Impact of noise in healthcareA research summary

Healthcare factsBenefits of a healthy sound environment

Studies show that a good sound environment dramatically increases the overall quality of care in healthcare facilities. The benefits include:

• Lowered blood pressure• Improved quality of sleep• Reduced intake of pain

medication• Improved communication• Lowered stress levels• Improved patient safety• Enhanced staff wellbeing,

performance and job satisfactionIt is quite astonishing that the acoustic solution can contribute to all this. And in addition to all the human benefits, think of what the benefits mean in terms of saving time and money.

2© Ecophon 2017 Idea and layout: Saint-Gobain Ecophon AB

All studies and facts in this brochure have been verified by Samuel Verburg, DTU, Technical University of Denmark.

Hospitals and outpatient clinic facts

˗Highsoundlevelsinhealthcarefacilitiesareknownto:impairsleep,increasestress,delaypost-illnessrehabilitation,aggravateagitation,causepsychiatricsymptoms,escalaterestlessness,increaserespiratoryratesandincreaseheartrates1

˗Sleepisfundamentaltohumanhealthingeneralandcriticaltopatientrecovery.Alertness,mood,behaviour,copingabilities,respiratorymusclefunction,healingtimeandlengthofstayarejustafewofthepotentialimpactsofpatientsleepdisturbanceordeprivation2

˗Noiseinemergencydepartmentsisregardedby60.5%ofstaffasbeing“very”or“somewhat”burdensome.383%ofallcommunicationwithaheadnurseinanemergencydepartmentissynchronous,e.g.facetofaceorviatelephone.470%ofcriticalmedicalerrorsinemergencydepartmentscanbetracedbackto“communicationshortcomings”suchasmultitaskingandinterruptions5

1 Weise, “Investigation of patient perception of hospital noise and sound level measurements: before, during and after renovations of a hospital wing”, Architectural engineering – Dissertations and Student Research, 2010, Paper 4, p7

2 Hsu, Ryherd, Ackerman, Persson Waye, “Noise pollution in hospitals: Impacts on patients”, J. Clin. Out. Mgmt. 2012, vol 19, no 7, p301–309

3 M. Simon, P. Tackenberg et al., Auswertung der ersten Befragung der NEXT-Studie in Deutschland. Wuppertal University, 2005

4 Woloshynowych, Davis et al., “Communication patterns in a UK emergency department”, Ann. Emerg. Med., Oct 2007, 50(4), p407–413

5 Joint Comission. Sentinel Event Data, Root Causes by Event Type, 2010

3

Elderly care facts

˗Age-relatedhearingloss(presbyacusis)causescommunicationproblemsforapproximately37%ofpeoplebetweentheagesof61and70.Thisprevalencerisesto60%forpeopleaged71to806

˗Impairedhearingadverselyaffectsspatialorientationandincreasestheriskoffalling.Impairedhearingturnscommunicationintoarealeffortandcausesrapidfatigue/exhaustion.Frequentmisunderstandingsareknowntoleadtowithdrawal,self-doubt,depressionanddogmatism7

˗Theseverityofhearinglosscorrelateswithreducedcognitionandanincreasedincidenceofdepressioninoldage8,9

˗Peoplewhoarecutoffacousticallyfromtheexternalworldnotonlylosetheirhearing,theyareatriskofbecomingsociallyandintellectuallyisolated.Thelessstimulationthebrainreceives,themorequicklyitscapacitydiminishes7

6 Baur et al., Einfluss exogener Faktoren auf Altersschwerhörigkeit, HNO 2009, Springer Medizin Verlag 2009, p1023–1028

7 Arneborg, E., Deutsche Seniorenliga e.V., Altersschwerhörigkeit – Symptome, Ursachen, Folgen, Diagnostik, Therapie, (Age-related hearing loss – symptoms, causes, consequences, diagnosis, therapy) Ausgabe 2010; Dalton et al., 2003; Chia et al., 2007; Chisolm et al., 2004

8 Cacciatore, F., Napoli, C., Abete, P., et al., 1999. Quality of Life Derterminants and Hearing Function in an Elderly Population: Osservatorio Geriatrico Campano Study Group, Gerontology, 45 (6), p323–328

9 Dalton, D. S., Cruickshanks, K. J., Klein, B. E., et al., 2003. The Impact of Hearing Loss on Quality of Life in Older Adults. The gerontologist, 43 (5), p661–668

4

Mental health facts

˗Themostwidespreadandwell-documentedsubjectiveresponsetonoiseisannoyance,whichmayincludefearandmildanger,relatedtoabeliefthatoneisbeingavoidablyharmed10

˗Noisemayreducehelpingbehaviour,increaseaggressionandreducetheprocessingofsocialcues10

˗Overcrowdingisafactorthatcancontributetofearandtensiononaward.Staffperformbetterinenvironmentsthatfeelsafe,calmandspacious11

