BACKGROUND: While meaningful sound (such as parents’ voices) stimulates proper development, noise in excess of 45 decibels (dB) can have adverse effects on the growth and neurodevelopment of neonates. Excessive auditory stimulation can also cause cochlear damage. In addition, numerous physiologic changes can be associated with excess noise, including apnea, bradycardia, hypertension, decreased perfusion, and lower oxygen saturation levels. Despite research documenting the negative effects noise has on the developing neonate, infants in the neonatal intensive care unit (NICU) are often exposed to noise that exceeds recommended levels. OBJECTIVE: To reduce NICU noise levels by 10% & maintain the accepted range of ≤ 45 dB per guidelines set by the American Academy of Pediatrics (AAP). METHODS/INTERVENTIONS: A multidisciplinary team consisting of healthcare providers, support staff, and parents is working to decrease noise levels in the NICU. Decibel meter readings were obtained at four designated locations in the NICU every hour (24 hours a day) for seven days at baseline & after each cycle. Cycle 1 (“Awareness and Education”): Quiet time and low lighting hours (10:00 - 11:00 AM & PM) were implemented, unit posters were displayed, staff education was provided in the form of in person lecture with PowerPoint, and educational handouts were provided to families of NICU patients. Cycle 2 (“Environmental Change”): Settings for alarm volumes were monitored and decreased as much as possible per unit protocol, staff placed personal cellphone ringers on silent and away from patient bedsides, unit telephone ringers were set to the lowest volume setting possible, automatic paper towel dispensers were replaced with manual dispensers, and metal soiled linen carts were replaced with carts containing a rubber insert to dampen sound when the cart is opened & closed. Cycle 3 (“Unit Modification”): Square footage per bed space was increased and separate work areas were provided for staff. RESULTS: Median decibel meter reading at baseline was 56.1 dB. After Cycle 1, median reading was 54.8 dB (2.2% decrease from baseline). After Cycle 2, median reading was 55.3 dB (0.92% increase from Cycle 1, 1.3% decrease from baseline). Cycle 3 data collection is currently in progress. CONCLUSION: Decline in sound was noted after Cycle 1 (especially during shift change which was a targeted area for improvement); however, rebound was noted after Cycle 2. It is apparent that education must be ongoing in order for noise reduction to remain a priority for staff. Upon admission, it will also be necessary to provide education for new parents/families regarding noise reduction and the importance of meaningful sound. In addition, hopefully by increasing overall unit dimensions & square footage per bed space during Cycle 3, noise levels will decrease.
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Council on Quality Improvement and Patient Safety| August 01 2019
Reducing Noise in the Neonatal Intensive Care Unit
Amber D. Coston, MPAS, PA-C;
Pediatrics (2019) 144 (2_MeetingAbstract): 154.
Amber D. Coston, Christine Aune; Reducing Noise in the Neonatal Intensive Care Unit. Pediatrics August 2019; 144 (2_MeetingAbstract): 154. 10.1542/peds.144.2MA2.154
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