Identification and Modification of Environmental Noise in an ICU Setting

Kahn, Douglas; Cook, Thorley E.; Carlisle, Carol C.; Nelson, David L.; Kramer, Naomi R.; Millman, Richard P.

doi:10.1378/chest.114.2.535

Cited by 194 publications

(157 citation statements)

References 17 publications

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“…When one considers environmental factors, the noises most commonly reported to be disruptive to patients include staff conversations, alarms, overhead pages, telephones, televisions, and family. 44,47,51,[64][65][66][67] The Environmental Protection Agency recommends maximum hospital noise levels to be 45 decibels (dB) during the day and 35 dB at night. 68 The average ICU routinely has a noise level of 80 dB, which contributes to sleep disruption.…”

Section: Reviewing the Evidencementioning

confidence: 99%

“…Reduce environmental noise (alarms, equipment, television, telephones, overhead pages, conversation) [43][44][45]51,64,67,69 Reduce light exposure during sleep time; dim lights 43,51,67 Provide patient and their family members with education about sleep promotion Consider ear plugs to reduce environmental noise 65,66 Regularly assess patients for delirium by using a valid and reliable tool 56 Promote a consistent sleep/wake cycle 53,56 Provide reorientation as needed 56 Provide hearing, vision, and communication tools as needed Implement nurse-driven early mobility protocols Assess for endotracheal tube discomfort 44 Limit dyssynchrony with the ventilator 44,75 Consider assist-control ventilation versus pressure support modes 73,74 Assess for medications that impair sleep: antipsychotics, β-blockers, proton pump inhibitors, H 2 blockers, antibiotics, antidepressants, corticosteroids, vasopressors, antiasthmatics, benzodiazepines, γ-aminobutyric acid agonists 45 Assess for medications that can cause withdrawal insomnia: sedatives, nicotine, alcohol, opiates 45 Ask the patient and/or family what the patient's regular sleep/wake cycle is to adapt care Promote consistent sleep and awake periods Encouraging activity helps with sleep hygiene 81 Limit use of sedatives when possible to promote improved sleep architecture 53,56,57 Limit the use of benzodiazepines 56,57 Assess the patient for signs of sleep deprivation and/or delirium 53,56,57 Use massage, music, acupressure, and/or aromatherapy to enhance relaxation 82,83 Assess the patient for sleep deprivation even if the patient appears to be sleeping (eg, eyes closed, vi...…”

Section: Interventionsmentioning

confidence: 99%

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Examining the Evidence to Guide Practice: Challenging Practice Habits

Makic

Rauen

Watson

et al. 2014

Critical Care Nurse

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I n 2001, the Institute of Medicine challenged all health care professionals to decrease variation in practice through adoption of practice interventions based on best evidence to improve patients' outcomes.1 Current reviews of clinical practice suggest that only 10% to 15% of clinicians consistently implement evidence-based care 2 and indicate that it may take up to 2 decades for original research to be put into routine clinical practice.3 It is well established that evidence-based practice (EBP) is associated with higher quality care and better outcomes for patients than care that is steeped in tradition. 4 Yet at times, clinicians continue to practice on the basis of tradition.

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Section: Reviewing the Evidencementioning

confidence: 99%

Section: Interventionsmentioning

confidence: 99%

Examining the Evidence to Guide Practice: Challenging Practice Habits

Makic

Rauen

Watson

et al. 2014

Critical Care Nurse

View full text Add to dashboard Cite

show abstract

“…In particular, they tend to suffer from sleep distance at night, as a common problem [1]. Unfortunately, as shown in previous studies, the noise levels measured in the wards frequently exceeded the WHO (World Health Organization) guideline values by more than 20dBA [2][3][4][5][6]. Behavioural modification and improvement of major noise sources is considered to be an effective noise reduction strategy in the context of hospital acoustic environments [1].…”

