Updating Noise Requirements

OCCUPATIONAL HEALTH CLINICS OF ONTARIO WORKERS

SUBMISSION TO THE MINISTRY OF LABOUR

REGARDING: CONSULTATION PAPER ON UPDATING NOISE REQUIREMENTS IN THE INDUSTRIAL REGULATION  (O.REG. 851) NOVEMBER 23, 2005

SUBMITTED TO: ONTARIO MINISTRY OF LABOUR
PREPARED BY: OCCUPATIONAL HEALTH CLINICS OF ONTARIO WORKERS
DATE: FEBRUARY 23, 2006

The Occupational Health Clinics for Ontario Workers Inc. is a pro-active team of health professionals committed to promoting the highest degree of physical, mental and social well being for workers and their communities. At five clinics in Ontario a team of nurses, hygienists, ergonomists and physicians see patients and identify work-related illness and injuries, promote awareness of health and safety issues, and develop prevention strategies. First established in 1989, the clinics have seen 1,000’s of individual patients and visited 100’s of workplaces helping to identify unhealthy and unsafe conditions, and providing advice to workplace parties on the prevention of occupational diseases. Noise induced hearing loss is a condition which we have seen as a regular condition in patients. Workplaces continually ask the clinics for help in quantifying exposures and providing ideas for noise control.

History of attempts to regulate noise in Ontario

The oldest copy of a proposed Noise Regulation we were able to locate was dated August 1980. A revised proposal was published on June 24, 1981. In order to address some outstanding issues (threshold for measurement, engineering controls required down to 90 and in any case lowest practical, mandatory use of hearing protection where engineering not practical, mandatory hearing conservation programs) a Special Advisory Committee was appointed in March 1983. This committee published its report in December 1985 and on July 9, 1986 William Wrye announced that based on the unanimous, bipartite agreement, he would enact the noise regulation in September 1986. This never happened. The next announcement from the Ministry of Labour in Ontario concerning noise in Ontario was on November 23, 2006. Twenty years of regulatory silence on noise in between! How many workers in the mean time developed noise induced hearing loss? 
Given the extensive consultations and efforts that went into the July 7, 1986 proposal, it would be a shame to waste these efforts. After 20 years of time, there would be the need to update the proposed regulation and perhaps adjust the strategy based on what has been learned over the years regarding the designated substance approach.

Comparisons with other jurisdictions

In comparing the proposed changes to O.Reg 851 to other provincial jurisdictions, one must keep in mind that noise regulations in other provinces include requirements for noise control programs and audiometric screening, training, etc. Merely changing the numerical value of the existing regulation (along with the changes in definitions) is not comparable to requiring a comprehensive engineering noise control program and hearing conservation program. The current requirements merely require “measures” to be taken to reduce the sound level below 90 dBA (where this is not practicable workers must wear hearing protection), and require posting of the noise level and the requirement to wear hearing protection. In our own experience in OHCOW visiting workplaces with noise, these simple requirements are more often than not ignored. Sometimes there are signs posted but rarely do they indicate the levels of noise (there is no direct requirement under the current clause to even measure the noise). There is no requirement to document any assessment of the practicability of adopting noise reductions and no requirement to consult with the JH&SC when determining practicability. There is no requirement for training workers about the hazards of noise and no comprehensive hearing protection code (fitting, training, etc.). Early recognition of a hearing deficit is key to the prevention of (further) damage to the hearing organs and the development of NIHL. Any proposed standard should address assessment of workers and action levels for protecting workers from hazardous exposures. 
It is interesting to note that the 1986 proposed noise regulation approach does not generally differ much from that recommended by NIOSH (Criteria for a Recommended Standard: Occupational Noise Exposure -- Revised Criteria, DHHS (NIOSH) Publication No. 98-126 (1998)). The NIOSH recommendations include an 85 dBA TWA REL (with a 3 dB exchange rate) and a ceiling level of 140 dBA to be achieved by means of a hearing loss prevention program which would include:

Noise exposure assessment
Engineering and administrative controls and work practices
Hearing protectors
Medical surveillance
Hazard communication
Training
Program evaluation criteria
Recordkeeping