˗Designsthathavegoodacoustics,minimisetheriskofcrowdingandhavenaturallightandventilationareimportantinhelpingtocreateapositivetherapeuticatmosphere11

˗Atherapeuticenvironmentisonewherenoiselevelsareadjustedtomeettheneedsofthepeoplelivingthere11

10 Stansfeld et al., Noise pollution: non-auditory effects on health, British Medical Bulletin 2003; 68: p243–257

11 United Kingdom Department of Health, “Health Building Note 03-01: Adult acute mental health units”, 2013, p6–11

5

Common sound levels and how they are perceived

Typical sound levels in decibels12

Four-enginejetaircraftat100m 120dBRivetingofsteelplateat10m 105dBPneumaticdrillat10m 90dBCircularwoodsawat10m 80dBHeavyroadtrafficat10m 75dBTelephonebellat10m 65dBMalespeech,average,at10m 50dBWhisperat10m 25dB

Anincreaseof10dBisperceivedbypeopleastwiceasstrong/high.

+10 db+10 db

Measuring decibelsDependingonwhatyouwanttomeasure,thesoundstrengthatdifferentfrequenciescanbeweighteddifferently.

-dB(A)isusedwhenyouwanttomeasuregeneralsoundstrengthasperceivedbythehumanear.

-WheneverdBismentionedinthisbrochure,itreferstodB(A).

12 Appendix 12B: Description of noise and vibration units, https://www.blaby.gov.uk/EasySiteWeb/GatewayLink.aspx?alId=3120

6

Effect of noiseon intellectual performance

Weinstein, University of California, Berkeley, Journal of applied psychology, 1974, vol 59, no 5, p548-554

Thestudyaimedtoestablishthedifferenceinperformancebetweenworkinginaquietenvironmentandonewithirregularburstsofbackgroundnoise.33collegestudentsweredividedintogroupsandperformedtasksintwosettings,onelessdemanding(findingspellingandtypographicalerrors)andonemorecomplex(findinggrammaticalerrors,missingwordsandincorrectwords).Wheninterviewedthesubjectsdidnotbelievethatthenoisehad

interferedsignificantlywiththeirproofreading.Mostofthemalsothoughttheydidalotbetterthantheyactuallydid.

Conclusions

-Therewasnotasignificantdifferencebetweenthetwoenvironmentswhenperformingtheeasiertask.Butwhenitcomestothecomplextask,theperformanceinthenoisyspacewas50%lessaccurate.

Simple task

(non-contextual errors)

Complex task

(contextual errors)

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Noise average

Mistakes, %

Quiet36 dB

Noisy55–70 dB

Quiet36 dB

Noisy55–70 dB

7

WHO guidelinesfor sound in healthcare

Berglund et al., “Guidelines for community noise”, Technical Report 1999, World Health Organization

TheWorldHealthOrganizationhasreleasedfactsabout,andrecommendationsfor,noiseinspecificenvironments.

In general:

˗HalfofallEuropeanUnioncitizensareestimatedtoliveinzonesthatdonotensureacousticcomfortforresidents.Atnightmorethan30%ofcitizensareexposedtoequivalentsoundlevelsexceeding55dB,whicharedisturbingtosleep

˗Worldwide,themedicalandsocialcostassociatedwithindoornoise-inducedillnesses,andtherelatedreductioninhumanproductivity,canresultinsubstantialeconomiclosses

˗Forfullintelligibilityinlistenerswithnormalhearing,thespeechlevelneedstobe15dBhigherthanthebackgroundnoise.Forvulnerablegroups,evenlowerbackgroundlevelsareneeded,andareverberationtimebelow0.6sisdesirableforadequatespeechintelligibility,eveninaquietenvironment

˗Foragoodnight’ssleep,continuousbackgroundnoiseshouldnotexceed30dB,andindividualnoiseeventsexceeding45dBshouldbeavoided

˗Noiseabove80dBmayreducehelpingbehaviourandincreaseaggressivebehaviour.Itmayalsoincreasethesusceptibilityofschoolchildrentofeelingsofhelplessness

And specifically for hospitals:

˗Forwardrooms,theequivalentsoundlevelsshouldbe30dB

˗Thenoisepeaksduringthenightshouldnotexceed40dB

˗Sincepatientshavelessabilitytocopewithstress,theaveragesoundlevelsshouldnotexceed35dBinmostroomsinwhichpatientsarebeingtreatedorobserved

˗Soundinsideincubatorsmayresultinhealthproblems,includingsleepdisturbance,andmayleadtohearingimpairmentinneonates

8

WHO

recommends

dB in hospitals

30–35

Actual sound levels in hospitals

Busch-Vishniac et al., “Noise Levels in John Hopkins Hospital”, Journal of the Acoustical Society of America, Dec 2005, 118(6), p3629-3645

Thestudylooksatnoisedatafromresearchinhospitalsacrosstheworld,between1960and2005.AsecondpartofthestudyfocusesonmeasurementsatJohnHopkinsHospital.

