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Introducing no-contact hearing testing

30 July 2020

Tom Parker, director at WorkScreen, looks at the concept of no-contact hearing tests as a way to address the complexities the response to COVID-19 is having on hearing tests at work.

The importance of hearing is well documented for staff welfare, safety and communication. The COVID-19 pandemic has also increased awareness, as millions of video conference users have got used to the abilities and limitations of their hearing in a new way. 

And as the UK gets back to work, organisations are embracing new approaches to work that fit the “new normal” of life after lockdown with the threat of C-19.

What’s the issue?
Protecting staff hearing is a legal requirement and affects millions of UK workers, who are now coming back to work

Even if you are committed to providing hearing tests at work, implementing a system that works for your organisation may not be easy. Typical complexities that WorkScreen has identified include:

  • Distancing: Distancing between staff, PPE and other hygiene controls may well persist, adapt or even cycle between being relaxed and re-imposed for a while yet. Some commentators suggest this may be a permanent change
  • Staff disruption: Self-isolation, furloughing and other measures are disrupting staff presence, affecting their availability on any given day for testing
  • Availability of clinical services: The workload driven by C-19 on clinical staff is reducing availability for non-safety critical activities such as hearing surveillance. There are also appreciable numbers of healthcare staff who are self-isolating – due to their work – and, therefore, cannot provide their valuable services.

Unfortunately, the general advice coming from the Health & Safety Executive (HSE) and other safety bodies on returning to work creates a headache for employers who must conduct mandatory HSE healthcare surveillance. In particular, the following recommendations are challenging for tests like hearing surveillance and vision tests, which are typically specialist tasks carried out face-to-face:  

  • Distancing between staff
  • Minimising the use of shared spaces 
  • High levels of PPE use.

Hearing is not just a noise issue

WorkScreen identified the issues affecting hearing surveillance early on in the pandemic. The Control of Noise at Work Act 2005 (NAW) requires hearing tests for staff at risk due to noise. But the reasons for hearing tests at work do not start and stop there:

  • The Law: If NAW says that you must provide hearing tests, then you must. Hearing protection on it’s own is not enough
  • Insurance requirements: Depending on your activities, your insurers may require healthcare monitoring, fitness to work and – at the least – compliance with the law
  • Risk: Hearing is an essential part of an individual’s personal safety system. 4.4M people of working age in the UK have a hearing loss.  As a non-line of sight warning system, understanding their hearing ability and risk profile at work is potentially a lifesaver
  • A moral duty to care: Not only is preventing harm to your staff a moral duty, healthcare and training are frequently cited as key ways to demonstrate care and investment in your staff
  • Wellness & productivity: When the average time to see someone about their hearing is 7 years, hearing problems can contribute to workplace fatigue, communication issues, performance and isolation long before individuals seek help
  • Previous roles: We all have a history. One in 8 people in the UK are estimated to have tinnitus. Hearing tests at induction can help employers understand and protect themselves in the case that new starters have a pre-existing hearing condition.

Clearing the backlog
Months of lockdown have created a backlog of hearing tests for many companies: hearing tests are just one more thing that was put on hold during the pandemic. 
And despite the HSE advice that a period of deferment was permissible, hearing tests cannot be deferred indefinitely: tests still have to be done. This means that not only do hearing checks still have to be completed, but companies will have a shorter period of time to do it in - and still have to manage the risks presented by Coronavirus.

Hearing test infection areas to consider
Conducting hearing tests poses a number of infection risks to consider - including:

  • Physical contact & external visitors: How to manage contact between health provide and patient, or contact with providers from off-site who could introduce infection into your workplace from other locations?
  • Communal areas & waiting rooms: How should these be arranged, cleaned and ventilated to lower the risk of infection?
  • Multiple test candidates: What processes and procedures are required to manage distancing between staff taking tests?
  • Testing areas & facilities: How can these be arranged to minimise the risks of cross-infection?

None of these problems are insurmountable – with management time, effort and boxloads of PPE. But, as well as being another thing to deal with, importantly these complications also raise issues around perception and communication of the steps being taken to protect staff.

Eliminate risks where possible
In time-honoured, risk-management fashion, the surest solution is to eliminate the risk areas themselves where possible. For example, (and the clue’s in the name) - no-contact hearing tests can reduce or eliminate the need for physical contact during hearing surveillance.

In the same vein, it may be sensible to do without a waiting room. A contactless self-test approach to hearing surveillance means you can achieve this. 

Perception and communication
Whatever changes you make to your surveillance system - and certainly before changing to a self-test system, it’s key to inform and reassure staff about hearing tests and the steps that are being taken to ensure their safety.

After all, C-19 is a constant source of anxiety for some and throwing hearing tests into the mix might increase this. This is especially true if their preconceptions are that they’re about to be pushed into a noise booth, directly after someone else – which is rarely a high-point of someone’s day at the best of times, even before we consider the sanitary implications.

