Characterizing noise and perceived work environment in a neurological intensive care unit

Reduction of sound levels in the intermediate care unit; a quasi-experimental time-series design study

OBJECTIVES

This study aimed to assess the effectiveness of an architectural redesign and a multicomponent intervention bundle on noise reduction to enhance workplace safety.

METHODS/DESIGN

Quasi-experimental study with a time-series and intensified intervention design conducted in an intermediate care unit. Two interventions were sequential introduced: the installation of a partition wall in the medication preparation room (architectural redesign) and the implementation of an a bundle. Effects on outcomes were evaluated comparing baseline, after architectural redesign (period-1) and after implementation of the bundle (period-2).

SETTING

Intermediate care unit.

MAIN OUTCOME MEASURES

A-weighted sound levels (LAeq), alarms/day/bed, annoyance ratings (numeric rating scale 0-10) and number of distractions of nurses during the medication preparation process.

RESULTS

LAeq baseline vs period-1, decreased in the medication preparation area from 56.8 (±5.0) to 53.7 (±7.2) dBA (p < 0.001) and in the nursing station from 56.8 (±5.0) to 54.3 (±4.0) dBA (p < 0.001). During period-2, further noise reduction was minimal to absent. Distractions decreased from 58 % during baseline to 45 % (p < 0.001) during period-1, with no further reduction during period-2. The median [IQR] number of alarms/day/bed increased from 263 [IQR 193-320] during baseline to 394 [IQR 258-474] during period-1 (p < 0.001), then decreased to 303 [IQR 264-370] (p < 0.05) during period-2. Median annoyance ratings decreased from baseline 3.0 [IQR 2.0-6.0] to 2.0 [IQR 1.0-3.0] (p < 0.001) during period-2.

CONCLUSION

An architectural redesign resulted in a significant, clinically relevant decrease in sound levels along with a notable reduction in distractions. The multicomponent bundle lowered alarms and annoyance ratings; however, its effectiveness on other outcomes seems less persuasive.

IMPLICATIONS FOR CLINICAL PRACTICE

Architectural redesign seems to be effective in controlling environmental noise. Architectural redesign results in a decrease in nurses' distractions during the medication preparation process. The effect of an intervention bundle is, despite a positive effect on alarms and perceived annoyance, still insufficiently clear.

Decibels in the operating theatre: a study of noise levels during surgical procedures

BACKGROUND

Exposure to excessive noise volumes is an occupational health and safety risk. Australian guidelines recommend a time weighted exposure maximum of 85 dB (dB) or a maximum peak noise level of up to 140 dB, as chronic and repeated high dB exposure can result in significant hearing impairment. The aim of this study was to assess the volume of noise generated by common surgical instruments while utilizing the National Institute for Occupational Safety and Health (NIOSH) app.

METHODS

Sound levels were measured using the NIOSH app. The NIOSH app was used to take equivalent continuous A-weighted sound levels (LAeq) and the C-weighted peak sound pressure (LCpeak) measurements for specific instruments while in use in theatre. A minimum of three readings per instrument were taken at immediate and working distances.

RESULTS

LAeq measurements ranged from 62.9 to 89.3 dB. The Padgett Dermatome and Frazier Sucker exceeded recommended exposure limits with an averaged LAeq reading of 85.7 dB(A) and 85.1 dB(A) respectively. LCpeak readings ranged from 89.9 to 114.7 dB(C) with none of the instruments exceeding a peak sound level beyond the recommended level of 140 dB(C).

CONCLUSION

The cumulative effect of loud surgical instruments across prolonged or combined operations may result in theatre staff being exposed to hazardous noise levels, impacting the health and wellbeing of staff, staff performance and patient care. Utilization of a phone app can improve the awareness of noise pollution in theatres, thereby empowering staff to be proactive about their health and improvement of their work environment.

The Working Environment in Primary Healthcare Outpatient Facilities: Assessment of Physical Factors and Health Professionals' Perceptions of Working Environment Conditions

The objectives of this study were to assess the adequacy of physical parameters/factors (temperature, relative humidity, noise, and illuminance levels) of the work environment in PHC facilities, to evaluate the association between the adequacy of these measured physical parameters and the physical characteristics of the PHC facilities and their surroundings and to assess the association between health professionals' perceptions about exposure to physical risks in the PHC work environment and the adequacy of physical parameters measured in the same facilities. The study monitored 23 PHC facilities in southern Brazil and interviewed 210 health professionals. Data analysis involved Pearson's chi-square, Fisher's exact test, Spearman's correlation, and multivariate linear regression analysis was used to control for confounding factors. The significance level was set at 5% (p ≤ 0.05). The combination of temperature and relative humidity presented thermal comfort levels outside the adopted criteria for adequacy in consultation (outdoor relative humidity, p = 0.013) and procedure rooms (front door open, p = 0.034). Inadequate sound comfort (noise) levels in the morning shift were found in the vaccination (front door open, p = 0.021) and consultation rooms (movement of people, p = 0.016). In PHC facilities where reception rooms had insufficient lighting, internal curtains were opened less frequently (p = 0.047). The analysis of health professionals' perceptions of physical factors demonstrated that physicians more frequently perceive the physical risk of temperature and humidity (p = 0.044). The higher the number of nurses (p = 0.004) and oral health technicians in the PHC facilities (p = 0.031), the greater the general percentage of adequacy of monitored physical parameters. It was also confirmed that the higher the perception of moderate or severe physical risk among health professionals, the lower the general percentage of the adequacy of the physical parameters of the work environment of the PHC facilities evaluated (rs = -0.450, p = 0.031). This study's evidence contributes to a better understanding of physical conditions and future occupational interventions to ensure the comfort, safety, and well-being of PHC workers.

Machine Alarm Fatigue among Hemodialysis Nurses in 29 Tertiary Hospitals

OBJECTIVES

 To understand the status quo and related influencing factors of machine alarm fatigue of hemodialysis nurses in tertiary hospitals in Liaoning Province.

METHODS

 This cross-sectional study employed convenience sampling to select 460 nurses from 29 tertiary hospitals in Liaoning Province, who are involved in hemodialysis care. Surveys were conducted using the General Information Questionnaire, Alarm Fatigue Scale, National Aeronautics and Space Administration Task Load Index, and Maslach Burnout Inventory Scale.

RESULTS

 The overall machine alarm fatigue score for 460 hemodialysis nurses from 29 tertiary hospitals in Liaoning Province was 17.04 ± 3.21, indicating a moderate level. The multiple linear regression analysis shows that years of experience in hemodialysis nursing, the number of patients managed per shift, whether specialized nursing training has been received, self-reported health status, emotional exhaustion, and workload have statistically significant associations with alarm fatigue among hemodialysis nurses (p < 0.05). Among them, the years of experience in hemodialysis nursing are negatively correlated with alarm fatigue among hemodialysis nurses, whereas the number of patients managed per shift and workload are positively correlated with alarm fatigue among hemodialysis nurses.

CONCLUSION

 This study indicates that certain demographic factors, workload, and occupational burnout are associated with machine alarm fatigue among hemodialysis nurses. Therefore, hemodialysis-related managers should establish a Machine Alarm Management System, implement Personalized Thresholds and Delayed Alarms, ensure reasonable staffing arrangements, improve compassion fatigue, and enhance anticipatory care. Our findings have implications for improving the health and well-being of hemodialysis nurses, providing a conducive environment for professional training in hemodialysis, and ultimately addressing the current situation of machine alarm fatigue among hemodialysis nurses.

Managing acoustic noise within MRI: A qualitative interview study among Swedish radiographers

INTRODUCTION

Acoustic noise from magnetic resonance imaging (MRI) can cause hearing loss and needs to be mitigated to ensure the safety of patients and personnel. Capturing MR personnel's insights is crucial for guiding the development and future applications of noise-reduction technology. This study aimed to explore how MR radiographers manage acoustic noise in clinical MR settings.

METHODS

Using a qualitative design, we conducted semi-structured individual interviews with fifteen MR radiographers from fifteen hospitals around Sweden. We focused on the clinical implications of participants' noise management, using an interpretive description approach. We also identified sociotechnical interactions between People, Environment, Tools, and Tasks (PETT) by adopting a Human Factors/Ergonomics framework. Interview data were analyzed inductively with thematic analysis (Braun and Clarke).

RESULTS

The analysis generated three main themes regarding MR radiographers' noise management: (I) Navigating Occupational Noise: Risk Management and Adaptation; (II) Protecting the Patient and Serving the Exam, and (III) Establishing a Safe Healthcare Environment with Organizational Support.

CONCLUSION

This study offers insights into radiographers' experiences of managing acoustic noise within MRI, and the associated challenges. Radiographers have adopted multiple strategies to protect patients and themselves from adverse noise-related effects. However, they require tools and support to manage this effectively, suggesting a need for organizations to adopt more proactive, holistic approaches to safety initiatives.

