Patients' Perception of Noise in the Operating Room—A Descriptive and Analytic Cross-Sectional Study

Noise, Distractions, and Hazards in the Operating Room

Anesthesiologists are perioperative leaders of patient and health care team safety. The anesthesiologist needs to remain vigilant in the perioperative setting and while caring for patients. The ability to navigate increased noise levels, distractions, and hazards is crucial for maintaining a safe environment. While some noise, such as music, can have benefits, overall noise levels can distract from patient care and have adverse effects on patient care and intraoperative staff. This study provides an overview of noise, distractions, and hazards in the perioperative environment.

Full of sound and fury

The subject of noise in the operating theatre was recognized as early as 1972 and has been compared to noise levels on a busy highway. While noise-induced hearing loss in orthopaedic surgery specifically has been recognized as early as the 1990s, it remains poorly studied. As a result, there has been renewed focus in this occupational hazard. Noise level is typically measured in decibels (dB), whereas noise adjusted for human perception uses A-weighted sound levels and is expressed in dBA. Mean operating theatre noise levels range between 51 and 75 dBA, with peak levels between 80 and 119 dBA. The greatest sources of noise emanate from powered surgical instruments, which can exceed levels as high as 140 dBA. Newer technology, such as robotic-assisted systems, contribute a potential new source of noise. This article is a narrative review of the deleterious effects of prolonged noise exposure, including noise-induced hearing loss in the operating theatre team and the patient, intraoperative miscommunication, and increased cognitive load and stress, all of which impact the surgical team's overall performance. Interventions to mitigate the effects of noise exposure include the use of quieter surgical equipment, the implementation of sound-absorbing personal protective equipment, or changes in communication protocols. Future research endeavours should use advanced research methods and embrace technological innovations to proactively mitigate the effects of operating theatre noise.

Perceptions on music and noise in the operating room: a cross-sectional study

Objectives. Noise in operating rooms (ORs) during surgery may affect OR personnel and pose a threat to patient safety. The sources of noise vary depending on the operation. This study aimed to investigate how OR staff perceived noise, whether music was considered noise and what its perceived effects were. Methods. Surgeons, anaesthesiologists, residents and nurses were interviewed. iPads were placed in the ORs to gather noise-level data. Results. Ninety-one interviews were conducted. Most participants (60.5%) reported the presence of noise and 25% the presence of music in the OR. Noise data from iPads registered levels ranging between 59.52 and 85.60 dB(A). χ2 analyses yielded significant results between participants' role and the perceived effects of noise (p = 0.02). Responses to open-ended questions were thematically categorized. Conclusions. Surgeons generally chose the music played in ORs and were likely positively inclined to its effects, while anaesthesiologists and nurses minded the lack of choice and were more likely to consider it as noise.

The impact of operating room noise levels on stress and work efficiency of the operating room team: A protocol for systematic review and meta-analysis

BACKGROUND

There is no high-quality meta-analysis in the literature to determine the noise level in the operating room. Therefore, the aim of this study is to systematically review the available evidence in the literature to elucidate the impact of operating room noise levels on stress and work efficiency of the operating room team.

METHODS

Two individual researchers will conduct the platform searches on the PubMed, Cochrane Library, and Embase databases from inception to June 1, 2022. The cohort studies assessing the impact of operating room noise levels on stress and work efficiency of the operating room team will be included. The outcomes include total workload level, stress scores, anxiety scores, operation time. We will collect data according to the guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. The Meta analysis will be performed using Review Manager version 5.3 provided by the Cochrane Collaboration. Risk bias analysis of the studies will be performed independently by two reviewers using the Cochrane Risk of Bias Assessment Tool.

RESULTS

The review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings.

REGISTRATION NUMBER

10.17605/OSF.IO/7N8RY.

Physiological and psychological effects of ambient noise in operating room on medical staff

BACKGROUND

The study was conducted to assess operating room noise levels and to investigate its effects on medical staff.

METHODS

Single-blind study. This study was conducted with 92 medical staff working in 11 operating rooms of a university hospital. Data was collected using a personal information form and sound level measuring devices. Sound measurements were made 3 days a week in the morning and in the afternoon, twice a day and lasted 15 min each. Mean values of the measurements in each room were collected and recommended maximum values for operating rooms (35 dB during daytime) by the World Health Organization were set as a reference point.

RESULTS

The highest noise level was measured in orthopaedic (67.5 dB), and the lowest in gynaecology room (55.5 dB). Daily mean noise level of all operating rooms was 60.90 dB. Noise disturbance score measured with Visual Analogue Scale was 6.66 ± 1.84. Of the medical staff, 84.8% were physiologically, 93.5% psychologically, and 82.6% both physiologically and psychologically affected. Of those affected physiologically, 51.1% experienced fatigue, and 33.7% headache, and of those affected psychologically, 43.5% experienced inattentiveness, 34.8% agitation and 15.2% restlessness. Only 4.34% reported not being affected by the noise.