Conclusions

˗NotonehospitalcompliedwithWHOguidelines

˗From1960to2005thesoundpressurelevelshaveincreasedonaverage15dBduringthedayand18dBduringthenight

˗Soundlevelsexceedthetypicalspeechlevelforcommunicationbetweentwopeople,whichis45–50dB.Thissuggeststhatstaffandpatientsconstantlyneedtoraisetheirvoicestobeheard

˗Thesoundpressurelevelsaresufficientlyhightointerferewithsleep,affectspeechintelligibilityandcreatealevelofbackgroundnoisethatwillannoyandaffectmostpeople

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201960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010

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201960 1965 1970 1975 1980 1985 1990 1995 2000 2005 2010

Daytime sound levels

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Night-time sound levels

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WHO recommendation in ward roomsWHO recommendation in ward rooms

9

Sleep disruptiondue to noise

Buxton et al., “Sleep disruption due to hospital noises”, Ann. Intern. Med., 2012, vol 157(3), p170-179

Thestudywasathree-daypolysomnographiclabstudywith12healthysubjectsexposedto14noisestimuli.Noiseslasting10secondswereintroducedduringsleepstagesN2,N3andREMtoevaluatetheirpropensitytodisturbsleep.

Conclusions

˗Electronicsoundswereconsistentlymorearousingthanothersoundsatthesamenoisedose.Staffconversationsandvoicepagingwerealsofoundtobehighlyalerting,producinga50%chanceofarousalat50dBinN2andREMsleep

˗Thearousaleffectsofnoiseonsleepincludeheartrateelevations,evenwhendisruptionsarebriefandfrequent

˗Preservationofpatients’sleepshouldbeapriorityforcontributingtoimprovedclinicaloutcomesforpatientswhoarehospitalised

˗Protectingsleepfromacousticassaultinhospitalsettingsisakeygoalinadvancingthequalityofcareforin-patientmedicine

˗Improvingtheacousticsinhealthcarefacilitieswillbecriticaltoensuringthattheseenvironmentsenablethehighestqualityofcareandthebestclinicaloutcomes

Phone ringing

IV pump alarm

Voice (“good” conversation)

Voice (“bad” conversation)

Paging (1 voice)

Snoring

Towel dispenser

Ice machine

Door open and close

Toilet flushing

Laundry cart rolling

Traffic

Helicopter takeoff

Jet flyover

40 50 60 700

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100

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sted

arou

sal p

roba

bility

, %

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sted

arou

sal p

roba

bility

, %

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sted

arou

sal p

roba

bility

, %

Phone ringing

IV pump alarm

Voice (“good” conversation)

Voice (“bad” conversation)

Paging (1 voice)

Snoring

Towel dispenser

Ice machine

Door open and close

Toilet flushing

Laundry cart rolling

Traffic

Helicopter takeoff

Jet flyover

40 50 60 700

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100

40 50 60 700

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100

40 50 60 700

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Phone ringing

IV pump alarm

Voice (“good” conversation)

Voice (“bad” conversation)

Paging (1 voice)

Snoring

Towel dispenser

Ice machine

Door open and close

Toilet flushing

Laundry cart rolling

Traffic

Helicopter takeoff

Jet flyover

40 50 60 700

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40

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80

100

40 50 60 700

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100

40 50 60 700

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Phone ringingIV pump alarmVoice (“good” conversation)Voice (“bad” conversation)Paging (1 voice)SnoringTowel dispenserIce machineDoor opening and closingToilet flushingLaundry cart rollingTrafficHelicopter takeoffJet flyover

Sound level, dB Sound level, dB Sound level, dB

N2 N3 REM

10

Average values –40%

Improved acousticsreduce sleep disruption

Berg, “Impact of reduced reverberation time on sound-induced arousals during sleep”, Sleep, 2001, vol 24, no 3, p289-292

Thestudywasconductedduringthreenightswith12people(6womenand6men),20–25yearsold.12differentsoundswereplayedduringsleeptoinvestigatearousal.Thesubjectswereignorantofthepurposeofthestudy.Theceilinginthebedroomswasmadeofplasteronthefirsttwo

nights,andclassAsoundabsorbersonthethirdnight.Theresultsofthefirstnightwereexcludedfromtheresults.

Conclusions

˗EEGarousalsresultingfromspecificsoundstimuliweresignificantlyreducedfrom5.1to3whenthesound-absorbingceilingwasinstalled

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EEG arousals

Subject

Plaster ceiling, reflective

Class A sound-absorbing ceiling

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Medicationincreases with noise

Minckley, “A study of noise and its relationship to patient discomfort in the recovery room”, Nursing Research, 1968, vol 17, no 3, p247-250

Thestudywasdoneina10-bedrecoveryroomonfiverandomworkingdays.Thenumberofnarcotic/sedativemedicationdosesthatweregivenwasrecorded.Periodsofheightenedactivity,presenceofalargenumberof

staff,overcrowdingofpatients,certainsoundssuchascrying,laughing,groaning,snoring,andringingoftelephonesproducednoiselevelsbetween60and70dB.

