DONNA S. HEIDEL, CIH, FAIHA, is principal industrial hygienist at Amazon.
Send feedback to The Synergist.
An Update on Standards of Care
Earlier this year, AIHA’s Standards of Care Advisory Group was formed to define the minimum level of expected risk management practice and performance, based on established professional norms and proven practices, standards, and regulations, for the professional practice of OEHS. Through this effort, AIHA seeks to elevate the performance of our risk management programs—in particular, those that are underperforming—by documenting a concise summary of minimum expected standards of care for critical aspects of OEHS practice, and by providing tools to help OEHS professionals practice at those minimum levels of performance or higher.
The Advisory Group is tasked with identifying the critical risk management processes and programs used by OEHS professionals so the minimally acceptable expectations can be identified. An example we all grapple with is assessing exposure risks using the OSHA PELs or the ACGIH TLVs. The Advisory Group has begun a pilot project for this initiative by collaborating with AIHA’s Noise Committee. Due to the nature of this initiative and based on input from our legal counsel, we are managing the effort under the auspices of the AIHA Guideline Foundation, a 501(c)(3) organization separate from AIHA. This will help protect AIHA’s assets in the hopefully unlikely event any litigation might ensue based on the application of the standards in a court of law. PILOT PROJECT For the pilot project, the Noise Committee is creating a prototype of a hearing loss prevention program that identifies several risk-critical practices, such as the methodology for assessing noise exposure, application of an appropriate occupational exposure limit, and implementation of hearing conservation programs and noise exposure controls. Working with the Standards of Care Advisory Group, the committee will categorize practices according to the following scheme: •A standard of care is the minimum expected standard of practice and performance established for a particular function. •Best in class is a designation for practices that are the best of their kind. •State of the art designates practices that represent the highest point of technological achievement to date. •Best practices are procedures that have been shown by research and experience to produce optimal results.
AIHA seeks to elevate the performance of our risk management programs—in particular, those that are under-performing—by documenting a concise summary of minimum expected standards of care for critical aspects of OEHS practice.
One of the complexities of this exercise is that a given practice may fall into more than one category. To use an example from a different domain, the application of exposure and control banding in chemical hazard recognition has a long history of success in the pharmaceutical industry, which suggests that it is a best practice. In cases where workers are potentially exposed to a chemical that does not have an OEL, exposure and control banding may also be considered the minimally accepted practice—that is, a standard of care.
A standard of care, therefore, may be the state of the art, the best in class, and a best practice, if it most effectively and efficiently delivers the minimum performance needed.
DEVELOPING A METHODOLOGY Noise is proving to be a fruitful topic for our first project on standards of care. Significant differences exist between the noise occupational exposure limits used in the United States: while OSHA’s PEL is an eight-hour time-weighted average of 90 dBA with a 5 dBA exchange rate, the ACGIH TLV is an eight-hour TWA of 85 dBA with a 3 dBA exchange rate. The volunteers participating in the pilot project are determining how these OELs are typically applied in actual hearing conservation programs. They will also investigate other elements of these programs to identify standards of care related to noise exposure.
The pilot project will help AIHA develop a methodology that can be repeated in other areas of OEHS practice. This work will take a lot of time and effort, but our goal—a comprehensive set of standards of care that can be applied to OEHS programs anywhere in the world—will be well worth achieving.
AIHA: “Standards of Care.”
The Synergist: “Standards of Care: Competence Plus Performance” (January 2022).