Authored by: Peggy Pilon, BSN, MS, RN VP of Clinical Success
The world is a noisy place, and it appears to be getting louder. At the same time, people may be less tolerant of noise in the post-pandemic work world. As employees have headed back to the office, 52% of office workers say they are concerned that noise levels in the office will make them less productive, according to a recent survey by HR Magazine. Nearly two-thirds of those people say they fear they’ll get fed up if their noisy coworkers break their concentration, and 42% worry that they’ll slip into “noise rage” if colleagues become too loud.
What is Noise Pollution?
Noise pollution is defined as unwanted or excessive sound that can have deleterious effects on human health, wildlife, and environmental quality. Noise pollution is commonly generated inside many industrial facilities and some other workplaces, but it also comes from highway, railway, and airplane traffic and from outdoor construction activities. Former U.S. Surgeon General William H. Stewart said in 1978, “Calling noise a nuisance is like calling smog an inconvenience. Noise must be considered a hazard to the health of people everywhere.” In fact, the ancient Romans banned chariots from the streets at night due to the noise from the clattering wheels. The Romans feared that this noise would disturb sleep and annoy their citizens.
How is Noise Measured?
Noise level is measured in decibels (dB). The louder the noise, the higher the decibels. Decibels can be adjusted to human hearing and therefore described in decibels A (dBA). The effects of noise varies based on the noise a person is exposed to. Prolonged exposure to loud noises (75 dBA over eight hours a day for years) can lead to hearing loss. The body also responds to lower noise levels during sleep which can be disturbed by an outdoor noise of 40 dBA.
Noise Pollution in the Work Environment:
It’s no wonder that the Bishop’s Salon in Denver received feedback from their customers that they were tired of the noisy salon. Customers “experienced a cacophony of sound: vacuum cleaners, hair dryers, thumping music, running water, clanging of spoons and bowls, and conversation—lots of conversations among the 35 to 45 clients who sit for appointments each day.” To combat this noise problem, Bishop’s CEO rolled out, throughout all their salons, the option for a “silent appointment.”
In other business environments, the majority of executives and employees report near-constant noise in their workplace. The noise in an average open-plan ranges from 60-65 dBA. People working from their home offices often experience only 50-55 dBA. A report from Oxford Economics also claims that noise and distractions are having a negative impact on employee wellness, productivity and financial performance. A larger percentage (63%) of employees say they lack quiet space for focused work, which has a negative effect on their productivity, satisfaction and well-being. 75% of employees say they need to take walks outside to focus, and another 32% use headphones to block out distraction. It is important to note that employees in the noisiest office environments are more likely to leave their job in the next six months. Millennials, ages 22 to 36 are more likely to say their organization should address noise, distraction and information overload. People lose an estimated 86 minutes of productivity each day because of noise distractions, according to a study by Steelcase. It takes another 23 minutes to get back on task after an interruption, according to a study from University of California at Irvine. How many workers have to quit before this noise pollution is addressed?
What about the Noise in Healthcare Environments?
As early as 1859, Florence Nightingale discussed the importance of maintaining a quiet environment for patients. In her book, she describes the needless noise as “the cruelest absence of care.” In 1995 the World Health Organization (WHO) outlined its hospital guidelines which suggested patient room sound levels should not exceed 35 decibels (dB). Yet since 1960, the average daytime hospital noise levels around the world have consistently more than doubled from the acceptable level of 35 to 72 dB. While night time noise levels in hospitals have increased from 42 to 60dB. Then in January of 2012, Jordan Yoder, BSE and his colleagues from the University of Chicago performed a study that showed that the average hospital-room noise was far more than the WHO recommended level of 35dB. They even found that the peak noise averaged at 80.3 dB, which is loud as a chainsaw or electric sander! So the study concluded that these noise levels are associated with clinically significant sleep loss among hospitalized patients. As stated previously, long or repeated exposure to sounds at or above 75 dBA can cause hearing loss.
