Penyakit Akibat kerja

dari Faktor Fisik

Kebisingan

Bima Uramanda
Akademi keperawatan
Dharma Wacana
Definisi dan pengertian
 Bising = suara-suara yang tidak
dikehendaki
 Definisi secara ilmiah = sensasi yang
diterima telinga sebagai akibat fluktuasi
tekanan udara ‘superimposing’ tekanan
atmosfir/udara yang steady
 Bising = sejenis vibrasi/energi yang
dikonduksikan dalam media udara,
cairan, padatan, tidak tampak, dan dapat
memasuki telinga serta menimbulkan
sensasi pada alat dengar
Inside NOISE
 What is noise?
– Definition, energy conducted and sensed, properties:
intensity/pressure, frequency, exposure,
 Why unwanted?
– Health Effect, age, psychological: annoyed, concentration,
rest/relax problem, communication annoyance,
physiological: blood, heart, hearing loss, nausea, muscle
control, acoustic trauma (permanent) vs temporary,
 Who are susceptible?
– Esp. Industrial workers, determining factors: sensitivity,
age,
 How to evaluate & control?
What is noise?
Definisi:
 Suara-suara yang tidak dikehendaki (for
Who? Why?)
 Suara: sensasi yang diterima telinga
sebagai akibat fluktuasi tekanan udara
terhadap tekanan udara yang stabil.
 Telinga akan merespons fluktuasi-fluktuasi
kecil tersebut dengan sensitivitas yang
sangat besar.
Properties of noise?
Karakteristik bising
1. Intensitas/tekanan (sound
pressure/tingkat tekanan/desibel)
2. Frekuensi (16-20.000 Hz)
3. Durasi eksposur terhadap bising
4. Sifat (stabil,fluktuasi, intermitten)
Ketiga karakteristik diperlukan karena:
 Semakin keras suara, semakin tinggi
intensitasnya
 Frekuensi tinggi lebih berbahaya
terhadap kemampuan dengar. Telinga
manusia lebih sensitif terhadap
frekuensi tinggi
 Semakin lama durasi eksposur semakin
besar kerusakan pada mekanisme
pendengaran
Jenis Bising
 Tergantung pada durasi dan frekuensi
 Steady wide band noise, bising yang meliputi
suatu jelajah frekuensi yang lebar (bising
dalam ruang mesin)
 Steady narrow band noise, bising dari sebagian
besar energi bunyi yang terpusat pada
beberapa frekuensi saja, contoh gergaji
bundar.
 Impact noise, kejutan singkat berulang, contoh
riveting
 Intermitten noise, bising terputus, contoh lalu
lintas pesawat
Contoh…
Tekanan = Sound Pressure
 Manusia dapar mendengar suara pada tekanan
antara 0,0002 dynes/cm2 (ambang
dengar/threshold of hearing) sampai 2000
dynes/cm2  range besar sehingga satuan
yang dipakai dB (decibel): logaritmik
 Dinyatakan dalam decibel (dB) yang dilengkapi
skala A, B, dan C
 sesuai dengan berbagai kegunaan
 Skala A digunakan karena merupakan response
yang paling cocok dengan telinga manusia
(peka terhadap frekuensi tinggi)
 Skala B dan C untuk evaluasi kebisingan
mesin, dan cocok untuk kebisingan frekuensi
rendah
Intensitas

 Laju aliran energi tiap satuan luas yang dinyatakan

dalam desibell (dB) – Alexander Graham Bell-
 dB adalah merupakan satuan yang dihasilkan dari
perhitungan yang membandingkan suatu tekanan
suara yang terukur terhadap suatu tekanan acuan
(sebesar 0,0002 dyne/cm2).
 B = log (int.terukur/int.acuan) untuk mendapatkan
angka yang lebih akurat ditentukan dengan angka
kelipatan 10 (desi)

 Intensity level dB=10 Log (IT/IA)

 Sound pressure level (tekanan bunyi) = 20 log
(IT/IA), karena intensitas sebanding dengan kuadrat
tekanan bunyi.
 Ruang kelas: ?dB
 Rumah
 Restauran
 Berbisik
 Berteriak
 Jet plane
 The decibel
SOUND INTENSITY
SOUND SOURCE LINEAR UNITS LOGARITHMIC UNITS
Bel Decibel

