An investigation of sound levels on intensive care units with reference to the WHO guidelines

Julie L Darbyshire, J Duncan Young, Julie L Darbyshire, J Duncan Young

Abstract

Introduction: Patients in intensive care units (ICUs) suffer from sleep deprivation arising from nursing interventions and ambient noise. This may exacerbate confusion and ICU-related delirium. The World Health Organization (WHO) suggests that average hospital sound levels should not exceed 35 dB with a maximum of 40 dB overnight. We monitored five ICUs to check compliance with these guidelines.

Methods: Sound levels were recorded in five adult ICUs in the UK. Two sound level monitors recorded concurrently for 24 hours at the ICU central stations and adjacent to patients. Sample values to determine levels generated by equipment and external noise were also recorded in an empty ICU side room.

Results: Average sound levels always exceeded 45 dBA and for 50% of the time exceeded between 52 and 59 dBA in individual ICUs. There was diurnal variation with values decreasing after evening handovers to an overnight average minimum of 51 dBA at 4 AM. Peaks above 85 dBA occurred at all sites, up to 16 times per hour overnight and more frequently during the day. WHO guidelines on sound levels could be only achieved in a side room by switching all equipment off.

Conclusion: All ICUs had sound levels greater than WHO recommendations, but the WHO recommended levels are so low they are not achievable in an ICU. Levels adjacent to patients are higher than those recorded at central stations. Unit-wide noise reduction programmes or mechanical means of isolating patients from ambient noise, such as earplugs, should be considered.

Figures

Figure 1
Figure 1
Average sound levels for patient sited recording device. Average sound levels at one-minute intervals (LAeq) throughout the day with recording device positioned adjacent to the patient. dB, decibel; WHO, World Health Organisation.
Figure 2
Figure 2
Average sound levels for centrally sited recording device. Average sound levels at one-minute intervals (LAeq) throughout the day measured by a recording device on a central station in the ICU. dB, decibel; WHO, World Health Organisation.
Figure 3
Figure 3
Peak sound levels for patient-sited recording device. Peak sound levels (LApk) measured at one-minute intervals throughout the day by a recording device positioned adjacent to the patient. dB, decibel.
Figure 4
Figure 4
Average number of peak values per hour for patient-sited recording device. Average number of minutes per hour when peak values above 85 A-weighted decibels (dBA) and above 100 dBA were recorded with the recording device positioned adjacent to the patient.
Figure 5
Figure 5
Frequency plot for 24 hours at John Radcliffe Hospital ICU. Frequency components of the noise adjacent to a patient at the John Radcliffe Hospital Adult ICU on a weekday at the quietest period (4:00 AM to 5:00 AM) and during working hours (4:00 PM to 5:00 PM).

