Hospitals & Healthcare
The High Cost of Noise in a Hospital on the Patients and Staff
When we think of where we would like to rest and recuperate from illness or medical treatment, most of us visualize places that are quiet and peaceful. This is a stark contrast to the typical hospital where sounds of beepers, alarms, machines, telephones and people's voices are more of the "normal environment".
The epidemic of noise in hospitals, which is one of the biggest complaints of patients and staff, is something that can no longer be ignored. Hospitals provide year round, round the clock residential & sleeping accommodations for patients, but in today's high tech environment of health care, there is noise everywhere and patients are paying a price.
Noise can come from nearby highways & roadways, airplanes & medical helicopters, building cooling towers, emergency generators, even construction equipment used for hospital additions or renovations. Regardless of where the patient is, equipment dominates the hospital experience.
The environment of multiple monitors, beepers, buzzers, paging systems, telephones, carts, wheel chairs & gurneys, hospital beds that are electric, pillow speakers and nurses call systems, IV poles that role on tiled floors, doors that close abruptly, and carts that squeak..all of this prior to one word being spoken or one person walking past the patient's room.
All this noise needs to be managed.
The noise that the equipment makes, plus the noise of the hustle & bustle of a busy hospital has a serious impact on patients & the staff alike. To name only a few problems that patients in poorly acoustically designed healthcare facilities experience, are:
Remember, this is supposed to be a HEALING environment. It should be acoustically designed to be healing environment. Loud noisy hospitals are contradictory to healing environments.
However, noise not only affects the patients, it affects the staff as well!
Research is showing that a noisy environment causes emotional exhaustion & burnout among critical care nurses and noise is strongly related to increased stress & annoyance among nurses in general.
Healthcare providers polled also showed a lower job satisfaction rate in noisy environments than in acoustically designed quieter ones.
Interesting enough, patients in noisy healthcare facilities were less satisfied with the level of care they received than in quieter facilities.
It has been shown, that while noise may not necessarily affect the performance of the staff, research does show that a healthcare worker who is working in a noisy situation will have to concentrate harder & exert more effort to be able to perform their function properly, which leads to them being more fatigued.
It is not hard for anyone of us to relate to the frustration that noise causes when we are trying to concentrate at our jobs. Trying to work with so much noise going on around us obviously opens the door to increased errors.
Why is noise so prevalent in healthcare facilities? It's a place of hard surfaces. In the world of hard surfaces it takes much longer for the noise to stop bouncing around. Think of a tennis ball. Throw it against a hard surface, and then throw it against a pillow. When the ball hits a hard surface it keeps bouncing around. When it hits a pillow, it drops. That's what happens to noise.
When the absorption of all that noise is not accounted for when the building is being designed, then working in or being a patient in a healthcare facility can be very hard on the body.
Hospital Noise Studies
A study published in the American Journal of Nursing shows why the problem strikes such a harsh note with patients. Hospitals can sound as loud as jackhammers.
The researchers, who were a team of Mayo Clinic nurses, found that during the hustle and bustle of a morning shift change, the blare reached 113 decibels. That's about as loud as a chain saw!
The nurses decided to conduct their investigation after hearing several patients complain about the noise. As a part of their study, 2 of the Mayo clinic nurses slept overnight in a room setup with equipment normally found in a thoracic unit, where patients recover from chest operations.
They also put sound monitoring devices in 3 empty rooms. 1 of the nurses who spent the night, wrote in the study that she was awakened by her roommates IV pump alarm at 1:15 am. She was awakened again at 3:15 am when the portable X ray machine was rolled into the room, sounding like an oversized power tool as its motor whirred, and the cartridges of X ray film bumped noisily together.
At 6:10 am the nurse was roused by the tapping of doctors dress shoes in the hallway.
A hospital in India did a study of the effects of noise in the operating room. Not low frequency noise, but the more typical high frequency noise. This is the only study of it's kind. They wanted to test 2 cognitive functions: mental efficiency & short term memory.
In 5 separate operating suites, they made professional grade recordings of noise that was generated during surgical procedures.
The noise levels were measured over 3 to 5 hours and it recorded the noise made by surgical instruments, suction apparatus, monitors & alarms and the ambient noises of doctors nurses & other operating room staff.
The microphones were placed 10 inches from the anesthesiologist's ears. The average noise level turned out to be slightly over 77 decibels, which is considerably louder than an alarm clock at 2 feet.
The results of the study showed that the anesthesiologists who were exposed to this level of noise for prolonged periods of time were less efficient & had decreased short term memory.
Much of the anesthesiologist's job involves obtaining information from various sources. Verifying the validity of the information, formulating priorities and taking prompt & immediate action based on the information obtained.
The conclusion of the study was "the administration of anesthesia is a task where even momentary inefficiency can result in serious consequences to the patient. Hence, operating room noise should be reduced."
