Keeping the hospital’s smallest patients safe

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An Indiana hospital reduces noise levels to help premature babies’ development

After reading this article, you will be able to:

  • Identify why noise level is important in the NICU
  • Discuss strategies for reducing noise level
  • List the benefits of reducing noise level in any hospital unit

For babies born prematurely, even the noise generated from a normal conversation can be too loud for proper development. But mothers who give birth to premature babies at The Women’s Hospital in Newburgh, IN, need not worry about the noise level in the hospital’s neonatal ICU (NICU).

The Women’s Hospital installed sound meters and visual feedback cues to ensure that babies receive the safest possible care.

“We think that the developing brain, especially of the premature baby, is influenced by its environment,” says Kenneth Herrmann, MD, medical director of newborn services for the Deaconess-Riley NICU at The Women’s Hospital. “The environment is either promoting healthy development of the brain or it’s not. There is a school of thought that says any noxious stimulus—too bright a light, too loud a sound—is distracting to the task of growing and developing.”

Average NICU noise level

The American Academy of Pediatrics recommends that NICU noise levels remain at or softer than 45 decibels. Noise at this level is slightly quieter than the sound of rainfall, which is estimated at 50 decibels.

Keeping the NICU this quiet is almost impossible, says Herrmann. Necessary equipment such as ventilators, incubators, and monitors; infection-preventing but echo-inducing design; and nurses and visitors in the NICU all add to the sound level.

“Nurses are people too, and in the course of their care, they tend to talk to each other across the room and they have to talk over the ambient sound,” says Herrmann.

Many NICUs operate at sound levels closer to 80 or 90 decibels, he says. For the most part, the noise levels generated from equipment and hospital design cannot be altered without significant hospital renovations.

The Women’s Hospital seized its chance to change the behaviors of staff members and visitors in the NICU. Posting a sign and asking visitors to keep their voices down was not effective, says Herrmann. Instead, the hospital installed sound meters and light “trees,” which resemble overhead traffic lights, to give staff members a sense of the decibel level.

Using a computer system called SONICU, the sound level is measured every five seconds, and the data are transmitted to the light trees, which show a green, yellow, or red light, depending on the noise level. Green means the noise is at a good level, and yellow means staff members should be cautious about the noise level. If the noise level reaches the red zone, the overhead lights in the NICU begin to flicker, alerting people that they must be more quiet.

“In the intensive care nursery where there are no complainers, sound levels can get out of control,” says Herrmann of a premature baby’s inability to verbally alert a caregiver to discomfort. “You can have an automated system that is nonjudgmental, that signals to everybody when it’s getting too loud.”

When The Women’s Hospital started using visual cues in 2007 to alert staff members and visitors to noise levels, the red light was triggered to go off at 75 decibels and the yellow light was triggered at 60 decibels. Since then, staff members have learned to keep their voices down enough so that the red light is now triggered at 60 decibels and the yellow at 48. Although the light trees help spread awareness about the NICU’s noise level, they are directly overhead and can blend in with the environment. The flickering overhead fluorescent lights, a special system that The Women’s Hospital NICU had installed, act as a visual cue that is more difficult for staff members to ignore. The lighting system has also allowed the NICU to simulate the effects of sunrise and sunset to prepare premature babies for the real world.

“People have to be willing to cooperate. SONICU enables us to get rid of the policeman, the person who has to walk around and say, ‘You’re being too loud,’ ” says Herrmann. “It means the staff has to embrace the idea that sound levels are important to the babies and that they are part of the reason why the care is better or worse.”

The SONICU system also allows the Deaconess-Riley NICU to track the number of yellow and red alerts that occur during a given time. That way, Hermann can show staff members that they are too loud or are speaking at appropriate levels.

Beyond the NICU

Although this technology is currently being used in the NICU at The Women’s Hospital, Herrmann sees potential for the SONICU system in a more general hospital setting, especially for those hospitals looking to improve their patient satisfaction scores.

“From my perspective, this piece of technology would be used to greatest advantage in those noisy hallways where most of the hospital patients are adults,” he says.

Adult patients often express dissatisfaction with noise levels during a hospital stay because they are uncomfortable in some other way because of their sickness or treatment. One question on the Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS) survey specifically asks patients whether the area around their rooms was quiet at night. The noise level is usually a stressor that can be reduced during a patient’s stay and is often a consideration with current evidence-based design initiatives. Any hospital being built today would be wise to include this type of technology, says Herrmann. A hospital doing renovations could easily implement an automated system, such as SONICU, to create a quieter, less stressful environment for patients.

Herrmann advises hospitals that want to attract more business to examine their quality ratings (often HCAHPS scores) and decide whether a system such as SONICU would help improve these ratings.

“The noise, commonly enough, is people’s voices out in the hall, which, if it’s during a no-visiting time, it’s nursing staff in the middle of the night talking too loud outside of the patient’s room,” says Herrmann. “It’s a big deal in the adult world, and yet not much is done about it.”


Adapted from Briefings on Patient Safety, July 2009, HCPro, Inc.