Reducing Light and Sound in the Neonatal Intensive Care Unit: An Evaluation of Patient Safety, Staff Satisfaction and Costs

The impact of a noise reduction quality improvement project upon sound levels in the open-unit-design neonatal intensive care unit

“…An openunit-designed configuration may dictate operational patterns that will accentuate the noise impact of human conversation and activity, especially with increasing census or acuity. Although previously published reports have not detected cyclical or periodic changes in sound levels, 19,21,[23][24][25] our results did demonstrate perceptible differences in periods of loudness (L 10 ) in the early morning as compared with early evening at TCH. The negative acoustic impact of higher acuity in the open design unit is suggested by greater noise levels in the Level-3 as compared with Level-2 areas, as well as the positive correlation with census.…”

“…[18][19][20][21][22][23][24][25]35 All five centers collaborating in the NICQ 26 remains an elusive goal. All five centers purchased the Larsen-Davis dosimeter, but only TCH and Benefis were able to coordinate an ongoing program of consistent 24-h measurements to obtain data that continued through the period of quality improvement initiatives.…”

“…[11][12][13][14][15][16][17] In addition, environmental noise pollution has a negative effect on individual staff attention, inter-staff communication and the risk of medical errors. 18 Reports of measured sound pressure levels (SPLs) [19][20][21][22][23][24][25] in open-unit-design NICUs uniformly are above published recommendations. 26,27 Behavior strategies targeting nursery personnel have been suggested to decrease nursery noise.…”

The development of potentially better practices to support the neurodevelopment of infants in the NICU

“…[328][329][330][331] Noise levels in the NICU have been shown to be excessive and chaotic, both in the incubator as well as in the ambient environment. [332][333][334][335][336][337][338] Published measurements of sound levels reported in NICUs have used various methodologies with variable results [339][340][341][342][343] and uniformly report sound pressure levels above the optimal recommended for new or renovated NICUs. 344 Studies demonstrating the clinical effect of sound are limited to animal models, or small non-randomized, case-control or observational designs, with wide variations in measurement technique and sound levels, 345 Animal research suggests that early exposure to sustained moderate noise may delay normal auditory development.…”

“…363 Unit design may mitigate some of these effects. 339,340,343,364,365 Well-designed studies are needed to clearly demonstrate the immediate and long-term impact of sound on the newborn infant. Existing evidence does not dictate the optimal acoustic environment for the growing preterm infant in the neonatal intensive care setting.…”