IMPLICATIONS FOR PRACTICE

The radiographers stressed the importance of a soundproofed work environment to minimize occupational adverse health effects and preserve work performance. They acknowledge noise as a common contributor to patient distress and discomfort. Providing options like earplugs, headphones, mold putty, software-optimized "quiet" sequences, and patient information were important tools. Fostering a safety culture requires proactive safety efforts and support from colleagues and management.

Managing Circadian Disruption due to Hospitalization: A Pilot Randomized Controlled Trial of the CircadianCare Inpatient Management System

The objective of the present study was to test the effects of an inpatient management system (CircadianCare) aimed at limiting the negative impact of hospitalization on sleep by enhancing circadian rhythmicity. Fifty inpatients were randomized to either CircadianCare (n = 25; 18 males, 62.4 ± 1.9 years) or standard of care (n = 25; 14 males, 64.5 ± 2.3 years). On admission, all underwent a full sleep-wake evaluation; they then completed daily sleep diaries and wore an actigraph for the whole length of hospitalization. On days 1 (T0), 7 (T1), and 14 (T2, if still hospitalized), salivary melatonin for dim light melatonin onset (DLMO) and 24-h skin temperature were recorded. In addition, environmental noise, temperature, and illuminance were monitored. Patients in the CircadianCare arm followed 1 of 3 schedules for light/dark, meal, and physical activity timings, based on their diurnal preference/habits. They wore short-wavelength-enriched light-emitting glasses for 45 min after awakening and short-wavelength light filter shades from 18:00 h until sleep onset. While the first, primary registered outcome (reduced sleep-onset latency on actigraphy or diary) was not met, based on sleep diaries, there was a trend (0.05 < p < 0.1) toward an advance in bedtime for CircadianCare compared to standard of care patients between T0 and T1. Similarly, DLMO time significantly advanced in the small group of patients for whom it could be computed on both occasions, with untreated ones starting from earlier baseline values. Patients sleeping near the window had significantly higher sleep efficiency, regardless of treatment arm. As noise fluctuation increased, so did the number of night awakenings, regardless of treatment arm. In conclusion, the CircadianCare management system showed positive results in terms of advancing sleep timing and the circadian rhythm of melatonin. Furthermore, our study identified a combination of environmental noise and lighting indices, which could be easily modulated to prevent hospitalization-related insomnia.

Noise levels and annoyance among staff in a tertiary care hospital in North India: A cross-sectional study

Hospital noise has remained a low priority problem in India. An area of not less than 100 meters around a hospital is considered a silence zone, with guidelines restricting noise levels at 50dBA during daytime and 40dBA during the night. World Health Organization (WHO) guidelines also stipulate an average of 30dBA and a maximum of 40dbA. Annoyance is a known effect of noise exposure. However, very few studies have attempted to explore the hospital soundscape and the annoyance among staff related to it. Noise data was collected from 30 sites, using a Digital Integrating Sound Level Meter, LutronSL-4035SD (ISO-9001,CE,IEC1010) meeting IEC61672 standards. Stratified random sampling of staff was done on basis of noise exposure. A pre-designed, semi-structured questionnaire collected information on sociodemographic and work profile. Annoyance was defined as a stress reaction to environmental noise and was measured using standardized general purpose noise reaction questionnaire (ISO-TS/15666). Data was analyzed in SPSS. The mean LAeq 24 h across all the sites was 69.5dBA (SD ±5.8dBA) for the weekdays and 66.2dBA (SD ±4.6dBA) for the weekends. Noise levels were higher during the day than during the night, and higher during the weekdays as compared to the weekends. 332(73.8%) study participants were found to be annoyed due to hospital noise. Annoyance among study participants was significantly associated with LAeq 24 h > 80 dBA during the weekdays [aOR = 5.08 (1.17-22.06)] and LAeq 24 h of 65-80 dBA during the weekends [aOR = 2.71 (1.46-5.01)]. Noise levels in the hospital far exceeded WHO and Central Pollution Control Board (CPCB) guidelines recommended for indoor hospital noise, as well as the national guidelines for sensitive zones. Almost three-fourth of the study participants were annoyed due to hospital noise. Significant association was found between annoyance among staff and higher noise levels of their workplace. Similar studies need to be conducted in hospitals across India to generate evidence on the current situtation and identify solutions.

Noise exposure among staff in intensive care units and the effects of unit-based noise management: a monocentric prospective longitudinal study

BACKGROUND

Intensive care units (ICUs) are often too noisy, exceeding 70-80 dBA, which can have negative effects on staff. The corresponding recommendation of the World Health Organization (average sound pressure level below 35 dBA) is often not achieved. To date there is a lack of intervention studies examining the extent to which unit-based noise management in ICUs contributes to a reduction in noise exposure for the staff. The study therefore aims to provide answers to 1) how unit-based noise management sustainably reduces the subjective noise exposure among staff, and 2) how this intervention affects other noise-related topics.

METHODS

We performed a monocentric prospective longitudinal study with three measurement points in a German university hospital in three ICUs. We collected data from different healthcare professionals and other professional groups between October 2021 and August 2022 using an online questionnaire. Data were analyzed using descriptive and inference statistics.

RESULTS

A total of n = 179 participants took part in the surveys. The majority of participants were nurses or pediatric nurses. Most participants worked more than 75% full-time equivalent. Staff on the three ICUs reported high levels of noise exposure. No significant changes in noise exposure over time were observed. Participants were already aware of the topic and believed that a behavior change could positively influence the noise environment.

CONCLUSIONS

This study provides an initial insight into how a unit-based noise management could contribute to a reduction in the subjective noise exposure among staff in ICUs. The results of this study highlight the importance of this topic. Future studies should aim to research aspects of adherence and their facilitators or barriers, which promote the sustained implementation of noise-reducing measures by staff.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS): DRKS00025835; Date of registration: 12.08.2021.

Evaluation of the sensory environment in a large tertiary ICU

BACKGROUND

ICU survival is improving. However, many patients leave ICU with ongoing cognitive, physical, and/or psychological impairments and reduced quality of life. Many of the reasons for these ongoing problems are unmodifiable; however, some are linked with the ICU environment. Suboptimal lighting and excessive noise contribute to a loss of circadian rhythms and sleep disruptions, leading to increased mortality and morbidity. Despite long-standing awareness of these problems, meaningful ICU redesign is yet to be realised, and the 'ideal' ICU design is likely to be unique to local context and patient cohorts. To inform the co-design of an improved ICU environment, this study completed a detailed evaluation of the ICU environment, focussing on acoustics, sound, and light.

METHODS

This was an observational study of the lighting and acoustic environment using sensors and formal evaluations. Selected bedspaces, chosen to represent different types of bedspaces in the ICU, were monitored during prolonged study periods. Data were analysed descriptively using Microsoft Excel.

RESULTS

Two of the three monitored bedspaces showed a limited difference in lighting levels across the day, with average daytime light intensity not exceeding 300 Lux. In bedspaces with a window, the spectral power distribution (but not intensity) of the light was similar to natural light when all ceiling lights were off. However, when the ceiling lights were on, the spectral power distribution was similar between bedspaces with and without windows. Average sound levels in the study bedspaces were 63.75, 56.80, and 59.71 dBA, with the single room being noisier than the two open-plan bedspaces. There were multiple occasions of peak sound levels > 80 dBA recorded, with the maximum sound level recorded being > 105 dBA. We recorded one new monitor or ventilator alarm commencing every 69 s in each bedspace, with only 5% of alarms actioned. Acoustic testing showed poor sound absorption and blocking.

CONCLUSIONS

This study corroborates other studies confirming that the lighting and acoustic environments in the study ICU were suboptimal, potentially contributing to adverse patient outcomes. This manuscript discusses potential solutions to identified problems. Future studies are required to evaluate whether an optimised ICU environment positively impacts patient outcomes.

A grounded theory study of alarm fatigue among nurses in intensive care units

OBJECTIVES

The aim of this study was to explore the process of how nurses experienced and dealt with alarm fatigue in intensive care units based on Iranian nurses' perceptions and experiences.

BACKGROUND

Alarm fatigue is the overstimulation of senses due to the constant ringing of alarms in intensive care units. It is associated with nurses' desensitization to critical alarms that can directly influence patient safety and quality of care.

METHODS

A qualitative exploratory study using the grounded theory approach by Strauss and Corbin was carried out. Participants were 20 nurses working in intensive care units. The sampling process was started purposively and continued theoretically. Data were collected using semi-structured, in-depth, and individual interviews and continued to data saturation. The constant comparative analysis approach was used consisting of the following steps: open coding, developing concepts, analysing the context, entering the process into data analysis, integrating categories.

