SILENCE IS GOLDEN BY: DR. LEE CHEW KIOK INTENSIVE CARE TRAINEE HOSPITAL PULAU PINANG
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SILENCE IS GOLDEN
B Y : D R . L E E C H E W K I O K
I N T E N S I V E C A R E T R A I N E E
H O S P I TA L P U L A U P I N A N G
NOISE POLLUTION IN ICU
• What is Noise?
• Effect of noise pollution in Intensive Care Unit.
• Noise level in ICU.
• Sources of noise.
• Strategies to decrease the noise in ICU.
WHAT IS NOISE?
• The word noise comes from the Latin word nauseas, meaning
seasickness.
Sound that is unwanted or that disrupts the activity or balance of human or animal life is
called NOISE.
When there is lots of noise in the environment, it is termed as NOISE POLLUTION.
WHAT IS NOISE?
• Sound becomes undesirable when it disturbs the normal activities
such as working, sleeping and during conversation
• It is an underrated problem in ICU because we can’t see, smell, or
taste it.
EFFECT OF NOISE POLLUTION
EFFECT OF NOISE POLLUTION
Patients Staff
STAFF PRODUCTIVITY AND ERRORS
• Increase likelihood of mistake e.g.dispensing errors.
• Reduced staff concentration and disrupt cognitive function
• Increase blood pressure and heart rate
• Reduced staff productivity and causing burnout.
PATIENT HEALTH, WELLBEING & RECOVERY
Studies in ICU showed that noise pollution in ICU causes:
• Increasing the need for oxygen support therapy
• Elevated blood pressure, heart rate and respiratory rate
• Worsened sleep
• Increase the need of sleep medications
Halfens, et al. J Adv Nurs 1994
PATIENT HEALTH, WELLBEING & RECOVERY
• Patient exposed to high noise levels are associated with high risk of
delirium.
Litton E, et al. Crit Care Med 2016.
WORLD HEALTH ORGANIZATION ( WHO) RECOMMENDATION < 35 dBA (decibel) at night
< 40 dBA (decibel) during the day
NOISE LEVEL IN ICU
• LAeq > 45 dBA at all times.
• LAeq between 52 to 59 dBA more than 50% of the time
SOURCES OF NOISE POLLUTION
SOURCES OF NOISE POLLUTION
• Conversation between staff, medical professionals and visitors
• Medical equipment alarms
• Caregiving activities such as hand washing, opening disposable
equipment package and storage drawers
• Telephones, pagers and television
• Closing doors and falling objects
SOURCES OF NOISE POLLUTION
57% of total acoustic energy could be
contribute to activity and speech of
hospital personal
Park M, et al. J Acoust Soc Am 2014.
STRATEGIES TO DECREASE NOISE
• Quiet time
• Sound Activated Light Alarm
• Modification of Alarms
• Earplugs
• Educational noise reduction programmes to ICU staff
• Low cost environmental modification
QUIET TIME
Quiet time may be beneficial to the patient as it
creates a restorative period- that is a period when
sound is at a level that is less likely to cause arousal
QUIET TIME
Restricting or limiting visitors, staff
movement.
Limiting treatments or changing
treatment time
Closing doors or privacy curtains
Decreasing noise and light
Intervention
QUIET TIME
• There is increase in the percentage of patient assessed as asleep
during the quiet time.
Gardner G et al. Int J Nurs stud 2009.
Dennis CM et al. J Neurosci Nurs 2010
• Quiet time intervention resulted in an approximate 10-dB decrease
in sound levels, although none of the units studied achieved the
WHO noise recommendation.
Li SY et al. Sleep Med 2013
SOUND ACTIVATED LIGHT SYSTEM
The sound activated light system will be activated (flash) when
sound level exceed certain level ( eg: 65dBA).
SOUND ACTIVATED LIGHT SYSTEM
• These device showed a significant decrease in sound level by 2 to 3
dBA.
Jousselme C, et al. Paed Crit Care Med 2011.
• Several studies results suggest that the alarm could contribute to
behavior modifications.
MODIFICATION OF ALARMS
• Increase the alarm sound levels in the patients room does not
increase the sound level in adjacent room.
• Closing the patient door decreased the average sound level but did
not significantly decrease the peak noise level.
Lawson N, et al.Am J Crit Care 2010.
EARPLUGS
EARPLUGS
• Use of ear plug decrease REM latency and improved REM sleep in
healthy subject exposed to ICU sounds.
Hu RF, Et al. Crit Care 2010.
Wallce CJ, et al. Am J Crit Care 1999.
• In ICU patient who are not intubated, earplugs significantly
improved the sleep satisfaction scores.
Scotto CJ, et al. Nurs Crit Care 2009..
EARPLUGS
• Placement of earplugs in ICU patient significantly reduced delirium
among ICU patients.
Litton E, et al. Crit Care Med 2016.
EARPLUGS
• Not suitable for all patient
• Does not tackle the problems of staff communication, staff
wellbeing , or potential for clinical error.
FREQUENCY- SELECTIVE SILENCING DEVICE
Joseph J et al, ICAD 2017
EDUCATIONAL NOISE REDUCTION PROGRAMMES 1. Create staff awareness about the potentially negative impact of noise.
2. Modifying staff behavior eg:
• Training staff to converse quietly or closing door before conversing.
• Sending silent messages with phone
• Wearing soft-soled shoes
• Padding medical card holder
• Turning off unnecessary alarms or at least answering alarm quickly.
ENVIRONMENTAL MODIFICATION
• Single room
• Siting entrance doors, nursing stations and hand over
rooms at a suitable distance from patients beds.
ENVIRONMENTAL MODIFICATION
• Keep the door well lubricated.
• Installation of sound absorbing ceiling
• Low-reverb flooring and wall covering
• Removal of rubbish bin lids
• Used plastic rather than metal bins
SUMMARY
• Majority of studies showed that the rate of noise pollution in ICU was higher than recommended by WHO.
• Human activity and operating equipments is the most common cause of noise pollution in ICU.
• To create a therapeutic environment, continued efforts are needed to decrease background noise and to modify behaviour and factor that cause peak noise events.
• Further research is needed in regarding to noise pollution in ICU.
W O R K H A R D I N S I L E N C E
L ET S U C C E S S M A K E T H E N O I S E !
T H A N K YO U……
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