CONCLUSION

Operating room noise levels were higher than normal limits set by the World Health Organization, which affected the medical staff both physiologically and psychologically. Since experienced negativities may reduce medical staff's motivation and increase error making, making arrangements to control noise levels is recommended.

Noise in the outpatient operating room

Background

Noise exposure in hospitals can negatively impact both patients and doctors. It can make patients feel more anxious or depressive and can impair doctors' concentration or judgment, potentially leading to poor decision-making or performance. In China, an increasing number of outpatient operating rooms have emerged in recent years for the convenience of patients planning to undergo minor surgery. In this study, we aimed to investigate the impact of noise exposure in the outpatient operating room and ways to deal with it.

Methods

By monitoring noise at different locations in three hospitals, we analyzed the average noise exposure intensity affecting outpatient operative procedures. After noise monitoring, we made some constructive suggestions and other adjustments to reduce and lower the noise exposure in one outpatient operating room [the experimental operating room (EOR)] to observe the feasibility and effectiveness of noise control in and out of the outpatient operating room.

Results

Noise intensity in the outpatient operating room was significantly higher than that in the inpatient operating room (68.3±14.7 vs. 45.7±9.6, P<0.05). After noise control, the noise intensity in the EOR decreased significantly (74.5±16.6 vs. 59.2±13.4, P<0.05) but was still higher than that in the inpatient operating room (59.2±13.4 vs. 46.0±9.3, P<0.05) of the same hospital. Further analysis revealed that noise affecting outpatient operating room mainly originates from vehicles outside, medical machines, ambulances, crowds in the outpatient main hall, and communication devices.

Conclusions

Noise exposure is a common and serious problem, but measures can be taken to deal with it effectively.

Modifications of Surgical Suction Tip Geometry for Flow Optimisation: Influence on Suction-Induced Noise Pollution

Introduction

Suction devices for clearing the surgical field are among the most commonly used tools of every surgeon because a better view of the surgical field is essential. Forced suction may produce disturbingly loud noise, which acts as a nonnegligible stressor. Especially, in emergency situations with heavy bleeding, this loud noise has been described as an impeding factor in the medical decision-making process. In addition, there are reports of inner ear damage in patients due to suction noises during operations in the head area. These problems have not been solved yet. The purpose of this study was to analyse flow-dependent suction noise effects of different surgical suction tips. Furthermore, we developed design improvements to these devices.

Methods

We compared five different geometries of suction tips using an in vitro standardised setup. Two commercially available standard suction tips were compared to three adapted new devices regarding their flow-dependent (10–2000 mL/min) noise emission (dB, weighting filter (A), distance 10 cm) and acoustic quality of resulting noises (Hamilton fast Fourier analysis) during active suction at the liquid-air boundary. Noise maps at different flow rates were created for all five suction devices, and the proportion of extracted air was measured. The geometries of the three custom-made suction tips (new models 1, 2, and 3) were designed considering the insights after determining the key characteristics of the two standard suction models.

Results

The geometry of a suction device tip has significant impact on its noise emission. For the standard models, the frequency spectrum at higher flow rates significantly changes to high-frequency noise patterns (>3 kHz). A number of small side holes designed to prevent tissue adhesion lead to increased levels of high-frequency noise. Due to modifications of the tip geometry in our new models, we are able to achieve a highly significant reduction of noise level at low flow rates (new model 2 vs. standard models p < 0.001) and also the acoustic quality improved. Additionally, we attain a highly significant reduction of secondary air intake (new model 2 vs. the other models p < 0.001).

Conclusion

Improving flow-relevant features of the geometry of suction heads is a suitable way to reduce noise emissions. Optimized suction tips are significantly quieter. This may help us to reduce noise-induced hearing damage in patients as well as stress of medical staff during surgery and should lead to quieter operation theatres overall. Furthermore, the turbulence reduction and reduced secondary air intake during the suction process are expected to result in protective effects on the collected blood and thus could improve the quality of autologous blood retransfusions. We are on the way to evaluate potential benefits.

Awake craniotomy: improving the patient's experience

PURPOSE OF REVIEW

Awake craniotomy patients are exposed to various stressful stimuli while their attention and vigilance is important for the success of the surgery. We describe several recent findings on the perception of awake craniotomy patients and address nonpharmacological perioperative factors that enhance the experience of awake craniotomy patients. These factors could also be applicable to other surgical patients.

RECENT FINDINGS

Proper preoperative counseling gives higher patient satisfaction and should be individually tailored to the patient. Furthermore, there is a substantial proportion of patients who have significant pain or fear during an awake craniotomy procedure. There is a possibility that this could induce post-traumatic stress disorder or related symptoms.

SUMMARY

Preoperative preparation is of utmost importance in awake craniotomy patients, and a solid doctor-patient relationship is an important condition. Nonpharmacological intraoperative management should focus on reduction of fear and pain by adaptation of the environment and careful and well considered communication.