FINDINGS

The participants' main concern in the exposure to alarm fatigue was 'threat to personal balance'. The core category in this research was 'trying to create a holistic balance', which reflected a set of strategies that the nurses consistently and continuously used to deal with alarm fatigue and consisted of four main categories as follows: 'smart care', 'deliberate balancing', 'conditional prioritisation', and 'negligent performance'. Threat to personal balance was strengthened by 'inappropriate circuit of individual roles', 'distortion of the organisational structure', and 'insecurity of the infrastructure'. The consequences of this process was harm to the patient, burnout among nurse, and damage to the healthcare organisation.

CONCLUSIONS

The research findings have practical implications for healthcare management, policymaking, nursing education, research, and clinical practice. Mitigating staff shortages, improving staff competencies, enhancing nurses' authority for responding to alarms, modifying care routines, improving the physical environment, and removing problems related to alarm equipment can prevent alarm fatigue and its unappropriated consequences.

Relating clustered noise data to hospital patient satisfaction

Hospital noise can be problematic for both patients and staff and consistently is rated poorly on national patient satisfaction surveys. A surge of research in the last two decades highlights the challenges of healthcare acoustic environments. However, existing research commonly relies on conventional noise metrics such as equivalent sound pressure level, which may be insufficient to fully characterize the fluctuating and complex nature of the hospital acoustic environments experienced by occupants. In this study, unsupervised machine learning clustering techniques were used to extract patterns of activity in noise and the relationship to patient perception. Specifically, nine patient rooms in three adult inpatient hospital units were acoustically measured for 24 h and unsupervised machine learning clustering techniques were applied to provide a more detailed statistical analysis of the acoustic environment. Validation results of five different clustering models found two clusters, labeled active and non-active, using k-means. Additional insight from this analysis includes the ability to calculate how often a room is active or non-active during the measurement period. While conventional LAeq was not significantly related to patient perception, novel metrics calculated from clustered data were significant. Specifically, lower patient satisfaction was correlated with higher Active Sound Levels, higher Total Percent Active, and lower Percent Quiet at Night metrics. Overall, applying statistical clustering to the hospital acoustic environment offers new insights into how patterns of background noise over time are relevant to occupant perception.

Characterization of sound pressure levels and sound sources in the intensive care unit: a 1 week observational study

Background

Exposure to elevated sound pressure levels within the intensive care unit is known to negatively affect patient and staff health. In the past, interventions to address this problem have been unsuccessful as there is no conclusive evidence on the severity of each sound source and their role on the overall sound pressure levels. Therefore, the goal of the study was to perform a continuous 1 week recording to characterize the sound pressure levels and identify negative sound sources in this setting.

Methods

In this prospective, systematic, and quantitative observational study, the sound pressure levels and sound sources were continuously recorded in a mixed medical-surgical intensive care unit over 1 week. Measurements were conducted using four sound level meters and a human observer present in the room noting all sound sources arising from two beds.

Results

The mean 8 h sound pressure level was significantly higher during the day (52.01 ± 1.75 dBA) and evening (50.92 ± 1.66 dBA) shifts than during the night shift (47.57 ± 2.23; F(2, 19) = 11.80, p < 0.001). No significant difference was found in the maximum and minimum mean 8 h sound pressure levels between the work shifts. However, there was a significant difference between the two beds in the based on location during the day (F(3, 28) = 3.91, p = 0.0189) and evening (F(3, 24) = 5.66, p = 0.00445) shifts. Cleaning of the patient area, admission and discharge activities, and renal interventions (e.g., dialysis) contributed the most to the overall sound pressure levels, with staff talking occurring most frequently.

Conclusion

Our study was able to identify that continuous maintenance of the patient area, patient admission and discharge, and renal interventions were responsible for the greatest contribution to the sound pressure levels. Moreover, while staff talking was not found to significantly contribute to the sound pressure levels, it was found to be the most frequently occurring activity which may indirectly influence patient wellbeing. Overall, identifying these sound sources can have a meaningful impact on patients and staff by identifying targets for future interventions, thus leading to a healthier environment.

The Effectiveness of the Interventions to Reduce Sound Levels in the ICU: A Systematic Review

Excessive noise is ubiquitous in the ICU, and there is growing evidence of the negative impact on work performance of caregivers. This study aims to determine the effectiveness of interventions to reduce noise in the ICU.

DATA SOURCES

Databases of PubMed, EMBASE, PsychINFO, CINAHL, and Web of Science were systematically searched from inception to September 14, 2022.

STUDY SELECTION

Two independent reviewers assessed titles and abstracts against study eligibility criteria. Noise mitigating ICU studies were included when having at least one quantitative acoustic outcome measure expressed in A-weighted sound pressure level with an experimental, quasi-experimental, or observational design. Discrepancies were resolved by consensus, and a third independent reviewer adjudicated as necessary.

DATA EXTRACTION

After title, abstract, and full-text selection, two reviewers independently assessed the quality of each study using the Cochrane's Risk Of Bias In Nonrandomized Studies of Interventions tool. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, and interventions were summarized.

DATA SYNTHESIS

After screening 12,652 articles, 25 articles were included, comprising either a mixed group of healthcare professionals (n = 17) or only nurses (n = 8) from adult or PICU settings. Overall, the methodological quality of the studies was low. Noise reduction interventions were categorized into education (n = 4), warning devices (n = 3), multicomponent programs (n = 15), and architectural redesign (n = 3). Education, a noise warning device, and an architectural redesign significantly decreased the sound pressure levels.

CONCLUSIONS

Staff education and visual alert systems seem promising interventions to reduce noise with a short-term effect. The evidence of the studied multicomponent intervention studies, which may lead to the best results, is still low. Therefore, high-quality studies with a low risk of bias and a long-term follow-up are warranted. Embedding noise shielding within the ICU-redesign is supportive to reduce sound pressure levels.

The experience of noise in communication-intense workplaces: A qualitative study

OBJECTIVE

The aim of the study was to explore and describe how workers in communication-intense workplaces in health care and preschools experience the sound environment. The dependence on vocal communication and social interaction poses a challenge using hearing protection in these working environments.

METHOD

A qualitative method was used, more specifically inductive thematic analysis was used, as this approach was deemed suitable to explore the staff's experiences of the sound environment. Data were collected by interviews and to increase trustworthiness, several researchers were involved in the data collection and analysis.

STUDY SAMPLE

Workers from two preschools, one obstetrics ward and one intensive care unit took part in the study.

RESULTS

Four main themes emerged from the thematic analysis: A challenging and harmful sound environment; Health-related effects of a challenging and harmful sound environment; A good sound environment is not prioritised; and Resourceful and motivated staff.

CONCLUSIONS

Workers in communication-intense workplaces in preschools, obstetrics care and intensive care reported that there was a relationship between the sound environment and negative health effects. In addition, the results suggests that the high motivation for change among staff should be utilised together with an increased prioritization from the management to reach innovative context specific improvements to the sound environment in communication intense working environments.

Perceived sounds and their reported level of disturbance in intensive care units: A multinational survey among healthcare professionals

PURPOSE

The noise levels in intensive care units have been repeatedly reported to exceed the recommended guidelines and yield negative health outcomes among healthcare professionals. However, it is unclear which sound sources within this environment are perceived as disturbing. Therefore, this study aimed to evaluate how healthcare professionals in Germany, Switzerland, and Austria perceive the sound levels and the associated sound sources within their work environment and explore sound reduction strategies.

MATERIAL AND METHODS

An online survey was conducted among 350 healthcare professionals working in intensive care units. The survey consisted of items on demographic and hospital data and questions about the perception of the sound levels [1 (strongly disagree) to 5 (strongly agree)], disturbance from sound sources [1 (not disturbing at all) to 5 (very disturbing)], and implementation potential, feasibility, and motivation to reduce sound reduction measures [1 (not high at all) to 5 (very high)].

RESULTS

Approximately 69.3% of the healthcare professionals perceived the sound levels in the ICUs as too high. Short-lasting human sounds (e.g. moans or laughs) [mean (M) ± standard deviation (SD) = 3.30 ± 0.81], devices and alarms (M ± SD = 2.67 ± 0.59), and short-lasting object sounds (M ± SD = 2.55 ± 0.68) were perceived as the most disturbing sounds. Reducing medical equipment alarms was considered to have greater implementation potential [M ± SD = 3.62 ± 0.92, t(334) = -7.30, p < 0.001], feasibility [M ± SD = 3.19 ± 0.93, t(334) = -11.02, p < 0.001], and motivation [M ± SD = 3.85 ± 0.89, t(334) = -10.10, p < 0.001] for reducing the sound levels.

