Page 18 - Delaware Medical Journal - March 2018
P. 18
The Bells and Whistles of Health Care: Noise
Levels in Acute and Long-Term Care Facilities
Javed M. Gilani, MD, FACP, FRCP, FRCP [E], DTM & H (Liv); Riddhi N. Patel, PA
IntroductionThe constant sounds of harsh bells, shrill ringers, and
beeping alarms can overwhelm any person in an acute or long- term health care setting. These observations began one evening when trying to reach a skilled nursing facility regarding a patient. The phone rang for minutes with no answer. After calling back multiple times, a patient of the facility that was irritated by the constantly ringing phone decided to answer. After being unable to reach staff, a visit was made within the next 10 minutes to the site. Upon arrival, a phone was ringing and there were several alarms beeping from multiple directions with varying intensity. That is how the idea began to quantify this noise. An iPhone app, The National Institute for Occupational Safety and Health Sound Level Meter (NIOSH SLM), was used to measure the sounds in long- term care, skilled nursing, and acute care facilities.
BACKGROUND
Numerous studies show a negative effect of sounds on patients
in acute and long-term care settings. For example, the adverse effects of noise may result in impairment of sleep, cardiovascular function, hearing, and woundhealing.1,2 cardiovascular function, heart rate increased in response to peak levels of noise while systolic blood pressure increased 2 mm Hg with every 10 decibel (dB) increase in average noise levels and diastolic blood pressure increased 2 mm Hg with every 13 dB increase in average noise levels leading to increased incidences of cardiovascular disease over time.3 A decrease of 5-6 mm Hg 4 Oxygen saturation was also decreased in nosier intensive care units.5 These changes
in blood pressure, heart rate, and oxygen saturation caused by noise levels may be misinterpreted and result in the patient being treated improperly.
Additional factors impacted by noise levels are hospital
stay length, pain tolerance, overall well-being, and ability
to comprehend speech. A literature review found one study reported louder noise levels correlated to a longer hospital stay and another study reported increased noise led to increased use of pain medication.6 patients that subjective well-being was impacted by sounds from
medical sources.7 In addition, the ability to comprehend speech was decreased in noisy environments, especially speech with unfamiliar content, such as communication between providers and patients, increasing the chance of misunderstanding information. The excessive noise in health care facilities affects many aspects of patient care.
Staff in health care facilities are often overwhelmed with patients and responsibilities. To function at the highest level, the many noises not regarding one’s own patients are ignored. The term “alarm fatigue” describes the desensitization of multiple alarms. Alarm fatigue often results in responses that are much slower than expected due to the constant sound stimulation. Those not expecting a loud, chaotic environment may be more sensitive to the same alarms, leading to patients or staff inadvertently turning off important alarms to reduce noise. Noisy environments
also lead to increased risk of mistakes and medical errors. By
errors.5,10 Even with desensitization to alarms, caregivers are just as susceptible to noise.
Excessive noise in hospitals is a common expectation; however, recommendations for sound levels exist. The Environmental Protection Agency (EPA) recommends hospital sounds should
be below 45 decibels (dB) while the World Health Organization (WHO) recommends levels below 30 dB, with levels above 45 dB showing adverse health effects.1,2
TABLE 1. NIOSH SLM Sound Level Examples
SOUND LEVEL (DB)
EXAMPLE
0
Weakest sound heard by average ear
30
Whisper
60
Normal conversation
80
Ringing telephone
90
Hair dryer/power lawn mower
96
Tractor
108
Chain saw
194
Loudest possible tone
82
Del Med J | March 2018 | Vol. 90 | No. 3
