Identification and modification of environmental noise in an ICU setting

Study objectives: Noise levels in the hospital setting are exceedingly high, especially in the ICU environment. We set out to determine what caused the noises producing sound peaks greater than or equal to 80 A-weighted decibels (dBA) in our ICU settings, and attempted to reduce the number of sound peaks greater than or equal to 80 dBA through a behavior modification program. Design: The study was divided into two separate phases: noise identification and a trial of behavior modification. During the noise identification phase we simultaneously recorded sound peaks and the loudest noise heard subjectively by one observer in the medical ICU (MICU) and the respiratory ICU (RICU). During the behavior modification phase of the study we implemented a behavior modification program, geared toward noise reduction, in all of the MICU staff. Sound levels were monitored before and at the end of the behavior modification trial. Setting: The MICU and RICU of a 720-bed teaching hospital in Providence, RI. Participants: All ICU staff during the study period. Interventions: Once the noises that were determined to be amenable to behavior modification were identified, a behavior modification program was conducted during a 3-week period in our MICU. Baseline and post-behavior modification noise recordings were compared in 6-h intervals after sites were matched by number of patients in a room and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. Measurements and results: We identified several causes of sound peaks greater than or equal to 80 dBA amenable to behavior modification; television and talking accounted for 49%. We also significantly reduced the 24-h mean peak noise level (p=0.0001), as well as the mean peak noise level (p=0.0001) and the number of sound peaks greater than or equal to 80 dBA (p=0.0001) in all 6-h blocks except for the 12 AM to 6 AM period. Conclusions: We conclude that many of the noises causing sound peaks greater than or equal to 80 dBA are amenable to behavior modification and that it is possible to reduce the noise levels in an ICU setting significantly through a program of behavior modification.