1
|
Imbriaco G, Capitano M, Rocchi M, Suhan A, Tacci A, Monesi A, Sebastiani S, Samolsky Dekel BG. Relationship between noise levels and intensive care patients' clinical complexity: An observational simulation study. Nurs Crit Care 2024; 29:555-563. [PMID: 37265028 DOI: 10.1111/nicc.12934] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/27/2023] [Accepted: 05/03/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Noise pollution in intensive care units is a relevant problem, associated with psychological and physiological consequences for patients and healthcare staff. Sources of noise pollution include medical equipment, alarms, communication tools, staff activities, and conversations. AIMS To explore the cumulative effects of noise caused by an increasing number and type of medical devices in an intensive care setting on simulated patients with increasing clinical complexity. Secondly, to measure medical device alarms and nursing activities' sound levels, evaluating their role as potentially disruptive noises. STUDY DESIGN Observational simulation study (reported according to the STROBE checklist). Using an electronic sound meter, the sound levels of an intensive care room in seven simulated clinical scenarios were measured on a single day (09 March 2022), each featuring increasing numbers of devices, hypothetically corresponding to augmented patients' clinical complexity. Secondly, noise levels of medical device alarms and specific nursing activities performed at a distance of three meters from the sound meter were analysed. RESULTS The empty room's mean baseline noise level was 37.8 (±0.7) dBA; among the simulated scenarios, noise ranged between 45.3 (±1.0) and 53.5 (±1.5) dBA. Alarms ranged between 76.4 and 81.3 dBA, while nursing tasks (closing a drawer, opening a saline bag overwrap, or sterile packages) and speaking were all over 80 dBA. The noisiest activity was opening a sterile package (98 dBA). CONCLUSION An increased number of medical devices, an expression of patients' higher clinical complexity, is not a significant cause of increased noise. Some specific nursing activities and conversations produce higher noise levels than medical devices and alarms. This study's findings suggest further research to assess the relationships between these factors and to encourage adequate noise reduction strategies. RELEVANCE TO CLINICAL PRACTICE Excessive noise level in the intensive care unit is a clinical issue that negatively affects patients' and healthcare providers' well-being. The increase in baseline room noise from medical devices is generally limited. Typical nursing tasks and conversations produce higher noise levels than medical devices and alarms. These findings could be helpful to raise awareness among healthcare professionals to recognize noise sources. The noisiest components of the environment can be modified by staff behaviour, promoting noise reduction strategies and improving the critical care environment.
Collapse
Affiliation(s)
- Guglielmo Imbriaco
- Centrale Operativa 118 Emilia Est, Prehospital Emergency Dispatch Center, Helicopter Emergency Medical Service, Maggiore Hospital Carlo Alberto Pizzardi, Bologna, Italy
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
| | - Martina Capitano
- Emergency Department, Maggiore Hospital Carlo Alberto Pizzardi, Azienda USL di Bologna, Bologna, Italy
| | - Margherita Rocchi
- Intensive Care Unit, Nuovo San Giovanni di Dio hospital, AUSL Toscana Centro, Florence, Italy
| | - Aglaia Suhan
- Medical Department (COVID-19), Madre Teresa di Calcutta hospital, Padova, Italy
| | - Alice Tacci
- Neonatal Intensive Care Unit, Maggiore Hospital, AOU Parma, Parma, Italy
| | - Alessandro Monesi
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
- Intensive Care Unit, Maggiore hospital Carlo Alberto Pizzardi, Azienda USL di Bologna, Bologna, Italy
| | - Stefano Sebastiani
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Boaz Gedaliahu Samolsky Dekel
- Critical Care Nursing Master Course, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| |
Collapse
|
2
|
Naef AC, Knobel SEJ, Ruettgers N, Rossier M, Jeitziner MM, Zante B, Müri RM, Schefold JC, Nef T, Gerber SM. Characterization of sound pressure levels and sound sources in the intensive care unit: a 1 week observational study. Front Med (Lausanne) 2023; 10:1219257. [PMID: 37521352 PMCID: PMC10382019 DOI: 10.3389/fmed.2023.1219257] [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: 05/08/2023] [Accepted: 06/13/2023] [Indexed: 08/01/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Aileen C. Naef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
| | - Samuel E. J. Knobel
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
| | - Nicole Ruettgers
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
| | - Marilyne Rossier
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse, Basel, Switzerland
| | - Bjoern Zante
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - René M. Müri
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Joerg C. Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Stephan M. Gerber
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse, Bern, Switzerland
| |
Collapse
|
3
|
Kalvas LB, Harrison TM, Solove S, Happ MB. Sleep disruption and delirium in critically ill children: Study protocol feasibility. Res Nurs Health 2022; 45:604-615. [PMID: 35986659 PMCID: PMC9529999 DOI: 10.1002/nur.22259] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/12/2022] [Accepted: 07/31/2022] [Indexed: 08/19/2023]
Abstract
Delirium is a serious complication of pediatric critical illness. Sleep disruption is frequently observed in children with delirium, and circadian rhythm dysregulation is one proposed cause of delirium. Children admitted to the pediatric intensive care unit (PICU) experience multiple environmental exposures with the potential to disrupt sleep. Although researchers have measured PICU light and sound exposure, sleep, and delirium, these variables have not yet been fully explored in a single study. Furthermore, caregiving patterns have not often been included as a component of the PICU environment. Measuring the light and sound exposure, caregiving patterns, and sleep of critically ill children requires continuous PICU bedside data collection. This presents multiple methodological challenges. In this paper, we describe the protocol for an observational pilot study of the PICU environment, sleep, and delirium experienced by a sample of 10 critically ill children 1-4 years of age. We also evaluate and discuss the feasibility (i.e., acceptability, implementation, practicality) of the study protocol. Light and sound exposure were measured with bedside sensors. Caregiving was quantified through video recording. Sleep was measured via actigraphy and confirmed by video recording. Delirium screening with the Cornell Assessment of Pediatric Delirium was conducted twice daily, either in person or via video review. This study provides a refined measurement framework to inform future, large-scale studies and the development of nurse-driven sleep promotion interventions.
