 CFR 62 – Occupational Noise Exposure
Source: Getty Images
OSHA regulations mandate for construction – 29 CFR (e) Exposure to impulsive or impact noise should not exceed 140 dB peak sound pressure level.
This isn’t exactly right and it’s a cutting-edge research question. Impulse noise isn’t really addressed in this presentation.

9. ASSESS NOISE/DOSE Compliance assessment – Dosimetry
Set dosimeter to OSHA criteria standards
Calibrate the tool before use.
Explain briefly to workers
Attach the microphone close to worker’s ear, lapel, or collar.
Point monitor upright, away from clothes and consider windscreen.
Keep detailed, organized records for 1) your program and 2) OSHA, and take useful notes on worker tasks and validation of sound level measurements.
Resources
OSHA Technical Manual Instructions:
Dosimeter manufacturer’s manual
Picture credit – OSHA Technical Manual

10. Monitoring OSHA regulatory requirements
Baseline dosimetry for full shift work for noisy tasks or environments
Must calibrate equipment:
Exchange rate: 5 dB
Frequency weighting: A
Response: slow
Criterion and threshold levels: 90 dBA.
Employees must receive notice of exposure monitoring.
Requirements for 85 dBA vs. 90 dBA
85 dBA TWA – Action Level
90 dBA TWA – Minimum Protection Level (OSHA requirement)
Follow-up dosimetry is required whenever changes in production, process, or controls increase noise exposure.
Source: OSHA Technical Manual -

11. Monitoring best practice: Use NIOSH recommendations for dosimeter settings
NIOSH recommended dosimeter settings:
Exchange rate: 3 dB
Frequency weighting: A
Response: slow
Threshold level: 80 dBA
Why you should follow NIOSH recommendations:
With a 40-year lifetime exposure
85-dBA REL, the excess risk of developing occupational noise-induced hearing loss (NIHL) is 8%
90-dBA permissible exposure limit (PEL) excess risk is 25%
3-dB exchange rate increasingly supported by national and international consensus
With a 40-year lifetime exposure at the 85-dBA REL, the excess risk of developing occupational NIHL is 8%—considerably lower than the 25% excess risk at the 90-dBA permissible exposure limit (PEL) currently enforced by the Occupational Safety and Health Administration (OSHA) and the Mine Safety and Health Administration (MSHA).
NIOSH recommends a 3-dB exchange rate, which is more firmly supported by scientific evidence. The 5-dB exchange rate is still used by OSHA and MSHA, but the 3-dB exchange rate has been increasingly supported by national and international consensus

12. WHY CONTROL NOISE? Why not just jump directly into hearing protection?
Source: NIOSH

13. ELIMINATE NOISE/BUY QUIET Buy Quiet case study
Florida Landscaping Crews
Crew A: battery-powered equipment
Crew B: gas-powered equipment
Approximate difference in noise levels (NIOSH Criteria)
Crew A: TWA (dBA)
Crew B: TWA (dBA)
What we can learn/act on:
For this task, this company finds the battery-powered equipment promising
Crew A may not need to be in a Hearing Conservation Program
Getting a rough idea of the difference is not hard
What we cannot (or need not) infer:
Repeatable results
This rough estimate replaces dosimetry
Source: NIOSH

14. Some Easy to Implement Noise Controls: Decrease impact noise of falling parts by decreasing falling distance
From: Noise Control - A guide for workers and employers, US Department of Labor

15. Some Easy to Implement Noise Controls: Eliminate restricted flow in pipes and ducts.
From: Noise Control - A guide for workers and employers, US Department of Labor

16. Some Easy to Implement Noise Controls: Reduce vibrating surfaces and parts
From: Noise Control - A guide for workers and employers, US Department of Labor

17. Some Easy to Implement Noise Controls: Add barriers and sound absorption for middle to high frequency issues.
From: Noise Control - A guide for workers and employers, US Department of Labor

18. Some Easy to Implement Noise Controls: Use anti-vibration connectors
From: Noise Control - A guide for workers and employers, US Department of Labor

19. Some Easy to Implement Noise Controls: Keep noisy machinery away from walls/reflective surfaces
From: Noise Control - A guide for workers and employers, US Department of Labor

20. Some Easy to Implement Noise Controls: Combine sound shields with sound absorbing ceilings
From: Noise Control - A guide for workers and employers, US Department of Labor

21. Some Easy to Implement Noise Controls: For low frequency sources – seal enclosures as much as possible
From: Noise Control - A guide for workers and employers, US Department of Labor

