The inhospitable hospital: no peace, no quiet.(Focus Nursing Issues)

Stokowski addresses the continuing concern of noisy hospital environments. She begins by defining the sound levels, measured as decibels (dB), which describe noise. In human ears, the threshold of hearing is 0 dB. Most human ears accommodate 120 dB, but hearing loss is associated with sounds at 85 dB and higher.

The World Health Organization states that hospital sound levels have steadily increased so that daytime sound levels average 72 dB and nighttime sound levels average 60 dB. They recommend sound levels not exceed 35 dB during the day and 30 dB during the night.

Stokowski believes that noise is a health hazard. Noise interferes with communication, contributes to stress, and disturbs sleep. In addition, research demonstrates increases in the length of hospitalization and the frequency of rehospitalization because of increased sound levels that may: increase the risk of hypertension and ischemic heart disease, increase reflux in GERD patients, increase the need for pain medication in surgical patients, and delay wound healing.

Stokowski also discusses the adverse effects on noise on staff and workplace performance. Physiological responses include tachycardia, and emotional responses include the annoyance and stress that contribute to fatigue and burnout.

Stokowski notes that more than 60% of noise is avoidable. She refers to an interesting research study on noise reduction that compared changes in human behavior to changes in both physical and structural environments. This research concludes that the greatest source of noise is the angles and surfaces that reflect rather than absorb noise.

Recommendations for noise reduction include staff education regarding the importance of sound levels, and practical guidelines such as placing pagers on vibrate. She suggests closing patient room doors except in intensive care units, where noisy monitors and equipment may continuously alarm. But the greatest improvements in noise reduction include lowering the volume of telephones, pagers, monitors and equipment (IV pump alarms), and designing an environment that minimizes sound. She notes that motion-sensor innovations produce excessive noise and their placement should be carefully considered for proximity to patient care.

Finally, Stokowski suggests Susan Mazer's data collection tool for the assessment of sound levels. This tool utilizes qualitative and quantitative data to identify noise reduction concerns and devise a plan to alleviate them.

Laura A. Stokowski, RN, MS

Medscape Continuing Education Article

Article Reviewed by Kathy Ryan

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