An investigation of sound levels on intensive care units with reference to the WHO guidelines

Abstract

Introduction: Patients in intensive care units (ICUs) suffer from sleep deprivation arising from nursing interventions and ambient noise. This may exacerbate confusion and ICU-related delirium. The World Health Organization (WHO) suggests that average hospital sound levels should not exceed 35 dB with a maximum of 40 dB overnight. We monitored five ICUs to check compliance with these guidelines.

Methods: Sound levels were recorded in five adult ICUs in the UK. Two sound level monitors recorded concurrently for 24 hours at the ICU central stations and adjacent to patients. Sample values to determine levels generated by equipment and external noise were also recorded in an empty ICU side room.

Results: Average sound levels always exceeded 45 dBA and for 50% of the time exceeded between 52 and 59 dBA in individual ICUs. There was diurnal variation with values decreasing after evening handovers to an overnight average minimum of 51 dBA at 4 AM. Peaks above 85 dBA occurred at all sites, up to 16 times per hour overnight and more frequently during the day. WHO guidelines on sound levels could be only achieved in a side room by switching all equipment off.

Conclusion: All ICUs had sound levels greater than WHO recommendations, but the WHO recommended levels are so low they are not achievable in an ICU. Levels adjacent to patients are higher than those recorded at central stations. Unit-wide noise reduction programmes or mechanical means of isolating patients from ambient noise, such as earplugs, should be considered.

Figure 1

Average sound levels for patient sited recording device. Average sound levels at one-minute intervals (L_Aeq) throughout the day with recording device positioned adjacent to the patient. dB, decibel; WHO, World Health Organisation.

Figure 2

Average sound levels for centrally sited recording device. Average sound levels at one-minute intervals (L_Aeq) throughout the day measured by a recording device on a central station in the ICU. dB, decibel; WHO, World Health Organisation.

Figure 3

Peak sound levels for patient-sited recording device. Peak sound levels (LApk) measured at one-minute intervals throughout the day by a recording device positioned adjacent to the patient. dB, decibel.

Figure 4

Average number of peak values per hour for patient-sited recording device. Average number of minutes per hour when peak values above 85 A-weighted decibels (dBA) and above 100 dBA were recorded with the recording device positioned adjacent to the patient.

Figure 5

Frequency plot for 24 hours at John Radcliffe Hospital ICU. Frequency components of the noise adjacent to a patient at the John Radcliffe Hospital Adult ICU on a weekday at the quietest period (4:00 AM to 5:00 AM) and during working hours (4:00 PM to 5:00 PM).