22. Some Easy to Implement Noise Controls: Use sound absorption for all enclosures and barriers
From: Noise Control - A guide for workers and employers, US Department of Labor

23. Common Administrative Controls
Limit workers’ exposure to noisy tasks
Isolate noisy processes from other workers (move the process)
Change working schedule to limit exposure to noisy processes
Source: Getty Images

24. Hearing protection – When your other options don’t work
PROS – When the noise can’t be eliminated or attenuated, hearing protection can be quite effective when chosen and used correctly!
CONS – Hearing protection is often
Incorrectly chosen
Worn incorrectly
Not worn at all
How to make the best of a bad situation in subsequent slides…
Source: Getty Images

25. From military’s Hearing Center of Excellence https://hearing. health

26. Hearing protection best practices
Follow a recommended exposure limit (REL) of 85 dBA.
Select a HPD that is comfortable and sufficient to prevent hearing loss, BUT does not over-protect.
Conduct a hearing protection fit testing to ensure adequate or optimal protection.
Help employees understand why hearing protection is important.
Source: Getty Images

27. When hearing protectors are like sunglasses…
Too light
Just right
Too dark
Source: Getty Images

28. How do you make the best of a bad situation?
TRAINING
Roll, pull, HOLD
Why and how do you get workers to care?
It’s like a safety belt.
From:
DEMO
This is a good time for a discussion…
Roll, pull, HOLD
Why and how do you get workers to care?
It’s like a safety belt.

29. Roll, pull, insert. How hard can that be?
Murphy et al., The effects of training on attenuation, Noise & Health, 2011
...but first, here are the findings from another NIOSH study... This was a laboratory-based study that showed that after receiving individual instruction, poorly performing subjects were able to properly insert their earplugs and achieve sufficient attenuation. So, the most effective method is usually individual one-on-one training.

30. Hearing protection requirements
Required
When you have exposure levels over the permissible exposure limit (PEL) of 90 dB over an 8-hour TWA
After a standard threshold shift (STS) has occurred
Selection
Select a HPD that is sufficient and comfortable to prevent hearing loss.
Provide a variety of choices to employees.
Reevaluate choice with change in working conditions.
Guidance
Help employees choose correct hearing protection.
Train them on proper use and care of hearing protection.
Apparently the most confortable choice is not the choice that provides the most attentuation: Byrne, D.C. Davis, R.R., Shaw, P.B., Specht, B.M. & Holland, A.N. (2011). Relationship between comfort and attenuation measurements for two types of earplugs. Noise and Health, 13,
Source: Getty Images

31. Fit testing basics
Hearing protector fit-test systems show how much protection an individual has when using a particular hearing protector
Use a system that interfaces with a computer and over-ear headphones to measure the amount of protection offered by in-ear hearing protection devices such as earplugs.
Hearing protector fit testing generates a Personal Attenuation Rating (PAR), which estimates worker noise exposure when subtracted from the measured noise.

32. Why fit test?
When you get to this slide, make sure you jump up and down, stand on your head, or do something to make sure they understand the implications of this graph.  If they don’t remember anything else from your presentation, you’d like them to know these things:
Particularly for earplugs (i.e., the group of bars on the left side), one cannot determine by looking at the lab data (i.e., the NRR) and decide which HPD is going to work the best.  As an example, the EP-100 tested very well in the lab, but was the absolute worst when tested in the field.  In other words, you can’t even rank-order the likely field attenuations of plugs based solely on the NRR.  One cannot assume that a plug with a labeled NRR of 26 dB is going to perform better (for a particular individual) than a plug with a labeled NRR of 12 dB.
Regardless of the make/model/brand, earmuffs (the group of bars on the right side of the graph) tend to give about the same amount of attenuation in the lab, and also about the same (but lesser) amount when tested in the field.  They are harder to get on “wrong” (although it is quite possible for some folks).

33. Real-life pictures say it best
All ears are not the same
Visual inspection may not identify a good fit
Qualitative checks cannot estimate actual noise reduction
High exposures require high attenuation
Source: NIOSH

34. Fit testing procedure
Measure noise exposure in each work area, ideally using a personal dosimetry.
Ensure the appropriate software has been installed on a computer compatible with the chosen fit testing system
Create a selection of various hearing protection devices, including the those the employee favors or uses primarily.
Conduct baseline test without earplugs, similar to an audiogram
Have the employee insert earplugs without instruction and perform fit test, this is similar to a short audiogram and takes less than 5 minutes
If the calculated exposure with PAR is still >80 dBA, teach the employee correct insertion techniques and conduct the test a second time
Repeat test with various HPDs until the PAR indicates adequate or optimal protection

