General introduction 21 Interventions Prevention Hearing loss that is attributed to occupational noise exposure is potentially preventable (Verbeek et al., 2014). Preventive measures have been described in a Cochrane review (Tikka et al., 2017) and in medical guidelines, such as the Dutch multidisciplinary guideline for the prevention of occupational hearing loss (Sorgdrager et al., 2006). It is important to first identify groups at risk of occupational hearing loss. The first group consists of individuals that work in noise of 80 dBA or higher. For this group, a protocol with a hierarchical order of preventive measures has been designed. Highest in the hierarchical order are measures that reduce or eliminate the source of the workplace noise, by changing materials, processes, or the workplace layout. Second are organizational measures, specifically changing work practices, management policies, or the behavior of workers. Examples are reducing the duration of the noise exposure or reducing the number of employees that is exposed to the noise.Third are measures that intend to increase the use of personal protection devices. Last in the hierarchical order are measures that include monitoring of the hearing levels of exposed workers. Also, it is important that employees at risk for occupational hearing loss receive information and training about the risk of noise exposure. Prevention of hearing loss is an ongoing process, and the efficacy of a prevention program should be evaluated every year. Based on the European Directive 2003/10/EC, preventive measures that must be undertaken by employers are embedded in the Dutch law. Three exposure limits and corresponding actions are defined: • Employees exposed to noise levels at or above 80 dBA should receive information and training on the risks of noise exposure, and should have access to hearing protection devices; • Employees exposed to noise levels above 85 dBA should have access to and use hearing protection devices and have the right to have their hearing checked every four years. Their employers are required to eliminate sound sources whenever reasonable practicable or implement technical or organizational measures to reduce the noise level;
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