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Effective Strategies in the Prevention of Noise Induced Hearing Loss


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Dr Ian Laird
Associate Professor in Occupational Health and Safety,
Centre for Ergonomics, Occupational Safety and Health,
Massey University, Palmerston North

(P09, Wednesday 26, Civic Room 1, 1.30)

Published in: Health & Medicine, Business
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Effective Strategies in the Prevention of Noise Induced Hearing Loss

  1. 1. Effective strategies in the prevention of NIHL Dr Ian Laird Centre for Ergonomics, Occupational Safety and Health, Massey University, Palmerston North Toward 2020 Challenges & Changes in OH&S 26-28 October 2011, Wellington Convention Centre
  2. 2. Introduction <ul><ul><li>Research literature on effective noise management strategies </li></ul></ul><ul><ul><li>Concepts of “Good & Best Practice” in OHS </li></ul></ul><ul><ul><li>Best practice in noise management </li></ul></ul><ul><ul><li>Strategies for the future </li></ul></ul>
  3. 3. <ul><li>Research literature concerning best practice and </li></ul><ul><li>effective noise management strategies </li></ul>
  4. 4. <ul><li>Noise exposure and NIHL have been evident for centuries, but only until relatively recently have strategies to reduce exposure been developed. </li></ul>
  5. 5. Relevant literature on best practice in NIHL management and prevention <ul><li>Thorne, Reid, Ameratunga, Williams, Purdy and Dodd (2006). </li></ul><ul><li>This review of literature was conducted for the Accident Compensation Corporation to assist in the development of immediate and long-term interventions for reducing the incidence of noise-induced hearing loss as well as directing potential future research. </li></ul>Report prepared by Professor Peter R Thorne
  6. 6. Thorne, Reid, Ameratunga, Williams, Purdy and Dodd (2006). <ul><li>Comprehensive review of the issues and characteristics of “best practice” in noise management; </li></ul><ul><li>Questions the efficacy of traditional approaches; </li></ul><ul><li>Reconceptualising the problem; </li></ul><ul><ul><li>Hearing conservation to noise management </li></ul></ul><ul><ul><li>Noise induced hearing loss to sound/ noise injury </li></ul></ul><ul><ul><li>New and innovative preventative models </li></ul></ul>
  7. 7. <ul><li>Occupational noise-induced hearing loss in Australia; Overcoming barriers to effective noise control and hearing loss prevention. Timmins et al (2010) </li></ul><ul><li>“ The report describes the outcomes of an investigation of the key factors (‘barriers’ and ‘enablers’) that influence the effective control of occupational noise and prevention of ONIHL”. </li></ul>
  8. 8. ONIHL in Australia, Timmins et al (2010) <ul><li>This research project found that; </li></ul><ul><ul><li>increased awareness, prominence, self-efficacy, economic and regulatory incentives, and managerial commitment </li></ul></ul><ul><li>are the most promising enablers of the adoption of effective control. </li></ul><ul><li>Based on these findings, several intervention strategies are proposed for overcoming barriers to effective noise control and ONIHL prevention. The major interventions are: </li></ul>
  9. 9. ONIHL in Australia, Timmins et al (2010) <ul><li>Provide education </li></ul><ul><li>Raise awareness of the potential benefits of effective noise control </li></ul><ul><li>Increase the likelihood and visibility of the enforcement of existing noise control regulations. </li></ul><ul><li>Increasing the legal and economic consequences of non-compliance. </li></ul>
  10. 10. Evidence from systematic reviews of literature <ul><li>Interventions to prevent occupational noise induced hearing loss (Review) (Verbeek et al, 2009): </li></ul><ul><ul><li>21 studies reviewed </li></ul></ul><ul><ul><li>1 evaluated a strategy to reduce noise exposure </li></ul></ul><ul><ul><li>14 studies with 75,672 participants evaluated hearing loss prevention programmes </li></ul></ul><ul><ul><li>6 studies with 169 participants evaluated hearing protection </li></ul></ul><ul><ul><li>Overall quality of studies reported as low. </li></ul></ul>The Cochrane Reviews
  11. 11. <ul><li>Conclusions (Verbeek et al, 2009): </li></ul><ul><ul><li>Low quality evidence that legislation can reduce noise levels in workplaces. </li></ul></ul><ul><ul><li>The effectiveness of hearing protection devices depends on their proper use. </li></ul></ul><ul><ul><li>There is contradictory evidence that HLPP’s are effective in the long-term. </li></ul></ul><ul><ul><li>Even though case studies show that substantial reductions can be achieved, there is no evidence that this is realised in practice. </li></ul></ul><ul><ul><li>Better implementation and reinforcement is needed. </li></ul></ul><ul><ul><li>Better evaluations of technical interventions and long-term effects are needed. </li></ul></ul><ul><ul><li>Audiometric and noise measurement data are potentially valuable for such studies. </li></ul></ul>