35. Fit testing DEMO

36. Fit testing systems E·A·Rfit TM SafetyMeter FitCheck FitCheck Solo
INTEGRAfit
VeriPRO
Photo courtesy of the U.S. Army Aeromedical Research Laboratory

37. Hearing protector fit testing with off-shore oil-rig inspectors in Louisiana and Texas
William J. Murphy, Christa L. Themann & Taichi K. Murata (2016) Hearing protector fit testing with off-shore oil-rig inspectors in Louisiana and Texas, International Journal of Audiology, 55:11, , DOI: /
Points:
Fit testing works in the long run
After 6 months, there is a drop in personal attenuation ratings (PAR)
. Therefore re-testing/training is a best practice.

38. What do workers think? "I know how to better fit my earplugs now.”
"Learned A LOT about best earplugs for me."
"I found a more comfortable fit. It was very beneficial."
"Recently had a threshold shift. Found better earplugs."
"Very glad I did the fitting test. Now I know the correct way to fit my ear plugs.”
"I was amazed with the results after being shown the proper way to use earplugs.
"I had no idea I was not using my earplugs correctly."
"Feel like am protected now!"
Up until recently, the most common feedback we heard were workers’ objections to wearing hearing protectors. Now, with the capability to do fit-testing, workers may understand the fitting process better, and as this feedback shows, they have more enthusiasm towards wearing their hearing protectors.

39. Fit testing conclusions and best practices
Assists in the selection of a proper hearing protection device (HPD)
Identifies workers at risk
Documents adequate protection
Provides opportunity for training
Several fit test systems can meet a range of needs.
Re-test and follow up training.
Choose the correct HPD and wear it properly.

40. Getting workers to care about following through
Some reasons not to wear hearing protection correctly, even with fit-testing training
Some ways to motivate workers
CPWR infographics:
Source:

41. Audiometry basics
Audiometry is a hearing test that measures the lowest level of sound that can be heard across several frequencies.
Conduct baseline and annual testing
Required for employees above action level 85 dBA TWA for your protection
Baseline testing is due within first 6 months of employment
Testing must be done by professional certified by the Council of Accreditation in Occupational Hearing Conservation (CAOHC)
Ask your certified tester for help with documentation and advice on how to follow up if there is a standard threshold shift (STS).
Mobile Test Van Exception
"Mobile test van exception." Where mobile test vans are used to meet the audiometric testing obligation, the employer shall obtain a valid baseline audiogram within 1 year of an employee's first exposure at or above the action level. Where baseline audiograms are obtained more than 6 months after the employee's first exposure at or above the action level, employees shall wear hearing protectors for any period exceeding six months after first exposure until the baseline audiogram is obtained.
OSHA calls it a “Standard” Threshold Shift, while NIOSH calls it a “Significant” Threshold Shift.

42. Recordkeeping basics and best practices
Cost Records
Audiometry
Training
Personal protective equipment (PPE)
Accidents caused by situational awareness issues
Hearing loss claims
Fit testing program
Keep other mandatory records, such as ….
Prepare for or expect an OSHA site visit from a Certified Occupational Safety and Health Official (COSHO)
Follow OSHA recordkeeping best practices

43. Hearing conservation program best practices
Provide a hearing conservation program as one part of the overall goal of protecting workers from noise
Protect workers from noise levels above 85 dBA.
Require fit testing as a key part of a successful hearing conservation program.
Use fit-testing as a one-on-one training opportunity.
Get people to care to improve training outcomes.
Consult a Certified Occupational Hearing Conservationist when needed.
Source: Getty Images

44. Useful resources OSHA Hearing Conservation Landing Page
OSHA Hearing Conservation Manual
OSHA Occupational Noise Exposure – Construction
NIOSH Page - Hearing Loss Prevention Programs
NIOSH Presentation – A Model Hearing Conservation Program

45. Useful resources continued
Landscape Management – The Scoop on Hearing Conservation Programs
NIOSH blog on Hearing Protector Selection
NIOSH HPD Well-Fit™
Best Practice Bulletin – Individual Fit Testing

46. Questions/Discussion as time permits
THANK YOU!!
Questions/Discussion as time permits
Bryan Beamer, PhD, PE, CSP

47. Feedback
Are you more aware of the importance of protecting workers from noise?
Are you better aware of OSHA regulatory requirements for noise exposure?
Will you use any of the best practices mentioned? If so which ones?
Are you likely to implement Hearing Protector Fit-Testing in your workplace?
What else would you like to have seen in this presentation that would help your fellow Safety Professionals?
Source: Getty Images