Preliminary noise reduction efforts in a medical intensive care unit

Nannapaneni, Srikant; Lee, Sarah J.; Kashiouris, Markos; Elmer, Jennifer; Thakur, Lokendra; Nelson, Sarah; Bowron, Catherine T.; Danielson, Richard D.; Surani, Salim; Ramar, Kannan

doi:10.1080/21548331.2015.1015389

Cited by 12 publications

(11 citation statements)

References 22 publications

(26 reference statements)

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“…Kol et al demonstrated a significant reduction in environmental noise levels in an intensive care environment after the introduction of staff education and a rearrangement of the ward environment (67.6 dB[A] pre versus 56 dB[A] post, p < 0.05) [ 38 ]. In contrast, Nannapaneni et al reported that a multipronged noise intervention inclusive of education and noise monitoring had a minimal effect on ambient noise levels, but did result in a reduction in the number of noise ascensions [ 39 ]. Although further research into behaviour modification approaches to noise reduction is needed, it appears that behavioural modification alone may not be successful in reducing noise levels [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

“They can rest at home”: an observational study of patients’ quality of sleep in an Australian hospital

Delaney

Currie

Hsu

et al. 2018

BMC Health Serv Res

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BackgroundPoor sleep is known to adversely affect hospital patients’ recovery and rehabilitation. The aim of the study was to investigate the perceived duration and quality of patient sleep and identify any environmental factors associated with patient-reported poor sleep in hospital.MethodA cross-sectional study was conducted involving 15 clinical units within a 672-bed tertiary-referral hospital in Australia. Semi-structured interviews to determine perceptions of sleep quantity and quality and factors that disturb nocturnal sleep were conducted with patients and nursing staff. Environmental noise, light and temperature were monitored overnight, with concurrent logging of noise sources by observers.ResultsPatients reported a mean reduction in hospital sleep duration, compared to home, of 1.8 h (5.3 vs. 7.1 h; p < 0.001). The proportions of patients reporting their sleep quality to be poor/very poor, fair and of good quality were 41.6, 34.2 and 24.2% respectively. Patients reported poorer sleep quality than nurses (p < 0.05). Patients, nurses and observers all reported the main factors associated with poor sleep as clinical care interventions (34.3%) and environmental noise (32.1%). Noise levels in all 15 clinical areas exceeded WHO recommended levels of < 30 dB [A] by 36.7 to 82.6%, with peak noise levels of 51.3 to 103.3 dB (A).ConclusionHospital in-patients are exposed to factors which reduce the duration and quality of their sleep. These extrinsic factors are potentially modifiable through behaviour change and reconfiguration of the clinical environment. The findings from this study provided the foundation for a quality improvement project currently underway to improve patients’ sleep.

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Section: Discussionmentioning

confidence: 99%

“They can rest at home”: an observational study of patients’ quality of sleep in an Australian hospital

Delaney

Currie

Hsu

et al. 2018

BMC Health Serv Res

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“…Recently, Nannapaneni et al [28] defined the concept of sound “defects” (aka peaks) as sound events greater than 60 dBA. Their sound reduction intervention did not change Leq, but decreased the number of defects / peaks [28]. In order to better understand sound variation, we examined the occurrence of sound peaks in detail.…”

Section: Discussionmentioning

confidence: 99%

Comparing average levels and peak occurrence of overnight sound in the medical intensive care unit on A-weighted and C-weighted decibel scales

Knauert

Jeon

Murphy

et al. 2016

Journal of Critical Care

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Purpose Sound levels in the intensive care unit (ICU) are universally elevated and are believed to contribute to sleep and circadian disruption. The purpose of this study is to compare overnight ICU sound levels and peak occurrence on A- versus C-weighted scales. Materials and Methods This was a prospective observational study of overnight sound levels in 59 medical ICU patient rooms. Sound level was recorded every 10 seconds on A- and C-weighted decibel scales. Equivalent sound level (Leq) and sound peaks were reported for full and partial night periods. Results The overnight A-weighted Leq of 53.6 dBA was well above World Health Organization (WHO) recommendations; overnight C-weighted Leq was 63.1 dBC (no WHO recommendations). Peak sound occurrence ranged from 1.8 to 23.3 times per hour. Illness severity, mechanical ventilation and delirium were not associated with Leq or peak occurrence. Leq and peak measures for A- and C-weighted decibel scales were significantly different from each other. Conclusions Sound levels in the medical ICU are high throughout the night. Patient factors were not associated with Leq or peak occurrence. Significant discordance between A- and C-weighted values suggests that low frequency sound is a meaningful factor in the medical ICU environment.

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“…Several studies looking at hospital decibel levels and the effect on sleep have been conducted. Average sound levels in intensive care unit settings have been reported to exceed 40 dB, with peak noises above 85 dB during the day and overnight [22,[28][29][30]. Sound peaks greater than 80 dB have been described in intensive and intermediate respiratory care units, and electroencephalogram has been used to study patient's arousal in relation to noise, which showed a strong correlation between the number of peaks above or equal to 80 dB and arousal from sleep [31].…”

Section: Introductionmentioning

confidence: 99%

Quality Improvement Initiative to Reduce Nighttime Noise in a Transplantation and Cellular Therapy Unit

Badia

Hickey

Flesch

et al. 2019

Biology of Blood and Marrow Transplantation

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Sleep is an essential biologic function vital for physiologic rest, healing, and emotional well-being. Sleep disruption is commonly seen in patients and caregivers with lengthy hospital stays such as patients undergoing hematopoietic stem cell transplantation and cellular therapy (TCT). Sleep disruption can lead to increased stress and fatigue, affecting caregivers' ability to support their loved one. The global aim of our quality improvement initiative was to improve sleep quality in TCT patients and caregivers. The smart aim of our project was to decrease nighttime hallway noise from 47 dB to 43 dB and decrease the number of overnight noise peaks greater than 60 dB from 865 to 432 in 6 months. Through a cross-sectional quantitative and qualitative evaluation of sleep we had previously identified poor sleep quality, and with a cross-sectional focus group analysis of patients, caregivers, and medical staff we identified the factors associated with poor sleep. Hallway noise was a major factor. A simplified failure mode analysis identified 4 main key drivers; unobtrusive nighttime cleaning process, nighttime awareness maintenance system, quiet nighttime nursing system, and reliable nighttime awareness system. Several plan-do-study-act interventions took place and were adopted. From January to June 2018 the overnight mean decibel level decreased from 47 dB to 44 dB (6% reduction). Overnight noise spikes above 60 dB decreased from a mean of 865 spikes to a mean of 463 spikes (46% reduction). With a quality improvement initiative, we identified the causes of hallway nighttime hospital unit noise that negatively impact sleep and through a teambased approach performed interventions that successfully mitigated these factors.

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Preliminary noise reduction efforts in a medical intensive care unit

Cited by 12 publications

References 22 publications

“They can rest at home”: an observational study of patients’ quality of sleep in an Australian hospital

“They can rest at home”: an observational study of patients’ quality of sleep in an Australian hospital

Comparing average levels and peak occurrence of overnight sound in the medical intensive care unit on A-weighted and C-weighted decibel scales

Quality Improvement Initiative to Reduce Nighttime Noise in a Transplantation and Cellular Therapy Unit

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