  12. 12. Johnston, Laird et al (2009) Evidence based review <ul><li>A systematic evidence based review (1999 – 2008) was undertaken as a part of the Prevention of NIHL project. </li></ul><ul><li>Review question 1 </li></ul><ul><li>How effective are strategies implemented in workplaces to prevent NIHL or noise exposure? </li></ul><ul><li>What are the barriers to implementation of effective interventions? </li></ul><ul><ul><li>Review question 2 </li></ul></ul><ul><li>What factors are associated with effective strategies; </li></ul><ul><ul><li>behavioural psychology? </li></ul></ul><ul><ul><li>social marketing? </li></ul></ul>
  13. 13. Results <ul><li>71 reports - peer-reviewed and non-peer reviewed literature of relevance </li></ul><ul><li>Included assessment of: </li></ul><ul><ul><li>study quality, </li></ul></ul><ul><ul><li>impact and quality of outcome measures, </li></ul></ul><ul><ul><li>consistency of study findings, and </li></ul></ul><ul><ul><li>generalisability and applicability of study findings to the NZ industrial context. </li></ul></ul><ul><li>Differed from Verbeek et al (2009) – more strategic focus, included the “grey” literature, social marketing and behavioural psychology perspectives. </li></ul>
  14. 14. Five key effective strategies in NIHL/noise exposure prevention Introduction of legislation, and consequent HLPP have reduced noise exposure and NIHL Strategies championed by leaders and managers are effective in NIHL prevention Interventions which combine multiple strategies are effective in NIHL prevention Engineering controls reduce noise exposure but little is known about their implementation One-off training has modest immediate effects, but is insufficient to prevent NIHL in the long term
  15. 15. Effectiveness of strategies based on behavioural psychology and social marketing <ul><li>Limited evidence explained by: </li></ul><ul><li>limitations of the models used (personal rather than ecological) </li></ul><ul><li>nature of the interventions developed (mostly one-off training sessions) </li></ul><ul><li>desired outcome of the intervention (wearing of HP) </li></ul><ul><li>no NIHL interventions based explicitly on social marketing principles </li></ul><ul><li>however, a number of effective interventions included many of its key features, with most evidence around formative research, targeting and exchange. </li></ul>
  16. 16. Summary: The body of evidence <ul><li>Methodological quality of quantitative evidence is weak </li></ul><ul><li>Sufficient consistency between studies, and with qualitative reports, to make recommendations for future prevention studies in NIHL. </li></ul><ul><li>Participants in most studies were middle aged, white, male workers </li></ul><ul><ul><li>evidence may not be directly applicable to women or indigenous or migrant workers </li></ul></ul><ul><li>Otherwise, applicability to NZ generally good </li></ul>
  17. 17. <ul><li>Effective NIHL prevention will require an approach which takes and combines the best strategies from multiple areas including: </li></ul>
  18. 18. <ul><li>Best practice in noise management </li></ul>
  19. 19. Concepts of “Good Practice” <ul><li>Concept of “good practice” (HSE, UK) </li></ul><ul><ul><li>“ Good practice” is the generic term for those standards for controlling risk which have been judged and recognised by HSE as satisfying the law when applied to a particular relevant case in an appropriate manner. </li></ul></ul>
  20. 20. Concepts of “Good Practice” <ul><li>Recognised good practice include: </li></ul><ul><ul><li>HSC Approved Codes of Practice </li></ul></ul><ul><ul><li>HSE Guidance; </li></ul></ul><ul><ul><li>Guidance produced by other government departments; </li></ul></ul><ul><ul><li>Standards produced by Standards-making organisations (e.g. BS, ISO, IEC); </li></ul></ul><ul><ul><li>Guidance agreed by a body (e.g. trade federation, professional institution, sports governing body) representing an industrial/occupational sector. </li></ul></ul>
  21. 21. Concepts of “Good Practice” <ul><li>Good practice may change over time because; </li></ul><ul><ul><li>technological innovation which improves the degree of control (which may provide potential to increase the use of elimination and of engineering controls), </li></ul></ul><ul><ul><li>cost changes (which may mean that the cost of controls decreases) or </li></ul></ul><ul><ul><li>changes in management practices. </li></ul></ul><ul><li>Good practice may also change because of; </li></ul><ul><ul><li>increased knowledge about the hazard and/or </li></ul></ul><ul><ul><li>a change in the acceptability of the level of risk control achieved by the existing good practice. </li></ul></ul>
  22. 22. Concepts of “Best Practice” <ul><li>The concept of “Best Practice”’ originated in the private sector as a tool to ‘benchmark’ performance against competitors and thereby stimulate improvement </li></ul><ul><li>“ Best practice” is a technique or methodology that, through experience and research, has proven to reliably lead to a desired result (HSE, 2006). </li></ul>A commitment to using all the knowledge and technology at one's disposal to ensure success.
