Evaluation of a sound environment intervention in an ICU: A feasibility study

Johansson, Lotta; Lindahl, Berit; Knutsson, Susanne; Ögren, Mikael; Waye, Kerstin Persson; Ringdal, Mona

doi:10.1016/j.aucc.2017.04.001

Cited by 24 publications

(33 citation statements)

References 28 publications

(28 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The standard measure of environmental noise, the average daily sound pressure levels value (LAeq24), is insufficiently detailed to enable targeted noise‐reduction interventions in an ICU. This may be one of the reasons why the majority of sound reduction studies conducted in ICUs have not resulted in significant change . This study was designed to identify spatial positioning of sound sources within an ICU.…”

Section: Discussionmentioning

confidence: 99%

Mapping sources of noise in an intensive care unit

et al. 2019

View full text Add to dashboard Cite

Summary Excessive noise in hospitals adversely affects patients’ sleep and recovery, causes stress and fatigue in staff and hampers communication. The World Health Organization suggests sound levels should be limited to 35 decibels. This is probably unachievable in intensive care units, but some reduction from current levels should be possible. A preliminary step would be to identify principal sources of noise. As part of a larger project investigating techniques to reduce environmental noise, we installed a microphone array system in one with four beds in an adult general intensive care unit. This continuously measured locations and sound pressure levels of noise sources. This report summarises results recorded over one year. Data were collected between 7 April 2017 and 16 April 2018 inclusive. Data for a whole day were available for 248 days. The sound location system revealed that the majority of loud sounds originated from extremely limited areas, very close to patients’ ears. This proximity maximises the adverse effects of high environmental noise levels for patients. Some of this was likely to be appropriate communication between the patient, their caring staff and visitors. However, a significant proportion of loud sounds may originate from equipment alarms which are sited at the bedside. A redesign of the intensive care unit environment to move alarm sounds away from the bed‐side might significantly reduce the environmental noise burden to patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Mapping sources of noise in an intensive care unit

et al. 2019

View full text Add to dashboard Cite

show abstract

“…During the full-text review of these 194 articles, 157 were excluded. In total 37 studies were included: 21 assessed association between environmental risk factors and delirium 13,19,20,[30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] , and 16 reported on delirium after an environmental intervention 7,14,15,18,[48][49][50][51][52][53][54][55][56][57][58][59] ( Figure 1).…”

Section: Literature Search Results and Outcomementioning

confidence: 99%

“…Included studies were conducted between 1997 to 2019, in the USA 19,31,37,39,43,46,58,59 , the Netherlands 14, 32,48,50,51 , Japan 38,41,52,53 , France 33,36,57 , Belgium 13,49 , Denmark 15,34 , Italy 42,47 , Sweden 18,20 , Canada 35 , China 45 , India 40 , Israel 30 , Singapore 55 , South Korea 54 , Thailand 56 , Turkey 44 , and the UK 7 . Of these, 31 studies were conducted among critically ill patients while five reviewed general hospital populations 30,35,41,44,54 , and one a geriatric monitoring unit for acute delirium care 55 .…”

Section: Characteristics Of the Reviewed Articlesmentioning

confidence: 99%

“…ICU noise levels are above the World Health Organization's (WHO) recommendations, which suggest 30 A-weighted decibels (dBA) for background noise, a maximum of 35 dBA for treatment and observation areas, and a maximum of 40 dBA at night [16][17][18] . Patients interviewed post-ICU discharge report noise as an overall stressor and contributor to loss of sleep 19,20 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The impact of environmental risk factors on delirium and benefits of noise and light modifications: a scoping review

et al. 2020

View full text Add to dashboard Cite

Background: To explore existing literature on the association between environmental risk factors and delirium, and to investigate the effectiveness of environmental modifications on prevention or management of delirium. Methods: This is a scoping review of peer-reviewed studies in PubMed and the reference lists of reviewed articles. Observational studies reporting the effect of noise, light, and circadian rhythm on delirium and interventional studies assessing delirium in modified environments were reviewed. Results: 37 studies were included, 21 of which evaluated the impact of environment on delirium and 16 studied possible solutions to mitigate those impacts. Mixed findings of the reviewed studies yielded inconclusive results; a clearly delineated association between high noise levels, abnormal amounts of light exposure, and sleep disruption with delirium could not be established. The environmental interventions targeted reducing noise exposure, improving daytime and mitigating night-time light exposure to follow circadian rhythm, and promoting sleep. The overall evidence supporting effectiveness of environmental interventions was also of a low confidence; however, quiet-time protocols, earplugs, and bright light therapy showed a benefit for prevention or management of delirium. Conclusions: Environmental modifications are non-invasive, risk-free, and low-cost strategies that may be beneficial in preventing and managing delirium, especially when used as part of a multi-component plan. However, given the limited evidence-based conclusions, further high-quality and larger studies focusing on environmental modifications and delirium outcomes are strongly recommended.

show abstract

“…The main argument for this position is based on the ongoing complex intervention research programme concerning the ICU room (Lindahl & Bergbom, ). The findings from the evaluation process have so far been positive and have shown that ICU patients are aware of their surrounding environment and that staff require more theoretical knowledge about the effects of disturbing sounds (Johansson, Knutsson, Bergbom, & Lindahl, ; Johansson et al, ). Furthermore, the patients’ circadian rhythms should be protected and a cyclic light system could be conducive to better health among both patients and staff (Engwall et al, ) and consequently should be used in the future design of ICU patients’ rooms.…”

Section: Discussionmentioning

confidence: 99%

Is it possible to feel at home in a patient room in an intensive care unit? Reflections on environmental aspects in technology‐dense environments

2019

Self Cite

View full text Add to dashboard Cite

This paper focuses on the patient's perspective and the philosophical underpinnings that support what might be considered optimal for the future design of the intensive care unit (ICU) patient room. It also addresses the question of whether the aspects that support at‐homeness are applicable to ICU patient rooms. The concept of “at‐homeness” in ICUs is strongly related to privacy and control of space and territory. This study investigates whether the sense of at‐homeness can be created in an ICU, when one or more patients share a room. From an interdisciplinary perspective, we critically reflect on various aspects associated with conflicts surrounding the use of ICU patient rooms. Thus, from an architectural and a caring perspective, the significance of space and personal territory in ICU patient rooms is emphasized. Recommendations for further research are suggested. In conclusion, privacy and control are deemed to be essential factors in the stimulation of recovery processes and the promotion of well‐being in situations involving severe illness or life‐threatening conditions.

show abstract

Evaluation of a sound environment intervention in an ICU: A feasibility study

Cited by 24 publications

References 28 publications

Mapping sources of noise in an intensive care unit

Mapping sources of noise in an intensive care unit

The impact of environmental risk factors on delirium and benefits of noise and light modifications: a scoping review

Is it possible to feel at home in a patient room in an intensive care unit? Reflections on environmental aspects in technology‐dense environments

Contact Info

Product

Resources

About