Lowest limit of hearing 1 0 0
Rustling leaf 10 1 10
Quiet farm setting 100 2 20
Whisper (5 feet) 1,000 3 30
Dripping faucet, quite office 10,000 4 40
Low conversation, residence 100,000 5 50
Ordinary conversation 1,000,000 6 60
Idling car 10,000,000 7 70
Silenced compressor, very noisy restaurant 100,000,000 8 80
Backhoe 1,000,000,000 9 90
Unsilenced compressor 10,000,000,000 10 100
Rock dril, woodworking 100,000,000,000 11 110
Pile driver* 1,000,000,000,000 12 120
Rivet gun* 10,000,000,000,000 13 130
Explosive-actuated tool*, jet plane 100,000,000,000,000 14 140
*Intermittent or "impulse" sound
Source: Construction Safety Association of Ontario, Hearing Protection for the Construction Industry, 1985, page 3
The decibel

 dB = 10 log10 (I1/I0) I = Intensitas

dB = 20 log10 (P1/P0) P= Tekanan = 0,0002
dynes/cm2

SP (microbar) SPL (dB) Ratio Intensitas

0,0002 0 100
0,002 20 102

Jadi bila SP berubah 10x, maka dB bertambah ? x

 Pressure Sound intensities
Pa Bel (B) Decibel (dB)
Threshold of hearing 0,00002 0 0
Quiet office 0,002 4 40
Ringing alarm clock at 1 m 0,2 8 80
Ship's engine room 20 12 120
Turbo jet engine 2000 16 160
Frekuensi
 Adalah jumlah getaran dalam tekanan
suara per satuan waktu (Hertz atau
cycle per detik), frekuensi dipengaruhi
ukuran, bentuk dan pergerakan
sumber, pendengaran normal orang
dewasa dapat menangkap bunyi
dengan frekuensi 20-15.000 Hz.
Frekuensi
 Dibagi dalam 8 octaf (octave bands), 37.5,
75, 150, 300, 600, 1200, 2400, 4800, 9600 Hz
 Telinga manusia bereaksi beda terhadap
berbagai frekuensi
 Kebisingan ‘rata-rata’ mencakup seluruh
taraf kebisingan dari setiap frekuensi 
dihitung Leq
Leq = ekuivalen noise level/ekuivalen energi
level
Leq = 10 log10 (Σ 10 Lpi/10)
Satuan (Konversi)
 1bar=105Pa=105N/m2
 =105.105dyne/104cm2
 =106dyne/cm2 atau
 1microbar = 1 dyne/cm2
Sumber > 1…..
 dB=L=20 log(P1/P2)=10 log(P1/P2)2
 L/10= log(P1/P2)2
 10L/10= 10log(P1/P2)^2=(P1/P2)2

 L=10 log(P1/P2)2
 =10 log 10L/10 (satu sumber)
 L =10 log (Σ10Li/10) (sumber banyak)
 =10 log (10L1/10+ 10L2/10+…)
Sumber > 1….. (Contoh)
Perbedaan ΣdBA yang turun
 =10 log (Σ10Li/10) antara sumber ditambah ke
bunyi bunyi terbesar
(banyak sumber) 0 3,0
 =10 log (10L1/10+ 1 2,6

10L2/10+…) 2 2,1
3 1,8
4 1,5
5 1,2
6 1,0
7 0,8
8 0,6
10 0,4
12 0,3
14 0,2
16 0,1
Satuan (Konversi)
 1bar=105Pa=105N/m2
 =105.105dyne/104cm2
 =106dyne/cm2 atau
 1microbar = 1 dyne/cm2
Sumber > 1…..
 dB=L=20 log(P1/P2)=10 log(P1/P2)2
 L/10= log(P1/P2)2
 10L/10= 10log(P1/P2)^2=(P1/P2)2