  23. 23. Concepts of “Best Practice” <ul><li>“ Best practice” in noise management context involves: </li></ul><ul><ul><li>a commitment to continual improvement in developing and actively enhancing current practices, equipment and procedures. </li></ul></ul><ul><li>The term is used frequently in the fields of OHS, health care, government administration, the education system, project management, hardware and software product development, and elsewhere. </li></ul>
  24. 24. UK Approach <ul><li>There have been significant changes in expectations with respect to policing the requirements of the UK noise regulations:- </li></ul><ul><ul><li>Less reliance on PPE is required </li></ul></ul><ul><ul><ul><li>not an acceptable long term solution unless noise control can be shown to be impractical </li></ul></ul></ul><ul><ul><li>Much more of a risk based approach is required </li></ul></ul><ul><ul><li>Much better compliance with the duty to reduce noise by engineering means is expected </li></ul></ul><ul><ul><li>Risk Assessments should identify a programme of work </li></ul></ul><ul><ul><li>Less assessment and &quot;process&quot;, more Action is expected </li></ul></ul><ul><ul><li>If solutions have been identified &quot;stop assessing and start controlling&quot; </li></ul></ul><ul><ul><li>Health Surveillance is required above 85dB(A) </li></ul></ul><ul><ul><ul><li>which can be considered to be &quot;a tax on failure to control the risks&quot; .. </li></ul></ul></ul>
  25. 25. Noise control best practice elements (INVC, 2009) <ul><li>Attitude & Commitment </li></ul><ul><li>Noise Control Audit </li></ul><ul><ul><li>based on detailed diagnosis and costing of the options and benefits using the best of current technology </li></ul></ul><ul><li>Implement Noise Control Programme </li></ul><ul><ul><li>based on the results of the audit </li></ul></ul><ul><li>Update Noise Assessment </li></ul><ul><ul><li>de-regulate areas; reduced PPE costs ... </li></ul></ul><ul><li>Buy Quiet purchasing policy </li></ul>This approach can produce noise control measures that actually improve productivity and reduce costs - in contrast to reliance on conventional enclosures and acoustic guarding.
  26. 26. Noise control is not a safety issue <ul><li>Noise control is an engineering problem that should be solved by engineering means, in particular through noise control at source. </li></ul><ul><li>Effective noise control must be based on an accurate diagnosis and not on assumptions </li></ul><ul><li>All the options must be considered, not just the conventional high cost palliatives of enclosures and silencers. These techniques should only be used where it can be proved that there is no engineering alternative (INVC, 2009). </li></ul>
  27. 27. <ul><li>Development of Intervention Strategy </li></ul><ul><li>for Prevention of NIHL </li></ul>
  28. 28. D evelopment of an intervention strategy for the prevention of NIHL <ul><li>The purpose of an Intervention Strategy for the Prevention of Noise Induced Hearing Loss (NIHL) should be to establish a framework for the prevention activities of government agencies, local government, non-government organisations, industry groups, iwi, communities, businesses, families/whanau and individuals to reduce the incidence of NIHL. </li></ul><ul><li>The Strategy should set out a vision for the prevention of hearing loss in New Zealand where; </li></ul><ul><li>“ hearing is regarded as a special sense that is valued by the community in home, work and leisure environments”. </li></ul>
  29. 29. D evelopment of an intervention strategy for the prevention of NIHL <ul><li>Involves a population health approach; </li></ul><ul><li>Workplace </li></ul><ul><li>Home </li></ul><ul><li>Leisure </li></ul>
  30. 30. D evelopment of an intervention strategy for the prevention of NIHL <ul><li>A key approach would be to incorporate the conceptual model for intervention research proposed by Goldenhar et al, in 2001. </li></ul><ul><li>The model suggests that the intervention research process is cyclical and progressive and involves three broad research phases of intervention development, implementation and evaluation. </li></ul>
  31. 31. National intervention strategy for the prevention of NIHL <ul><li>The development of a national strategy should use a multi-layered approach, based on consultation. </li></ul><ul><li>There needs to be a long-term commitment to the development and resourcing of a strategy, which can be effectively initiated or incorporated into existing/ongoing programs. </li></ul><ul><li>A communications system needs to be established that allows information to flow between all stakeholders and establishment of relevant partnerships for action. </li></ul><ul><li>Related national strategies include the Workplace Health and Safety Strategy for New Zealand to 2015 and the National Foundation for the Deaf (NFD) National Noise Induced Hearing Loss Strategy. </li></ul>
