Silence please!

Opinion

Silence please!

IMT News Desk 3 years ago

Research suggests that ICU noises go way above the threshold. The need for a collective effort can result in a quieter and restorative environment that can bear a direct effect on patients’ health improvement. Sujayanti Dasgupta, Co-Founder and Director, Ward Four Architects gives an insight The Intensive Care Unit (ICU) of a hospital, one of the most sophisticated areas of a hospital after operation theatre, is often found to be a source of nightmares for its patients. These are attributed to the high noise levels of the critical room. The World Health Organisation (WHO) recommends that the average background noise in hospitals should not exceed 35 dB during daytime and 30 dB during nighttime. However, many researchers have concluded that ICU noises go way above the threshold. The discord in ICU is attributed to three primary sources – (1) alarms, (2) staff conversations, and (3) the sophisticated biomedical equipment used for continuous monitoring and supporting of vital functions of patients. The cumulative effect of sounds from these sources is known to induce stress on both the patients as well as the caregivers or nursing staff. Impacts of noise in ICU Both patients and nursing staff get affected by the rising decibels. Many types of research have been undertaken to evaluate its impacts on the recovery of patients and the well-being of ICU staff. Some of the common effects recorded across researches included: -

ICU Delirium- It is characterised by hallucinations, sleep deprivation, delusions, and sometimes paranoia too. These could also impact patients’ recovery.
Detrimental for nursing staff’s well-being - Staying in a continuous area of high decibels, impact the nursing staff’s health too. Research has found that increased sound affects nurses’ job satisfaction and anxiety levels. It also stated that increased quality of patient care can be achieved by providing healthy working conditions for nurses working in special units such as ICUs.

Ironically, a room that houses the most critical patients and hence demands high standards of care and attention is the nosiest in hospitals. What is more disturbing is that these sounds are being normalised and becoming a part of the ICU, its patients, and staff. But these increasing sound levels are cause for concern and require immediate attention. With a heightened emphasis on the ill-effects of these noises and continuous researches proving their harmful effects are not allowing the authorities to sit back and brush it under the carpet. It may sound hounding but once acknowledged, constructive steps can be taken to reduce them. While analysing the sources, it was found that while primary sources remained constant across all hospital ICU irrespective of the geography, noise levels amplified because of the open bays in ICUs in some regions. Such open bays tend to be noisier as they do not allow auditory secrecy of any sort. Noise reduction In-depth analysis revealed that a significant reduction in noise level can be brought about by bringing in behavioural, operational, and infrastructural changes. A collective effort from these modifiable factors can result in a quieter and restorative environment that can bear a direct effect on patients’ health improvement. Infrastructural modifications

Replacement of common ICU bays with individual enclosed bays with partial glass doors which can provide a continuous visual connection sans the noise
A smaller cluster, that can house approx. Six to eight patients, instead of huge bays and shared support staff should be built
Multiple sounds, however feeble, when echoes can create trouble which is the case in ICU’s too where even the slightest beep when echoed becomes a source of the noise. Hence, installation of sound absorption ceilings with dampeners in the HVAC system becomes imperative
Construction of walls of bays or clusters that go up to plenum and thus reduce sound travel from one bay to another

Operational modifications

Decentralised nursing station to reduce noise generated during staff conversation
Clean storage, hand washing, and dirty utility areas have also been pointed as noise sources. These can easily be moved away from the ICU bays and the distance provides a desired buffer for noise reduction
Installing ‘dimmable lights’ provides a visual cue to all to maintain a quieter environment
A display unit that provides a visual alert every time decibels reach alarming and non-conducive limits
Adjusting equipment’s volumes to a minimum and replacing usual sound alarms with visual alarms for nursing staff

Behavioural modification

Bedside conversations between nursing staff, physicians, and family members are also found to be contributing to the increasing levels. Therefore, limiting these consultations to a separate private room will be ideal
Reducing the usage of intercom in ICUs
Limiting the number of visitors in ICUs and instructing them on the need to maintain a quiet environment

Technology is evolving every day and with the rising awareness for reducing noise in ICUs, the future is likely to introduce systems that while addressing this need, at the same time also ensures well-attended and timely care of patients. Visual light-based and vibration-based alarms are likely to become common in ICUs. In addition, infrastructural modifications of design, configurations, and build type and quality are itself capable of reducing noise in ICU substantially. It is globally recognised that ICU noises are a daunting experience for patients and staff. ICU environment is prone to chaotic and unpredictable disruptions and due to the vulnerable critically ill patients, it demands the highest levels of management that ensures a conducive environment at all times and offers the best care. A conscious and collaborative effort involving few changes discussed can bring about a change that can go a long way in healthcare.

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Silence please!

Opinion

Silence please!

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