CONCLUSION

This study showed that healthcare professionals perceive short-lasting human sounds as most disturbing and rated reducing medical equipment alarms as the best approach to reduce the sound levels in terms of potential, feasibility, and motivation for implementation.

Noise in ICUs: Review and Detailed Analysis of Long-Term SPL Monitoring in ICUs in Northern Spain

Intensive care units (ICUs) are busy and noisy areas where patients and professional staff can be exposed to acoustic noise for long periods of time. In many cases, noise levels significantly exceed the levels recommended by the official health organisations. This situation can affect not only patient recovery but also professional staff, making ICUs unhealthy work and treatment environments. To introduce the measures and reduce the acoustic noise in the ICU, acoustic noise levels should first be measured and then appropriately analysed. However, in most studies dealing with this problem, measurements have been performed manually over short periods, leading to limited data being collected. They are usually followed by insufficient analysis, which in turn results in inadequate measures and noise reduction. This paper reviews recent works dealing with the problem of excessively high noise levels in ICUs and proposes a more thorough analysis of measured data both in the time and frequency domains. Applied frequency domain analysis identifies the cyclic behaviour of the measured sound pressure levels (SPLs) and detects the dominant frequency components in the SPL time series. Moreover, statistical analyses are produced to depict the patterns and SPLs to which patients in ICUs are typically exposed during their stay in the ICU. It has been shown that the acoustic environment is very similar every night, while it can vary significantly during the day or evening periods. However, during most of the observed time, recorded SPLs were significantly above the prescribed values, indicating an urgent need for their control and reduction. To effectively tackle this problem, more detailed information about the nature of noise during each of the analysed periods of the day is needed. This issue will be addressed in the continuation of this project.

Intelligibility of medically related sentences in quiet, speech-shaped noise, and hospital noise

Noise in healthcare settings, such as hospitals, often exceeds levels recommended by health organizations. Although researchers and medical professionals have raised concerns about the effect of these noise levels on spoken communication, objective measures of behavioral intelligibility in hospital noise are lacking. Further, no studies of intelligibility in hospital noise used medically relevant terminology, which may differentially impact intelligibility compared to standard terminology in speech perception research and is essential for ensuring ecological validity. Here, intelligibility was measured using online testing for 69 young adult listeners in three listening conditions (i.e., quiet, speech-shaped noise, and hospital noise: 23 listeners per condition) for four sentence types. Three sentence types included medical terminology with varied lexical frequency and familiarity characteristics. A final sentence set included non-medically related sentences. Results showed that intelligibility was negatively impacted by both noise types with no significant difference between the hospital and speech-shaped noise. Medically related sentences were not less intelligible overall, but word recognition accuracy was significantly positively correlated with both lexical frequency and familiarity. These results support the need for continued research on how noise levels in healthcare settings in concert with less familiar medical terminology impact communications and ultimately health outcomes.

[Noise Reduction on the ICU]

Noise pollution in the intensive care unit is not only an omnipresent but also a considerable problem, both for patients and healthcare staff. There are a number of significant sources of noise that are at least partially responsible for the frequent and serious sleep disorders of intensive care unit patients. This has a negative impact on the recovery of intensive care patients and favours the occurrence of delirium, which can be associated with increased overall mortality. This article provides a summary of the current evidence on the occurrence of noise-associated consequences and possible options for reducing noise exposure in the intensive care unit and offers perspectives for improving treatment of intensive care patients.

Intensive Care Unit Built Environments: A Comprehensive Literature Review (2005-2020)

BACKGROUND

The intensive care environment in hospitals has been the subject of significant empirical and qualitative research in the 2005-2020 period. Particular attention has been devoted to the role of infection control, family engagement, staff performance, and the built environment ramifications of the recent COVID-19 global pandemic. A comprehensive review of this literature is reported summarizing recent advancements in this rapidly expanding body of knowledge.

PURPOSE AND AIM

This comprehensive review conceptually structures the recent medical intensive care literature to provide conceptual clarity and identify current priorities and future evidence-based research and design priorities.

METHOD AND RESULT

Each source reviewed was classified as one of the five types-opinion pieces/essays, cross-sectional empirical investigations, nonrandomized comparative investigations, randomized studies, and policy review essays-and into nine content categories: nature engagement and outdoor views; family accommodations; intensive care unit (ICU), neonatal ICU, and pediatric ICU spatial configuration and amenity; noise considerations; artificial and natural lighting; patient safety and infection control; portable critical care field hospitals and disaster mitigation facilities including COVID-19; ecological sustainability; and recent planning and design trends and prognostications.

CONCLUSIONS

Among the findings embodied in the 135 literature sources reviewed, single-bed ICU rooms have increasingly become the norm; family engagement in the ICU experience has increased; acknowledgment of the therapeutic role of staff amenities; exposure to nature, view, and natural daylight has increased; the importance of ecological sustainability; and pandemic concerns have increased significantly in the wake of the coronavirus pandemic. Discussion of the results of this comprehensive review includes topics noticeably overlooked or underinvestigated in the 2005-2020 period and priorities for future research.

An Energy Model for the Calculation of Room Acoustic Parameters in Rectangular Rooms with Absorbent Ceilings

The most common acoustical treatment of public rooms, such as schools, offices, and healthcare premises, is a suspended absorbent ceiling. The non-uniform distribution of the absorbent material, as well as the influence of sound-scattering objects such as furniture or other interior equipment, has to be taken into account when calculating room acoustic parameters. This requires additional information than what is already inherent in the statistical absorption coefficients and equivalent absorption areas provided by the reverberation chamber method ISO 354. Furthermore, the classical diffuse field assumption cannot be expected to be valid in these types of rooms. The non-isotropic sound field has to be considered. In this paper, a statistical energy analysis (SEA) model is derived. The sound field is subdivided into a grazing and non-grazing part where the grazing part refers to waves propagating almost parallel to the suspended ceiling. For estimation of all the inherent parameters in the model, the surface impedance of the suspended ceiling has to be known. A method for estimating the scattering and absorbing effects of furniture and objects is suggested in this paper. The room acoustical parameters reverberation time T20, speech clarity C50, and sound strength G were calculated with the model and compared with calculations according to the classical diffuse field model. Comparison with measurements were performed for a classroom configuration. With regard to all cases, the new model agrees better with measurements than the classical one.

"Noise Factory": A qualitative study exploring healthcare providers' perceptions of noise in the intensive care unit

OBJECTIVES

This study aimed to explore healthcare providers' perceptions of noise in the intensive care unit.

DESIGN

A qualitative exploratory study was conducted using group interviews.

SETTING

The setting comprised a total of 15 participants (five physicians and ten registered nurses) working in an 18-bed medical surgical intensive care unit at a teaching hospital in Istanbul, Turkey. Semi-structured questions were formulated and used in focus group interviews, after which the recorded interviews were transcribed by the researchers. Thematic analysis was used to identify significant statements and initial codes.

FINDINGS

Four themes were identified: the meaning of noise, sources of noise, effects of noise and prevention and management of noise. It was found that noise was an inevitable feature of the intensive care unit. The most common sources of noise were human-induced. It was also determined that device-induced noise, such as alarms, did not produce a lot of noise; however, when staff were late in responding, the sound transformed into noise. Furthermore, it was observed that efforts to decrease noise levels taken by staff had only a momentary effect, changing nothing in the long term because the entire team failed to implement any initiatives consistently. The majority of nurses stated that they were now becoming insensitive to the noise due to the constant exposure to device-induced noise.

CONCLUSION

The data obtained from this study showed that especially human-induced noise threatened healthcare providers' cognitive task functions, concentration and job performance, impaired communication and negatively affected patient safety. In addition, it was determined that any precautions taken to reduce noise were not fully effective. A team approach should be used in managing noise in intensive care units with better awareness.

Effects of patient-level noise abatement orders on sound levels experienced by critically ill subarachnoid hemorrhage patients: an observational study

BACKGROUND/OBJECTIVE

Patients with aneurysmal subarachnoid hemorrhage (aSAH) may be at risk for complications related to excessive environmental noise. Our ICU utilizes a variety of universal interventions to minimize ambient noise levels, but patients with aSAH additionally have specific orders intended to further minimize physiologic stress and noise exposure. It is unknown whether such orders can have a supplementary reductive effect on noise exposure.

METHODS

Sound levels were measured for at least three consecutive days in the rooms of 17 patients with aSAH and implemented 'subarachnoid precautions' orders. Sound levels were similarly recorded in the rooms of 11 geographically-proximate, critically-ill control patients without aSAH.

RESULTS

Linear mixed models were used to assess the difference in measurements between groups. Observations were combined into fifteen-minute windows, then group means and their differences were calculated and plotted to help identify what times of the day had significant differences. aSAH patients consistently experienced lower sound levels than control patients, with a statistically significant difference (p < 0.05) in mean sound levels at 62 of 96 intervals throughout the day. Overall, the mean sound level for aSAH patients was always between 62-63dBA, while the mean sound level experienced by control patients ranged between 64-66dBA.