Conclusions

˗Significantdifferenceinthenumberofpatientsgivenmedicationattimeswhennoiselevelswerehigh

Medication given at different sound levels

% of patients

0%40−50 dB 50−60 dB 60−70 dB

2%

4%

6%

8%

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11,4%

Expected level

Patients given medication

12

Lower noise levels reduce medication

Hagerman et al., “Influence of intensive coronary care acoustics on the quality of care and physiological state of patients”, International Journal of Cardiology, Feb 2005, 98(2), p267-270

ThestudytookplaceovereightweeksinahospitalinHuddinge,Sweden,with94patientssufferingfromchestpain.Forthefirstfourweekstheceilingwasareflectivetype,andforthelastfourweekstheceilingconsistedofclassAsoundabsorbers.

Conclusions

˗Thesoundleveldroppedby5–6dBinthepatientroomsand1dBinthemainworkingarea

˗Reverberationtimedroppedfrom0.9to0.4inthepatientroomsandfrom0.8to0.4inthemainworkingarea

˗Therewasasignificantriseintheneedforextraintravenousbeta-blockersinthegroupduringtheperiodwithpooracoustics

˗Patientsduringtheperiodwithgoodacousticsconsideredthestaffattitudetobemuchbetterthanduringtheperiodwithpooracoustics

35%

30%

25%

20%

15%

10%

5%

0%

Percentage of patients needing extra intravenous beta-blockers

Reflective ceiling Class A ceiling

13

During the period with good acoustics, patients felt that the staff attitude was much better than during the period with poor acoustics

83% of communication in the emergency department is speech-related

Woloshynowych, Davis et al., “Communication patterns in a UK emergency department”, Ann. Emerg. Med., Oct 2007, 50(4), p407-413

Observationalstudycarriedoutinaninner-cityhospitalemergencydepartmentinLondon,UK.ThenurseinchargeoftheEDwasobservedandthefollowingfactorswerestudied:thelevelofcommunication,interruptionsandsimultaneousevents;thechannelandpurposeofcommunication;interactiontypes;unresolvedcommunicationsandannoyingaspectsoftheobservedperiods.Datacollectiontookplaceduringa6-monthperiod.Eleven

nurseswereobservedduring18observationperiodsoveratotalof20hours.

Conclusions

˗Atotalof2,019distinctcommunicationeventswereidentified

˗Thismeansthatonaveragetherewere100.9communicationeventsperhour,or1.68perminute

˗Communicationmultitaskingwasevidenton286(14%)occasions

˗Thecommunicationloadcandisruptmemoryandleadtomistakes.Improvingcommunicationbetweenhealthcarestaffbyreducingthelevelsofinterruptionsandminimisingthevolumeofirrelevantorunnecessaryinformationexchangecouldthereforehaveimportantimplicationsforpatientsafety

Type of communication channel Number of

communication events (%)

Face to face 1,528 (76)

Telephone 144 (7)

Computer 107 (5)

Whiteboard 104 (5)

Pager 35 (2)

Patient records 35 (2)

4-h Target 19 (1)

Tannoy 7 (<1)

Paper source, e.g., patient transport form, staff allocation

sheet, booking request form, incident reporting form

40 (2)

83%83%

14

Orellana, Busch-Vishniac, West, “Noise in the adult emergency department of Johns Hopkins Hospital”, Journal of the Acoustical Society of America, Apr 2007, 121(4), p1996-1999

Thestudycollected24-hourmeasurementsthroughouttheadultemergencydepartmentofJohnsHopkinsHospital,thetop-rankedhospitalintheUnitedStatesfor16yearsrunning.

Conclusions

˗Theaveragesoundlevelthroughouttheemergencydepartmentisabout5–10dBhigherthaninin-patientunitsatthesamehospital

˗Thesoundlevelsarehighduringthedayandnightandtheyareparticularlyhighinthespeechfrequencyband

˗Withintheemergencydepartmentthetriageareaattheentrancetothedepartmenthasthehighestaveragesoundlevel,65to73dB

˗Soundlevelsintheemergencydepartmentareonaveragebetween61and69dB

˗Thesoundlevelsraiseconcernsregardingthepossibilityofspeechcommunicationwithouterrors

˗Themainconcernisforpatientsafety,whichcouldbecompromisedbylessthanperfectspeechcommunication.Additionally,medicalstafffatigueisanissuesincespeakinginaraisedvoiceistiring

24 hour sound levels75

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Hospital noise impedes speech communication

15

Noise leads to communication errors …

Mahmood et al., “Nurses’ perception of how physical environment affects medication errors in acute care settings”, Applied Nursing Research, 2011, vol 24, issue 4, p229–237

Inthisstudy,across-sectionalsurveywasconductedwith84nursesinfourhospitalsinthePacificNorthwestregionoftheUnitedStates.Thesurveyincludedquestionsonnursingunitdesign,medicationroomconfigurations,perceivedincidenceoferrors,andadverseevents.

