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Zhang L, Cheng W, Zhao M, Tang H. Effect of Acoustic Environment in Wards on Postoperative Rehabilitation in Patients with Oral Cancer: A Retrospective Study. Noise Health 2024; 26:148-152. [PMID: 38904815 DOI: 10.4103/nah.nah_34_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/11/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVE The increase in patient flow, replacement of medical equipment, and variations in surrounding environments induce increasingly serious acoustic environment problems in hospitals. This study aims to provide additional bases for the formulation of subsequent management plans in clinical practice by analyzing the influence of the acoustic environment in wards and the postoperative rehabilitation effect among patients with oral cancer. METHODS The medical records of 210 patients with oral cancer undergoing surgical treatment in Jinan Stomatological Hospital from February 2020 to October 2022 were selected for retrospective analysis. Patients with the acoustic environment in wards >55 and ≤55 dB were classified as groups A and B, respectively, according to the acoustic environment in wards. The effects of the acoustic environment in wards on postoperative blood pressure, blood viscosity, and blood glucose fluctuation (BGF) were observed to further analyze their relationship. RESULTS No significant difference was observed in indices such as preoperative systolic pressure (SP), diastolic pressure (DP), cardiac output (CO), postoperative CO, total cholesterol, and low- and high-density lipoproteins between the two groups (P > 0.05). The SP, DP, whole blood low-shear viscosity (WBLSV), whole blood middle-shear viscosity (WBMSV), whole blood high-shear viscosity (WBHSV), and BGF in group B were significantly lower than group A (P < 0.05). Correlation results showed that the total mean value of the acoustic environment in wards was positively correlated with SP, DP, WBLSV, WBMSV, WBHSV, and BGF (P < 0.05). CONCLUSION The high acoustic environment in wards is significantly positively correlated with postoperative blood pressure, blood viscosity, and BGF in patients with oral cancer. The hospital should focus on and strengthen the management of the acoustic environment in wards, providing additional schemes to promote the postoperative recovery of patients with oral cancer.
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Affiliation(s)
- Lu Zhang
- Department of Periodontology, Tianjin Medical University Stomatological Hospital, Tianjin 300070, China
| | - Wei Cheng
- Special Diagnosis Department, Jinan Stomatological Hospital, Jinan 250000, Shandong, China
| | - Mingzhe Zhao
- Department of Prosthodontics, Jinan Stomatological Hospital, Jinan 250000, Shandong, China
| | - Hanying Tang
- Department of Prosthodontics, Jinan Stomatological Hospital, Jinan 250000, Shandong, China
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Faez N, Hmami F, Boujraf S, Kojmane W, Atmani S. Practices for respecting the newborn's sleep-wake cycle: Interventional study in the neonatal intensive care unit. J Neurosci Rural Pract 2024; 15:278-285. [PMID: 38746497 PMCID: PMC11090542 DOI: 10.25259/jnrp_579_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/26/2023] [Indexed: 05/16/2024] Open
Abstract
Objectives Premature newborns are exposed to a great deal of over-stimulation, which can affect their cerebral development. For better sleep, certain practices should be recommended. The aim of this study was to evaluate the effect of a professional training program on the improvement of practices promoting respect for the newborn's sleep-wake cycle. Materials and Methods This was an interventional study with a longitudinal, single-group, and before-and-after design. The experimental design followed a three-stage time series: Eight months before, three months after, then eight months after intervention. It targeted a comprehensive sample of 66 professionals. It took place between October 2020 and March 2022 at the Neonatal Intensive Care Unit of the Hassan II University Hospital in Fez, Morocco. It was based on an observation grid and a self-administered questionnaire, validated and tested with a Cronbach's alpha reliability of 0.91. Results The light environment showed significant differences between the 1st and 3rd step (3.3% vs. 45.0%; P = 0.02; confidence interval [CI] = 13.644-10.456) for knowledge and (13.3% vs. 78.3%; P = 0.01; CI = 14.412-10.888) for practices; the noise environment showed a positive improvement between the 2nd and 3rd intervention (31.7% vs. 41.7%; P < 0.001; CI = 5.954-2.913) for knowledge and (65.0% vs. 73.3%; P < 0.001; CI = 3.597-1.236) for practices, with an average of (8.98 ± 0.30-28.15 ± 0.48; CI = 3.806-1.094) between the 1st and 3rd step. Practices surrounding sleep and wakefulness reported significant improvement between the three periods (14.35 ± 0.22 vs. 18.10 ± 0.35 vs. 19.90 ± 0.35; P P < 0.001; CI = 4.647-2.853) for sleep and (13.25 ± 0.48 vs. 22.27 ± 0.59; P < 0.001; CI = 10.563-7.471) for wakefulness with statistically significant correlations between knowledge and practices (0.426**) for sleep and (0.606**) for wakefulness. Conclusion The study demonstrated the positive impact of this sleep management and assessment program on the development of professional skills. Its implementation requires rigorous application of developmental support strategies for individualized care in neonatology.