 L=10 log(P1/P2)2
 =10 log 10L/10 (satu sumber)
 L =10 log (Σ10Li/10) (sumber banyak)
 =10 log (10L1/10+ 10L2/10+…)
Sumber > 1….. (Contoh)
Perbedaan ΣdBA yang turun
 =10 log (Σ10Li/10) antara sumber ditambah ke
bunyi bunyi terbesar
(banyak sumber) 0 3,0
 =10 log (10L1/10+ 1 2,6

10L2/10+…) 2 2,1
3 1,8
4 1,5
5 1,2
6 1,0
7 0,8
8 0,6
10 0,4
12 0,3
14 0,2
16 0,1
 Kebisingan dari 2 sumber

3 Perbedaan Tambah pada yg

Decibel yang ditambahkan pada

(dB) lebih tinggi

tingkat kebisingan lebih tinggi

0 atau 1 3
2,5
2 atau 3 2
2 4–9 1
10+ 0
1,5

0,5

2 4 6 8 10 12 14
Perbedaan antara 2 tingkat bising, dB(A)
Why unwanted?

Health Effect, age, psychological:

annoyed, concentration, rest/relax
problem, communication annoyance,
physiological: blood, heart, hearing loss,
nausea, muscle control, acoustic trauma
(permanent) vs temporary,
Efek bising pada manusia
 Psikologis, terkejut, mengganggu dan
memutuskan konsentrasi, tidur dan
saat istirahat
 Fisiologis, seperti menaikkan tekanan
darah dan detak jantung, mengurangi
ketajaman pendengaran, sakit telinga,
mual, kendali otot terganggu, dll.
 Gangguan komunikasi yang
mempengaruhi kenyamanan kerja
dan keselamatan.
 Efek klinis
 Gangguan pendenganran telinga
dalam
 Garis V pada test audiogram
 Apopleksi akut dapat dijumpai pada
pekerj yg terpapar bising yang keras
(ledakan)
Interference with communication by
speech

 When background or ambient noise levels are

sufficiently high enough, the background noise can
mask the sound levels of speech that wish to be
heard.

 Restaurants can often be classic examples of

excessive noise interference due to lack of
sufficient quality or quantity of sound absorbing
materials that prevent excessive noise buildup.
 Diners have to speak louder and louder to be heard
and in doing so compete with one another, thereby
increasing the sound levels to even greater levels.
Appropriate acoustical treatment will prevent the
reflected noise buildup and significantly reduce the
necessity for diners to speak louder to enjoy
conversations with one another.
Mechanics of hearing

 Mekanisme pendengaran
• Terdiri dari 3 bagian: telinga luar (daun telinga
sampai membran timpani) meneruskan
gelombang ke telinga tengah
• Telinga tengah: membran timpani (yang
melekat pada 3 tulang kecil sampai membrana
ovale)  getaran diteruskan
• Telinga dalam: tube berspiral seperti rumah
siput berisi cairan  cairan bervibrasi 
stimulasi rambut sel  impuls syaraf otak
Gangguan pendengaran
 Pemaparan pada suara tinggi dan
periode/durasi yang lama akan
menyebabkan sel syaraf pendengar dan
rambut pada corti over aktif sehingga
menimbulkan kehilangan pendengaran
permanen
 Pengukuran kebisingan
• Mengukur overall level  sound level
meter (satuan dBA)
• Mengukur kebisingan pada setiap level
frekuensi  SLM dengan frequency
analyzer
• Penentuan eksposur kebisingan pada
pekerja  noise dosimeter (satuan dBA)
Alat ukur

 Sound level meter, mencatat keseluruhan

suara yang dihasilkan tanpa memperhatikan
frekuensi yang berhubungan dengan bising
total (30-130 d) – (20-20.000Hz)
 Sound level meter dengan octave band
analyzer, mengukur level bising pada
berbagai batas oktaf di atas range
pendengaran manusia dengan
mempergunakan filter menurut oktaf yang
diinginkan (narrow band analyzers untuk
spektrum sempit 2-200 Hz)
 NOISE
MEASUREMENT
KIT

NOISE KALIBRATOR

SOUND
LEVEL
METER
NOISE DOSIMETER
PENGUKURAN PADA DOSEBADGER
PEKERJA
Pneumatic
103-113 Crane 90-96
chip hammer

Jackhammer 102-111 Hammer 87-95

Concrete joint
99-102 Gradeall 87-94
cutter

Front-end
Skilsaw 88-102 86-94
loader

Stud welder 101 Backhoe 84-93

Garbage
Bulldozer 93-96 disposal (at 3 80
ft.)