Conclusions

˗Respondentsnotedseveralphysicalenvironmentalfactorsthatarepotentiallyproblematicinthenursingstationareaandcanleadtomedication,documentation,andothertypesofnursingerrors

˗Afewnon-environmentalfactors(e.g.,overwork,stress,orfatigueofstaff,highernumberofpatientspernurse)wereidentifiedasthemostfrequentcausesleadingtoerrors

˗Buttheroleofenvironmentalfactorsinlatentcausesoferror(e.g.,fatigue,stress,tiredness)shouldnotbeoverlookedwhileplanningforinterventionstoreduceerrorsinacutecaresettings

˗Effectivestrategiesandmeaningfulinterventionstoreducemedicationerrorsshouldbeconsideredwhendesigningormodifyingthephysicalenvironment

Number of times frequent factors contribute to

documentation errors, %

0 20 40 60 80 100

Very Important

Somewhat Important

4,8 6 1,2 10,70

2

4

6

8

10

12

Location of

charting space

Small or inadequate

size of charting space

Poor lighting

High level of noise

Top 5 physical environmental factors leading

to nursing errors

1. Insufficient space for documentation for charting/record keeping

2. Inappropriate space layout in the nursing unit3. Lack of privacy in nurses’ work area4. Problematic location of nursing station5. High noise level / acoustic problems in nursing

unit

Very important

Somewhat

important

1 2 3 4 5

%

4,8%6%

10,7%

1,2%

16

… that can have critical consequencesPennsylvania patient safety authority, “Improving the safety of telephone or verbal orders”, PA-PSRS Patient Safety Advisory, Jun 2006, vol 3, no 2, p1-7

AnadvisoryreportbasedonhealthcarestaffreportingtothePAPSRS,PennsylvaniaPatientSafetyReportingSystem(USA).Thereportcontainsmanyexamplesofreal-lifemedicalerrorsduetomishearing.

Conclusions

˗Interpretingspeechisinherentlyproblematicbecauseofdifferentaccents,dialects,andpronunciations

˗Backgroundnoise,interruptions,andunfamiliardrugnamesandterminologyoftencompoundtheproblem

˗Oncereceived,averbalordermustbetranscribedasawrittenorder,whichaddscomplexityandrisktotheorderingprocess

˗Theonlyrealrecordofaverbalorderisinthememoriesofthoseinvolved

“A nurse thought that the nursing student stated the patient’s blood sugar as 257 when it was 157. The patient was given 6 units regular insulin instead of 2 units regular insulin.”

“A phone order mistaken for Toradol 50 mg was administered prior to the pharmacy review, when the intended dose was 15 mg.”

“An emergency room physician verbally ordered ‘morphine 2 mg IV’ but the nurse heard ‘morphine 10 mg IV’. The patient received a 10 mg injection and developed respiratory arrest.”

“A physician called in an order for ‘15 mg’ of hydralazine to be given IV every 2 hours. The nurse, thinking that he had said ‘50 mg’ administered an overdose to the patient who developed tachycardia and had a significant drop in blood pressure.”

“

17

Noiseinduces stress …

Blomkvist et al. ”Acoustics and psychosocial environment in intensive coronary care”, Occup Environ Med, Mar 2005, 62(3):e1

Thestudytookplaceovereightweeksinanintensivecoronarycareunit(CCU)atHuddingeUniversityHospital,Sweden.ForthefirstfourweekstheceilingwasofareflectivetypeandforthelastfourweeksaclassAsoundabsorbingceilingwasinstalled.36nursesattheCCUansweredquestionnairesofa

psychologicalnatureatthestartoftheirshiftandattheend.

Conclusions

˗Thesoundleveldroppedby5–6dBinthepatientroomsand1dBinthemainworkingarea

˗Reverberationtimedroppedfrom0.9to0.4inthepatientroomsandfrom0.8to0.4inthemainworkingarea

˗Importantgainsinthepsychosocialhealthcareenvironmentcanbeachievedbyimprovingroomacoustics

˗Improvementsinhealthcareacousticswillbeinadequateiftheyonlyfocusonreducingsoundlevels

˗TherewasahighlysignificantimprovementinDemand, Pressure and Strain

Mood states, perceived by nurses on the afternoon shift

-3

-2,5

-2

-1,5

-1

-0,5

0

0,5

1

1,5

2 Demand Control/Support

Distress Pressure Strain

Reflective ceiling,

average value

Sound-absorbing

ceiling, average value

18

… and raises epinephrine levelsEvans Johnson, Cornell University, 2000, “Stress and Open-Office Noise”, Journal of Applied Psychology, 2000, vol 85, no 5, p779–783

Thestudytested40clericalworkersforelevatedlevelsofhormonesintheurineafterthreehoursexposuretolow-intensitynoise,incomparisontohormonelevelsinquietofficeconditions.