Section: Introductionmentioning

confidence: 99%

Behavior observation of major noise sources in critical care wards

Xie

Kang

Mills

2013

Journal of Critical Care

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PurposeTo investigate the behaviour patterns of typical noise sources in critical care wards, and relate their patterns to healthcare environment in which the sources adapt themselves in several different forms. Methods An effective observation approach was designed for noise behaviour in the critical care environment. Five descriptors have been identified for the behaviour observations, namely interval, frequency, duration, perceived loudness and location. Both the single-bed and multiple-bed wards at the selected Critical Care Department were randomly observed for three inconsecutive nights, from 11:30PM to 7:00AM the following morning. The Matlab distribution fitting tool was applied afterwards to plot several types of distributions, and estimate the corresponding parameters. Results The lognormal distribution was considered to be the most appropriate statistical distribution for noise behaviours in terms of the interval and duration patterns. The turning of patients by staff was closely related to the increasing occurrences of noises. Among the observed noises, talking was identified with the highest frequency, shortest intervals and the longest durations, followed by monitor alarms. The perceived loudness of talking in the night time wards was classified into 3 levels (raised, normal and low). The majority of people engaged in verbal communication in the single-bed wards occurred around the Entrance Zone, whereas talking in the multiple-bed wards was more likely to be situated in the Staff Work Zone. As expected, more occurrences of noises along with longer duration were observed in multiple-bed wards rather than single-bed wards. 'Monitor plus ventilator alarms' was the most commonly observed combination of multiple noises.

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“…Christensen, Kahn and colleagues and Sasol The importance of personal conversations between audio sources in the ICU unit, respectively 25, 26 and 18% reported. Accordingly, the most important action for noise control in the ICU is due to noise in the building sector (15)(16)(17). Through a variety of sound sources, volume control can be studied from different aspects.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Noise level at Qazvin University Hospital’s Intensive Care Units

Nikpey¹,

Ghalenoei²,

Variani³

et al. 2015

Biotech Health Sci

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Background: Noise at Intensive Care Units (ICU) has an adverse effect on patients and ICU staff. There are some evidences that sleep, recovery from critical illness and average background noise in hospitals as recommended by the US Environmental Protection Agency (EPA) and World Health Organization (WHO) should not exceed 30 A-weighted decibel (dBA) and peaks during night time should be less than 40 dBA. This survey was conducted to measure noise levels and their relationship with the time of the day and location in the ICU. Objectives: The objectives of this study were to measure noise levels and evaluate their relationship with time of day and location in the ICU. Materials and Methods: This cross sectional study was conducted in a public university hospital, namely Qazvin University of Medical Sciences, Qazvin, Iran. Noise levels were measured with SLM Sound level meter (model: Tes-1443) during 24 hours with the equivalent sound level (LEQ), maximum (Max) and peak sound pressure based on the ISO 9612.this tool can measure in the range of 30 to 110 dB dynamic network. While frequency A, fast time scale networks with 125 ms fast response microphones were selected. This method says that measuring point must have distance 1.5 meter from the wall at a height of 1.25 m above ground level. At the bedside of patients measurement done by 3 TES model 1353 H Tool by a Taiwanese company. Results: This survey showed that the Equivalent Sound Level (Leq) in ICU was much higher than the standard level. The Maximum Sound Level (Lmax) in most places was 84 -89 dBA and just in one measurement in the Internal ICU reached 90 dB. The average level of Leq in ICU was 70 dB. Conclusions: Equivalent noise level and Noise Criteria in ward remarkably exceeds the standards levels. This condition will be produce Dangerous circumstances for admitted patients in ward.

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Identification and Modification of Environmental Noise in an ICU Setting

Cited by 194 publications

References 17 publications

Examining the Evidence to Guide Practice: Challenging Practice Habits

Examining the Evidence to Guide Practice: Challenging Practice Habits

Behavior observation of major noise sources in critical care wards

Evaluating the Noise level at Qazvin University Hospital’s Intensive Care Units

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