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Hospital Program Quiets NICU to Keep Infants Safe

Heather Comak, for HealthLeaders Media, May 12, 2009

For babies born prematurely, even the noise generated from a normal conversation can be too loud for proper development. Mothers who give birth to premature babies at The Women's Hospital in Newburgh, IN, however, need not worry about the noise level in the hospital's neonatal intensive care unit (NICU).

Women's Hospital installed both sound meters and visual feedback cues to ensure that babies receive the safest possible care.

"We think that the developing brain, especially of the premature baby, is influenced by its environment," says Kenneth Herrmann, MD, medical director for newborn services for the Deaconess-Rile NICU at The Women's Hospital. "The environment is either promoting healthy development of the brain, or its not. There is a school of thought that says any noxious stimulus—too bright a light, too loud a sound—is distracting to the task of growing and developing."

The American Academy of Pediatrics recommends that NICUs noise levels remain at or softer than 45 decibels. This is a nearly impossible task, says Herrmann.

The necessary equipment found in a NICU, such as ventilators and monitors, all generate a certain amount of noise, the room's infection-preventing but echo-inducing design is not conducive to keeping quiet, and the nurses who work in the NICU and family members who visit all add to the sound level.

Many NICUs operate at sound levels closer to 80 or 90 decibels, says Herrmann. The noise levels generated from equipment and hospital design cannot, for the most part, be altered without significant hospital renovations.

Women's Hospital seized its chance to change the behaviors of staff members working in and family members visiting the NICU. The hospital installed both sound meters to evaluate the sound level in the room, and light "trees" to give staff members a sense of the decibel level (the light trees resemble an overhead traffic light).

Using a computer system called SONICU, the sound level is measured every five seconds and that data is transmitted to the light trees, which either show a green, yellow, or red light, depending on the noise level. If the noise level reaches the designated "red" zone, the overhead lights in the NICU also begin to flicker, alerting anyone in the NICU they must be quieter.

"In the intensive care nursery where there are no complainers, sound levels can get out of control," says Herrmann of a premature baby's inability to verbally alert a caregiver to discomfort. "You can have an automated system that is non judgmental, that signals to everybody when it's getting too loud."

When The Women's Hospital first started using visual cues in 2007 to alert staff members and visitors to noise levels, the red light was triggered to go off at 75 decibels and the yellow light was triggered at 60 decibels. Since then, staff members have learned to keep their voices down enough so that the red light is now triggered at 60 decibels, and the yellow at 48.

Although the light trees help spread awareness about the NICU's noise level, they are directly overhead and can blend in with the environment. The flickering overhead fluorescent lights, a special system that The Women's Hospital NICU had installed, act as a visual cue that is harder for staff members to ignore. The lighting system has also allowed the NICU to simulate the effects of sunrise and sunset to get the premature babies ready for the real world.

"People have to be willing to cooperate. SONICU enables us to get rid of the policemen, the person who has to walk around and say 'you're being too loud,'" says Herrmann. "It means the staff has to embrace the idea that sound levels are important to the babies and that they are part of the reason why the care is better or worse."

Beyond the NICU
Although this technology is being used in a NICU at The Women's Hospital currently, Herrmann sees potential for the SONICU system in a more general hospital setting, especially for those hospitals looking to improve their patient satisfaction scores. Herrmann says the technology could be used in noisy hospital hallways where most of the patients are adults. Adult patients often express dissatisfaction with noise levels during a hospital stay, especially because they are most likely uncomfortable in some other way because of their sickness or treatment.

Any hospital being built today would be wise to include this type of technology, says Herrmann. In addition, hospitals undergoing renovations could easily implement an automated system, such as SONICU, to create a quieter, less stressful environment for the patient.

"The noise commonly enough is people's voices out in the hall, which, if it's during a no-visiting time, it's nursing staff in the middle of the night talking too loud outside of the patient's room," says Herrmann. "It's a big deal in the adult world, and yet not much is done about it."


Heather Comak is a Managing Editor at HCPro, Inc., where she is the editor of the monthly publication Briefings on Patient Safety, as well as patient safety-related books and audio conferences. She is also is the Assistant Director of the Association for Healthcare Accreditation Professionals. Contact Heather by e-mailing hcomak@hcpro.com.

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