Those of us who work in the world of hearing conservation are familiar with the five aspects of program compliance -- exposure monitoring, hearing tests, training, personal protective equipment, and recordkeeping. To take our efforts to the level of hearing loss prevention, though, we should consider shooting for all A's.

Access to information

If we expect workers to take responsibility for their own hearing health, we must provide access to information. If we expect them to develop an attitude that fosters a hearing-healthy safety culture, workers need to know enough about their environment and its risks to motivate them to undertake self-protective behavior.

The risk of hearing loss only becomes real to workers when it relates to each of them personally -- to their jobs and to their recreational activities. It's not enough to show a video demonstrating the physiology of noise-induced hearing loss. Workers must be provided with job-specific risk analyses, so that the risk of losing hearing on the job becomes personalized and real.

Posting noise maps or even more specific worker-oriented risk communication tools on the shop floor is a start to making sure that each worker is aware of the hazards involved with excessive noise exposure. The most powerful communication tools include not only a list of job-related exposures, but other metrics as well.

Measures of hearing loss in the workforce like standard threshold shift (STS) rates close the cause-and-effect loop between exposure and hearing loss locally and personally. Show workers the risk of noise exposure; then demonstrate how that noise exposure is causing or resulting in hearing loss in the workers' friends and co-workers.

Hearing protection device (HPD) requirements indicate to the worker that self-protective behaviors are available and are supported by the employer. Posting exposure trends over time demonstrates management commitment to controlling noise at the source.

Audit your program

The saying goes, 'what gets measured gets done.' How and what gets measured can be a good indication to the worker of what matters to management. We measure product quality. We measure profit and loss. Then, why don't we measure the hearing health of the workforce to assess the success of our hearing loss prevention processes?

NIOSH has included checklists in its publication, Preventing Occupational Hearing Loss: A Practical Guide (DHHS (NIOSH) Publication No. 96-110, available from NIOSH at 1-800-35NIOSH) to help assess program effectiveness. Consider applying SPC-type (Statistical Process Control) trend measures to metrics such as:

Workers at risk Are we exposing fewer workers to hazardous noise over time? If not, perhaps the noise abatement/engineering program may merit scrutiny. As new equipment is introduced to the work environment, are exposure levels trending up or down? This could give a measure of the net effectiveness of 'buy quiet' limits in new equipment purchase specification efforts.

STS/Impairment rates If fewer people are showing standard threshold shifts (STS) over time, it may mean that our efforts are bearing fruit, or it may mean that the workforce has already lost most or all of the hearing that they will. Considering worker demographics, like age, is an important aspect of this analysis. Hearing impairment analysis, using NIOSH or AAOHN impairment criteria, is essential as well when planning to accommodate hearing impaired workers (see "When the Damage is Done," ISHN, March 1998). Hearing protection use How well are workers complying with HPD requirements? If participation in the HPD aspect of the process is not strong, it could mean that workers don't own the risk of hearing loss on the job, or it may mean that the HPD provided is not comfortable, accessible, or well-suited to the workplace environment, demographics, or culture. Audiometric tests Are we getting services of reliable quality and integrity to the people who need them? Our STS and impairment analyses -- the 'net effect' measures of program effectiveness -- presume good quality, reliable and comprehensive hearing test data. Does the worker understand the implications of his or her hearing test? Does the person or firm providing the tests understand what they will be used for?

Training initiatives Are we training the appropriate people? Can we use attitude surveys to assess the effectiveness of our training? Is the net effect of our training effort reflected in reduced hearing loss or increased HPD use? How can we use hearing conservation training opportunities to foster a safety culture that supports hearing health?

Engineering benchmarks Noise control remains the foundation of our efforts. If the hazard goes away, so do all the ancillary requirements -- no hazard, no work-related hearing loss. How are we selecting engineering priorities? Is worker exposure (the degree of exposure and number of workers at risk) the overriding criteria, or do we select engineering projects based on only the highest sound level or proximity to a manager's office? Are we using a compliance-based engineering goal (to meet OSHA's 90 dB criteria), or are we aiming for effectiveness, trying to simply make the environment as safe and as quiet as possible? How are we progressing toward our goal? Are engineering projects meeting schedule and cost benchmarks?

Accountability is a must

The most effective programs are those where a champion takes ultimate responsibility for preventing hearing loss in the workforce. That champion should be an upper-level manager with sufficient clout to ensure that the various professionals responsible for aspects of the process -- medical, safety, engineering, first-line supervision -- are on task.

The champion need only devote a small portion of his or her time to the hearing loss prevention initiative, perhaps as little as an hour per quarter to be briefed on program progress and status. More important, however, the champion must be willing to apply his or her influence and political capital to ensure that appropriate resources are devoted to hearing loss prevention and that progress is measured and maintained -- to make sure that the issue doesn't 'fall off the plate' of the responsible parties. This is an area where the audit process is essential, as it provides a means to talk to business managers in terms they understand. Trends, compliance, and SPC measures are second nature to today's business managers, so we can use those avenues to make the issue of hearing health important and comprehensible to them.

Act on your plans

Get moving! Start with what information is available, and conduct a needs analysis to find the weaknesses. Give the workers results of exposure monitoring studies. Set up a meeting with the vice president of production to show hearing loss trends. Put the hearing loss prevention audit file in the front of the cabinet where you have to look at it every day. Pressing accessibility, audit, and accountability into action will provide the attention and focus necessary to prevent hearing loss in your workforce.