References

    1. Salluh JI, Soares M, Teles JM, Ceraso D, Raimondi N, Nava VS, Blasquez P, Ugarte S, Ibanez-Guzman C, Centeno JV, Laca M, Grecco G, Jimenez E, Árias-Rivera S, Duenas C, Rocha MG. the DECCA (Delirium Epidemiology in Critical Care) Study Group. Delirium Epidemiology in Critical Care (DECCA): an international study. Crit Care. 2010;17:R210.
    1. Aaron JN, Carlisle CC, Carskadon MA, Meyer TJ, Hill NS, Millman RP. Environmental noise as a cause of sleep disruption in an intermediate respiratory care unit. Sleep. 1996;17:707–710.
    1. Topf M. Personal and environmental predictors of patient disturbance due to hospital noise. J Appl Psychol. 1985;17:22–28.
    1. Berglund B, Lindvall T, Schwela DH. Guidelines for Community Noise. Geneva: World Health Organization; 1999.
    1. Pugh RJ, Jones C, Griffiths RD. In: Yearbook of Intensive Care and Emergency Medicine 2007 (Annual Update) Vincent JL, editor. New York: Springer; 2007. The impact of noise in the intensive care unit; pp. 942–949.
    1. Eliassen KM, Hopstock LA. Sleep promotion in the intensive care unit--a survey of nurses' interventions. Intensive Crit Care Nurs. 2011;17:138–142.
    1. Kamdar BB, Needham DM, Collop NA. Sleep deprivation in critical illness: its role in physical and psychological recovery. J Intensive Care Med. 2012;17:97–111.
    1. Boyko Y, Ording H, Jennum P. Sleep disturbances in critically ill patients in ICU: How much do we know? Acta Anaesthesiol Scand. 2012;17:950–958.
    1. Buxton OM, Ellenbogen JM, Wang W, Carballeira A, O'Connor S, Cooper D, Gordhandas AJ, McKinney SM, Solet JM. Sleep disruption due to hospital noises: a prospective evaluation. Ann Intern Med. 2012;17:170–179.
    1. Smith R, Johnson L, Rothfield D, Zir L, Tharp B. Sleep and cardiac arrhythmias. Arch Intern Med. 1972;17:751–753.
    1. Minckley BB. A study of noise and its relationship to patient discomfort in the recovery room. Nurs Res. 1968;17:247–250.
    1. Busch-Vishniac IJ, West JE, Barnhill C, Hunter T, Orellana D, Chivukula R. Noise levels in Johns Hopkins Hospital. J Acoust Soc Am. 2005;17:3629–3645.
    1. Akansel N, Kaymakci S. Effects of intensive care unit noise on patients: a study on coronary artery bypass graft surgery patients. J Clin Nurs. 2008;17:1581–1590.
    1. Ryherd EE, Waye KP, Ljungkvist L. Characterizing noise and perceived work environment in a neurological intensive care unit. J Acoust Soc Am. 2008;17:747–756.
    1. Gladd DK, Saunders GH. Ambient noise levels in the chemotherapy clinic. Noise Health. 2011;17:444–451.
    1. Kahn DM, Cook TE, Carlisle CC, Nelson DL, Kramer NR, Millman RP. Identification and modification of environmental noise in an ICU setting. Chest. 1998;17:535–540.
    1. Connor A, Ortiz E. Staff solutions for noise reduction in the workplace. Perm J. 2009;17:23–27.
    1. Dennis CM, Lee R, Woodard EK, Szalaj JJ, Walker CA. Benefits of quiet time for neuro-intensive care patients. J Neurosci Nurs. 2010;17:217–224.
    1. Boehm H, Morast S. Quiet time: a daily period without distractions benefits both patients and nurses. Am J Nurs. 2009;17:29–32.
    1. Freedman NS, Gazendam J, Levan L, Pack AI, Schwab RJ. Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit. Am J Respir Crit Care Med. 2001;17:451–457.
    1. Gabor JY, Cooper AB, Crombach SA, Lee B, Kadikar N, Bettger HE, Hanly PJ. Contribution of the intensive care unit environment to sleep disruption in mechanically ventilated patients and healthy subjects. Am J Respir Crit Care Med. 2003;17:708–715.
    1. Stanchina ML, Abu-Hijleh M, Chaudhry BK, Carlisle CC, Millman RP. The influence of white noise on sleep in subjects exposed to ICU noise. Sleep Med. 2005;17:423–428.
    1. Freedman NS, Kotzer N, Schwab RJ. Patient perception of sleep quality and etiology of sleep disruption in the intensive care unit. Am J Respir Crit Care Med. 1999;17:1155–1162.
    1. Simini B. Patients' perceptions of intensive care. Lancet. 1999;17:571–572.
    1. Hweidi IM. Jordanian patients' perception of stressors in critical care units: a questionnaire survey. Int J Nurs Stud. 2007;17:227–235.
