NIOSH Recommends Controls to Protect Orthopedic Surgeons from Noise Exposures

Published August 30, 2017

​A new NIOSH report details the agency’s evaluation of noise exposures among operating room employees during total knee replacement surgeries at a hospital. The evaluation, which was part of NIOSH’s Health Hazard Evaluation (HHE) Program, was completed at the request of employer representatives at the hospital who were concerned about the potential of noise-induced hearing loss among staff performing these surgeries. On one of the two days that NIOSH staff monitored noise, one surgeon’s personal noise exposure exceeded the NIOSH recommended exposure limit (REL) of 85 dBA as an 8-hour time-weighted average (TWA). Personal noise exposure measurements for the other surgeons and surgical staff were below all occupational exposure limits, including OSHA’s noise exposure limits: a permissible exposure limit (PEL) of 90 dBA and an action level (AL) of 85 dBA, both as 8-hour TWAs.

A typical surgical team included a surgical assistant, anesthesiologist, circulating nurse, scrub nurse, and a surgeon, who might ask a surgical fellow to assist during some procedures. According to the authors of the report, the use of pneumatically powered surgical tools—saws and drills—and hammers were the primary noise sources in the operating room. Other sources of noise included placing or moving surgical equipment and tools on metal surgical trays, noise from vital signs monitors, anesthesia equipment, background music, and talking. The surgical staff did not wear hearing protection devices, though one employee reportedly used pieces of paper that had been rolled into balls and inserted into the ear canals as protection against noise exposure.

“On the basis of our noise measurements and our estimates of potential noise exposures, surgeons’ noise exposures may exceed the NIOSH REL, depending on surgery length, shift length, and number of surgeries in a shift,” the authors conclude. “Surgeons can reduce their risk of hearing loss by using flat attenuation ear plugs or noise cancellation earmuffs.”

NIOSH recommends that the hospital purchase powered surgical tools that generate the least amount of noise when replacing or buying new ones. The agency also urges the hospital to include orthopedic surgeons in a hearing loss prevention program that includes annual hearing tests, appropriate hearing protection, training, and noise exposure assessments.

The full report, including a summary of the personal noise exposures recorded by NIOSH, is available as a PDF on the agency’s website.