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Affiliation(s)
- Naima Faez
- Laboratory of Epidemiology and Research in Health Science, Sidi Mohamed Ben Abdelah University, Fez, Morocco
| | - Fouzia Hmami
- Human Pathology, Biomedicine and Environment Laboratory, Sidi Mohamed Ben Abdelah University, Fez, Morocco
| | - Saïd Boujraf
- Clinical Neurosciences Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdelah University, Fez, Morocco
| | - Widade Kojmane
- Laboratory of Epidemiology and Research in Health Science, Sidi Mohamed Ben Abdelah University, Fez, Morocco
| | - Samir Atmani
- Laboratory of Epidemiology and Research in Health Science, Sidi Mohamed Ben Abdelah University, Fez, Morocco
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Fusch G, Mohamed S, Bakry A, Li EW, Dutta S, Helou SE, Fusch C. Analysis of noise levels in the neonatal intensive care unit: the impact of clinical microsystems. Eur J Pediatr 2024; 183:1245-1254. [PMID: 38095715 DOI: 10.1007/s00431-023-05335-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 03/20/2024]
Abstract
Reorganization of neonatal intensive care by introducing clinical microsystems may help to allocate nursing time more appropriately to the needs of patients. However, there is concern that cohorting infants according to acuity may enhance noise levels. This single-center study investigated the impact of reorganization of neonatal intensive care unit by implementing clinical microsystems in a Level III NICU on environmental noise. This prospective study measured 24-h noise levels over a period of 6 months during pre- and post-implementation of microsystems cohorting infants of similar acuity. Comparative analyses of the mixed acuity (i.e., before) and the cohorting (i.e., after) model were performed by creating daily profiles from continuous noise level measurements and calculating the length of exposure to predefined noise levels. Compared to baseline daytime measurements, noise levels were 3-6 dBA higher during physician handover. Noise levels were 2-3 dBA lower on weekends and 3-4 dBA lower at night, independent of the organizational model. The introduction of clinical microsystems slightly increased average noise levels for high-acuity pods (A and B) but produced a much more substantial decrease for low-acuity pods (E), leading to an overall reduction in unit-wide noise levels. Conclusion: Our data show that noise levels are more driven by human behavior than by technical devices. Implementation of microsystems may help to reduce noise exposure in the lower acuity pods in a NICU. What is Known: • Excessive noise levels can lead to adverse effects on the health and development of premature infants and other critically ill newborns. • The reorganization of the neonatal intensive care unit following the clinical microsystems principles might improve quality of care but also affect noise exposure of staff and patients. What is New: • The transition from a mixed -acuity to cohorting model is associated with an overall reduction in noise levels, particularly in low-acuity pods requiring less nursing care. • Nevertheless, baseline noise levels in both models exceeded the standard permissible limits.
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Affiliation(s)
- Gerhard Fusch
- Department of Pediatrics, Division of Neonatology, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
| | - Saber Mohamed
- Department of Mechanical Engineering, McMaster University, Hamilton, Canada
| | - Ahmad Bakry
- Department of Pediatrics, Division of Neonatology, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
| | - Edward W Li
- Department of Pediatrics, Division of Neonatology, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
| | - Sourabh Dutta
- Department of Pediatrics, Division of Neonatology, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
- Department of Pediatrics, Neonatology Unit, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Salhab El Helou
- Department of Pediatrics, Division of Neonatology, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada
| | - Christoph Fusch
- Department of Pediatrics, Division of Neonatology, McMaster University, 1280 Main Street West, L8S 4K1, Hamilton, ON, Canada.
