Intended for healthcare professionals

Rapid response to:

Editorials

Noise pollution in hospitals

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4808 (Published 19 November 2018) Cite this as: BMJ 2018;363:k4808

Linked opinion

Engaging with patients on the hospital soundscape

Rapid Response:

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 [1].
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 [2].
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
Discussion:
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]
2. What are the psychological effects of noise? [6]
3. Can a sudden loud noise cause a heart attack? [8,9,10]
4. Can spontaneous pneumothorax occur due to loud music? [11]
5. Can wind turbine noise cause sleep disturbance? [12]
Concluding remark:
Noise pollution is a preventable condition that causes sleep disturbance and sickness. General awareness, precautions and systematic monitoring may reduce this menace.
References:
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

06 April 2019
Prof.Dr.Jogenananda Pramanik
Professor and Dean & CEO
Dr. Evertz Solomon Associate Professor, Prof Dr Tanu Pramanik, Principal Dr.Orette Williams Associate Professor Dr. Ananya Pramanik, Lecturer, Lincoln College Mandeville, and Dr Eric Williams Consultant Emergency Medicine Unit, UWI, Kingston, Jamaica,WI
Lincoln College Mandeville
32,Hargreaves Avenue, Hargreaves Medical Complex, Mandeville, Manchester, Jamaica,WI