Collapse
Affiliation(s)
- Laura Beth Kalvas
- Post-Docotral Fellow
- The Ohio State University College of Nursing, Columbus, OH
| | - Tondi M. Harrison
- The Ohio State University College of Nursing, Columbus, OH
- Associate Professor
| | - Sandra Solove
- The Ohio State University College of Nursing, Columbus, OH
- Research Regulatory Coordinator
| | - Mary Beth Happ
- The Ohio State University College of Nursing, Columbus, OH
- Senior Associate Dean for Research and Innovation
- Distinguished Professor of Critical Care Research
| |
Collapse
|
4
|
Naef AC, Knobel SEJ, Ruettgers N, Jeitziner MM, Holtforth MG, Zante B, Schefold JC, Nef T, Gerber SM. Methods for Measuring and Identifying Sounds in the Intensive Care Unit. Front Med (Lausanne) 2022; 9:836203. [PMID: 35733869 PMCID: PMC9207602 DOI: 10.3389/fmed.2022.836203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Despite many studies in the field examining excessive noise in the intensive care unit, this issue remains an ongoing problem. A limiting factor in the progress of the field is the inability to draw conclusions across studies due to the different and poorly reported approaches used. Therefore, the first goal is to present a method for the general measurement of sound pressure levels and sound sources, with precise details and reasoning, such that future studies can use these procedures as a guideline. The two procedures used in the general method will outline how to record sound pressure levels and sound sources, using sound level meters and observers, respectively. The second goal is to present the data collected using the applied method to show the feasibility of the general method and provide results for future reference. Methods The general method proposes the use of two different procedures for measuring sound pressure levels and sound sources in the intensive care unit. The applied method uses the general method to collect data recorded over 24-h, examining two beds in a four-bed room, via four sound level meters and four observers each working one at a time. Results The interrater reliability of the different categories was found to have an estimate of >0.75 representing good and excellent estimates, for 19 and 16 of the 24 categories, for the two beds examined. The equivalent sound pressure levels (LAeq) for the day, evening, and night shift, as an average of the sound level meters in the patient room, were 54.12, 53.37, and 49.05 dBA. In the 24-h measurement period, talking and human generated sounds occurred for a total of 495 (39.29% of the time) and 470 min (37.30% of the time), at the two beds of interest, respectively. Conclusion A general method was described detailing two independent procedures for measuring sound pressure levels and sound sources in the ICU. In a continuous data recording over 24 h, the feasibility of the proposed general method was confirmed. Moreover, good and excellent interrater reliability was achieved in most categories, making them suitable for future studies.
Collapse
Affiliation(s)
- Aileen C. Naef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Samuel E. J. Knobel
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Nicole Ruettgers
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Nursing Science (INS), Department of Public Health (DPH), Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Martin grosse Holtforth
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
- Psychosomatic Medicine, Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bjoern Zante
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joerg C. Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan M. Gerber
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- *Correspondence: Stephan M. Gerber
| |
Collapse
|
5
|
Pal J, Taywade M, Pal R, Sethi D. Noise Pollution in Intensive Care Unit: A Hidden Enemy affecting the Physical and Mental Health of Patients and Caregivers. Noise Health 2022; 24:130-136. [PMID: 36124521 PMCID: PMC9743307 DOI: 10.4103/nah.nah_79_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Noise in intensive care units (ICUs) has always been a problem, but noise above the recommended range affects not only the patient but staff as well. It is clear that some noise in the ICU is inevitable, but exceeding the normal range brings various physiologic and psychologic changes, which directly affect health. This review presents a synthesis of noise sources in the ICU and the potential interventions designed to attenuate noise and protect patients. Materials and Methods An extensive literature search, using electronic databases such as MEDLINE, PubMed, Google Scholar, and Research gate to understand the noise in ICU, effects of noise, and noise reduction interventions were undertaken. Results Findings were such as noise enhances the release of cortisol, increases oxygen consumption, increases sleep disturbances, increases the need for analgesia and sedation, and disrupts circadian rhythm. Many studies reported that measurement was always higher despite implementing noise reduction interventions. Conclusions ICU survivors always recall their memories, and for them, ICU admission becomes a negative experience for life. However, the sustainability of any single intervention did not show awe-inspiring results, whereas a bundle kind of interventions did show some effects. However, high-quality evidence demonstrating the benefit of any intervention on patient outcomes is still lacking.