CONCLUSIONS

Implementation of patient-specific orders can have a supplementary reductive effect on noise exposure for aSAH patients in an intensive care unit that already utilizes universal noise abatement interventions.

Noise pollution in hospitals - A study of public perception

Introduction:

Hospitals are categorized under silent zone, but noise pollution in this setup is inevitable. The noise in hospitals may have adverse effects on the patients, caregivers and professionals working in hospitals.

Aim:

The aim of the study was to determine awareness of public regarding noise pollution in hospitals, its health effects and mitigation measures.

Method:

The present study was an internet-based questionnaire survey. The questionnaire consisted of a common Section-I for all participants and an additional Section-II for participants of the study who were Audiologists. Descriptive statistical analysis was done on the acquired data.

Results:

174 completed questionnaires were received and analysed, out of which 108 were general public and 66 were Audiologists. The data analysis revealed that the public is aware of the presence of noise in hospitals, some of its overt health effects and measures that can be taken to control the noise pollution in hospitals. Only 22.7% Audiologists who participated in the study were aware of the more technical aspects like permissible noise level in hospitals and their response was similar to that of the general public.

Conclusion:

Though the public is aware of some of the basic facts related to noise in hospitals, there is a need to create public awareness and to train Audiologists regarding hearing conservation program in hospital setups.

Team-Based Intervention to Reduce the Impact of Nonactionable Alarms in an Adult Intensive Care Unit

BACKGROUND

Nonactionable alarms comprise over 70% of alarms and contribute a threat to patient safety. Few studies have reported approaches to translate and sustain these interventions in clinical settings.

PURPOSE

This study tested whether an interprofessional team-based approach can translate and implement effective alarm reduction interventions in the adult intensive care unit.

METHODS

The study was a prospective, cohort, pre- and postdesign with repeated measures at baseline (preintervention) and post-phase I and II intervention periods. The settings for the most prevalent nonactionable arrhythmia and bedside parameter alarms were adjusted during phases I and II, respectively.

RESULTS

The number of total alarms was reduced by 40% over a 14-day period after both intervention phases were implemented. The most prevalent nonactionable parameter alarms decreased by 47% and arrhythmia alarms decreased by 46%.

CONCLUSIONS

It is feasible to translate and sustain system-level alarm management interventions addressing alarm fatigue using an interprofessional team-based approach.

Noise in Maternity Wards: A Research on Its Contributors and Sources

AIMS

This research aimed to investigate the major user behavior patterns of noise sources in healthcare environments and summarize such information as evidence that can inform the design of maternity wards for indoor noise control and patients' well-being.

METHODS

Field investigations were conducted to identify users' behaviors as the major contributors of noises in the maternity wards of a typical hospital. A control experiment was set to test the feasibility of a noise control system that consisted of smart bracelets, mobile terminals, and monitors. Comparative studies were designed for statistical analysis of patients' sleep quality and satisfaction. Finally, a follow-up interview was conducted among the experts who were from the fields of healthcare environment design, medical treatments, and hospital administration to shed an insight into their concerns on the findings.

RESULTS

The enclosed waiting areas, instead of open ones that were often seen in hospitals, around the entrances of operation rooms, were considered as the appropriate design strategy for maternity wards in China. Such a design could keep patients from being exposed to the excessive noises generated by visitors during nighttime, although it would occupy the floor area of wards and lead to a reduction of beds. Moreover, the statistical information of patients' behaviors could be used to moderate visitors' behaviors.

CONCLUSIONS

It was necessary to include user behavior information in building information management and then make a good trade-off between the proportions of wards and enclosed waiting rooms in order to achieve a balance of medical efficiency and environmental satisfaction.

The evaluation of in-chamber sound levels during hyperbaric oxygen applications: Results of 41 centres

INTRODUCTION

Noise has physical and psychological effects on humans. Recommended exposure limits are exceeded in many hospital settings; however, information about sound levels in hyperbaric oxygen treatment chambers is lacking. This study measured in-chamber sound levels during treatments in Turkish hyperbaric centres.

METHODS

Sound levels were measured using a sound level meter (decibel meter). All chambers were multiplace with similar dimensions and shapes. Eight measurements were performed in each of 41 chambers; three during compression, three during decompression, and two at treatment pressure, one during chamber ventilation (flushing) and one without ventilation. At each measurement a sound sample was collected for 25 seconds and A-weighted equivalent (LA_eq) and C-weighted peak (LC_peak) levels were obtained. Recorded values were evaluated in relation to sound level limits in regulations.

RESULTS

The highest sound level measured in the study was 100.4 dB(A) at treatment pressure while ventilation was underway and the lowest was 40.5 dB(A) at treatment pressure without ventilation. Most centres had sound levels between 70 dB and 85 dB throughout the treatment. Ventilation caused significant augmentation of noise.

CONCLUSIONS

The chambers were generally safe in terms of noise exposure. Nevertheless, hyperbaric chambers can be very noisy environments so could pose a risk for noise-related health problems. Therefore, they should be equipped with appropriate noise control systems. Silencers are effective in reducing noise in chambers. Thus far, hyperbaric noise research has focused on chambers used for commercial diving. To our knowledge, this is the first study to investigate noise in hospital-based chambers during medical treatments.

Noise levels in an academic veterinary intensive care unit

OBJECTIVE

To quantify the noise levels in a veterinary Intensive Care Unit (ICU) and ascertain how they compare to current recommendations in the human literature.

DESIGN

A Larson Davis SoundTrack LXT Sound Meter device measured noise levels in a veterinary ICU for 41 days.

SETTING

Specialty referral academic small animal teaching hospital ICU.

ANIMALS

Passive involvement of dogs and cats housed in the ICU during the study period of 41 days.

INTERVENTIONS

No alterations to the hospital environment or patient care were made.

MEASUREMENTS

A-weighted average (LAeq) and maximum decibel measurements (LFmax) were recorded. The data were analyzed to look for correlations in elevated noise levels with the number and type of patients hospitalized, the time of day, and whether it was a weekday or weekend.

MAIN RESULTS

The average, median, and maximum decibel levels measured in our ICU were 76.97 dB(A), 76.13 dB(A), and 86.54 dB(A), respectively, for the duration of this study. The time frames of 6:00 am to 9:00 am and 6:00 pm to 9:00 pm were associated with higher decibel levels in this study.

CONCLUSIONS

The noise levels recorded in this study exceed the World Health Organization recommendations for noise levels in hospital care settings and are higher than the previously reported elevated noise levels in 2 veterinary referral private practice ICUs. Increased noise levels in veterinary ICUs may have adverse effects on our veterinary patients and staff and warrant further investigation.

Effects of intensive care unit ambient sounds on healthcare professionals: results of an online survey and noise exposure in an experimental setting

BACKGROUND

Noise levels on intensive care units (ICUs) are typically elevated. While many studies reported negative effects of ICU ambient sounds on patients, only few investigated noise as a factor to influence well-being or performance in healthcare professionals.

METHODS

An online survey in the German-speaking part of Switzerland was conducted to assess how ICU soundscapes are subjectively perceived by healthcare professionals. The questionnaire was answered by 348 participants. Additionally, effects of noise on working memory performance were evaluated in an experimental noise exposure setting. Twenty-six healthcare professionals and 27 healthy controls performed a 2-back object-location task while being exposed to either ICU or pink noise.

RESULTS

Survey results demonstrate that a majority of participants was aware of heightened noise levels. Participants reported that mostly well-being, performance, and attention could be reduced, along with subjective annoyance and fatigue by ICU ambient sounds. Although no significant effects of noise exposure on working memory performance was observed, self-assessments revealed significantly higher stress levels, increased annoyance and distraction ratings as well as decreased confidence in performance after ICU-noise exposure.

CONCLUSION

Subjective assessments indicate that heightened noise levels on ICUs induce annoyance, with heightened stress levels, impaired well-being, and reduced performance being potential consequences. Empirical evidence with objective and physiological measures is warranted.

The intensive care unit environment from the perspective of medical, allied health and nursing clinicians: A qualitative study to inform design of the 'ideal' bedspace

BACKGROUND

While the impact of the intensive care environment on patients' experiences and outcomes has been extensively studied, relatively little research has examined the impact on clinicians and their provision of care in the intensive care unit (ICU). Understanding staff experience and views about the environment is needed to optimise the ICU environment, patient outcomes and staff wellbeing.

OBJECTIVE

The objective of this study was to inform design of an optimised intensive care bedspace by describing clinicians' views about the current environment, including experience, impact on performance of clinical duties, and experience and outcomes of patients and family members.

