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Determining Protected Exposures for NoiseExposed Workers Theresa Y. Schulz, PhD. Lt. Col. USAF (ret.) Agenda • • • • • Background NRR Fit-testing studies Fitting HPDs Motivation Background Noise-induced hearing loss is the most common permanent and preventable occupational injury in the world. World Health Organization Background Worker’s Compensation In many countries, excessive noise is the biggest compensable occupational hazard. Cost of NIHL to developed countries ranges from 0.2 to 2% of its GDP. NIHL is on the rise globally. (Source: WHO) Background United States Statistics Most common occupational injury in the United States. 22 million US workers are exposed to hazardous noise at work on a daily basis. Approx. 8 million Americans suffer from NIHL. (Source: NIOSH, 2009) Background In the United States, 76% of noise-exposed workers need no more than 10 dB of protection. 90% need no more than 15 dB of protection. Noise Reduction Rating (NRR) Noise Reduction Rating Noise Reduction Rating Noise Level = 100 dB Noise Reduction Rating = 30 dB How much noise is reaching the ear of the worker ? That is completely unknown … (55 – 104 dB) 0 dB 0 dB 33 dB EAR #1 EAR #2 EAR #3 How much protection? Good Fit vs Bad Fit 90 80 Attenuation in dB 70 60 50 40 30 20 10 0 -10 Max Good Fit NRR = 33dB Max Poor Fit NRR = 0dB 8000 6300 4000 3150 2000 1000 500 250 125 Frequency in Hz Noise Reduction Rating Noise Reduction Rating • A laboratory estimate of the amount of attenuation achievable by 98% of users when properly fit • A population-based rating ― some users will get more attenuation, some will get less The NRR is only a population estimate, not a predictor of individual attenuation. Noise Reduction Rating NVLAP-Accredited Labs San Diego, CA Indianapolis, IN State College, PA Noise Reduction Rating – Determining an NRR • 10 human subjects tested in a reverberant room • Tested with ears open/occluded at nine frequencies • Each subject tested 3x • NRR calculated to be population average A test subject in the Howard Leight Acoustical Lab, San Diego, CA, accredited by the National Voluntary Laboratory Accreditation Program (NVLAP) Noise Reduction Rating – in the real world Real-World Attenuation 192 users of a flanged reusable earplug ~ 27 NRR 50 NRR = 27 Multiple-Use Earplug Attenuation in dB 40 30 20 10 0 -10 From Kevin Michael, PhD and Cindy Bloyer “Hearing Protector Attenuation Measurement on the End-User” ≠ NRR Noise Reduction Rating De-Rating Methods OSHA NIOSH CSA NRR ÷ 2 Earmuffs NRR – 25% Class A up to 100 Formable Earplugs NRR – 50% B up to 95 (feasibility of engineering controls) Fit Test All Other Earplugs NRR – 70% C up to 90 Noise Reduction Rating Noise Reduction Rating • The EPA recently made an announcement about a proposed change to the Noise Reduction Rating [NRR] • This is the first change in hearing protector regulation in nearly 30 years Noise Reduction Rating Three New Labels LABEL DESCRIPTION Conventional HPD Perform lab test with 20 subjects who fit the protector after brief training Estimates the range of protection achieved by 20% and 80% of users Active Noise Reduction [ANR] • Uses a Microphone-in-Real-Ear [MIRE] method to estimate protection • Measured with ANR turned OFF and ON to show the additional attenuation from the ANR Level Dependent/ Impulse Noise Reduction • Testing will occur over a range of impulse noise levels. Multiple tests to determine lower and upper ranges of impulse noise reduction • Will include two ranges to identify attenuation for passive and active modes Noise Reduction Rating The New System: A Range • Represents a range of expected protection • Uses a new ANSI-standard (S12.6-2008) lab testing to generate the attenuation ratings • New NRR will provide an indication of how much attenuation minimally-trained users [the lower number] versus highly-motivated trained users [the higher number] can be expected to achieve • For some hearing protectors, the spread of this range may be quite significant Noise Reduction Rating Current vs. Proposed NRR Rating Description of Rating Test Protocol Current NRR Proposed NRR A single-number estimate of protection A high/low range of estimated protection Estimates the 98th percentile of protection obtained by users when properly fitted Estimates the 80th and 20th percentile of protection obtained by users ANSI S.3.19-1974 [Experimenter Fit] 10 subjects for earplugs and earmuffs, HPDs fit by experimenter ANSI S12.6-2008 Method A [Supervised Subject-Fit] 20 subjects [for earplugs] or 10 subjects [for earmuffs], HPDs fit by subject after brief training Noise Reduction Rating Current vs. Proposed NRR Current NRR Proposed NRR Application Intended for use with dBC noise measurements. Requires a 7 dB correction for use with dBA noise measurements. Can be applied directly to dBA noise measurements De-Rating Various de-rating schemes promulgated by various organizations [including OSHA] Designed to be used with no required de-rating Retesting Currently, no retesting of HPDs required Periodic retesting of HPDs required every 5 years Noise Reduction Rating Current NRR Label 80th % 20th % Minimallytrained Proficient Users Mock-up of New Label Noise Reduction Rating How to Apply the New Label Two-number range displays the estimated protection achievable by minimally-trained users [80%] versus proficient users [20%]. 