In 5 published studies over the last 45 years, not 1 study reported noise levels that complied with the World Health Organization guidelines for hospital noise levels.
However, hospital noise levels have been rising consistently since the 1960s. The background noise levels rose from 57 decibels during daytime hours in 1960 to 72 decibels today, and from 42 decibels during nighttime hours in 1960 to 60 decibels today. Many studies indicate that peak hospital noise levels often exceed 85 to 90 decibels.
Noises from alarms from equipment such as portable X-Ray machines that exceed 90 decibels are comparable to walking next to a busy highway when a motorcycle or a large truck passes. Interestingly enough, federal safety standards list 85 decibels as the safe MAXIMUM level of noise exposure for an 8 hour period without hearing protection!
Another way of characterizing the extraordinary loudness of common hospital sounds is to consider that an 85 decibels noise is 100,000 times higher in sound pressure than the recommended daytime level of 35dBA for patient spaces.
A decibel is a unit for quantifying loudness levels based on a logarithmic scale. Think of the Richter Scale. A few decibel difference can mean a lot! The way the ear hears, something that is 30 decibels is twice the sound as something that is 20 decibels.Something that is 40 decibels is twice as loud as something that is 30 decibels. For every 10 decibel increase, that means twice the sound.
It is not surprising that high noise levels in hospitals have serious implications for staff & patient health & well being.
Think of the surgery and testing sections of the hospital. Scanning & optical microscopes, MRI machines, CAT scanners, laser devices, and other sensitive equipment can be badly compromised by the low frequency rumble from HVAC systems & by vibration. Sensitive equipment can be affected by vibrations that humans cannot feel. In fact, these are at levels of vibration 1 to 3 orders of magnitude below what a human tactile sense can detect.
MRI equipment, for example, can give what are called "Ghost Images" if they are not properly acoustically isolated from vibration.
And, not only does low frequency noise affect the equipment, it affects the people using them as well.
Cornell University did a study on low frequency noise and they found that prolonged exposure to low frequency noise, such as the low rumble of HVAC equipment could :
- Raises a person's blood pressure level
- Makes them feel more stressed
- Causes headaches
- And Respiratory ailments
The Privacy Rule
The Health Insurance Portability and Accountability Act ("HIPAA") was enacted by the federal government in 1996. Part of this act addressed confidentiality of patient insurance and medical records. This "Privacy Rule," which went into effect on April 14, 2003, addresses the use and dissemination of patient health information through electronic form as well as in print or verbal communication. Organizations covered by the Privacy Rule include doctor's offices, dental offices, hospitals, pharmacies, and other health care and insurance providers. The Privacy Rule states that covered entities must adopt reasonable safeguards to protect their patient's medical information.
Although there are no specified speech privacy criteria currently defined in the HIPAA law, the industry has adopted a standard referred to as the Articulation Index. Articulation Index is a measure of the intelligibility of speech that takes into account the reduction in sound pressure level afforded by a partition in question, the ambient noise level, and various weighting factors. The Articulation Index of a space in question can be measured and compared to industry standard values that define levels of acceptability. An Articulation Index of .05 or less is typically used as an indication that a reasonable effort has been made to protect patient information.
Impact of the Law
Since passage of the Privacy Rule, many health care providers are finding that their facility is not living up to the speech privacy requirements. Other health care providers do not know if their facility is in compliance or not. If a complaint is proven to be valid, the Department of Health and Human Services may impose a civil penalty of $100 per failure to comply with the Privacy Rule requirements (maximum of $25,000 per year).
What Can Be Done?
It is time to address your facility's speech privacy concerns. AcoustiControl can visit your facility to conduct a noise survey and measure the Articulation Index to determine if your facility exhibits a reasonable accommodation toward acoustical privacy. If not, AcoustiControl can recommend ways to improve acoustical privacy. Please contact us for a thorough site visit and a serious analysis of your situation.
If the project is still in the design phase, AcoustiControl can make recommendations to help ensure a good acoustical design throughout the healthcare facility
There's good news...
Those hospitals that have attacked the noise problem successfully by looking equipment and making acoustical modifications to their facilities have improved patient satisfaction.
At Northside Hospital in Atlanta Georgia, a committee of employees from throughout the hospital ( even accounting) studied ways to reduce noise. In 2 years, the committee was able to drop the decibel level by as much as 40% in some hospital areas.
At other hospitals that took steps to reduce noise levels, patients were more satisfied with their care, slept better, had lower blood pressure and were less likely to be re hospitalized. Also, the staff felt better about their jobs and they also reported improved sleep quality.
Poor acoustics have dramatic consequences in healthcare environments, and using the services of an acoustical consultant when designing hospital or healthcare environments will help ensure that the facility will perform the purpose that it is designed to perform.