METHODS

A pragmatic, qualitative descriptive study was conducted, with data collected in focus groups and interviews with 30 intensive care clinicians at a large cardiothoracic specialist hospital and analysed using the framework approach.

RESULTS

Participants acknowledged that the busy and noisy ICU provided a suboptimal healing environment for patients, was confronting for visiting families and exposed clinicians to risk of psychological injury. The bedspace, described as small and cluttered, hindered provision of clinical care of various kinds and contributed to an increased risk of staff physical injuries. Participants noted that the bland, sterile environment, devoid of natural light and views of the outside world, negatively affected both staff and patients' mood and motivation. Aware of the potential benefits of natural light, cognitive stimulation and visually appealing environments for patients and families, clinicians were frustrated by their inability to personalise the bedspace. Some participants, while acknowledging the importance of family contact for patients, were concerned about the impact of visitors on care delivery, particularly within already crowded bedspaces, suggesting restrictions on visiting.

CONCLUSIONS

Intensive care clinicians perceive that the current intensive care environment is suboptimal for patients, their families and staff and may contribute to suboptimal patient outcomes. The intensive care bedspaces need to be redesigned to ensure they are built around the needs of the people using them. Optimisation is dependent on engaging all stakeholders in future design processes.

Contribution of alarm noise to average sound pressure levels in the ICU: An observational cross-sectional study

OBJECTIVES

To explore sound levels, alarm frequencies and the association between alarms and sound levels.

DESIGN

A single center observational cross-sectional study.

SETTING

Four intensive care units.

MAIN OUTCOME MEASURES

Contribution of alarms: red (life threatening), yellow (indicate excess of limits) and blue (technical) to sound pressure levels dB(A) at nursing stations.

RESULTS

Mean sound pressure levels differed significantly between day (56.1 ± 5.5), evening (55.1 ± 5.7) and night periods 53.6 ± 5.6; p < 0.01. 175,996 alarms were recorded of which 149,764 (85%) were yellow, 18,080 (10%) were red and 8,152 (5%) were blue. The mean sound levels without alarms (background) is 56.8 dB(A), with only red: 56.0 dB(A), only yellow: 55.6 dB(A), only blue: 56.0 dB(A) and mixed alarms: 56.3 dB(A). Yellow alarms (b = -0.93; 95% CI: -1.26 to -0.6; p < 0.001) were weakly but significantly associated with mean sound levels and lead to a slight decrease in noise level (1 dB), Red alarms (b = -0.3; 95% CI: -1.237 to 0.63; p = 0.52). The R Square of the model with all alarms was 0.01 (standard error of estimate, 6.9; p < 0.001).

CONCLUSIONS

Sound levels were high during all day-periods. Alarms exceeding limits occurred most frequently. However, the contribution of alarms to sound levels measured at the nursing station is clinically limited.

Associations between stressors and difficulty sleeping in critically ill patients admitted to the intensive care unit: a cohort study

Background

Patients admitted to the intensive care unit (ICU) experience sleep disruption caused by a variety of conditions, such as staff activities, alarms on monitors, and overall noise. In this study, we explored the relationship between noise and other factors associated with poor sleep quality in patients.

Methods

This was a prospective cohort study. We used the Richards–Campbell Sleep Questionnaire to explore sleep quality in a sample of patients admitted to the ICU of a private hospital. We measured the noise levels within each ICU three times a day. After each night during their ICU stay, patients were asked to complete a survey about sleep disturbances. These disturbances were classified as biological (such as anxiety or pain) and environmental factors (such as lighting and ICU noise).

Results

We interviewed 71 patients; 62% were men (mean age 54.46 years) and the mean length of stay was 8 days. Biological factors affected 36% and environmental factors affected 20% of the patients. The most common biological factor was anxiety symptoms, which affected 28% of the patients, and the most common environmental factor was noise, which affected 32.4%. The overall mean recorded noise level was 62.45 dB. Based on the patients’ responses, the environmental factors had a larger effect on patients’ sleep quality than biological factors. Patients who stayed more than 5 days reported less sleep disturbance. Patients younger than 55 years were more affected by environmental and biological factors than were those older than 55 years.

Conclusions

Patient quality of sleep in the ICU is associated with environmental factors such as noise and artificial lighting, as well as biological factors related to anxiety and pain. The noise level in the ICU is twice that recommended by international guides. Given the stronger influence of environmental factors, the use of earplugs or sleeping masks is recommended. The longer the hospital stay, the less these factors seem to affect patients’ sleep quality.

Research Outcomes of Implementing CEASE: An Innovative, Nurse-Driven, Evidence-Based, Patient-Customized Monitoring Bundle to Decrease Alarm Fatigue in the Intensive Care Unit/Step-down Unit

INTRODUCTION

The research literature is replete with evidence that alarm fatigue is a real phenomenon in the clinical practice environment and can lead to desensitization of the need to respond among nursing staff. A few studies attest to the effectiveness of incorporating parts of the American Association of Critical-Care Nurses recommended nursing practices for alarm management. No studies could be found measuring the effectiveness of the American Association of Critical-Care Nurses recommendations in their entirety or the effectiveness of a nursing-driven, evidence-based, patient-customized monitoring bundle.

PURPOSE/RESEARCH QUESTION

The purpose of this study was to describe the effect of implementing CEASE, a nurse-driven, evidence-based, patient-customized monitoring bundle on alarm fatigue. CEASE is an acronym for Communication, Electrodes (daily changes), Appropriateness (evaluation), Setup alarm parameters (patient customization), and Education (ongoing).

RESEARCH QUESTIONS

(1) In a 36-bed intensive care unit/step-down unit (ICU/SDU) with continuous hemodynamic and respiratory monitoring, does application of an evidence-based, patient-customized monitoring bundle compared with existing monitoring practice lead to less alarm fatigue as measured by the number of hemodynamic and respiratory monitoring alarms? (2) In a 36-bed ICU/SDU with continuous hemodynamic and respiratory monitoring, does application of an evidence-based, patient-customized monitoring bundle compared with existing monitoring practice lead to less alarm fatigue as measured by duration of alarms? and (3) In a 36-bed ICU/SDU with continuous hemodynamic and respiratory monitoring, does application of an evidence-based, patient-customized monitoring bundle compared with existing monitoring practice lead to less alarm fatigue as measured by nurse perception?

METHODS

This was an institutional review board approved exploratory, nonrandomized, pretest and posttest, 1-group, quasi-experimental study, without-comparators design describing difference in pretest and posttest measures following CEASE Bundle implementation. The study was conducted over a 6-month period. Convenience sample of 74 registered nurses staffing a 36-bed ICU/SDU using the CEASE Bundle participated. Preimplementation/postimplementation number of alarms and alarm duration time for a 30-day period were downloaded from the monitoring system and compared. Nurses completed an electronic 36-item Clinical Alarms Survey provided by the Healthcare Technology Foundation: 35 before implementation and 18 after implementation. Researchers measured CEASE alarm bundle adherence. χ and t-tests determined statistical significance.

RESULTS

Total number of monitoring alarms decreased 31% from 52 880 to 36 780 after CEASE Bundle implementation. Low-priority Level 1 alarms duration time significantly decreased 23 seconds (t = 1.994, P = .045). Level 2 duration time did not change. High-priority Level 3 alarms duration time significantly increased to 246 seconds (t = 4.432, P < .0001). CEASE alarm bundle adherence significantly improved to 22.4% (χ = 5.068, P = .0244). Nurses perceived a significant decrease in nuisance alarm occurrence (68% to 44%) postimplementation (χ = 3.243, P = .0417). No adverse patient events occurred.

CONCLUSIONS

Decreased total number of monitoring alarms improved nurse perception of alarm fatigue. Continued monitoring of CEASE Bundle adherence by nursing staff is required. Longer high-priority Level 3 alarms duration suggests need for further research.

Assessment Of Ambient-Noise Exposure Among Female Nurses In Surgical Cardiac Intensive Care Unit

PURPOSE

To measure noise levels in the Saud Albabtain Cardiac Center cardiac surgical intensive-care unit (CSICU) at different locations to find out the prevalence of noise-induced hearing loss among female nurses.

METHODS

Ambient CSICU noise was measured using a sound-level meter and personal noise dosimeter during morning and night shifts (12 hours each) for 30 days. An audiometry test and questionnaire were used to test nursing responses to noise levels.

RESULTS

Mean 12-hour average noise levels at the station during night shift were 60.3±7.1 dB(A) and inside rooms 62.48±8.02 dB(A). However, during morning shift 64.1±8.4 dB(A) in the rooms was recorded, while 68.8±8.2 dB(A) was recorded at the station, with a significant difference between the shifts (p<0.0001). ICU monitors recorded the highest noise-source levels of 82.7±5.3 dB(A). The lowest significant source was the suction machines, with an average of 67.1±12.5 dB(A). A significant correlation between decibel loss and nurse experience was observed.

