Wednesday, April 27, 2011

Noise in The NICU

As developmental care in the NICU continues to become a stronger force the high noise levels are coming into question. In my research I've come across the following article that confirms this is not a new idea, "Like libraries, hospitals used to be considered quiet zones. In her 1859 book "Notes on Nursing," Florence Nightingale railed against unnecessary noise, calling it "the most cruel absence of care." The article states that hospitals use to be quiet zones but as technology rapidly advanced so did the noise. It is proven that premature babies in a NICU environment have lower stress levels, thrive, and have a shorter recovery time when they get optimal rest and uninterrupted sleep. Although a baby may not "wake up" by opening their eyes and looking up at the world around them, when beeps are constantly going off their brain patterns reflect this stress. In addition to non stop beeps you get the occasional voice that may be a little on the noisy side, crying babies who may be "rooming" in, and the loud (to the preemie anyway) tapping on the incubator. All reasons why private rooms are proving to be most beneficial for developmental care. I came across another website that sells NICU noise meters. These things are selling! The website states that, "Noise from visitors and staff is best dealt with using a device such as the SoundEar as it is not influenced by the complicated human perception of noise". This makes sense and it seems to be a simply way to keep the noise under control.

Neonatal units, like most hospital environments, tend to be very poor acoustically due to hard, reflective surfaces. Beds are often closely spaced, visitors can talk loudly (especially the younger ones) and staff have to work quickly and move equipment about. Add to this the incubators being opened and closed, occasional tapping on the lid and items dropped accidentally and the noise levels soon become unpleasant for the baby. One of the biggest culprits is the alarm, which is clearly essential, but as the background noise levels get higher the alarm has to be louder still. A quieter background allows for quieter alarms.

Another article states that, "current literature supports the theory that neonates, particularly premature infants, are not sensory deprived but receive a bombardment of large amounts of stimulation. This stimulation is often noxious in nature and contributes to "overload." This article written in 2011 continues on to explain a study conducted where the NICU staff was educated on noise reduction and forced to change their speaking habits to be lower. In addition monitors were turned down and clipboards were not allowed to be placed on or near incubators. When comparing the data from before the study and after, they found the decibels decreased from an average of 70 dB to 68 dB in the NICU environment. Although, this is only 3 points it represents a 50 percent reduction of perceived noise intensity to a sick baby. These are great results. They continue on to state, "clearly, there are obvious benefits of reducing noise in the NICU. Decreased noise helps to improve infants' physiological stability and growth, the inci-dence/severity of hearing loss may be reduced, as well as long-term perceptual difficulties. A quieter, more nurturing NICU environment helps support the development of a well-regulated infant behavioral state. Moreover, noise reduction can promote infants' bonding with relatives and extend parent visitation. Additionally, staff members directly benefit, with the possibility of stress reduction." I think what is most interesting about the study is that these are very simple cost efficient changes that can be made and they are having a positive impact on the babies' development. Even in a semi-quiet NICU environment, like I would compare mine to, positive changes can me implemented. I distinctly remember numerous times a false alarm was sounding and a nurse let it go on for longer than it should have because she A) knew it was false and B) was busy with something else. In the womb a fetus is only exposed to low frequency sounds then when they come out they are then exposed to high frequency. If we could bring down all noise levels, even talk in a lower tone consistently, it seems it would be more comparable to the womb. It may get to a point where it seems extreme, especially when you are in the NICU environment all day long, working and parenting, but if the obvious goal is for these babies to thrive, develop at the fastest rate possible, and decrease the time they have to be in the hospital, as time goes on we may witness more and more noise control. Shhh!! You are about to enter a quiet zone....


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