Dr. Fred Buckhold, an internist at SSM Health St. Louis University Hospital in Missouri, said one patient’s experience spurred his hospital to reduce reliance on bed alarms. A 67-year-old woman was placed on a bed alarm while being treated for a collapsed lung. “I feel like I’m in jail,” she protested. “I can’t sit up or go to the bathroom without them coming after me.” “Did the bed alarm help her at all?” Buckhold reflected… “It just made her want to kill us.” The patient went on to describe that by only making slight position changes, the bed alarm would sound and continue to ring for up to 10 minutes every hour, day or night. She became so frustrated that she gave up trying to sleep at all while hospitalized. And she only had one bed alarm device! Imagine what it is like to be an ICU patient.
What about Patients in ICU Environments?
It is well documented that ICU patients can experience sleep deprivation and ICU delirium while in an ICU due to the noisy monitor alarms and medical devices. These side effects can also delay a patient’s recovery, which increases their length of stay (LOS). However, too many un-actionable alarms can lead to patient injury or death. Boston’s Medical Center’s cardiac care unit reported that their unit experienced a total of 12,000 alarms a day! While the Washington Post reported in 2013 that Johns Hopkins Hospital ICU tallied 771 alarms per bed per day. These huge numbers of alarms are overwhelming and inadvertently creating alarm fatigue in nurses. Alarm fatigue can cause nurses to ignore an alarm or to miss an emergent alarm, causing patient harm. This in turn can lead to medical negligence or malpractice suits against hospital staff.
What about ICU Nurses?
According to the World Health Organization, the maximum level of noise at night in hospitals should not be greater than 40 decibels (dBa), and no more than 30 dBA during the day and evening hours. While in patient rooms, the WHO recommendation is the noise should not exceed 35dBA. Despite these recommendations, ICU peak sound levels can register as high as 90 dBA to 101 dBA, with the average ICU sound levels within a 24-hour time interval ranging from 53 dBA to 60 dBA. It is important to recognize that the sound of a ventilator is 85 dBA, and the sound of an IV pump is almost 60 dBA. A heart monitor in the ICU can go up to 85 dBA. To put these sound levels into context, a motorcycle is 90 dBA, and a vacuum cleaner 70 dBA. Distraction during cognitive tasks is likely to occur when sound levels reach 40 dBA. So in addition to experiencing alarm fatigue, cognitive overload, burnout and potential medical negligence issues, ICU nurses are also at risk for long term hearing loss because of the noisy ICU environment.
What Can Be Done to Eliminate the Noisy ICU Environment?
There has been a great deal suggested in the literature to lessen the noise in the ICU for both patients and staff. These interventions center around environmental strategies that include: adding sound barrier materials to dampen noise, ear plugs or noise cancellation headphones for patients, establishing “quiet hours” in the ICU and more training on noise reduction for staff. These strategies are a starting point and their aim is to lessen the noise. Perhaps it is time to implement AI-driven technologies that will eliminate noise and can be immediately implemented.
CalmWave is an operations-based artificial intelligence (AI) platform that captures, analyzes, and synthesizes real-time data from dozens of data sources (monitors, labs, orders, findings, etc.) to empower hospitals with the intelligence critical to improving patient outcomes, optimizing operations, and retaining staff. The AI technology from CalmWave presents objective solutions that reduce non-actionable alarms by providing proper alarm management insight to the caregiver, thereby decreasing alarm fatigue, excessive cognitive load, and burnout. The issue of noisy ICU environments affecting our patients and nurses is a problem that has been going on for years and is only getting worse… but CalmWave is here now…as an innovative, data-driven solution that can be implemented today.
We in healthcare need to take a step back and take a page from the non-clinical world of work. Non-Clinicians are standing up for themselves and refusing to work in noisy offices where they have difficulty concentrating and will no longer accept 60-65 dBA environments. It’s time that clinicians, especially ICU based-staff, say no to ICUs with consistently noisy, harmful units (85 dBA), where they have to take care of critically ill patients at decibels that could risk their hearing and their health long term. CalmWave is here now, and we can make the ICUs a quiet, healing environment…the way they were intended to be.