Noise pollution in hospitalsBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4808 (Published 19 November 2018) Cite this as: BMJ 2018;363:k4808
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Noise pollution in hospitals—An ever escalating menace ignored unfortunately. Re: Noise pollution in hospitals
“Even in intensive care units, which cater for the most vulnerable patients, noise levels over 100dB have been measured, the equivalent of loud music through headphones,” said lead author Dr Andreas Xyrichis from King's College London .
The World Health Organisation guidelines say that for a good sleep, sound level should not exceed 30 dB(A) for continuous background noise, and 45 dB(A) for individual noise events .
Most unfortunately noise pollution in hospitals is continuing unabated exceeding international recommendations, despite series of scientific articles published [3-5] with mounting evidences emphasising detrimental impact of noise on hospitalised patients, hospital staffs, nurses, clinicians.
Current situation demands a detail systematic investigation to explore repercussions of noise pollution on in-patients admitted in different speciality units of tertiary level hospitals e.g. Intensive respiratory care unit, Stroke unit, Coronary care unit, Emergency medicine unit, Paediatric unit, post-operative care unit etc.
Most commonly several patients complain about noise induced personal irritations which are often ignored or overlooked leading to-
A. Rising Irritation, annoyance, and fatigue of patients’ and hospital staffs.
B. Negative impact on a patients’ ability to rest, heal and recover,
C. Detrimentally impact on the quality of sleep and sleep deprivation
There is a long list of noises generated from different sources which often disturb hospitalised patients:
1. Beeping sounds from various electronic equipment inside emergency care units
2. Ringing of cell phones of hospital staffs, nurses, clinicians
3. Car alarm from parking areas around hospitals
4. Night security whistles
5. Cumulative noises during emergency patient admission
6. Health care staffs conversations
7. Rattling of emergency trolley
8. Staff, visitor, and patient conversations at crowded reception or cash counters
9. Music systems, Television noise
10. Road traffic noise
11. Ambulance horn
12. Indoor noises from air-conditioners, fans, noisy doors and windows etc.
We need to spread overall awareness and inculcate sense of responsibility, empathy and soft corners towards seriously ill patients, fatally injured street accident cases, terminally ill cancer patients and many others. Some of those patients may be our relatives or friends lying on hospital beds for comfort, care, uneventful recovery which may be delayed due to unhealthy noisy environments created by other insensitive people around [6,7]
We are in the process of developing a collaborative research project to investigate different scenarios at tertiary level hospitals and explore different protocols to measure degrees of noise pollution in different units of those hospitals aiming towards a long term solution to recommend which may be widely acceptable to relieve this ever increasing menace that left ignored unfortunately.
We are planning to evaluate the impact of the existing systems as follows:
A. Implementation of general instructions from management to reduce noise pollution
B. Instruction to hospital staffs, patient, visitors
C. Installation of noise nuisance recorder [https://www.cirrusresearch.co.uk/products/trojan2-noise-nuisance-recorder/] to ear mark most noisy units in a hospital.
D. Monitor frequency of sedative, hypnotic and analgesic drugs use
E. Hospitalised patients’ interview to record Impact of noise on duration of hospital stay
G. Use of standardised patient experience questionnaires
There are published reports on relentless noise pollution in and around hospital units where a number of sick patients are seeking for peaceful sleep at night. Sleep deprived patients ask for sleep medicine to get relief from chronic irritation and fatigue. [4,5] Repeated use of sedative or hypnotic medicines to induce sleep in noisy environment may cause addiction and other related disorders.
There are series of research questions as follows:
1. What is the acceptable level of noise in hospital ward?
2. What are the psychological effects of noise? 
3. Can a sudden loud noise cause a heart attack? [8,9,10]
4. Can spontaneous pneumothorax occur due to loud music? 
5. Can wind turbine noise cause sleep disturbance? 
Noise pollution is a preventable condition that causes sleep disturbance and sickness. General awareness, precautions and systematic monitoring may reduce this menace.
1. Xyrichis A, Wynne J, Mackrill J, Rafferty AM, Carlyle A. Noise pollution in hospitals. BMJ 2018;363:k4808.
2. Berglund B, Lindvall T, Schwela DH. Guidelines for Community Noise. Geneva: World Health Organization; 1999. Available from: http://www.who.int/docstore/peh/noise/guidelines2.html . [Accessed on 2010 March 28].
3. Cunha M, Silva N. Hospital Noise and Patients’ Wellbeing. Procedia 2015;171:246-251.
4. Park MJ, Yoo JH, Cho BW, Kim KT, Jeong WC, Ha M. Noise in hospital rooms and sleep disturbance in hospitalized medical patients. Environ Health Toxicol 2014;29: e2014006.