Vacuum
Earth Tamper 90-96 70
cleaner

Pengukuran akibat bising

Untuk mengevaluasi akibat

pemaparan terhadap kehilangan
pendengaran, kenyamanan,
interferensi komunikasi dan
mengumpulkan informasi untuk
pengontrolan.
How Does Excessive Noise
Damage Your Ears?
 Microscopic hair cells of the cochlea are
exposed to intense noise over time
 Hair cells become fatigued and less responsive,
losing their ability to recover.
 Damage becomes permanent resulting in noise-
induced permanent threshold shift.
 Risk of Hearing Loss
 Estimated Risk of Incurring Material Hearing
Impairment as a Function of Average Daily
Noise Exposure Over a 40-year Working
Lifetime (source: NIOSH)

 Average Exposure 90 dBA 29%

 Average Exposure 85 dBA 15%
 Average Exposure 80 dBA 3%
 Ketulian
= berkurangnya ketajaman pendengaran
dibanding/terhadap orang normal (15 dB)/ gol usia
• Ada 2 macam:
- permanen: karena penyakit, usia tua, obat, trauma, dan
kebisingan
- temporer: akibat ekposur bising, dapat pulih setelah
istirahat beberapa saat tergantung keparahan
• Ketulian temporer akan menjadi permanen bila terus
terekpos bising (dari rumah, tempat umum, rekreasi,
musik, industri, dll.)
• Secara mekanisme: ketulian ada 2:
- konduktif: peralatan konduksi suara rusak akibat
trauma atau sakit
- sensorinueral: akibat persyarafan pendengaran rusak
Audiometric test

Audiometric test

Audiometric test
Current OSHA Standards
•1926.52 Occupational Noise Exposure
•TABLE D-2 - PERMISSIBLE NOISE EXPOSURES

Sound Level dBA slow

Duration per day, hours
response
8 90
6 92
4 95
3 97
2 100
1 1/2 102
1 105
1/2 110
1/4 or less 115
What Is The Purpose of Having a
Hearing Test on a Regular Basis?
 An audiometric testing program is used to track
your ability to hear over time.
– Baseline and annual
 Test records provide the only data that can be
used to determine whether the program is
preventing noise-induced permanent threshold
shifts. It is an integral part of the hearing
conservation program.
 Case Study 1. Teenage Girl
From the American Academy of Family
Physicians website, Rabinowitz article
 FIGURE 1. Audiogram findings in the patient in
case 1.

The area below the curves represents sound levels that the patient could still
hear.
(X = left ear; O = right ear)
Case Study 1 Conclusion

 "Temporary threshold shift" example

 Common in persons exposed to high
noise
 Represents transient hair cell
dysfunction
 Complete recovery can occur
 Repeated episodes of such shifts causes
permanent threshold shifts because hair
cells in the cochlea are progressively
lost.
Case Study 2 Factory Worker Age 55
Case Study 2 Conclusion
 Noise Induced Hearing Loss
– Speech discrimination and social function
interference
– Difficulty in perceiving and differentiating consonant
sounds
– Sounds such as a baby crying or a distant telephone
ringing, may not be heard at all.
 Tinnitus
– Common symptom of noise overexposure
– Further interferes with hearing acuity, sleep and
concentration.
 These impairments have been associated with
depression and an increased risk of accidents.
Carpenter Hearing Losses by Age
Damage risk criteria
 Variation in individual susceptibility
 The total energy of the sound
 The frequency distribution of the sound
 Other characteristics of the noise
exposure, such as whether it is
continuous, intermittent, or made up of a
series of impacts
 The total daily time of exposure
 The length of employment in the noise
environment.
Noise control
 A source radiating sound energy
 A path along which the sound
energy travels
 A receiver such as the human ear
 Pengendalian kebisingan
SUMBER PATHWAY/MEDIA PENERIMA/RECEIVER