CONCLUSION

Noise levels in the CSICU at Saud Albabtain Cardiac Center were higher than World Health Organization standards. CSICU nurses are exposed to noise levels that can affect their hearing capacity. Further research isneeded for effective medical device-alarm management.

Mapping sources of noise in an intensive care unit

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.

Evaluating hospital soundscapes to improve patient experience

Hospital soundscapes can be difficult environments to assess acoustically due to alarms, medical equipment, and the continuous activity within units. Routinely, patients perceive these soundscapes to be poor when rating their hospital experience on HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) surveys administered after discharge. In this study, five hospital units of widely varying HCAHPS "quietness" performance were analyzed. Sound pressure levels were measured in 15 patient rooms and 5 nursing stations over 24-h periods. HCAHPS "quietness of the hospital environment" patient survey data were correlated with measured acoustical data at a room-level, revealing acoustical metrics linked to patient perceptions of hospital soundscape conditions. Metrics found to be statistically correlated (p < 0.05) included the absolute LA_MIN levels in patient rooms, which found significantly higher HCAHPS quietness scores in units with average LA_MIN levels below 35 dBA, in addition to specific low frequency octave bands and occurrence rates. Many other standard acoustical metrics (such as LA_EQ, LA_MAX, LC_PEAK, and LA₉₀) were not found to be statistically correlated between measured acoustical data and HCAHPS quietness patient responses. Taken as a whole, this study provides insights into the potential relationships between hospital noise and patient satisfaction.

Mapping the noise in a Greek general hospital

Sound pressure levels were monitored in a general hospital, in Greece, at ten indoor locations and at three outdoor locations, in the yard of the building. The selected indoor locations are representative of distinct activities that are common in every hospital, such as the emergency department, patient wards and several supporting services, like washing the clothes or the dishes. Noise levels were highly variable in each monitoring location and depended on the activities in the room, such as conversations, medical equipment in use, analytical devices or other machinery in operation. The highest noise levels that were recorded were in the blood donation unit and in the laundry room (the L_10,8h was 73 and 79 dB(A) respectively), mainly due to the opening/closing of the metal lids of garbage bins in the first location and due to the wringing of the clothes in the second. Indoor background noise levels i.e. the L_95,8h values, were more than 55 dB(A) and higher than the respective outdoor values (except of the L_95,8h in one ward of the paediatric ward). The calculated average L_{EX, 8h} was 69.3 dB(A), below the European Union lower exposure action limit value, i.e. 87 dB(A), that was set to prevent hearing loss of the employees. However, noise levels in the wards, in the emergency and the outpatient department were above the values suggested by international guidelines for a healing environment. Sound spectra revealed peaks in frequencies that were representative of the sources of the noise and also the presence of low frequency noise components.

Noise in the intensive care unit and its influence on sleep quality: a multicenter observational study in Dutch intensive care units

BACKGROUND

High noise levels in the intensive care unit (ICU) are a well-known problem. Little is known about the effect of noise on sleep quality in ICU patients. The study aim is to determine the effect of noise on subjective sleep quality.

METHODS

This was a multicenter observational study in six Dutch ICUs. Noise recording equipment was installed in 2-4 rooms per ICU. Adult patients were eligible for the study 48 h after ICU admission and were followed up to maximum of five nights in the ICU. Exclusion criteria were presence of delirium and/or inability to be assessed for sleep quality. Sleep was evaluated using the Richards Campbell Sleep Questionnaire (range 0-100 mm). Noise recordings were used for analysis of various auditory parameters, including the number and duration of restorative periods. Hierarchical mixed model regression analysis was used to determine associations between noise and sleep.

RESULTS

In total, 64 patients (68% male), mean age 63.9 (± 11.7) years and mean Acute Physiology And Chronic Health Evaluation (APACHE) II score 21.1 (± 7.1) were included. Average sleep quality score was 56 ± 24 mm. The mean of the 24-h average sound pressure levels (L_{Aeq, 24h}) was 54.0 dBA (± 2.4). Mixed-effects regression analyses showed that background noise (β = - 0.51, p < 0.05) had a negative impact on sleep quality, whereas number of restorative periods (β = 0.53, p < 0.01) and female sex (β = 1.25, p < 0.01) were weakly but significantly correlated with sleep.

CONCLUSIONS

Noise levels are negatively associated and restorative periods and female gender are positively associated with subjective sleep quality in ICU patients.

TRIAL REGISTRATION

www.ClinicalTrials.gov, NCT01826799 . Registered on 9 April 2013.

Acoustic source localization with microphone arrays for remote noise monitoring in an Intensive Care Unit

An approach is described to apply spatial filtering with microphone arrays to localize acoustic sources in an Intensive Care Unit (ICU). This is done to obtain more detailed information about disturbing noise sources in the ICU with the ultimate goal of facilitating the reduction of the overall background noise level, which could potentially improve the patients' experience and reduce the time needed for recovery. This paper gives a practical description of the system, including the audio hardware setup as well as the design choices for the microphone arrays. Additionally, the necessary signal processing steps required to produce meaningful data are explained, focusing on a novel clustering approach that enables an automatic evaluation of the spatial filtering results. This approach allows the data to be presented to the nursing staff in a way that enables them to act on the results produced by the system.

Noise Reduction in Progressive Care Units

Uncontrolled noise in the hospital setting can have a negative physiological and psychological impact on patients and nurses. To reduce unit noise levels and create a quiet patient and nurse experience, an evidence-based practice project was conducted in 4 progressive care units in a community hospital. The Quiet Time Bundle implementation improved patient satisfaction and patient and nurse perceptions of noise even though the decrease in noise levels may not be discernible.

The impact of neurosurgical procedure on cognitive resources: Results of bypass training

Background:

Neurosurgeons are exposed to unavoidable distractions in their natural operating environment. Distractions can affect both the surgeon's concentration and the safety and duration of the surgery. Such distraction can be studied by applying a simultaneous cognitive task during a surgical procedure.

Methods:

We used a previously described cognitive task: a forward (DF) and backward digit (DB) repetition task to interfere with the surgeon's attention during a training bypass. A pilot study was performed to find suitable digit repetition lengths. For the main experiment, we used four-digit strings. The test task was alternated across two consecutive sutures (n = 153, 8 bypasses), followed by two consecutive control sutures without digit repetition. The duration and the number of correct answers for the digit repetition task were compared to a baseline digit repetition without simultaneous surgery.

Results:

During the bypass surgery, digit repetitions (especially DB) became slower (P < 0.0001). More errors were made during DB compared to DF only during simultaneous bypass (P < 0.0001). However, we found no effect of digit repetition tasks on individual suture times (P = 0.823).

Conclusions:

The ability to engage in simultaneous tasks while performing surgery is diminished. A surgeon with extensive training can withstand external distraction without an effect on performance; however, this is achieved by partially ignoring the simultaneous task. Our data support that during surgery other cognitive tasks should be avoided to ensure safety.

Systematic review of the effects of intensive-care-unit noise on sleep of healthy subjects and the critically ill

Intensive-care-unit (ICU) patients exhibit disturbed sleeping patterns, often attributed to environmental noise, although the relative contribution of noise compared to other potentially disrupting factors is often debated. We therefore systematically reviewed studies of the effects of ICU noise on the quality of sleep to determine to what extent noise explains the observed sleep disruption, using the Cochrane Collaboration method for non-randomized studies. Searches in Scopus, PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library were conducted until May 2017. Twenty papers from 18 studies assessing sleep of adult patients and healthy volunteers in the ICU environment, whilst recording sound levels, were included and independently reviewed by two reviewers. We found that the numbers of arousals between the baseline and the ICU noise condition in healthy subjects differed significantly (mean difference 9.59; 95% confidence interval 2.48-16.70). However, there was considerable heterogeneity between studies (I² 94%, P < 0.00001), and all studies suffered from a considerable risk of bias. The meta-analysis of results was hampered by widely varying definitions of sound parameters between studies and a general lack of detailed description of methods used. It is, therefore, currently impossible to quantify the extent to which noise contributes to sleep disruption among ICU patients, and thus, the potential benefit from noise reduction remains unclear. Regardless, the majority of the observed sleep disturbances remain unexplained. Future studies should, therefore, also focus on more intrinsic sleep-disrupting factors in the ICU environment.

Enhancing Hospital Well-being and Minimizing Intensive Care Unit Trauma: Cushioning Effects of Psychosocial Care

CONTEXT

Hospitalization has the potential to induce hospital anxiety, while admission in the Intensive Care Unit (ICU) is found to surpass the anxiety and result in what is termed as "ICU Trauma."