  32. 32. Industry level intervention strategy for the prevention of NIHL <ul><li>A model industry level intervention strategy for the prevention of NIHL (applicable in New Zealand industry) has been recently developed by Farmsafe Australia (2009). </li></ul><ul><li>“ The Noise Injury Prevention Strategy for the Australian Farming Community 2009-2012” - provides a structure within which to focus efforts to reduce the incidence, severity and impact of noise injury across all members of the farming community. </li></ul>
  33. 33. Organisational level intervention strategy for the prevention of NIHL <ul><li>At the organisational level, the further “upstream” from exposure one aims, the more likely one is to achieve the preferred goal of exposure prevention versus control. </li></ul><ul><li>The principle is fundamental to OHS practice, but </li></ul><ul><li>Challenging to implement; </li></ul><ul><ul><li>Large businesses </li></ul></ul><ul><ul><li>Small businesses </li></ul></ul><ul><li>which constitute the largest proportion of NZ businesses, where the burden of exposures to noise and NIHL lie. </li></ul><ul><li>i.e. agriculture, manufacturing, & construction. </li></ul>
  34. 34. Employ less than 20 employees <ul><li>97% of enterprises in agriculture, </li></ul><ul><li>92% of enterprises in manufacturing, </li></ul><ul><li>98% of enterprises in construction, </li></ul><ul><li>92% of hospitality enterprises and </li></ul><ul><li>75% of education enterprises have less than 20 employees (NZ Statistics, 2010). </li></ul>
  35. 35. I ntervention strategies for small business <ul><li>Hasle and Limborg (2006) developed a useful model of intervention research in small businesses. </li></ul><ul><li>The model highlights the important role of intermediaries in the “embedment” or “ownership” of the intervention in the small business. </li></ul><ul><li>The model has been developed further (Hasle, 2010). </li></ul>
  36. 36. Conceptual model for intervention in small businesses <ul><li>Source; Hasle and Limborg (2006) </li></ul>Embedment of intervention method The Intermediaries Governmental Authorities Embedment of intervention method The small enterprise Process Intervention Effects Dissemination to the enterprise Embedment Act’s, Regulations CoP’s and rules Embedment of intervention method
  37. 37. Designing and evaluating support systems Dissemination to the enterprise interpretation Change process Effects The small enterprise Embedment of the outreach activities Embedment Programme theory: By which mechanism should the system work? Moderators: What can constrain or enhance the effect? The intermediary organisation Source; Hasle (2010)
  38. 38. Conclusions <ul><li>Effective strategies need to be developed that; </li></ul><ul><li>Identify hearing as a special sense that is valued by the community in work, home and leisure environments (population health). </li></ul><ul><li>Change employer reliance on HPD’s to control of noise at source (behavioural & social marketing strategies) </li></ul><ul><li>Provide technical advice and incentives for control at source; (prevention through design; “buy quiet”: “good & best practice”). </li></ul><ul><li>Change enforcement agency expectations in controlling noise at source; increase enforcement activity. </li></ul><ul><li>Improve surveillance for NIHL and noise exposure in high risk industry sectors. </li></ul><ul><li>Are designed for small business (stakeholders/intermediaries) . </li></ul>
  39. 39. For prevention of NIHL there are many challenges , but fundamental changes in attitude, leadership, commitment, collaboration, resources and expectations are required as we look toward 2020 .
  40. 40. Thank you <ul><li>Contact details; </li></ul><ul><li>Associate Prof Ian Laird, Centre for Ergonomics, Occupational Safety and Health, School of Management, Massey University, Private Bag 11222, Palmerston North. 06 356 9099. </li></ul><ul><li>[email_address] . </li></ul><ul><li>This research was supported by funding through the OCCUPATIONAL HEALTH AND SAFETY JOINT RESEARCH PORTFOLIO; A joint initiative in Occupational Health and Safety research, by the Accident Compensation Corporation, Department of Labour and the Health Research Council of New Zealand </li></ul>