This study aimed to reduce noise levels in a pediatric intensive care unit (PICU) through measuring existing noise, identifying sources, and implementing reduction measures. Researchers measured noise using dosimeters worn by nurses and sound level meters in patient rooms. Common sources of noise included medical equipment alarms, conversations, and care activities. A behavior modification program using a sound level display was then tested. Post-implementation measurements showed noise level reductions, especially in peak sounds. However, incentives were determined to be needed to sustain reductions over time through continued staff participation in limiting noise.

1. Reduction of Noise Levels in the Pediatric Intensive
Care Unit (PICU) of Beaumont Hospital
The OU-Beaumont
Biomedical Research
Symposium - November 14,
2012 held at
Banquet Rooms, Oakland
Center, Oakland University.
Research Team: Beaumont : Julie Topacio, S.Noel Simpson, Beth Kring
OU : Dr.Barbara Oakley, Dr.Barbara Penprase and Avinash Konkani.
Presenter : Avinash Konkani – Doctoral Student / Graduate Assistant
Industrial and Systems Engineering, Oakland University.

2. National Recognition
Publications:
1)“Noise in hospital intensive care units—a critical review of a critical topic” -
Journal of Critical Care, Volume 27, Issue 5 , Pages 522.e1-522.e9, October 2012.
2)“Reducing Hospital Noise: A Review of Medical Device Alarm Management”-
pending publication (Nov/Dec-2012) - Journal of Biomedical Instrumentation &
Technology.
1) AAMI’s The Michael J. Miller Scholarship-2012 – One of the two recipient
nationwide
2) Member ( from July, 2012) – Clinical Alarms Steering Committee – AAMI’s
Healthcare Technology Safety Institute.
3) Junior Associate Editor (from Oct, 2012) - The IEEE Journal of Translational
Engineering in Health and Medicine
(AAMI - Association for the Advancement of Medical Instrumentation)

3. The objectives of the study
1) To estimate the noise levels experienced by the
patients as well as the nursing staff
2) To carry out an amplitude and frequency analysis of
the noise
3) To implement appropriate low- or no-cost sound
reduction measures
4) To comparing the noise levels before and after
implementation of the sound reduction measures

4. Effects of Noise on Patients and ICU Staff
o Sleep disturbances & has negative effect on Immune System
o Slow healing and recovery process
o Increased stay of length
o Increased blood pressure and heart rate
o Noise as occupational stress
o Reduces the staff’s work performance
o Affects communication and increases errors
o delayed recognition and response to medical device’s alarms
Reference: Choiniere D. The Effects of hospital noise. Nursing Administration Quarterly 2010; 34(4): 327–33.

5. Example of sound sources with its levels
Table 1. Example of sound sources with their sound pressure levels in
dBA. Adapted from:
http://www.sengpielaudio.com/TableOfSoundPressureLevels.htm
Sound pressure level in
Sound source examples with distance
dBA
2-stroke chain-saw at 10 m distance, loud toilet flush at 1
85
m distance Sound Level Limits for Hospital Patient
Passing car at 7.5 m distance 75 Rooms
Noisy lawn mower at 10 m distance 60
Low volume of radio or TV at 1 m distance, noisy vacuum
Table 2. The recommended sound level limits for
55
cleaner at 10 m distance hospital patient rooms as defined by different
Noise of normal living; talking, or radio in the organizations.
45
background WHO Intnl Noise EPA
Learning or concentration is possible, but distraction Council
occurs.
40 (Berglund et (Kahn et al.,
al., 1999 ) (Elander and 1998)
Very quiet room fan at low speed at 1 m distance 35 Hellström,
Sound of breathing at 1 m distance 25 1995)
Auditory threshold 0
Day 35dBA 45dBA 45dBA
WHO –World Health organization Evening - 40dBA -
EPA – Environmental Protection Agency (USA)
Night 30dBA 20dBA 35dBA
Intnl Noise Council - International Noise
Council

6. Sources of Noise in the ICU
 Conversations between the ICU staff, medical professionals
and visitors
 Increased number of medical equipment’s false alarms
 Telephones, pagers, televisions, overhead speaker, closing
doors, falling objects..
 Care-giving activities such as opening disposable equipment
packages and storage drawers etc.

7. Measurement of Noise Levels in the PICU
Noise Level Meters:
doseBadge personal Noisemeter – wore by RN
Integrating Sound Level Meter (ISLM) Type –II
with Octave Band Filters. Placed in Nursing
Station and Patient Rooms.
Measurements :
•Equivalent continuous Sound Level –LAeq
•Peak sound level -LCPeak

8. Behavior modification program using a sound
detecting device
• Mobile phones, pagers on vibrating mode
• Any loud conversation should be avoided as
much as possible in the PICU
• Limit bedside conversations with colleagues
• Keep the telephone ringer volume as low as
possible
• Limit the number of telephone calls in the
At 45 dBA- yellow light PICU
indicator will be “ON” • Maintaining quiet time periods for at least an
hour during each shifts
At- 50 dBA- “Warning”
sign will be “ON”

9. Results

10. Results

11. Results

12. Results: Frequency Analysis

13. Conclusion and Outcome of the study
Behavior Modification program needs to include
some form of incentive to be more effective
A combined program to control the noise from
humans and machines ( medical devices) is required
We are working on to conduct a second study with
such combined program

14. References:
 Berglund, B, T Lindvall, et al., “Guidelines for Community Noise”, World Health Organization
http://www.who.int/docstore/peh/noise/guidelines2.html (accessed Mar/16/ 2011).
 Choiniere, DB. “The Effects of hospital noise”. Nursing Administration Quarterly 2010; 34, no. 4:
327–333.
 Christensen, M. “Noise levels in a general intensive care unit: a descriptive study”. Nursing in Critical
Care 2007; 12, no. 4: 188-197.
 Elander, G, and G Hellström. “Reduction of noise levels in intensive care units for infants: evaluation
of an intervention program”. Heart & Lung: The Journal of Acute and Critical Care 1995; 24, no. 5:
376-379.
 Kahn, D.M., T.E. Cook, et al. “Identification and modification of environmental noise in an ICU
setting”. Chest 1998; 114, no. 2: 535-540.
 Milette, I. Decreasing noise level in our NICU: the impact of a noise awareness educational program.
Advances in Neonatal Care 2010; 10, no. 6: 343-351.
 Morrison, W.E., E.C. Haas, et al. “Noise, stress, and annoyance in a pediatric intensive care unit”.
Critical Care Medicine 2003; 31, no. 1: 113-119.
 Pope, D. “Decibel levels and noise generators on four medical/surgical nursing units”. Journal of
Clinical Nursing 2010; 19, no. 17 18: 2463-2470.
 Ryherd, E.E., K.P. Waye, et al. “Characterizing noise and perceived work environment in a
neurological intensive care unit”. The Journal of the Acoustical Society of America 2008; 123: 747-
756.

15. Questions ?