The Impact of Noise on Patients in the ICU

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Noise is unwanted sound. Over the past 50 years, sound levels in hospitals have increased,1-3 with all studies exceeding the recommendations from World Health Organization (WHO) Guidelines for Community Noise.4 In 2006 the Hospital Consumer Assessment of Healthcare Providers and Systems began surveying patients regarding their perspectives on hospital care. This survey specifically asks about noise: “During this hospital stay, how often was the area around your room quiet at night?” In 2013, the responses to this question were included in the calculation of a Value Based Purchasing score, which is linked to payments from the Centers for Medicare & Medicaid Services. To effectively carry out noise reducing interventions it is important to understand what we know about noise in the hospital. This article, which focuses on noise in the Intensive Care Unit (ICU), describes basic sound level measurement terminology, the effect of noise on critically ill patients and evidence-based strategies to which nurses can actively contribute to decrease or protect patients from noise.
Noise in the ICU
Despite the increased emphasis on the need for noise reduction, studies published in the past five years found that sound levels in the ICU continue to exceed the WHO noise recommendations.3, 5-10 To interpret research on noise in the hospital, it is important to have an understanding of the terminology used (Table 1.) Noise is simply unwanted sound. What is noise to one individual may not be to another. Sound levels are reported in decibels (dB), with 0 dB being the threshold for human hearing. A 3 dB change in sound level is just discernible, a 5 dB change is discernible and a 10 dB change is perceived as a doubling or halving of the sound level....

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...o generalize the results to broader ICU populations.
Conclusions
Despite interventions aimed at decreasing noise, sound levels continue to exceed WHO recommendations and the ICU sounds (e.g., alarms and conversations) may interfere with sleep. The psychological impact of noise in the ICU varies. For some patients, the sounds in the ICU are comforting and for others they cause distress. To create a therapeutic environment, continued efforts are needed to decrease background noise, and to modify behaviors and factors that cause peak noise events. Interventions to protect patients from noise in the ICU, such as earplugs, may be beneficial in optimizing outcomes; however, further research is needed in a broader ICU population. Finally, to evaluate the effects of these interventions, valid and reliable methods for outcomes, such as sleep and sound levels, must be used.

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