80% 20% A wider range indicates greater variability in the fit of that HPD. Smaller ranges indicate more consistency of fit. For example, earmuffs will usually have a tighter fitting range than earplugs, and may have a smaller NRR range. Noise Reduction Rating Will OSHA 29 CFR 1910.95 change? • OSHA has not announced any proposed changes to the Occupational Noise Standard • OSHA will presumably respond to the revised NRR label by issuing a field directive or technical memorandum, informing its compliance officers how to deal with the new two-number NRR range Noise Reduction Rating Will the new rating methods favor earplugs or earmuffs? • While a well-fit foam earplug generally has greater attenuation than most earmuffs, earmuffs are inherently easier to fit for most users • There is less variability in the fit of earmuffs • Overall range of attenuation for earmuffs will usually be tighter and often higher, than earplugs • Workers should be offered a choice of earplugs, bands and earmuffs that meet the requirements of the work environment Noise Reduction Rating Earplug Fit Testing Provides an accurate, real-world picture of hearing protector effectiveness. Identify if hearing protection users are: • Receiving optimal protection • Require additional training • Need to try a different earplug style Earplug Fit-testing As a problem solver: • Derating Schemes • One-on-One Training • HPD Selection • NRR Change Field Verification – Fit-Testing Real-Ear Attenuation at Threshold Loudness Balance (R.E.A.T.) (Real-Ear Attenuation Above Threshold) Microphone in Real-Ear In-Ear Dosimetry (M.I.R.E.) Ear plug fit-testing methods Audiomet FitCheck ric EARfit VeriPRO REAT REAT MIRE REAAT Sound booth Very Quiet Room Quiet Room Anywhere PAR PAR Derived PAR PAR Any earplug Any earplug Selected modified earplugs Any earplug Special training Special training Special training Anyone can perform Reducing Costs + Claims OSHA Alliance: Best Practice Bulletin www.hearingconservation.org Additional Information www.howardleight.com Earplug fit-testing Reducing Costs + Claims as a Problem Solver Training tool for noise-exposed workers Train-the-trainer tool Follow-up on significant threshold shifts in hearing Documentation of HPD adequacy Assessment of overall HCP effectiveness Match HPD to worker’s specific noise level Selection of appropriate HPDs for new hires Benefits per Best Practices Bulletin (OSHA Alliance) Review of some fit-testing studies Noise Reduction Rating – in the real world Attenuation in dB Real-World Attenuation ≠ NRR 192 users of a flanged reusable earplug ~ 27 NRR 50 NRR = 27 Multiple-Use Earplug 40 30 20 10 0 -10 From Kevin Michael, PhD and Cindy Bloyer “Hearing Protector Attenuation Measurement on the End-User” Retraining and refitting resulted in an average 14 dB improvement for this group Fit-testing Studies Variation from Published NRR 10 Published NRR 0 -5 -10 -15 -20 Distribution of PARs -25 12 -30 0 10 20 30 40 50 10 60 Workers Workers Difference in dB 5 70 80 90 100 8 6 4 2 0 -30 -25 -20 -15 -10 -5 0 5 10 Variation from Published NRR 15 20 25 30 Fit-testing Studies Personal Factors Gender Age Distribution of PARs 12 Years in Noise Workers 10 Ear Canal Size 8 6 Familiarity 4 Model of Earplug 2 0 -30 -25 -20 -15 -10 -5 0 5 10 15 20 25 30 Program Factors Variation from Published NRR # Group Trainings # Personal Trainings REDUCINGStudies Fit-testing COSTS / CLAIMS Difference on 2nd / 3rd Test 10 Variation from NRR 5 Published NRR 0 -5 -10 -15 -20 -25 -30 Subjects Trying a second earplug often improves attenuation Self-Efficacy Pilot Study “How well can users predict their attenuation after a short fit-testing training session?” Pilot PilotStudy study Subjects • Subjects: 17 construction workers with varied HPD experience levels • Equipment: VeriPRO earplug fit-test system • HPD: Volunteers • Process: 2-4 Quick Check fits where employee sees feedback of exact PAR Pilot Study Results Data show improved PARs! Initial Final RE=19 RE=29 LE=22 LE=27 Average improvement 7.5 dB Pilot Study Pre and Post-Test Pre- and Post-Test How would you rate your ability to fit your earplugs? 1 2 3 4 5 Don’t know how I do OK Expert Pilot Study Pre and Post-Test Post-Test Ability Initial Ability Expert Expert Pretty good I do OK I do OK Don't know how Not good I do OK Pretty good Expert Fitter Pretty good Pilot Study Pre and Post-Test Self-Efficacy “How much noise do you think your earplugs block?” 