Ambient noise levels in the chemotherapy clinic

Abstract

Many of the drugs used for chemotherapy treatments are known to be ototoxic, and can result in permanent hearing threshold shifts. The degree of ototoxic damage can be influenced by many factors including dosage, duration of exposure, genetics, and coadministration with other ototoxic agents. Cisplatin is known for its ototoxic effects on hearing thresholds, particularly in the high frequencies. Recent studies have indicated a synergistic relationship between Cisplatin administration and moderate to high noise level exposure starting between 70–85 dB SPL. This study measured the noise levels in the Portland Veteran’s Affairs Medical Center’s outpatient chemotherapy clinic. Average (LAeq) and peak (LCpeak) noise measures were recorded every minute from 7 am until 6 pm on the two busiest clinic days. Patients, visitors, and staff members filled out anonymous surveys regarding their reactions to noise levels. Cumulative noise levels were not at levels known to interact with Cisplatin for a significant period of time. Noise measurement analysis indicated that levels were at or above 70 dB SPL for less than ten minutes during the 11-hour recording window. The patient and visitor surveys indicated that both groups were unbothered by noise in the clinic. However, most staff members were bothered by or concerned about noise levels, and many felt that it caused stress and difficulty communicating on the phone.

Proposed comprehensive ototoxicity monitoring program for VA healthcare (COMP-VA)

“…The equivalent A-weighted noise level (LA EQ ) has been measured in hospital wards and reported to be in the range of 40 to 46 dB with instantaneous peaks (LC PK ) exceeding 90 dB [44]. Gordon et al reported that Portland VAMC oncology ward noise measurements in 1/3-octave frequency bands did not exceed 37.5 dBA at 500 Hz, 35 dBA at 1,000 Hz, 36 dBA at 2,000 Hz, and 32 dBA at frequency bands greater than 3,000 Hz [45].…”

“…MPANLs for DPOAE testing using an insert probe with sufficient averaging were estimated to be 55 dBA for frequencies 2,000 to 6,000 Hz [47], which easily exceeds the ambient noise levels on the hospital ward [44][45]. The measurement of DPOAE data involves signal averaging in order to improve the signalto-noise ratios of the measurement.…”

Acoustic assessment of speech privacy curtains in two nursing units

“…Studies were conducted that were designed to measure decibel levels, describe what generated the noise, and in some cases included simple interventions to reduce the levels. [ 8 9 10 ] One study demonstrated the value of closing a patient's room door in reducing the noise level to more acceptable levels. That same study illustrated that turning the alarm volume up to high did not increase audibility for the staff outside the room, providing evidence that localized alarms within patient rooms should be adjusted for patient exposure and not to notify the staff.…”

“…[ 8 ] Another study conducted in a chemotherapy unit, revealed that a squeaky chair and the main entrance door to the chemo unit generated the most noise and both could be repaired to remediate the noise. [ 10 ]…”

Noise peaks influence communication in the operating room. An observational study

“…A noise peak was recorded for each second the noise level reached 70 dB(A) or higher in any given five-minute interval of the surgery, similar to the practice of other studies (Broom et al 2011, Gladd and Saunders 2011, Engelmann et al 2014. Noise peaks were rather infrequent, which would yield extremely small coefficients in regression analyses.…”