Pengendalian dilakukan di 3 bagian: SUMBER, RUANG

ANTARA sumber dan penerima/pekerja, pada
PENERIMA/PEKERJA
Urutan pengendalian paling efektif:
• Kurangi/hilangkan sumber bising
• Pengendalian pathway: jarak diperjauh dengan
perisai/isolator/automatisasi
• Perlindungan penerima dari bising (APD)
•Cara teknis:
SUMBER PATHWAY PENERIMA
Substitusi Absorpsi/damping Isolasi pekerja
Insulasi sumber Perisai Reduksi waktu
Perpanjang jarak APD

•Cara medis:
Pemeriksaan ketajaman pendengaran secara periodik
Penempatan pekerja sesuai dengan kepekaan thd bising
Monitor ketulian temporer
•Cara manajemen:
Reduksi waktu eksposur
Diklat pemakaian dan pemeliharaan APD
Noise control
 Source: modification or
redesigning of the source.
– The modification of compressed air jets for
parts
ejection, to reduce noise by altering the jet flow.
– Multiple-opening air ejection nozzel: less
noise than
single-opening.
Noise control
 Noise can be controlled at the source, along the
path or at the worker.
 At the source, equipment may be replaced by
quieter models, or less noisy work procedures
can be adopted.
- In general, less friction and vibration mean less
noise. Maintenance procedures such as
lubrication may sometimes reduce noise by
reducing friction.
- Equipment can sometimes be modified to
reduce the amount of noise that is generated.
Sound-absorbing material may be attached to
the noise source. Or the frequency of the noise
may be shifted to one that is less hazardous.
Noise control
 Noise can often be controlled along the
path to the worker with:
- the use of sound-absorbing paneling on
walls or ceilings, and
- enclosures around noisy machinery.
 Controls at the worker include both
administrative controls and personal
protective equipment.
– Administrative controls modify how the work
is carried out.
– The time employees spend in noisy areas may
be reduced.
– Workers in noisy areas may be rotated to less
noisy areas.
As the distance from the noise source increases, the
pressure (or intensity) of the noise decreases faster than its
sound level.
Noise control
 Noisy operations may be
conducted outside normal working
hours to reduce the number of
people exposed.
 Where noise exposures cannot be
reduced by other methods, hearing
protection is required. This
includes ear plugs and ear muffs.
Insulation of the workers
 A separate noise insulated room
provides effective control (up to 30
dB noise reduction).
Machine insulation
 Machine: on floors and walls
vibrate themsound radiation
proper use of machine mountings
insulates the machine and reduce
the transmission of vibration
Control of noise by absorption
 Travels out in all direction
 When encounter wallsreflected
 Total noise exposure within the
room = direct + reflected noise
 Application of sound absorption
material (However, limited: no effect
on direct noise).
Reduction of exposure time
 Limiting the total daily exposure
reduces the noise hazard.
 See TLV
Personal protection against noise
 Many operations cannot be quieted
by engineering methods.
Therefore  protection: ear plugs
 Properly worn: 25 – 400 dB
protection
 Degree of discomfort  employee
education is adequate
 Example….
 Durasi tingkat bising yang
diijinkan dapat dilihat dari Durasi per Tingkat
tabel di bawah ini: hari bising
 Kebisingan yang terukur di
suatu area adalah 90 dB 8 90
selama 2 jam sehari, 97 dB 6 92
selama 2 jam, dan sisa 4 4 95
jam berikutnya terdapat 3 97
variasi tingkat bising 2 100
secara bergantian 95 dB
selama 10 menit dan 80 dB 1,5 102
selama 10 menit. 1 105
Tentukan apakah tingkat ¾ 107
kebisingan yang terukur ½ 110
masih dalam batas yang
diijinkan atau tidak. ¼ 115
Faktor-faktor yang mempengaruhi
bising

 Tipe bising: menerus dan terputus

 Lokasi pekerja
 Waktu kerja
NAB Kebisingan di lingkungan kerja
INDONESIA Permen 51/1999
USA (TLV ACGHI)
t dBA
t (eksposur) jam dB(A)
8 90
8 85
6 92 4 88
4 95 2 91
3 97 1 94
2 100 30 mnt 97
1,5 102 15 mnt 100
1 105 7,5 mnt 103
0,5 110 3,75 mnt 106
<0,25 115 1,88 mnt 109
kebisingan impulsif < 140 dB dst
dilarang > 140 dB
 Waktu pemaparan vs dB (TLV)

