Identifying determinants of noise in a medical intensive care unit

Abstract

Continuous and intermittent exposure to noise elevates stress, increases blood pressure, and disrupts sleep among patients in hospital intensive care units. The purpose of this study was to determine the effectiveness of a behavior-based intervention to reduce noise and to identify determinants of noise in a medical intensive care unit. Staff were trained for 6 weeks to reduce noise during their activities in an effort to keep noise levels below 55 dBA during the day and below 50 dBA at night. One-min noise levels were logged continuously in patient rooms 8 weeks before and after the intervention. Noise levels were compared by room position, occupancy status, and time of day. Noise levels from flagged days (>60 dBA for >10 hr) were correlated with activity logs. The intervention was ineffective, with noise frequently exceeding project goals during the day and night. Noise levels were higher in rooms with the oldest heating, ventilation, and air-conditioning system, even when patient rooms were unoccupied. Of the flagged days, the odds of noise over 60 dBA occurring was 5.3 dBA higher when high-flow respiratory support devices were in use compared to times with low-flow devices in use (OR = 5.3, 95% CI = 5.0–5.5). General sources, like the heating, ventilation, and air-conditioning system, contribute to high baseline noise and high-volume (>10 L/min) respiratory-support devices generate additional high noise (>60 dBA) in Intensive Care Unit patient rooms. This work suggests that engineering controls (e.g., ventilation changes or equipment shielding) may be more effective in reducing noise in hospital intensive care units than behavior modification alone.

KEYWORDS:

• Hospital
• quality improvement
• respiratory device
• sound
• ventilation

Acknowledgments

The authors gratefully acknowledge the contributions of our MICU colleagues to this study: Emily Rockafellow, Kelsey Mallen, Cheryl Bombei, Rhonda Barr, and Kevin Doerschug.

The authors declare no conflict of interest.

Additional information

Funding

This research was partially supported by the Heartland Center for Occupational Health and Safety Research-Industrial Hygiene Training Program (CDC/NIOSH - T42 OH008491). The Institute for Clinical and Translational Science at the University of Iowa is supported by the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) program, grant U54TR001356. The CTSA program is led by the NIH's National Center for Advancing Translational Sciences (NCATS). This publication's contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or the CDC/NIOSH.