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Noise pollution in the ICU

Citation for published version (APA):

Simons, K. S., Park, M., Kohlrausch, A., van den Boogaard, M., Pickkers, P., de Bruijn, W., & de Jager, C. P. C. (2014). Noise pollution in the ICU: time to look into the mirror. Critical Care, 18(4), [493].

https://doi.org/10.1186/s13054-014-0493-1

DOI:

10.1186/s13054-014-0493-1 Document status and date: Published: 27/08/2014

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LETTER

Noise pollution in the ICU: time to look into the

mirror

Koen S Simons

1,2*

, Munhum Park

3

, Armin Kohlrausch

3

, Mark van den Boogaard

2

, Peter Pickkers

2

,

Werner de Bruijn

3

and Cornelis PC de Jager

1

See related research by Darbyshire and Young, http://ccforum.com/content/17/5/R187

We read with interest the recent issue ofCritical Care in which Darbyshire and Young [1] reported on noise levels in five different ICUs and demonstrated average sound pressure levels far above the World Health Organization recommended standard of 35 dB LAeq

(A-weighted energy-equivalent sound pressure level in decibels). Although their article provides an interesting insight into the ICU soundscape, the authors did not attempt to investigate the sources of noise. In the lit-erature, only few studies have performed an analysis of noise sources, using either questionnaires [2] or a hu-man observer in the patient’s room [3-5]. Aiming to provide more insight into this matter, some of the au-thors recently performed an acoustic survey in an ICU room in order to determine which sources are respon-sible for the high noise levels, and details of this study were recently published [6]. Briefly, an audio recording was made by using a calibrated microphone in an ICU room at Jeroen Bosch Hospital for a duration of 67 hours. In addition to the analysis of various acoustic parameters, a 24-hour audio fragment was manually annotated by six research assistants. All sound events (n = 27,421) were identified by using 28 noise source labels, which were grouped into five noise categories.

Acoustic analysis showed an average sound pressure level of 61 dB LAeq when the room was occupied. In

agreement with the aforementioned study, the num-ber of predicted loudness peaks was up to 90 per hour. Restorative periods were defined as periods of at least 5 minutes in which the sound pressure level relative to the background level did not exceed 17.7

dBA (A-weighted sound pressure level in decibels); only approximately 46% of the periods recorded at night were considered to be restorative, and the aver-age duration of these restorative periods was approxi-mately 13 minutes. Source-specific analysis revealed that, on average, noisy events related to staff activities (54 dB LAeq) occurred approximately 10 times per

mi-nute, staff speech (55 dB LAeq) occurred

approxi-mately 4 times per minute, and alarms (57 dB LAeq)

also occurred approximately 4 times per minute. Fur-ther analyses showed that 57% of total acoustic energy and 92% of predicted loudness peaks could be attrib-uted to the activities and speech of hospital personnel (Figure 1). We agree with Darbyshire and Young [1] that high sound pressure levels may have detrimental effects in the already vulnerable population of ICU patients. The aforementioned study demonstrates that more than half of all acoustic energy in an ICU is re-lated to human activities and speech and therefore is potentially modifiable. Strategies involving the adap-tation of human behavior therefore may prove to be very effective at reducing noise pollution in the ICU.

Abbreviation

dB LAeq:A-weighted energy-equivalent sound pressure level in decibels.

Competing interests

MP, AK, and WdB are employees of Koninklijke Philips n.v. (Amsterdam, The Netherlands), which provided the recording equipment used in the study described above. KSS, MvdB, PP, and CPCdJ declare that they have no competing interests.

Author details

1Department of Intensive Care and Emergency Medicine, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1,‘s Hertogenbosch 500 ME, The Netherlands.2Department of Intensive Care Medicine, Radboud University Medical Centre, Geert Grooteplein 21, Nijmegen 6500 HB, The Netherlands.3Smart Sensing & Analysis Group, Philips Research Laboratories, High Tech Campus 36, Eindhoven 5656 AE, The Netherlands.

* Correspondence:k.simons@jbz.nl

1Department of Intensive Care and Emergency Medicine, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1,‘s Hertogenbosch 500 ME, The Netherlands

2

Department of Intensive Care Medicine, Radboud University Medical Centre, Geert Grooteplein 21, Nijmegen 6500 HB, The Netherlands

Full list of author information is available at the end of the article

© 2014 Simons et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Simonset al. Critical Care 2014, 18:493 http://ccforum.com/content/18/1/493

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References

1. Darbyshire JL, Young JD: An investigation of sound levels on intensive care units with reference to the WHO guidelines. Crit Care 2013, 17:R187. 2. Ugras GA, Oztekin SD: Patient perception of environmental and nursing

factors contributing to sleep disturbances in a neurosurgical intensive care unit. Tohoku J Exp Med 2007, 212:299–308.

3. Tegnestedt C, Gunther A, Reichard A, Bjurstrom R, Alvarsson J, Martling CR, Sackey P: Levels and sources of sound in the intensive care unit - an observational study of three room types. Acta Anaesthesiol Scand 2013, 57:1041–1050.

4. Hilton BA: Noise in acute patient care areas. Res Nurs Health 1985, 8:283–291. 5. Tsiou C, Eftymiatos D, Theodossopoulou E, Notis P, Kiriakou K: Noise

sources and levels in the Evgenidion Hospital intensive care unit. Intensive Care Med 1998, 24:845–847.

6. Park M, Kohlrausch A, de Bruijn W, de Jager C, Simons K: Analysis of the soundscape in an intensive care unit based on the annotation of an audio recording. J Acoust Soc Am 2014, 135:1875–1886.

doi:10.1186/s13054-014-0493-1

Cite this article as: Simons et al.: Noise pollution in the ICU: time to look into the mirror. Critical Care 2014 18:493.

A

B

Figure 1 The contribution of each noise category for (A) the acoustic energy and (B) the number of predicted loudness peaks. Noise generated by or involving patients is excluded. For more details, refer to [6].

Simonset al. Critical Care 2014, 18:493 Page 2 of 2

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