    1. Uğraş GA, Oztekin SD. Patient perception of environmental and nursing factors contributing to sleep disturbances in a neurosurgical intensive care unit. Tohoku J Exp Med. 2007;17:299–308.
    1. Hofhuis JG, Spronk PE, van Stel HF, Schrijvers AJ, Rommes JH, Bakker J. Experiences of critically ill patients in the ICU. Intensive Crit Care Nurs. 2008;17:300–313.
    1. de Miranda S, Pochard F, Chaize M, Megarbane B, Cuvelier A, Bele N, Gonzalez-Bermejo J, Aboab J, Lautrette A, Lemiale V, Roche N, Thirion M, Chevret S, Schlemmer B, Similowski T, Azoulay E. Postintensive care unit psychological burden in patients with chronic obstructive pulmonary disease and informal caregivers: a multicenter study. Crit Care Med. 2011;17:112–118.
    1. Hu RF, Jiang XY, Zeng YM, Chen XY, Zhang YH. Effects of earplugs and eye masks on nocturnal sleep, melatonin and cortisol in a simulated intensive care unit environment. Crit Care. 2010;17:R66.
    1. Novaes MA, Aronovich A, Ferraz MB, Knobel E. Stressors in ICU: patients' evaluation. Intensive Care Med. 1997;17:1282–1285.
    1. Topf M, Dillon E. Noise-induced stress as a predictor of burnout in critical care nurses. Heart Lung. 1988;17:567–574.
    1. Morrison WE, Haas EC, Shaffner DH, Garrett ES, Fackler JC. Noise, stress, and annoyance in a pediatric intensive care unit. Crit Care Med. 2003;17:113–119.
    1. Tompkins OS. Secondhand noise and stress. AAOHN J. 2009;17:436.
    1. Witterseh T, Wyon DP, Clausen G. The effects of moderate heat stress and open-plan office noise distraction on SBS symptoms and on the performance of office work. Indoor Air. 2004;17(Suppl 8):30–40.
    1. Evans GW, Johnson D. Stress and open-office noise. J Appl Psychol. 2000;17:779–783.
    1. Van Rompaey B, Elseviers MM, Van Drom W, Fromont V, Jorens PG. The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients. Crit Care. 2012;17:R73.
    1. Scotto CJ, McClusky C, Spillan S, Kimmel J. Earplugs improve patients' subjective experience of sleep in critical care. Nurs Crit Care. 2009;17:180–184.
    1. Momtahan KL, Tansley BW. An ergonomic analysis of the auditory alarm signals in the operating room and recovery room. Paper presented at the Annual Meeting of the Canadian Acoustical Association, Halifax, NS, Canada, October 1989.
    1. Lawless ST. Crying wolf: false alarms in a pediatric intensive care unit. Crit Care Med. 1994;17:981–985.
    1. ECRI Institute. Top 10 health technology hazards for 2012. Health Devices. 2011;17(11):1–18.
    1. Graham KC, Cvach M. Monitor alarm fatigue: standardizing use of physiological monitors and decreasing nuisance alarms. Am J Crit Care. 2010;17:28–35.
    1. Solet JM, Barach PR. Managing alarm fatigue in cardiac care. Prog Pediatr Cardiol. 2012;17:85–90. A published corrigendum appears in Prog Pediatr Cardiol 33:183.
    1. Konkani A, Oakley B, Bauld TJ. Reducing hospital noise: a review of medical device alarm management. Biomed Instrum Technol. 2012;17:478–487.
    1. Schmid F, Goepfert MS, Reuter DA. Patient monitoring alarms in the ICU and in the operating room. Crit Care. 2013;17:216.
    1. Gorges M, Markewitz BA, Westenskow DR. Improving alarm performance in the medical intensive care unit using delays and clinical context. Anesth Analg. 2009;17:1546–1552.
    1. Tarassenko L, Clifton DA, Pinsky MR, Hravnak MT, Woods JR, Watkinson PJ. Centile-based early warning scores derived from statistical distributions of vital signs. Resuscitation. 2011;17:1013–1018.
    1. Clifton L, Clifton DA, Pimentel MA, Watkinson PJ, Tarassenko L. Gaussian process regression in vital-sign early warning systems. Conf Proc IEEE Eng Med Biol Soc. 2012;17:6161–6164.
    1. Hugueny S, Clifton DA, Tarassenko L. In: Biomedical Engineering Systems and Technologies: Third International Joint Conference, BIOSTEC 2010, Valencia, Spain, January 20-23, 2010, Revised Selected Papers (Communications in Computer and Information Science Series, Vol. 127) Fred A, Filipe J, Gamboa H, editor. Berlin: Springer; 2011. Probabilistic patient monitoring with multivariate, multimodal extreme value theory; pp. 199–211.

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