Conclusions

˗Thetwogroupsofsubjectsdidnotdifferinperceivedstress

˗Levelsofthestress-indicatorepinephrinedifferedbetweenthetwogroups

˗Socalledmotivationalafter-effects,suchasfewerattemptsatunsolvablepuzzlesandalowerlikelihoodofmakingergonomicposturaladjustmentswerefound

˗Theinabilitytocontrolsoundratherthanitsintensityiswhatmakesitstressful.Evenlow-intensitysoundlevelscaninduceperformanceafter-effects,indicativeofdiminishedtaskmotivation

Increased epinephrine level

Ng/ml

5,61

3,9

0

1

2

3

4

5

6

Noisy, 55−66 dB Quiet, 40 dB

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Sound levels affect critical care …

Johansson et al., “The sound environment in an ICU patient room – a content analysis of sound levels and patient experiences”, Intensive and Critical Care Nursing Journal, Oct 2012, 28(5), p269–279

ThestudydescribesthesoundenvironmentinanICUpatientroomataregionalhospitalinsouth-westernSweden.

Conclusions

˗AveragesoundlevelintheICUwas53dB

˗Soundlevelpeaksexceeded55dB68–79%ofthetime

˗Soundsfromneighbouringpatientsandfromadvancedmedicaltreatmentsandequipmentareperceivedasdisturbingandcancreatefeelingsofhelplessnessandmakeitdifficulttofindthepeaceandcalmthatareessentialforrecoveryandwellbeing

0 10 20 30 40 50 60 70 80 90 100

30

53

0 10 20 30 40 50 60 70 80 90 100

40

82–101

Sound levels, average

WHO recommendation

Actual

dB

Sound levels, peaks

WHO recommendation

Actual

dB

20

… and can impair your hearingKracht, Busch-Vishniac et al., “Noise in the operating rooms of Johns Hopkins Hospital”, Journal of the Acoustical Society of America, May 2007, 121(5 pt1), p2673–80

SoundpressurelevelsintheoperatingroomsatJohnsHopkinsHospital,USA,weremonitoredbefore,during,andafteroperations.Thedurationofnoisewasrecordedduringeachsurgicalprocedure,permittingtheassociationofsoundlevelswithparticulartypesofsurgery.

Conclusions

˗Soundlevelswerefoundtoaveragebetween55and70dBwithsignificantsoundpeaks,someofgreatintensityduringsurgicalprocedures

˗TheconcernsraisedbyhighsoundlevelsinORsaretwofold:thepotentialforhearingloss,andthedisruptiontoclearspeechcommunication

˗Themajorityofthesurgicaldepartmentsexperiencedsoundpeaksofatleast110dB.Levelsover120dBwerenotuncommon

˗Ingeneral,clearspeechcommunicationrequiresatleasta15dBsignal-to-noiseratio.GiventhesustainedsoundlevelsintheORduringsurgery,thatwouldsuggestnormalspeechlevelsat70–85dB

˗MedicalstaffareconfrontedwiththechoiceofeitherspeakingloudlyintheORinordertoensuregoodcommunication,orrunningtheriskofsomewhatcompromisedcommunicationclarity.Giventhenatureofsurgery,thelatteroftheseoptionsisclearlyunacceptable

dB

dB

0%10%20%30%40%50%60%70%80%90%

100%

Time Lpeak over 90 dBTime Lpeak over 95 dBTime Lpeak over 100 dBTime Lpeak over 105 dB

Sound level peaks, % of the time

Time peak over 90 dB

Time peak over 95 dB

Time peak over 100 dB

Time peak over 105 dB

Averag

eCard

iolog

yGas

trointe

stinal

Neuros

urgery

Orthop

aedic

sOtol

aryng

ology

Plastic

, pae

diatric

Thora

cic

Urolog

y

21

The helpless suffer the most

Johannes van der Berg, Care for Sound, Sound Environment, Healing & Health Care, Publications from Sound Environment Center at Lund University n. 12, 2014, p27–429

Theseresultsareasummaryofpresentresearchinneonatalintensivecareunit(NICU)soundenvironments,theirimpactontheinfantandpreventativestrategies.