5. Bevan R, Grantham-Hill S, Bowen R, et al. Sleep quality and noise: comparisons between hospital and home settings. Arch Dis Child. Published Online First: 17 July 2018. doi: 10.1136/archdischild-2018-315168
6. Horne S, Hay K, Watson S, Anderson KN. An evaluation of sleep disturbance on in-patient psychiatric units in the UK. BJPsych Bull 2018; 42: 193–197
7. Hui Xie,, Jian Kang, and Gary H Mills Clinical review: The impact of noise on patients' sleep and the effectiveness of noise reduction strategies in intensive care units Crit Care. 2009; 13(2): 208.. doi: 10.1186/cc7154 PMCID: PMC2689451 PMID: 19344486
8. Muzet A, Weber LD, Di Nisi J, Ehrhart J. Comparison of cardiovascular reactivity to noise during waking and sleep. National Center for Scientific Research Center for Bioclimatic studies. Convention No 82243, 1985.
9. Sforza E, Chapotot F, Lavoie S, Roche F, Pigeau R, Buguet A. Heart rate activation during spontaneous arousals from sleep: Effect of sleep deprivation. Clin Neurophysiol 2004;115:2442-51.
10. Tanu Pramanik: The effects of noise on sleep and their potential harmful repercussions on cardiac patients in hospitals: https://annals.org/aim/fullarticle/1305527/sleep-disruption-due-hospital....
11. Noppen M1, Verbanck S, Harvey J, Music: a new cause of primary spontaneous pneumothorax. Thorax. 2004 Aug;59(8):722-4.
12. Tanu Pramanik: Re: Wind turbine noise: https://www.bmj.com/content/344/bmj.e1527/rr/597809.
Competing interests: No competing interests
Xyrichis and colleagues convincingly laid out the case that noise levels in hospitals are excessive and lead to harmful effects for staff and patients.1 We were pleased to find the effects of noise on sleep were highlighted. However, we believe the adverse effects of noise on patients sleep may be even more worrying than was stressed in this article.
Studies have shown that sleep disruption is the complaint noted most frequently by patients on noisy wards, nearly more than stress, headaches and impaired concentration combined.2 Furthermore, rising noise levels on medical wards has been shown to be significantly correlated with subjective and objective measures of patient sleep quality, in a dose response manner: the louder the hospital environment, the more severe the sleep disruption.3 In addition, whilst it is already well known that sleep disruption on medical wards and intensive care units is prevalent; recent research has begun to identify that sleep disruption as a result of noise is also a problem on paediatric and psychiatric wards too.4,5 Given the wealth of evidence showing that lack of sleep leads to longer recovery times, increased pain, worsened cognitive function and poorer mental health, it is of paramount importance that hospital wide initiatives are put in place.6,7
We are leading a quality improvement project at Colchester Hospital that focuses on reducing the effects of noise pollution on patients' sleep. This is a multidisciplinary collaboration between clinical and non-clinical staff, and with input from patients and relatives. An initial patient experience questionnaire was carried out, which confirmed that noise was a key contributor to our patients’ lack of sleep. To rectify this problem, we provided a 'sleep pack' containing ear plugs and eye masks to suitable patients on a busy medical ward to be used overnight. This simple intervention indeed showed promise as a cost-effective way of improving our patient’s experience of sleep. We are now rolling out this intervention hospital wide, particularly on wards with patients at high risk of sleep disruption, such as the Stroke Unit.
We find it perplexing that such simple and cost-effective interventions that can influence one of the most important yet chronically overlooked aspects of our health - sleep - are scarcely implemented in hospitals across the country. We urge the healthcare profession to listen to the complaints of its patients and wake up to the sleep crisis we have in our midst - we cannot afford to ignore the noise any longer.7
Abidemi Otaiku, Zhilin Jiang, Stephanie Ellis
1. Xyrichis A, Wynne J, Mackrill J, Rafferty AM, Carlyle A. Noise pollution in hospitals. BMJ 2018;363:k4808
2. Cunha M, Silva N. Hospital Noise and Patients’ Wellbeing. Procedia 2015;171:246-251.
3. Park MJ, Yoo JH, Cho BW, Kim KT, Jeong WC, Ha M. Noise in hospital rooms and sleep disturbance in hospitalized medical patients. Environ Health Toxicol 2014;29: e2014006.
4. Bevan R, Grantham-Hill S, Bowen R, et al. Sleep quality and noise: comparisons between hospital and home settings. Arch Dis Child. Published Online First: 17 July 2018. doi: 10.1136/archdischild-2018-315168
5. Horne S, Hay K, Watson S, Anderson KN. An evaluation of sleep disturbance on in-patient psychiatric units in the UK. BJPsych Bull 2018; 42: 193–197
6. Krause AJ, Simon EB, Mander BA, et al. The sleep-deprived human brain. Nat Rev Neurosci 2017;18:404-418.
7. Walker MP. A sleep prescription for medicine. Lancet 2018;391:2598-2599
Competing interests: No competing interests
40 years ago I cautioned a medical resident to be aware of taping his wedding ring nervously against the top of an infant isolette. Being an advocate for my wee patients, I wanted to protect them against aural insult.
I fear my request was dismissed out of hand.
I floated my concern up my chain of command and received naught but disinterest. To this day I have not been able to find any traction on the role of excessive noise and patient experience in healthcare.
I compliment the authors on their work in this area.
Matt King, RN-BC, BSN, MSN
Competing interests: No competing interests