NIOSH also has excellent resources online for noise control and hearing loss prevention programs. While both the NIOSH and the Ministry of Labour 1986 proposed regulation are quite bureaucratic, Malchaire (“Strategy for Prevention and Control of the Risks Due to Noise”, Occup. Environ. Med. 57:361-369 (2000)) has a rationalized approach to noise control and hearing loss prevention. Both the NIOSH and MoL documents would benefit from the adoption of Malchaire’s SOBANE approach to their respective noise control and hearing loss prevention programs. Malchaire’s program is based on the European Union Directive 2003/10/EC which requires employers use the ALARA (as low as reasonably achievable) approach to controlling noise exposure: “Taking account of technical progress and of the availability of measures to control the risk at source, the risks arising from exposure to noise shall be eliminated at their source or reduced to a minimum.” (Article 5(1)). The EU standard appears to be a much more streamlined version of the approaches of NIOSH and the original MoL proposals.
The EU directive uses an action limit of 80 dBA for the provision of hearing protection, training and information. At an action limit of 85 dBA, engineering and administrative controls are required to ensure that “… the risks arising from exposure to noise shall be eliminated at their source of or reduced to a minimum.” 85 dBA is also the threshold at which workers have rights to access medical surveillance (seeing a doctor regarding concerns about one’s hearing) and audiometric testing. Where a single case of NIHL is identified in a workplace, the employer has the responsibility to determine if other similarly exposed workers have been affected by arranging “systematic health surveillance”. The EU has established a limit of 87 dBA as a type of ceiling level above which no exposure shall occur. 

Relying on the effectiveness of hearing protection

The reliance on hearing protection is not an effective control if one considers the evidence. Poor compliance, fitting and usage time, all limit the “field” performance of hearing protection devices (Neitzel & Seixas, “The Effectiveness of Hearing Protection Among Construction Workers”, J Occ Env Hyg 2:227-238 (2005); Lusk et al., “Effectiveness of an Intervention to Increase Construction Workers’ Use of Hearing Protection”, Human Factors 41:487-494 (1999); Behar, “Field Evaluation of Hearing Protectors” Noise Control Engineering Journal 24:13-18 (1985); Edwards, Broderson, Green and Lempert, “A Second Study of the Effectiveness of Earplugs as Worn in the Workplace”, Noise Control Engineering Journal 20:6-15 (1983)). Neital & Sexias concluded that the effective amount of protection construction workers were provided by their hearing protective equipment was the equivalent of 3 dB!

Prevalence and cost of NIHL

It has been noted in the documentation for the proposed change (November 23, 2005) that the WSIB cost of NIHL for the years 1995-2004 was $30,000,000. However, what is not mentioned is the tremendous number of workers with NIHL cases not recognized by the WSIB. Based on data from NHANES online (2001-2002 data) it is estimated that 45% of males aged 60-69 have a hearing loss exceeding 25 dBA in both ears (as per the WSIB criteria), 30% of these have an audiogram that has the signature 3000-4000 Hz “notch” typical of NIHL. Thus 13.7% of the 2001-2002 US male population aged 60-69 have audiometric results which have the NIHL pattern and exceed 25 dB in both ears. Given an estimated 450,000 men aged 60-69 in the year 2001, that would translate to roughly 61,000 men with NIHL in Ontario. Based on these estimates, there is a significant portion of NIHL which is not recognized by the WSIB and thus the costs cited represent a significant under-estimate of the true costs of NIHL (realizing that many of the non-economic costs cannot be quantified).

Prevention effectiveness of an 85 dBA standard

If the goal is to eliminate noise induced hearing loss (NIHL) then the MoL must realize that lowering the allowable level of noise to 85 dBA (8 hour equivalent) will not prevent all NIHL. From the Malchaire publication (Table 9) 35 years of exposure to 85 dBA produces an expected 29% of workers to have a 25 dBA hearing loss (4% having a 50 dBA hearing loss). This residual risk level at 85 dBA provides justification for the use of the ALARA approach to noise control.

Summary

While the proposal to reduce the allowable exposure level to noise from 90 dBA to 85 dBA represents progress in reducing levels of noise-induced hearing loss (NIHL), 85 dBA is not low enough to fully prevent NIHL. 

The current regulation does not require a comprehensive approach similar to those required in other jurisdictions. Missing are:

- an explicit requirement to assess noise exposure and risk of hearing loss, 
- an ALARA approach to noise control, 
- formalizing the risk assessment and the practicability of instituting noise control, 
- formalizing a control program, 
- consultation with the JH&SC in developing assessment and control programs, 
- training for workers regarding the hazards of noise exposure and control noise efforts, 
- a formal program to ensure adequate personal hearing protection, 
- audiometric screening and medical follow-up, 
- recordkeeping and periodic audits of noise control and hearing conservation programs. 

The existing provisions required noise control where practicable, hearing protection and warning signs, have not been rigorously enforced by the Ministry of Labour, thus it is expected without a change in enforcement attitudes, the changes would not result in reductions in noise exposure in Ontario workplaces. 

Construction, mining and other sectors not covered by the O.Reg 851 should also be included. 

Based on the evidence gathered from numerous field studies, any approach based on a reliance on hearing protection is doomed to be a failure for a very significant portion of exposed workers (if not the majority). 

Merely changing the numbers and definitions while leaving everything else the same (including present level of enforcement) will not significantly prevent hearing loss in Ontario workers. The Ministry of Labour should update the 1986 proposed regulation (which had bipartite agreement), regulate noise in a comprehensive self-standing regulation and increase enforcement. 

Contact the author of the submission joudyk@ohcow.on.ca