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Noise Levels in a Tertiary Neonatal Intensive Care Unit

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Journal of Perinatology. 20:S54-S59. Bremmer, P., Byers, J.F. ... Journal of Perinatology. 20:S76-S87. Nair, M.N.G, Gupta, G. ... of Perinatology, 20: ... – PowerPoint PPT presentation

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Title: Noise Levels in a Tertiary Neonatal Intensive Care Unit


1
Noise Levels in a Tertiary Neonatal Intensive
Care Unit
  • Cindy T. Chavez, BA1
  • Abbey L. Berg, PhD2,3
  • Yula C. Serpanos, PhD1
  • 1Adelphi University 2 Pace University 3College
    of Physicians Surgeons, Columbia University

American Speech-Language-Hearing
Association November 21, 2008
2
Specific Aims
  • To monitor and examine noise levels in a tertiary
    neonatal intensive care unit (NICU) of a large
    urban regional perinatal center
  • Morgan Stanley Children's Hospital of New York
    City

3
Rationale
  • Excessive noise levels negatively effect overall
    health specifically, hearing, blood pressure,
    heart and respiratory rates, and sleep.1
  • When exposed to intense noise in the NICU,
    premature infants behavioral and physiological
    responses change significantly, increasing
    susceptibility to poor overall development,
    length of stay in the hospital, and decreasing
    weight gain. 2,3

4
Rationale
  • These infants are at greater risk of developing a
    hearing loss when compared to full-term babies as
    a result of the synergistic effects of
    aminoglycosides and loop diuretics, as well as
    potentially noxious levels of noise. 4
  • The American Academy of Pediatrics (AAP, 1997)
    recommends that NICU noise levels not exceed 50
    dB(A). 5

5
Rationale
  • Studies show average noise levels in NICUs range
    from 50-75 dB(A), with peak levels often reaching
    105 dB(A). 2,5
  • Philbin (2000) found noise levels exceeding 77
    dB(A) caused discomfort to the neonate. 6

6
Rationale
  • The NICU staff in this newly designed tertiary
    care facility was committed to providing an
    environment that supported infants needs and
    promoted their development.
  • Concern remained that noise levels were greater
    than recommended. The staff of the Newborn
    Hearing Screening Program was approached about
    monitoring noise levels in the NICU and to
    identify noxious sources.

7
Design
  • An Extech Instruments 407764 Sound Level Meter
    RS232/Data Logger range 30-130 dB(A) recorded
    noise levels in each of seven designated NICU
    areas for a 24 hour-seven days per week period,
    in 2 second time intervals.
  • The dimensions of each area were
  • 8 ft. x 24 ft. in area size
  • 2-3 isolettes per area (one isolette on either
    side of the pod, with a third in the middle)

8
Design
  • Each isolette (open or closed) was equipped with
    monitors, which measured infants heart rate,
    respiration, pulse oxidation, and oxygen
    saturation.
  • Infant population, approximately,
  • 50 had a feeding tube
  • 25 were either on continuous positive air
    pressure (CPAP) or undergoing phototherapy
  • 20 were attached to an intravenous (IV) drip
  • lt5 required usage of a suction machine

9
Design
  • The sound level meter (SLM) was positioned on a
    36-inch high counter and was equidistant,
    approximately 10 ft., from each isolette in each
    area being monitored.
  • Calibration of the SLM was completed, pre- and
    post- data collection, using an Extech
    Instruments Model 407766 Sound Level Calibrator,
    to ensure accurate measurements.
  • Data was downloaded to a Dell Inspiron 4000
    notebook and converted into Excel for analysis.

10
Results Table 1
Noise Levels Across Areas Over a 24-Hour Seven
Day Period
11
Results
  • Noise levels from monitors, alarms, and equipment
    although always gt50 dB(A), rarely exceeded 75
    dB(A), range 52-79.5 dB (A), mean 58.88, SD
    5.51.
  • Data analysis revealed that peak noise levels 82
    - 102.1 dB(A) consistently occurred in
    conversations during physician chart reviews and
    family visits.

12
Discussion
  • The results of this investigation revealed noise
    levels in each of seven areas measured in this
    NICU to exceed the AAP (1997) recommendation of
    lt50 dB(A) for the majority of time within a
    typical day.
  • The highest levels of noise gt75 dB(A) were
    noted to occur in conversations during medical
    rounds and family visits.
  • The lowest levels of noise lt50 dB (A), occurred
    during the late evening and early morning, when
    NICU activity was reduced.

13
Discussion
  • While prior research suggests excessive noise
    levels may occur in the NICU, this study served
    to confirm excessive levels and to identify
    sources.
  • Study outcomes were presented to NICU attendings,
    fellows, nurses, and other staff during Grand
    Rounds to discuss strategies to lower noise
    levels in the general NICU environment and
    specific to the observed sources.

14
Recommendations to reduce noise in this NICU
include
  • Modifications to the Physical Environment, e.g.
  • rubber stoppers on cabinet doors
  • blankets on top of isolettes
  • use of flash-light vs. sound alarms 3,5,7
  • installing door silencers
  • disconnecting ventilators before suctioning
  • not using the isolette as a writing surface
  • closing isolette doors gently
  • removing radios from NICU areas near the neonates8

15
Recommendations to reduce noise in this NICU
include
  • Monitoring of Conversation Levels
  • conduct medical rounds and other conversations at
    a remote location to ensure a more optimal
    environment
  • post signs in each area as intended reminders for
    staff and visitors to monitor conversation levels
    while in the NICU

16
Conclusions
  • Periodic monitoring of noise levels in the NICU
    environment is recommended in order to identify
    and modify potential new and unexpected instances
    of noxious noise sources.
  • Education of new attendings, fellows, and medical
    students before they begin their rotation as well
    as veteran staff to alert and sensitize them to
    the adverse effects of noise to the premature
    neonate.

17
Conclusions
  • These findings also serve to remind the
    audiologist of the importance of their role in
    the routine performance of noise measurements in
    the NICU.
  • The findings and recommendations of this study
    may be useful to the oversight and management of
    noise levels in other NICU facilities.

18
References
  • Bahadori, R.S. Bohne, B.A. (1993). Adverse
    effects of noise on hearing. American Family
    Physician. 47(5)1219-1230.
  • Morris, B.H., Philbin, M.K., Bose, C. (2000).
    The full-term and premature newborn
    Physiological effects of sound on the newborn.
    Journal of Perinatology. 20S54-S59.
  • Bremmer, P., Byers, J.F., Kiehl, E. (2003).
    Noise and the premature infant Physiological
    effects and practice implications. Journal of
    Obstetric, Gynecologic and Neonatal Nursing.
    32447-454.
  • Bernard, P.A. (1981). Freedom from ototoxicity in
    aminoglycoside treated neonates A mistaken
    notion. Laryngoscope. 91(12)1985-1994.
  • American Academy of Pediatrics (Committee on
    Environmental Health). (1997). Noise A hazard
    for the fetus and newborn. Pediatrics.
    100724-727.
  • Philbin, M.K. (2000). The influence of auditory
    experience on the behavior of preterm newborns.
    Journal of Perinatology. 20S76-S87.
  • Nair, M.N.G, Gupta, G., Jatana, S.K. (2003).
    NICU environment Can we be ignorant? Medical
    Journal Armed Forces India. 59(2)93-95.
  • Graven, S.N. (2000). Sound and the developing
    infant in the NICU Conclusions and
    recommendations for care. Journal of
    Perinatology, 20S88-S93.
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