Chest
Volume 114, Issue 2, August 1998, Pages 535-540
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Clinical Investigations In Critical Care
Identification and Modification of Environmental Noise in an ICU Setting

https://doi.org/10.1378/chest.114.2.535Get rights and content

Study objectives

Noise levels in the hospital setting are exceedingly high, especially in the ICU environment. We set out to determine what caused the noises producing sound peaks ≥80 A-weighted decibels (dBA) in our ICU settings, and attempted to reduce the number of sound peaks ≥80 dBA through a behavior modification program.

Design

The study was divided into two separate phases: noise identification and a trial of behavior modification. During the noise identification phase we simultaneously recorded sound peaks and the loudest noise heard subjectively by one observer in the medical ICU (MICU) and the respiratory ICU (RICU). During the behavior modification phase of the study we implemented a behavior modification program, geared toward noise reduction, in all of the MICU staff. Sound levels were monitored before and at the end of the behavior modification trial.

Setting

The MICU and RICU of a 720-bed teaching hospital in Providence, RI.

Participants

All ICU staff during the study period.

Interventions

Once the noises that were determined to be amenable to behavior modification were identified, a behavior modification program was conducted during a 3-week period in our MICU. Baseline and post-behavior modification noise recordings were compared in 6-h intervals after sites were matched by number of patients in a room and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores.

Measurements and results

We identified several causes of sound peaks ≥80 dBA amenable to behavior modification; television and talking accounted for 49%. We also significantly reduced the 24-h mean peak noise level (p=0.0001), as well as the mean peak noise level (p=0.0001) and the number of sound peaks ≥80 dBA (p=0.0001) in all 6-h blocks except for the 12 am to 6 am period.

Conclusions

We conclude that many of the noises causing sound peaks ≥80 dBA are amenable to behavior modification and that it is possible to reduce the noise levels in an ICU setting significantly through a program of behavior modification.

Section snippets

Site Selection

This study was conducted in two phases at Rhode Island Hospital, a 720-bed university-based teaching hospital in Providence, RI. The specific locations within the hospital for the sound measurements were chosen based on a previous study done at Rhode Island Hospital by Meyers et al,1 which evaluated sound levels in four different settings throughout the hospital and found that sound was consistently elevated above the EPA's recommended levels. The present study took place from August 1995

Noise Identification

We were able to identify 12 individual noises that contributed to the high peak sound levels. The mean peak sound levels for these noises ranged from 74.8 to 84.6 dBA. Table 2 lists these noises with the percent occurrence and mean peak sound levels detected. The miscellaneous category encompasses noises such as suctioning, banging, coughing, and alarms that didn't occur frequently enough to separate them out. Fifty-one percent of the noises identified were potentially modifiable, with

Discussion

Several important issues regarding environmental noise were highlighted in this study. First, we demonstrated again that sound levels in our hospital are extremely high. This corresponds to sound measurements obtained in previous studies at our hospital.1, 2 In one study, we found the mean peak sound level in our MICU to be 83.6 dBA.1 Our study showed slightly lower, but still very high, mean peak sound levels in the MICU (80.0 dBA). Environmental noise in hospitals has received attention in

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    Supported in part by a grant from the Respiratory Therapy Saklad Fellowship at Rhode Island Hospital.

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