The hospital’s Intensive Care Unit (ICU), one of the most sophisticated areas of the hospital after the operating room, is frequently a source of traumatic experiences for its patients. One of the prominent sources of discomfort stem from alarms, staff conversations, and sophisticated biomedical equipment is used for continuous monitoring and supporting patients’ vital functions. The combined effect of sounds from these sources has been shown to cause stress in both patients and caregivers. The World Health Organization (WHO) recommends that ambient noise in hospitals not exceed 35 decibels during the day and 30 decibels at night. Many studies, however, have found that ICU noises exceed the threshold.

However, published studies show that noise levels in hospitals, particularly in intensive care units (ICUs), are higher than what is recommended. Busch-Vishniac et al. (2005) discovered that mean noise levels in hospitals ranged from 57 dB-A to 75 dB-A during the day to 42 dB-A to 60 dB-A at night, with ICUs reaching 90 dB-A.

Patients exposed to loud noise in ICUs experience the following physiologic changes: increased heart rate, metabolism, and oxygen consumption (Hsu et al., 2010; Lawson et al., 2010), immune system suppression due to increased corticosteroid release and stress (Bigert, Bluhm, & Theorell, 2005; Choiniere, 2010), and difficulty concentrating due to exaggerated noise perception (Bigert, Bluhm, & Theorell, 2005 (Hasfeldt, Laerkner, &Birkelund, 2010; Pope, Gallun, &Kampel, 2013). Sleep disorders and ICU psychosis are two other changes associated with noise in intensive care units (Morton, 2013; Pope et al., 2013).

Impacts of noise in ICU
Family members of patients in the ICU often have reported disorientation in ICU patients. This is a disorder in which patients in an intensive care unit (ICU) may experience anxiety, become paranoid, hear voices, see things that are not there, become severely disoriented in time and place, become very agitated, even violent, etc.

According to current estimates, one out of every three patients who spend more than five days in ICU experiences some form of psychotic reaction. Health factors such as dehydration, low blood oxygen), heart failure, infection in combination with sedatives and strong pain medications can contribute to delirium. Additionally, environmental factors also play a significant role in causing this disorientation like:

• ICUs are notorious for being designed without windows that take away the body’s natural ability to process its circadian rhythm, resulting in severe sleep deprivation.
• ICU bays are commonly designed without any auditory isolation, resulting in Sensory overload (being tethered to noisy machines day and night), crashing of another patient in a bay nearby, and conversations among staff and physicians.
• ICU units are designed without any area that allows caregivers to enable shift change without disturbing the patients.
• Lights are designed to facilitate caregiving at 6000k or above, which are harsh white lights to fall asleep to and without the ability to dim down to a warmer light for ambient lighting.
• Patients often feel the overall loss of control over their lives in an ICU.

According to several studies, sound increases affect nurses’ job satisfaction and anxiety levels. They also state that the only way to provide high-quality patient care was to ensure safe working conditions for nurses in specialised units such as ICUs.

The truth of the matter is that because ICU Psychosis is a temporary condition and is a patient often is “cured” of it upon leaving the ICU environment, there is a normalisation of this condition among the healthcare fraternity. The impact of ICU Psychosis manifests high blood pressure, which causes anxiety. Patients need to be on sedatives and anti-psychotics to control the effects of the psychosis. We can avoid medication and complications by making simple operational and environmental changes. There is data to bolster a case for a healthier ICU – an in-depth analysis revealed that behavioural, operational, and infrastructure changes could significantly reduce noise levels. A concerted effort from these modifiable factors can result in a more tranquil and restful environment, directly impacting the patient’s health.

Infrastructural Modifications

• Individual enclosed bays with break open glass doors
• Smaller cluster 6-8 patients
• Install sound absorption ceilings with dampeners in the HVAC system.
• Building walls of bays or clusters that go up to the plenum can reduce sound travel between bays.
• Relocate work areas like the counsel rooms, staff work area, change area, cleaning storage, hand wash area, and utility areas away from the ICU bays.
• Install ‘dimmable lights’ to maintain a quieter environment.
• Install monitors outside of bays to display patient condition for nurses and doctors to view vitals without disturbing the patient.

Behavioural Modification

• Limit the consultations among patients, nurses and family members in a separate room to reduce the noise inside the room.
• Shift change also should be done away from the patients’ earshot.
• Limit the number of general visitors in ICUs. However, always allow a family member to help keep the patient comforted and oriented.

Operational Modification

• Monitoring Sound levels – this is an essential first step because we do not know what we do not measure.
• Introduce written reminders around the ICU to maintain desired decibel levels. Centralised nursing monitors should be established to reduce noise at patient bays.
• Adjust the volume of the equipment volumes to a minimum. Visual cues from light-based and vibration-based alarms are more common in intensive care units.
• Encourage staff and physicians to take group discussions to a quieter place and not within the earshot of patients.
• Install quiet times in the unit when patients are not disturbed with medical interventions like physical therapy, vital checks, medication administration, physician visits and hygiene routines.

The results of this study suggest that physical space rearrangement, the repair and settings of equipment, staff education, and a written reminder that noise measurements are continuous in the ICU setting are effective in reducing noise in ICUs and, therefore beneficial to patients and staff in the most critical of areas within the hospital.

Sujayanti Dasgupta, Co-Founder & Director – Healthcare,
Siddharth Puri, Co-Founder & Director – Design of W-ARD FOUR

(DISCLAIMER: The views expressed are solely of the author and ETHealthworld does not necessarily subscribe to it. ETHealthworld.com shall not be responsible for any damage caused to any person / organisation directly or indirectly.)