AIMS

This study aimed to determine the impact of psychosocial care and quality of ICU on ICU trauma and hospital well-being in patients who underwent coronary artery bypass grafting (CABG).

SETTINGS AND DESIGN

This correlational study involved 250 CABG patients, who were recruited from five major corporate hospitals.

PARTICIPANTS AND METHODS

The ICU Psychosocial Care Scale, Hospital Wellbeing Scale, and ICU Trauma Scale were used. Each of the participants was assessed individually. The ICU Practices Checklist was used to assess the environment of the ICU in the hospital.

STATISTICAL ANALYSIS USED

Descriptive statistics, correlation, and simple and multiple linear regression analyses were done.

RESULTS

The results revealed the significant contribution of psychosocial care in ICU in enhancing hospital well-being as well as minimizing ICU trauma of patients who underwent CABG. The results of multiple regressions clearly indicated that psychosocial care was a powerful predictor of hospital well-being and ICU trauma.

CONCLUSIONS

Although psychosocial care was not a component of hospital well-being and had a negative correlation with ICU trauma, it contributed significantly with a cushioning effect to minimize trauma and helped enhance the feelings and experiences of well-being among patients in ICU.

Training Effectiveness of a Wide Area Virtual Environment in Medical Simulation

INTRODUCTION

The success of war fighters and medical personnel handling traumatic injuries largely depends on the quality of training they receive before deployment. The purpose of this study was to gauge the utility of a Wide Area Virtual Environment (WAVE) as a training adjunct by comparing and evaluating student performance, measuring sense of realism, and assessing the impact on student satisfaction with their training exposure in an immersive versus a field environment.

METHODS

This comparative prospective cohort study examined the utility of a three-screen WAVE where subjects were immersed in the training environment with medical simulators. Standard field training commenced for the control group subjects. Medical skills, time to completion, and Team Strategies and Tools to Enhance Performance and Patient Safety objective metrics were assessed for each team (n = 94). In addition, self-efficacy questionnaires were collected for each subject (N = 470).

RESULTS

Medical teams received poorer overall team scores (F1,186 = 0.756, P = 0.001), took longer to complete the scenario (F1,186 = 25.15, P = 0.001), and scored lower on The National Registry of Emergency Medical Technicians trauma assessment checklist (F1,186 = 1.13, P = 0.000) in the WAVE versus the field environment. Critical thinking and realism factors within the self-efficacy questionnaires scored higher in the WAVE versus the field [(F1,466 = 8.04, P = 0.005), (F1,465 = 18.57, P = 0.000), and (F1,466 = 53.24, P = 0.000), respectively].

CONCLUSIONS

Environmental and emotional stressors may negatively affect critical thinking and clinical skill performance of medical teams. However, by introducing more advanced simulation trainings with added stressors, students may be able to adapt and overcome barriers to performance found in high-stress environments.

Nursing staff's experiences of working in an evidence-based designed ICU patient room-An interview study

INTRODUCTION

It has been known for centuries that environment in healthcare has an impact, but despite this, environment has been overshadowed by technological and medical progress, especially in intensive care. Evidence-based design is a concept concerning integrating knowledge from various research disciplines and its application to healing environments.

OBJECTIVE

The aim was to explore the experiences of nursing staff of working in an evidence-based designed ICU patient room.

METHOD

Interviews were carried out with eight critical care nurses and five assistant nurses and then subjected to qualitative content analysis.

FINDINGS

The experience of working in an evidence-based designed intensive care unit patient room was that the room stimulates alertness and promotes wellbeing in the nursing staff, fostering their caring activities but also that the interior design of the medical and technical equipment challenges nursing actions.

CONCLUSIONS

The room explored in this study had been rebuilt in order to create and evaluate a healing environment. This study showed that the new environment had a great impact on the caring staffs' wellbeing and their caring behaviour. At a time when turnover in nurses is high and sick leave is increasing, these findings show the importance of interior design ofintensive care units.

Usability evaluation (IEQ survey) in hospital buildings

Purpose

As hospital operations are undergoing major changes, comprehensive methods are needed for evaluating the indoor environment quality (IEQ) and usability of workspaces in hospital buildings. The purpose of this paper is to present a framework of the characteristics that have an impact on the usability of work environments for hospital renovations, and to use this framework to illustrate the usability evaluation process in the real environment.

Design/methodology/approach

The usability of workspaces in hospital environments was evaluated in two hospitals, as an extension of the IEQ survey. The evaluation method was usability walk-through. The main aim was to determine the usability characteristics of hospital facility workspaces that support health, safety, good indoor air quality, and work flow.

Findings

The facilities and workspaces were evaluated by means of four main themes: orientation, layout solution, working conditions, and spaces for patients. The most significant usability flaws were cramped spaces, noise/acoustic problems, faulty ergonomics, and insufficient ventilation. Due to rooms being cramped, all furnishing directly caused functionality and safety problems in these spaces.

Originality/value

The paper proposes a framework that links different design characteristics to the usability of hospital workspaces that need renovation.

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

BACKGROUND

Currently, it is well known that the sound environment in intensive care units (ICU) is substandard. Therefore, there is a need of interventions investigating possible improvements. Unfortunately, there are many challenges to consider in the design and performance of clinical intervention studies including sound measurements and clinical outcomes.

OBJECTIVES

(1) explore whether it is possible to implement a full-scale intervention study in the ICU concerning sound levels and their impact on the development of ICU delirium; (2) discuss methodological challenges and solutions for the forthcoming study; (3) conduct an analysis of the presence of ICU delirium in the study group; and (4) describe the sound pattern in the intervention rooms.

METHODS

A quasi-randomized clinical trial design was chosen. The intervention consisted of a refurbished two-bed ICU patient room (experimental) with a new suspended wall-to-wall ceiling and a low frequency absorber. An identical two-bed room (control) remained unchanged.

INCLUSION CRITERIA

Patients >18 years old with ICU lengths of stay (LoS) >48h. The final study group consisted of 31 patients: six from the rebuilt experimental room and 25 from the control room. Methodological problems and possible solutions were continuously identified and documented.

RESULTS

Undertaking a full-scale intervention study with continuous measurements of acoustic data in an ICU is possible. However, this feasibility study demonstrated some aspects to consider before start. The randomization process and the sound measurement procedure must be developed. Furthermore, proper education and training are needed for determining ICU delirium.

CONCLUSION

This study raises a number of points that may be helpful for future complex interventions in an ICU. For a full-scale study to be completed a continuously updated cost calculation is necessary. Furthermore, representatives from the clinic need to be involved in all stages during the project.

[Environmental noise levels in 2 intensive care units in a tertiary care centre]

INTRODUCTION

The World Health Organisation (WHO) has established a maximum noise level of 40 decibels (dB) for an intensive care unit. The aim of this study was to compare the noise levels in 2 different intensive care units at a tertiary care centre.

METHODS

Using a cross-sectional design study, an analysis was made of the maximum noise level was within the intensive coronary care unit and intensive care unit using a digital meter. A measurement was made in 4 different points of each room, with 5minute intervals, for a period of 60minutes 7:30, 14:30, and 20:30. The means of the observations were compared with descriptive statistics and Mann-Whitney U. An analysis with Kruskal-Wallis test was performed to the mean noise level.

RESULTS

The noise observed in the intensive care unit had a mean of 64.77±3.33dB (P=.08), which was similar to that in the intensive coronary care unit, with a mean of 60.20±1.58dB (P=.129). Around 25% or more of the measurements exceeded the level recommended by the WHO by up to 20 points.

CONCLUSIONS

Noise levels measured in intensive care wards exceed the maximum recommended level for a hospital. It is necessary to design and implement actions for greater participation of health personnel in the reduction of environmental noise.

A Community Hospital's Evaluation of Alarm Management Safety Factors

BACKGROUND

The Joint Commission's 2014 National Patient Safety Goals required hospitals to evaluate alarm safety in 2014-2015 and implement alarm safety policies.

OBJECTIVE

The aim of this study was to assess common alarm management safety factors in our 187-bed community hospital.

METHODS

Two weeks' worth of IV pump report data was evaluated to characterize 33 IV pump alarm types. Hospital and IV pump noise was measured, and an alarm management nurse survey was conducted.

RESULTS

There were 8731 total IV pump alarms/alerts (24-hour mean, 623.6) across 6 units. The 2-minute idle alarm accounted for 32.4% of all total IV alarms/alerts, suggestive of high levels of nurse multitasking and nurse work interruptions. IV pump volumes contributed to overall hospital noise. Survey data identified patient units and alarm safety practices needing additional support.

CONCLUSIONS

Characterization of IV pump alarms/alerts is an emerging area of scientific inquiry. Findings indicate the need for organizations to evaluate alarm burden and alarm management safety practices to reduce alarm fatigue risks.