- Department of Pediatrics, Paracelsus Medical University Nuremberg, Nuremberg, Germany.
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Van der Linden IA, Hazelhoff EM, De Groot ER, Vijlbrief DC, Schlangen LJM, De Kort YAW, Vermeulen MJ, Van Gilst D, Dudink J, Kervezee L. Characterizing light-dark cycles in the Neonatal Intensive Care Unit: a retrospective observational study. Front Physiol 2023; 14:1217660. [PMID: 37664437 PMCID: PMC10469299 DOI: 10.3389/fphys.2023.1217660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
Objectives: To characterize bedside 24-h patterns in light exposure in the Neonatal Intensive Care Unit (NICU) and to explore the environmental and individual patient characteristics that influence these patterns in this clinical setting. Methods: We conducted a retrospective cohort study that included 79 very preterm infants who stayed in an incubator with a built-in light sensor. Bedside light exposure was measured continuously (one value per minute). Based on these data, various metrics (including relative amplitude, intradaily variability, and interdaily stability) were calculated to characterize the 24-h patterns of light exposure. Next, we determined the association between these metrics and various environmental and individual patient characteristics. Results: A 24-h light-dark cycle was apparent in the NICU with significant differences in light exposure between the three nurse shifts (p < 0.001), with the highest values in the morning and the lowest values at night. Light exposure was generally low, with illuminances rarely surpassing 75 lux, and highly variable between patients and across days within a single patient. Furthermore, the season of birth and phototherapy had a significant effect on 24-h light-dark cycles, whereas no effect of bed location and illness severity were observed. Conclusion: Even without an official lighting regime set, a 24-h light-dark cycle was observed in the NICU. Various rhythmicity metrics can be used to characterize 24-h light-dark cycles in a clinical setting and to study the relationship between light patterns and health outcomes.
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Affiliation(s)
- Isabelle A. Van der Linden
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Esther M. Hazelhoff
- Laboratory for Neurophysiology, Department of Cellular and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Eline R. De Groot
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Daniel C. Vijlbrief
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Luc J. M. Schlangen
- Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Yvonne A. W. De Kort
- Department of Industrial Engineering and Innovation Sciences, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Marijn J. Vermeulen
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC—Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Demy Van Gilst
- Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, Erasmus MC—Sophia Children’s Hospital, Rotterdam, Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Laura Kervezee
- Laboratory for Neurophysiology, Department of Cellular and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
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Bringel JMDA, Abreu I, Muniz MCMC, de Almeida PC, Silva MRG. Excessive Noise in Neonatal Units and the Occupational Stress Experienced by Healthcare Professionals: An Assessment of Burnout and Measurement of Cortisol Levels. Healthcare (Basel) 2023; 11:2002. [PMID: 37510443 PMCID: PMC10379383 DOI: 10.3390/healthcare11142002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
Excessive noise in the work environment has been associated with extra-auditory symptoms, which can have harmful long-term effects on individuals. The purpose of this study was to identify noise levels in neonatal intensive care units and investigate their impact on the occurrence of stress among healthcare professionals, using cortisol levels as a biomarker for Burnout Syndrome. This descriptive, observational, and cross-sectional study was conducted in four public teaching hospitals in Fortaleza, Ceará, Brazil. Sound pressure levels in the environment were measured, and questionnaires were administered to collect sociodemographic data and assess perceptions of the work environment and Burnout symptoms. Saliva samples were collected at the beginning and end of work shifts for cortisol quantification. The average sound pressure ranged from 59.9 to 66.4 dB(A), exceeding the recommended levels set by Brazilian and international legislation. Among the 256 participants, the average age was 39.4 years, with 95% being female. The majority (70.9%) were nurses, and 22.7% were physicians. There was no significant association found between noise and Burnout Syndrome, nor with changes in cortisol levels. However, a significant association was observed between the perception of excessive noise and the sensation of a stressful work shift (p = 0.012). All evaluated professionals displayed symptoms of Burnout. The high sound pressure levels indicated that the assessed environments did not meet the recommended standards for acoustic comfort, and this was associated with the participants' perception of stressful work shifts. While Burnout symptoms were evident in our participants, it was not possible to confirm a correlation with high noise levels.
