Impact of a hearing conservation programs on occupational noise-induced hearing loss

Lopes, Adalva Virgínia Couto; Teixeira, Cleide Fernandes; Vilela, Mirella Bezerra Rodrigues; Lima, Maria Luiza Lopes Timóteo de

doi:10.1590/1982-0216/20222456322

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ORIGINAL ARTICLES • Rev. CEFAC 24 (5) • 2022 • https://doi.org/10.1590/1982-0216/20222456322 copy

Impact of a hearing conservation programs on occupational noise-induced hearing loss

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

to analyze the impact of a Hearing Conservation Program on occupational noise-induced hearing loss in a metallurgical plant.

Methods:

a longitudinal case study (2003-2018) was carried out and a Hearing Conservation Program assessed with interviews and document verification. The assessment also included 2,350 audiometric examinations and occupational noise exposure of 152 Hearing Conservation Program - participating employees, collecting the data from the company’s database.

Results:

high compliance indices regarding occupational noise -induced hearing loss - prevention Hearing Conservation Program practices were found between 2003 and 2018. The comparison between 2018 and 2003 showed a reduced number of workers exposed to noise at 85 dB(A) or above. The final prevalence of audiometric changes suggestive of occupational noise-induced hearing loss that remained in degree I differed from the initial one in the period. The high Hearing Conservation Program percentages and low occupational noise-induced hearing loss indicators point to an inverse relationship between them.

Conclusion:

the results suggest a positive impact of a Hearing Conservation Program on occupational noise-induced hearing loss in this metallurgical plant, in the period studied.

Keywords:
Public Health; Occupational Risks; Occupational Health Program; Hearing Loss, Noise-Induced; Prevalence

ABRAMO Associação Brasileira de Motricidade Orofacial Rua Uruguaiana, 516, Cep 13026-001 Campinas SP Brasil, Tel.: +55 19 3254-0342 - São Paulo - SP - Brazil
E-mail: revistacefac@cefac.br

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[1] Corresponding address: Adalva Virgínia Couto Lopes, Rua Jerônimo Vilela 118 / 1502 - Campo Grande, CEP: 52.040-180 - Recife-, Pernambuco, Brazil, E-mail: adalva.lopes@hotmail.com