Conclusions

˗Inneonatalsoundenvironments,theAmericanAcademyofPediatricshasrecommendedthatthesoundlevelshouldbelowerthan45dB.ButnumerousstudiesfromNICUsreportaveragesoundlevelsrangingfromaround55dBto89dB

˗SoundspectralanalysisinNICUshasshownthatthesoundsaremostlyinthehigh-frequency(1–8kHz)bandsandexistclosetotheinfantcarearea.Buttherearealsosoundsinthelow-frequencyband,forinstancefromtheincubator

˗Theeffectofsoundcanbeobservedaschangesinphysiologicalandbehaviouralsigns.Highsoundlevels(70–80dB)havebeenreportedtoincreasetheinfant’sheartrateandrespirationrate,andalsolowertheinfant’soxygenationlevel

˗Increasedbloodpressurewasfoundwheninfantswereexposedtointermittentsoundsatalevelof79–88dB,butnotwhenexposedtocontinuoussoundof50–60dB

˗WhenusingEMGrecordingsandbehaviourassessmenttostudyinfantsexposedtosoundlevelsrangingfrom70to90dB,asignificantreactioninboththesemeasureswasshown,thatpreventedtheinfantsfromreturningtobaseline

˗Sleepisimportantforneurodevelopmentandtherearestudiesindicatingthathighsoundlevelsaffectpreterminfantsnegatively,alteringsleepstatesorbehaviouralstates

˗Areviewofhearinglossamonginfantswithverylowbirthweight(VLBW)reportedthathearingimpairmentininfantsandyoungchildrenare0.1%to0.2%,whilehearinglossamonginfantsdischargedfromNICUsis0.7–1.5%,i.e.aroundseventimeshigher

22

Studies from NICUs report average sound levels ranging from around 55 dB to 89 dB

Johansson et al., Meanings of Being Critically Ill in a Sound-Intensive ICU Patient Room – A Phenomenological Hermeneutical Study, The Open Nursing Journal, 2012, 6, p108–116

Theaimofthestudywastoilluminatethemeaningsofbeingcriticallyillinasound-intensiveICUpatientroom,asdisclosedthroughpatients’narratives.ThirteenpatientswereaskedtonarratetheirexperiencesofthesoundenvironmentinICUpatientrooms.

The helpless suffer the most

A night in the ICU “There are three of us in this room, three patients with different disorders and each of us seems to be in the same bad condition. This means it is never quiet. Every minute there are unexpected noises from different directions which make it very hard to relax or sleep. Moreover, I feel helpless hearing these frightening noises from my roommates. One patient has severe pneumonia I think, because he coughs all the time and breathes very strangely. Another patient screams a lot. I also heard him throw up once and that was awful. Nor can I see any of them. A thin fabric curtain divides our beds so I just hear the different sounds and noises and that means that I am never prepared for them. Every time I fall asleep an unexpected noise wakes me up again. Last night I woke up because of an unexpected noise beside me and something unpleasant happened. Gradually I understood that the patient beside me had become severely ill and needed some kind of treatment. Three physicians had come into the room and I heard everything they said very clearly. I became paralyzed when I realized that I had to stay in the room and listen to all that. I was too tired to get up and leave. I did not even have enough strength to tell the staff about how I felt or ask for help. I just lay there scared and terrified but quiet and calm on the outside. The conversations among the physicians and nurses lasted for what I thought was hours. After a while they started some kind of treatment and I understood that the man might not survive. I was exhausted but I did not know what to do. That night I didn’t sleep at all and it was one of the longest nights of my life.”

“

23

Hearing loss reduces quality of life …

Dalton, D. S., Cruickshanks, K. J., Klein, B. E., et al., 2003. The Impact of Hearing Loss on Guality of Life in Older Adults. The Gerontologist, 43 (5), p661–668.

Afive-yearfollow-upepidemiologyofhearinglossstudy,apopulation-basedlongitudinalstudyofage-relatedhearingimpairmentconductedinBeaverDam,USA,betweenMarch1998andJuly2000.Thestudycovered2,688peoplewithanagerangeof53–97.42%weremaleand58%female.

Conclusions

˗Oftheparticipants,28%hadmildhearinglossand24%hadmoderatetoseverehearingloss

˗Severityofhearinglosswassignificantlyassociatedwithhavingahearinghandicapandwithself-reportedcommunicationdifficulties

˗IndividualswithmoderatetoseverehearinglossweremorelikelythanindividualswithouthearinglosstohaveimpairedADLsandIADL(ActivitiesofDailyLivingandinstrumentalADLs)

˗Overall,52%ofthestudyparticipantsreportedhavingproblemswithcommunication

˗Participantswithmoderatetoseverehearinglosswerealmosteighttimesaslikelyasthosewithouthearinglosstohaveself-reporteddifficultieswithcommunication

˗Participantswithmildhearinglosswerenearlythreetimesaslikelyasthosewithouthearinglosstoreportdifficultieswithcommunication

Population in the world aged 60 years or older, estimation

500

1950

1 000

1 500

2 000

2 500

1960 1970 1980 1990 2000 2010 2020 2030 2040 2050

Milli

on p

eopl

e

United Nations, Department of Economic and Social Affairs, Population Division, World Population Prospects: The 2015 Revision. 2015

24

Chia et al., “Hearing Impairment and Health-Related Quality of Life: The Blue Mountains Hearing Study”, Ear & Hearing, 2007, vol 28 no 2, p187–195

Thestudyaimedtoassesstheassociationbetweenhearingimpairmentandhealth-relatedqualityoflife(HRQOL)inanolderpopulation,usingtheself-administered36-itemShort-FormHealthSurvey(SF-36).2956participantsintheBlueMountainsHearingStudyattendedacomprehensiveinterviewandhearingexaminationinwhichbothself-reportedandmeasuredhearingimpairmentswereassessed.