76% (13 of 17) judged attenuation as HIGHER post-test Pilot Study Pre and Post-Test Post-Test Are you better able to assess the effectiveness of your earplugs after VeriPRO fit-testing? 1 2 3 4 5 No Maybe No change Improved Yes 64% (11 of 17) rated their ability HIGHER post-test Pilot Study Pre and Post-Test “How well can users predict their attenuation after a short fit-testing training session?" Pilot Study Pre and Post-Test Ability to Predict Noise Reduction (Each subject estimated atten. for each ear) Number of Ears 20 18 16 14 12 10 8 6 4 2 0 Within 5 dB category +/- 7.5 dB +/- 12.5 dB (one Category off) (2 categories off) Risk Management Risk Management Indicators for Hearing Loss: • • • • • • • Standard Threshold Shift Temporary Threshold Shift Recordable Hearing Loss Dosimetry Labeled NRR (derated?) In-ear Dosimetry Personal Attenuation Level (PAR) Risk Management Lagging Indicators vs. Leading Indicators Risk Management Indicators for Hearing Loss: • • • • • • • Standard Threshold Shift Temporary Threshold Shift Recordable Hearing Loss Dosimetry Labeled NRR (derated?) In-ear Dosimetry Personal Attenuation Level (PAR) Risk Reducing Costs + Claims RiskManagement Management Fit Testing In-Ear Dosimetry In-ear dosimetry measures/records worker’s actual noise dose, with and without protection Provides real-time monitoring and alerts when worker approaches/exceeds safe limits Only metric with direct potential to measure and prevent further progression of occupational hearing loss In-earManagement Reducing Risk dosimetry Costs +as Claims a Problem Solver Employees with Documented Noise-Induced Hearing Loss or Standard Threshold Shift [STS] Employees At-Risk for NIHL Employee Training + Sampling Dual-Protection/Extreme Noise Exposure Engineering Controls Risk Management Research > Alcoa Intalco Works Reducing Risk Management Costs + Claims Mean hearing threshold and 4 kHz)2000 – 2007 (N = 46) • Mean Hearing Threshold (2k, 3k, (2,3, 4kHz): Employees using continuous ESP starting in 2005 • Employees using continuous in-ear dosimetry starting in 2005 2000 - 2007 (N=46) 50 ESP Introduced Mean HTL 3,4,6kHz 45 trend line 40 35 30 25 20 15 10 5 0 2000 2001 2002 2003 2004 Year of test 2005 2006 2007 Reducing Risk Management Costs + Claims Preventive Action After NIHL In practice, an OSHA-recordable STS is not a preventive action It is documentation of a hearing loss after the fact. How soon will an employee suffering NIHL be re-fit / re-trained ? “Best case scenario” per Hearing Conservation Amendment In-ear dosimetry “worst case” scenario … 1 Day • Retest • Audiometric test 0 2 4 6 8 10 Months 12 14 • Notification 16 Fitting Tips Roll-Down Foam Earplugs 1. Roll entire earplug into a crease-free cylinder 2. Pull Back pinna by reaching over head with free hand, gently pull top of ear up and out 3. Insert earplug well into ear canal and hold until it fully expands Earplug Fitting Fitting Tips Fitting Tips Multiple-Use Earplugs 1. Reach While holding the stem, reach hand overhead and gently pull top of ear up and back. 2. Insert Insert earplug so all flanges are well inside the ear canal. 3. Fit If properly fitted, only the stem of the earplugs should be visible to someone looking at you from the front. Fitting Tips Visual + Acoustical Checks 1. Visual Check The earplug should sit well inside the ear canal and not stick out. 2. Acoustical Check Cup hands over ears and release. Earplugs should block enough noise so that covering your ears with hands should not result in a significant noise difference. Training + Motivation Training + Motivation Personalize Hearing Loss Show, Don’t Tell • Provide copy of annual audiogram to worker • Use personal examples to demonstrate consequences of hearing loss • Ask questions: • What is your favorite sound? • What sound would you miss the most if you couldn’t hear? • What sounds connect you to people and your environment? Training + Motivation Demonstrate Future Risk Training Materials • www.hearforever.org • www.hearingconservation.org • atl.grc.nasa.gov/HearingConserv ation/Resources/index.html • www.cdc.gov/niosh/topics/noise • www.dangerousdecibels.org Training + Motivation Send Clear Message On + Off Job HC Part of Everyday Life • Include recreational hearing conservation in annual training • Provide extra HPDs for home use • Promote Hearing Conservation at company/family events Training + Motivation Remove Barriers to HPD Use Make HPDs Available • Highlight “where to find HPDs” in annual training • Make sure HPDs are wellstocked and accessible • Include group of workers in selection process for increased acceptance • Offer wide variety to match comfort, job requirements Training + Motivation Hearing Loss Due To Noise Exposure Is … Painless Permanent Progressive … and very Preventable!