Responses year by year: "Y" (Yes) or "N" (No) or "U" (Unknown).
I	Occupational Health Policies	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018
1	Does the company have an occupational safety certificate?
2	Is compliance with safety rules one of its administrators’ performance indicators?
3	If employees do not comply with occupational safety rules, does the company take disciplinary measures?
4	Are employees’ occupational medical examinations part of its administrators’ performance indicators?
5	Does the extent of the Specialized Safety Engineering and Occupational Medicine Services comply with current regulations?
6	Does the company have a Hearing Conservation Program (HCP)?
7	Does the company have routine HCP audits?
8	Does the company involve employees other than the Specialized Safety Engineering and Occupational Medicine Service team in HCP development?
II	Collective control measures	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018
9	Does the company make provision in its budget for acoustic projects to reduce noise?
10	Has the company undertaken acoustic projects to reduce noise?
11	Does the company evaluate equipment sound power when acquiring production machinery?
III	Educative measures	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018
12	Does the company provide training to newly hired employees on occupational risks, cautions, and safety rules?
13	Does the company take educative measures on occupational risks, cautions, and safety rules at least once a year?
14	Is training revised once a year?
15	Does the company assess the participants’ performance in training?
IV	Worker exposure assessment	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018
16	Does the company have job descriptions for the employees?
17	In the environmental assessment, does the company consider the physical risk due to noise?
18	In the environmental assessment, does the company consider the physical risk due to full-body vibration?
19	In the environmental assessment, does the company consider the chemical risk?
20	In the environmental assessment, does the company consider the ototoxic chemical risk?
21	Does the company regularly make quantitative assessments of the physical risk due to noise?
22	Does the company perform noise dosimetry in employees exposed to physical risk due to noise?
23	Does the company inform employees of their noise dosimetry results?
V	Personal protective equipment - PPE	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018
24	Are employees provided with PPE according to recognized risks?
25	Does the company have signs indicating the required PPE in risk places?
26	Does the company acquire certified PPE approved by regulating agencies?
27	Does the company evaluate the level of noise reduction of hearing protection devices?
28	Does the company verify hearing protection fitting?
29	Does the company assess the employees’ satisfaction with the hearing protection provided?
30	Does the company periodically replace hearing protection devices?
31	Does the company require and inspect hearing protection use?
32	Does the company make individual attenuation tests of the hearing protection devices?
VI	Auditory surveillance	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018
33	Does the company recommend audiometry to employees at recognized noise risk?
34	Does the company recommend audiometry to employees at recognized ototoxic risk?
35	Does the company recommend audiometry to employees at recognized full-body vibration risk?
VI	Auditory surveillance	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016	2017	2018
36	Does the company plan audiometry in the periodicity required by current regulations?
37	Does the company perform 100% of planned audiometry?
38	Does the company perform 100% of audiometry in its facilities?
39	Does the company perform sequential audiometry, month by month, throughout the year?
40	Does the company perform audiometry according to the technical parameters required by current regulations?
41	Does the company monitor the progression of auditory thresholds according to current regulations?
42	Does the company conduct audiometric monitoring simultaneously with audiometry?
43	Does the company individually instruct employees regarding changes in their audiometry?
44	Does the company make reports analyzing the employees’ hearing stability?
45	Has the company defined a line of multidisciplinary investigation to determine causal relationships?
46	Does the company conduct multidisciplinary investigations to determine causal relationships in progressions?
Date________________________ Researcher (name/signature) ________________________ Interviewee (position/name/signature) ________________________
Room for observations
Clarifications about the questions. Attention! Responses may differ from one year to another.
I. Occupational health policies Occupational health and safety certificate: Process through which an independent entity assesses, based on audits, whether the company meets the standards of hazard identification systems and elimination or attenuation of risks from identified hazards. Performance indicators: Goal achievement parameters according to the established by the organization. Disciplinary measures: Admonition, suspension, or fair dismissal of employees who break the company’s rules. Occupational medical examination: Examination upon which an occupational health certificate is emitted. Specialized Safety Engineering and Occupational Medicine Services: Team of professionals defined by Brazilian regulatory norm NR4, determined according to the degree of risk of the company’s main activity and its number of employees.
II. Collective control measures Acoustic projects: Every equipment change or replacement that physically changes the source or transmission of high sound pressure levels, reducing the sound pressure levels to which workers are exposed - e.g., installing silencers, enclosing machinery, reducing vibration in wall panels and structures with sound-absorbing material. Performance indicators: Goal achievement parameters according to the established by the organization. Administrative control: Measures taken to change the way of working or operating machines and reduce exposure - e.g., alternating employees in places where there are high sound pressure levels, operating certain equipment in shifts or hours with the least people present, assessing equipment sound power when acquiring it.
III. Educative measures Educative measures: Measures taken to educate and motivate employees with training programs, courses, debates, commissions, and events. These measures must ensure that the workers at least understand HCP issues, namely: health effects of exposure to high sound pressure levels, notions of environmental assessments, collective protection measures, notions of hearing and audiometric examination; practical training to put on, use, care for, and replace hearing protection devices.
IV. Worker exposure assessment Job description: Detailed description of the activities a worker performs in the company. Recognition of noise risk: Stage of the work setting qualitative assessment in which activities that pose noise risk capable of hurting employees according to regulatory norms NR9 and NR15 are identified, recognized, and characterized. Recognition of full-body vibration risk: Stage of the work setting qualitative assessment in which activities that pose full-body vibration risk capable of hurting employees according to regulatory norms NR9 and NR15 are identified, recognized, and characterized. Recognition of chemical risk: Stage of the work setting qualitative assessment in which activities that pose chemical risk capable of hurting employees according to regulatory norms NR9 and NR15 are identified, recognized, and characterized. Recognition of ototoxic chemical risk: Stage of the work setting qualitative assessment in which activities that pose ototoxic chemical risk capable of hurting employees according to FUNDACENTRO are identified, recognized, and characterized. Quantitative assessment of noise: Measurement, according to regulatory norms NR9 and NHO 01, of the noise intensity to which employees are exposed. Noise dosimetry: Quantitative assessment of the employees’ exposure to high sound pressure levels, using an integrating personal-use meter, whose results are shown in percentage of sound energy in relation to the maximum daily limit of sound energy.
V. Personal protective equipment - PPE Personal protective equipment (PPE): Every personal-use device or product worn by workers to protect them from risks that may threaten their health and safety at work. The PPE referred to in this paper is that used for hearing protection. Certificate of PPE approval: Certificate emitted by corresponding national agencies authorizing PPE to be sold and used. Noise reduction level of hearing protection devices: Sound energy attenuation value hearing protections provide to their wearers, shown in dB in its certificate of approval. Verification of PPE fitting: Qualitative personal verification of how well a hearing protection device fits its wearer, specifying whether the PPE provides adequate sound isolation to its wearer. PPE personal attenuation test: Quantitative sound isolation testing method that estimates the personal attenuation level for hearing protection wearers, shown in dB SPL.
VI. Auditory surveillance Auditory surveillance: Measures used along with audiometry; medical history; referrals to specialized services; investigation n cases of significant threshold changes; multidisciplinary meetings; operational and technical reports. Pure-tone threshold audiometry: Examination that assesses audibility threshold - i.e., the lowest intensity capable of causing a sound sensation in a person due to sound stimuli in different tones, shown in dB HL. Recommendation for audiometry: Medical recommendation to perform pure-tone audiometry as part of the Occupational Health Medical Control Program, based on results of the company’s risk environmental assessment. Audiometry planning: Audiometry schedule, following the recommendations of the Occupational Health Medical Control Program. Audiometry: Audiometry examinations performed according to medical recommendations, considering the minimum recommended periodicity and legal technical parameters established by regulation norm NR7 Referral to specialized services: Referral of employees for assessment, treatment, and evaluation report by an otorhinolaryngologist. Audiometric monitoring: Analysis of auditory stability with follow-up of auditory threshold progression in sequential audiometry in relation to reference audiometry. The parameters used in this paper are based on lesion progression - i.e., the progression of the degree of auditory acuity impairment. Causal relationship: Logical cause-and-effect relationship with an established link between occupational activities and occupational diseases.