Conclusions

˗Ofthe2431participantswithcompletedata,1347(55.4%)didnothavemeasuredhearingloss,whereas324(13.3%)hadunilateral(285mild,22moderate,17severe)and760(31.3%)hadbilateralhearingimpairment(478mild,207moderate,75severe)

˗BilateralhearingimpairmentwasassociatedwithpoorerSF-36scoresinbothphysicalandmentaldomains

˗Personswithself-reportedhearinglosshadsignificantlypoorerhealth-relatedqualityoflife(HRQOL)thancorrespondingpersonswithout

… for older adults

Hearing impairment, % of population by age

%

Bilateral impairment

050−59 60−69 70−79

10

20

30

40

50

60

70

80

90

100

80+

Unilateral impairment 50−5960−6970−7980+

900,25 0,5 1 2 3 4 6 8

80

70

60

50

40

30

20

10

0

Bilateral impairment

Unilateral impairment

Age

Average hearing threshold audiogram by age group

Hea

ring

leve

l, dB

Frequency, kHz

50–59

60–69

70–79

80+

25

A sound investment Sadler et al., “Fable Hospital 2.0: The Business Case for Building Better Health Care Facilities,” Hastings Center Report, 2011, vol 41, no 1, p13–23

Thisisabusinesscasetoestimatebenefitsofevidence-baseddesign(EBD)hospitals.Preventableerrorsandpreventableharmarementionedasimportant.Inthiscase,high-performanceacousticceilingsandsound-

absorbingwallmaterialswereusedinpatientrooms.High-performanceacousticceilingswereusedinallpatientcareareas.

Conclusions

˗ThepaybacktimeforEBDatthishospitalisestimatedat3years

˗ThepremiumforEBDisestimatedat7.2%oftotalbuildingcost

˗Noisereductioncontributedtolesssleepdeprivation,quickerrecoveryanddecreasedstress

˗Inthebusinesscase,lessnoiseisconsideredtocontributetolessadversedrugeffectsandreducednursingturnover

˗Buildingdesignsthathelpreducepreventableharmarebecomingkeyelementsinahospital’ssurvivalstrategy

˗Medicarewillnolongerreimbursefortheincrementalcostsincurredbycertainpreventableerrors(USA)

Evidence Based Design, % of total building cost

7,2%

26

Salonen, Heidi et al., “Design approaches for promoting beneficial indoor environments in healthcare facilities: a review”. Intelligent Buildings International (2013), 5(1), p 26–50.

Thisisareviewoftheimplicationsofkeyindoorphysicaldesignparameters,inrelationtotheirpotentialimpactonhumanhealthandwellbeing.Inaddition,thefindingswerediscussedwithinthecontextoftherelevantguidelinesandstandardsforthedesignofhealthcarefacilities.Atotalof810abstractsthatmettheinclusioncriteria,wereidentifiedthroughaPubmedsearch,andthesecoveredjournalarticles,guidelines,books,reportsandmonographsinthestudiedarea.Ofthese,231fullpublicationswereselectedforthisreview.

Conclusions

˗Accordingtotheliterature,themostbeneficialdesignelementswere:single-bedpatientrooms,safeandeasilycleanedsurfacematerials,sound-absorbingceilingtiles,adequateandsufficientventilation,thermalcomfort,naturaldaylight,controlovertemperatureandlighting,views,exposureandaccesstonature,andappropriateequipment,toolsandfurniture

˗Theeffectsofsomedesignelements,suchaslightingandlayout,onstaffandpatientsvary,and“thebestdesignpractice”foreachhealthcarefacilityshouldalwaysbeformulatedinco-operationwithdifferentusergroupsandamulti-professionaldesignteam

˗Therelevantguidelinesandstandardsshouldalsobeconsideredinfuturedesign,constructionandrenovations,inordertoproducemorefavourablephysicalindoorenvironmentsinhealthcarefacilities

Enhance wellbeing

27

2015.06.400.CM

Ecophon dates back to 1958, when the first sound absorbers from glass wool were produced in Sweden to improve the acoustic working environment. Today the company is a global supplier of acoustic systems that contribute to good room acoustics and a healthy indoor environment with the focus on offices, education, health care and industrial manufacturing premises. Ecophon is part of the Saint-Gobain Group and has sales units and distributors in many countries.

Ecophon efforts are guided by a vision of earning global leadership in room acoustic comfort through sound-absorbing systems, enhancing end-user performance and wellbeing. Ecophon maintains an ongoing dialogue with government agencies, working environment organisations and research institutes, and is involved in formulating national standards in the field of room acoustics where Ecophon contributes to a better working environment wherever people work and communicate.

www.ecophon.com

www.ecophon.com