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Affiliation(s)
| | - Isabel Abreu
- Faculty of Science and Technology, University Fernando Pessoa, 4249-004 Porto, Portugal
- FP-I3ID, University Fernando Pessoa, 4249-004 Porto, Portugal
| | | | - Paulo César de Almeida
- Postgraduate Program in Clinical Health Care Nursing, Universidade Estadual do Ceará, Fortaleza 60714-903, Brazil
| | - Maria-Raquel G Silva
- FP-I3ID, University Fernando Pessoa, 4249-004 Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, 4200-150 Porto, Portugal
- CIAS-Research Centre for Anthropology and Health-Human Biology, Health and Society, University of Coimbra, 3000-456 Coimbra, Portugal
- CHRC-Comprehensive Health Research Centre, Nova Medical School, Nova University of Lisbon, 1150-090 Lisbon, Portugal
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Restin T, Gaspar M, Bassler D, Kurtcuoglu V, Scholkmann F, Haslbeck FB. Newborn Incubators Do Not Protect from High Noise Levels in the Neonatal Intensive Care Unit and Are Relevant Noise Sources by Themselves. CHILDREN (BASEL, SWITZERLAND) 2021; 8:704. [PMID: 34438595 PMCID: PMC8394397 DOI: 10.3390/children8080704] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND While meaningful sound exposure has been shown to be important for newborn development, an excess of noise can delay the proper development of the auditory cortex. AIM The aim of this study was to assess the acoustic environment of a preterm baby in an incubator on a newborn intensive care unit (NICU). METHODS An empty but running incubator (Giraffe Omnibed, GE Healthcare) was used to evaluate the incubator frequency response with 60 measurements. In addition, a full day and night period outside and inside the incubator at the NICU of the University Hospital Zurich was acoustically analyzed. RESULTS The fan construction inside the incubator generates noise in the frequency range of 1.3-1.5 kHz with a weighted sound pressure level (SPL) of 40.5 dB(A). The construction of the incubator narrows the transmitted frequency spectrum of sound entering the incubator to lower frequencies, but it does not attenuate transient noises such as alarms or opening and closing of cabinet doors substantially. Alarms, as generated by the monitors, the incubator, and additional devices, still pass to the newborn. CONCLUSIONS The incubator does protect only insufficiently from noise coming from the NICUThe transmitted frequency spectrum is changed, limiting the impact of NICU noise on the neonate, but also limiting the neonate's perception of voices. The incubator, in particular its fan, as well as alarms from patient monitors are major sources of noise. Further optimizations with regard to the sound exposure in the NICU, as well as studies on the role of the incubator as a source and modulator, are needed to meet the preterm infants' multi-sensory needs.
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Affiliation(s)
- Tanja Restin
- Department of Neonatology, Newborn Research Zurich, University Hospital Zurich, 8091 Zurich, Switzerland; (D.B.); (F.S.); (F.B.H.)
- Institute of Physiology, University of Zurich, 8057 Zurich, Switzerland; (M.G.); (V.K.)
| | - Mikael Gaspar
- Institute of Physiology, University of Zurich, 8057 Zurich, Switzerland; (M.G.); (V.K.)
| | - Dirk Bassler
- Department of Neonatology, Newborn Research Zurich, University Hospital Zurich, 8091 Zurich, Switzerland; (D.B.); (F.S.); (F.B.H.)
| | - Vartan Kurtcuoglu
- Institute of Physiology, University of Zurich, 8057 Zurich, Switzerland; (M.G.); (V.K.)
| | - Felix Scholkmann
- Department of Neonatology, Newborn Research Zurich, University Hospital Zurich, 8091 Zurich, Switzerland; (D.B.); (F.S.); (F.B.H.)
| | - Friederike Barbara Haslbeck
- Department of Neonatology, Newborn Research Zurich, University Hospital Zurich, 8091 Zurich, Switzerland; (D.B.); (F.S.); (F.B.H.)
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