Collapse
Affiliation(s)
- Jagriti Pal
- All India Institute of Medical Science, Bhubaneswar, Odisha, India,Maharaja Agrasen Nursing College, Bahadurgarh, Haryana, India
| | - Manish Taywade
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India,Address for correspondence: Manish Taywade, Associate Professor, Department of Community and Family medicine All India Institute of Medical Sciences, Bhubaneswar 751019, Odisha, India. Tel: +91-9970840967; E-mail:
| | - Rajni Pal
- All India Institute of Medical Science, Bhubaneswar, Odisha, India
| | - Divya Sethi
- All India Institute of Medical Science, Bhubaneswar, Odisha, India,Gandhi Dham, Jagadhri, District Yamuna Nagar, Haryana, India
| |
Collapse
|
6
|
de Lima Andrade E, da Cunha E Silva DC, de Lima EA, de Oliveira RA, Zannin PHT, Martins ACG. Environmental noise in hospitals: a systematic review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:19629-19642. [PMID: 33674976 PMCID: PMC7935697 DOI: 10.1007/s11356-021-13211-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/24/2021] [Indexed: 06/04/2023]
Abstract
Environmental noise has been growing in recent years, causing numerous health problems. Highly sensitive environments such as hospitals deserve special attention, since noise can aggravate patients' health issues and impair the performance of healthcare professionals. This work consists of a systematic review of scientific articles describing environmental noise measurements taken in hospitals between the years 2015 and 2020. The researchers started with a consultation of three databases, namely, Scopus, Web of Science, and ScienceDirect. The results indicate that for the most part, these studies are published in journals in the fields of medicine, engineering, environmental sciences, acoustics, and nursing and that most of their authors work in the fields of architecture, engineering, medicine, and nursing. These studies, which are concentrated in Europe, the Americas, and Asia, use as reference values sound levels recommended by the World Health Organization. Leq measured in hospital environments showed daytime values ranging from 37 to 88.6 dB (A) and nighttime values of 38.7 to 68.8 dB (A). Leq values for outdoor noise were 74.3 and 56.6 dB (A) for daytime and nighttime, respectively. The measurements were taken mainly inside hospitals, prioritizing more sensitive departments such as intensive care units. There is a potential for growth in work carried out in this area, but research should also include discussions about guidelines for improvement measures aimed at reducing noise in hospitals.
Collapse
Affiliation(s)
- Erik de Lima Andrade
- São Paulo State University (UNESP) - Institute of Science and Technology of Sorocaba, Avenida Três de Março, 511 - Alto da Boa Vista, Sorocaba, SP, 18.087-180, Brazil.
| | | | - Eligelcy Augusta de Lima
- São Paulo State University (UNESP) - Institute of Science and Technology of Sorocaba, Avenida Três de Março, 511 - Alto da Boa Vista, Sorocaba, SP, 18.087-180, Brazil
| | - Renan Angrizani de Oliveira
- São Paulo State University (UNESP) - Institute of Science and Technology of Sorocaba, Avenida Três de Março, 511 - Alto da Boa Vista, Sorocaba, SP, 18.087-180, Brazil
| | - Paulo Henrique Trombetta Zannin
- Federal University of Paraná - Laboratory of Environmental and Industrial Acoustics and Acoustic Comfort, Curitiba, PR, Brazil
| | - Antônio Cesar Germano Martins
- São Paulo State University (UNESP) - Institute of Science and Technology of Sorocaba, Avenida Três de Março, 511 - Alto da Boa Vista, Sorocaba, SP, 18.087-180, Brazil
| |
Collapse
|
7
|
Hampton T, Everett S, Sharma S, Krishnan M. Noise in the operating theatre. Br J Surg 2021; 108:e203-e204. [PMID: 33655291 PMCID: PMC8159175 DOI: 10.1093/bjs/znab059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/19/2021] [Accepted: 01/26/2021] [Indexed: 12/01/2022]
Affiliation(s)
- T Hampton
- Ear, Nose and Throat Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - S Everett
- Acoustic Engineering, Hydrock, Manchester, UK
| | - S Sharma
- Ear, Nose and Throat Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - M Krishnan
- Ear, Nose and Throat Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| |
Collapse
|