The HSE surveillance guidelines are a great place to plan the information staff need. So if you are taking a new approach to hearing surveillance, a more complete information set may include:

  • Why you’re doing tests, including the importance of hearing health
  • Why you’re testing now and not waiting
  • The steps you’re taking to keep them safe and reduce risks of infection
  • Changes the staff may notice and benefits to them
  • Implementing a No-Contact, User operated Regime

Administration and coordination
Your tele-audiology provider is administering the test, but checks will require on-site co-ordination. The right co-ordinator should have some level of responsibility and training for staff welfare, including the right to access staff health information. In larger companies, this may be an HSA, HSM or occupational health nurse. In smaller organisations, the health & safety hat is often worn by HR or production managers.

Select the right hearing test system
No-contact hearing surveillance is a system, combining the hardware and processes required to provide effective, high quality care. The latest e-health/telehealth and teleaudiology solutions like WorkScreen include a qualified professional in the patient pathway - either remotely or on-site. An on-site technician is optional, and although the assumption here is that the testing takes place on a tablet-pc based audiometer, it is fair to say that a safe service may be available from occupational health providers using more traditional equipment.

Either way, it is a common misconception - that can be promulgated by health providers who are not yet cognisant of new techniques - that no-contact testing is somehow inferior or involves downloading smartphone apps. Smartphone apps are a no-no, since hearing surveillance must be conducted on CE certified equipment that is calibrated and follows the correct audiology standards. This is one of the key determinants of test quality and standardisation.

Select your test environment
Quiet is a prerequisite for hearing tests. This has traditionally meant using a sound shelter, although arguably buildings are quieter than they used to be due to better acoustic standards, less heavy industry and better acoustic treatment with the likes of windows, ceiling tiles or acoustic door fittings. Whichever route you go and reflecting COVID-19, test environments should be suitably quiet, and:

  • Airy/well ventilated
  • Supplied with minimal furnishings and cleanable, hard surfaces
  • Unoccupied by any other person/s.

All testing areas need to be cleaned regularly - so a bare minimum of surfaces for wipe down will make cleaning quicker and easier. In addition to the above, any instructional paperwork should be laminated for easy cleaning.

Allow more time and do away with the waiting room
Depending on the number of staff who need hearing tests and the urgency, a rota, timetable or an even more radical “help yourself, free-for-all” approach can limit the number of people in a waiting room or even remove it all together. This means staff can stay at their work station until their pre-appointed time, or the test room becomes available. Although WorkScreen self-tests only take around 15-minutes to complete, it’s advisable to understand the total patient to patient time for your system and then allow extra time - 20 minutes per test for example, plus 5 minutes at each end of the test to wipe down and leave the room clear.

To prevent people barging in or in case testing and cleaning overrun, an ‘Occupied’ or ‘Test in Progress’ sign or door open/door closed policy will prevent users from sharing the same space.

Communication and guidance
However you engage with your staff to prepare them for surveillance tests, this is a valuable part of the test. Sending an email with instructions is a good idea with all the relevant information, including a simple cleaning routine before and after each test - including hand washing! Again, the objective is to reassure everyone: wiping the area for themselves before and after their tests improves personal trust and accountability. Even if the double cleaning that results seems over the top, it does support staff. A simple cleaning log may even be appropriate, alongside the wipedown instructions sheet, for use before and after the hearing test.

To complete the communication picture for what is likely to be a different or a new process, be prepared for the usual questions about changes. This is in addition to providing a pathway to discuss an employees’ results and follow up their report or any concerns they have with either the test or their results.

Create safe test rules
While organisation will need to adhere to the rules they have in place that keeps pace with their requirements and Government advice, you can never be too safe, a couple of extra rules are good practice and support effective testing:

  • Keep personal items (e.g. car keys, mobile phone) out of the testing room unless placed inside a wipeable, polythene bag – i.e. a freezer bag, rather than a carrier bag
  • No food or drink in the testing room

Getting started with no-contact hearing tests
C-19 continues to be a significant challenge to business and safety around the world. However,  dealing with the complexities of the pandemic have also produced a number of changes which could bring permanent benefits. 

With this in mind, the idea of a high-quality user-operated hearing test that is simple to use and can be carried out by the employee, without specialist training, may seem fanciful. But in fact, the WorkScreen system is an easy way to provide contactless hearing tests and can also support wider benefits, such as:

  • Improved access to hearing surveillance and compliance
  • Reduced anxiety and acceptance
  • Supported hearing awareness and training
  • Lower costs and business disruption

Getting started with contactless hearing tests is easy – WorkScreen can be rented on a simple price-per-test basis to test a number of staff, or licenced over a period of time for bigger organisations and healthcare providers.

HSM readers can download support documentation and a discount on WorkScreen Services at www.workscreenuk.co.uk/HSM