Waktu pemaparan (jam) dB

8 90
6 92
4 95
2 100
1,5 102
1 105
0,5 110
<0,25 115
(Sumber: FHI)
Steps aiming to control noise at
work
 Assess risks to develop a noise control
plan
 Reduce risks for all employees
 Investigate and implement good practice
for control of noise
 Prioritise noise control measures
 Use hearing protection for residual risks
 Carry out a noise dosimetry program to
check the effectiveness of noise control
measures
Some simple noise control
techniques
 Application of damping material to
chutes, hoppers, machine guards etc.,
can give a 5-25 dB reduction in the noise
radiated
 Cabin internal noise can be reduced by
10-12 dB by applying damping pads and
sound barrier mats to floor and engine
bulkhead
 Reduce fan speed by 30% to achieve a
noise reduction of 8 dB
BARRIER-BARIER ATAU PANEL
 ISOLASI PEKERJA/MESIN DI TEMPAT BISING

BAHAN ABSORBER BAHAN BARRIER

 Noise control can be complex

Engage
employees in
process

Use noise control

consultants to
help solve your
problems if
complex
Hearing protectors
 Selected for protection, user preference
and work activity
 Guard against over-protection — isolation
can lead to under-use and safety risks
 Require information, instruction,
training, supervision and motivation
 Will only protect if worn all the time and
properly
Rating hearing protectors

The sound level conversion (SLC80 ) rating of a

hearing protector, ear plugs or headset is a simple
number and class rating that is derived from a test
procedure as outlined in the Australian/New Zealand
Standard AS/NZS 1270:2002
 Class and specification of
hearing protectors
May be used up to this
SLC80 Class noise exposure level

10 to 13 1 90 dB(A)
14 to 17 2 95 dB(A)
18 to 21 3 100 dB(A)
22 to 25 4 105 dB(A)
26 or
5 110 dB(A)
greater
Ear plugs

Properly fitted Wrongly fitted

Ear muffs

Proper clamping force Worn-out head band

Reduction in protection provided by
hearing protectors with decreased
wearing time
Effective
Wear time
attenuation
Example:
Effectiveness of 60 minutes 30 dB
wearing an ear
muff with a rating 55 minutes 11 dB
of 30 dB for an
exposure time of 50 minutes 8 dB
one hour
45 minutes 6 dB
Our challenge
Away from …
 Noise assessment as the end point
 Reliance on hearing protection
Towards …
 Control of noise risks through prioritised
action plans
 Introducing equipment with good noise
and vibration characteristics – ‘Buy
Quiet’
TWA untuk kebisingan: berdasarkan standar
kebisingan.

STANDA Jumlah jam dB(A) Jumlah jam dB(A)

R 8 90 1,5 102

KEBISING 6 92 1,0 105

AN 4 95 0,75 107

3 97 0,5 110

2 100 0,25 115

dB(A) 80 90 95 97 100
1 T ukur 2 jam 4 jam 2 jam
T TLV tt 8 jam 4 jam 3 jam
TWA 0 4/8 2/4 = 1 < batas aman
2 T ukur 0 2 jam 2 jam 2 jam

T TLV tt 8 jam 4 jam 3 jam

TWA 0 2/8 2/4 2/3 = 17/12 >batas aman
3. 4 orang pekerja printer di unit percetakan dimana terdapat
Noise
offset press. Masing-masing terpapar sbb:

No. of presses Average Sound Average daily

operating Pressure Level (dBA) time in operation
(hours)
0 81 4.5

1 93 2.1

2 96 1.0

3 98 0.4
Berapa dosis harian yang diterimanya? dan Equivalent 8-
hour Sound Pressure Level (SPL) yang dialami pekerja
percetakan tersebut?
Noise
4. How much longer is an individual, without
hearing protection, permitted to work at a
location where the noise level has just been
reduced from 104 dBA to 92 dBA?