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ARTICLE Table of Contents   
Year : 2008  |  Volume : 10  |  Issue : 41  |  Page : 110-112
Noise levels in Greek hospitals

1 2nd Pulmonary Department, GH ‘G. PAPANIKOLAOU’, Thessaloniki, Greece
2 Architectural Technology Laboratory, Polytechnic School, Aristotle University of Thessaloniki, Thessaloniki, Greece
3 Intensive Care Unit, GH ‘PAPAGEORGIOU’, Thessaloniki, Greece

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  Abstract 

High noise levels have been recognized as a serious problem in hospital environments during both night- and daytime, and have been associated with a negative impact on patients' health status. The aim of this study was to measure and detect differences in noise levels between an ICU and a pulmonary ward in two general hospitals in Greece.
Methods: Noise measurements were recorded in one-hour intervals using the Cirrus CR: 245/R2 Environmental Noise Analyzer in a 30-bed pulmonary ward and in a 16-bed general ICU for seven consecutive days. Results: Noise levels detected in the ward were significantly lower than those detected in the ICU (52.6 ± 8.2 dB vs 59 ± 2.2 dB, P < 0.001). Noise levels decreased significantly during the course of the day in the ward, reaching the lowest limits during the night shift. This was not observed in the ICU and this pattern was constant during the periods monitored in both departments. Conclusion: Noise levels measured in the ward and in the ICU were high, significantly exceeding the highest permitted values for hospitals. The latter was more obviously recorded in the ICU.

Keywords: Hospitals, hospital environment, noise pollution

How to cite this article:
Tsara V, Nena E, Serasli E, Vasileiadis V, Matamis D, Christaki P. Noise levels in Greek hospitals. Noise Health 2008;10:110-2

How to cite this URL:
Tsara V, Nena E, Serasli E, Vasileiadis V, Matamis D, Christaki P. Noise levels in Greek hospitals. Noise Health [serial online] 2008 [cited 2020 Jul 2];10:110-2. Available from: http://www.noiseandhealth.org/text.asp?2008/10/41/110/44350

  Introduction Top


Environmental noise present in hospitals all over the world is a common stressor and is recognized as a serious health hazard and not just as a nuisance. The World Health Organization (WHO) has drawn up guidelines to promote a community noise management plan and to reduce the effects of noise exposure on health. According to these guidelines, acceptable noise levels in indoor spaces (dwellings) are set to 35 dB, whereas limits are set to 30 dB for bedrooms to avoid sleep disturbances. [1]

Previous studies have measured hospital noise and have pointed out the influence of environmental noise on patients' performance, and, especially, on their sleep quality. [2],[3],[4]

The aim of our study was to estimate noise levels in two different settings in two major hospitals in northern Greece, and to detect any possible differences regarding the measured levels and the noise pattern between a pulmonary department and a general ICU.


  Materials and Methods Top


Site

The study was conducted in a 30-bed pulmonary department and a 16-bed general ICU, located in two tertiary general hospitals in the same semiurban area of Thessaloniki, a city in northern Greece with 8,00,000 habitants.

The architectural lay of the pulmonary department includes a main corridor with patients' rooms located across one side, and the doctors' offices, auxiliary rooms, and a nursing station on the other side. All the rooms are lighted through large windows with a view to the country with the doors usually being open to the main corridor. Each room is equipped with three beds, and each patient's bed is supplied with one outlet each of oxygen, compressed air, and vacuum. Additionally, a telephone device, an intercommunication system, and a television set are available in every room. Mobile equipments are also available for the measurement of vital signs (blood pressure, pulse, oxygen saturation) and for noninvasive mechanical ventilation.

The ICU includes only acute-care beds arranged in two semiopen, semicircular plans, including a total of eight cubicles. A source of daylight source is available in each cubicle. Each semicircle includes a nursing station equipped with two telephone lines, an intercom, and an emergency-call system. Each ICU bed is equipped with a ventilator, an eight-channel monitor for hemodynamic and oxygenation monitoring, a noninvasive arterial blood measurement module, and six infusion pumps for drug administration. The ventilator and monitor alarm sound are set at 55 dB.

Noise measurements

Noise measurements were conducted by using the Cirrus CR: 245/R2 Environmental Noise Analyzer designed for long- and medium-term outdoor and indoor measurements. This instrument measures sound levels in decibels A {dB(A)} and the maximum noise level (LA max ) during a predetermined time period. The specifications of the sound level meter are: a measuring range from 25 to 130 dB(A), an accuracy of IEC 651 and 804 Type1, BS EN 60651 and BS EN 69804 Type 1, and a MK224 microphone.

Two noise-monitoring stations were placed in each department for seven consecutive days. All the measurements were recorded per hour to calculate the noise indications: L day , L evening , L night , and L den according to the 2002/49/EC (noise measurements for the time indicated).

The working personnel of both departments were informed about the study, but no special order was given regarding noise caution. For the purpose of analysis, recordings were divided into three eight-hour shifts (morning, evening, and night) corresponding to the working schedule of nursing and medical personnel in Greek hospitals.

Data analysis

Descriptive statistics were used. Analysis of variance (ANOVA) and Student's t-test were employed for comparisons of the mean values between groups of variables. P < 0.05 was considered statistically significant. All calculations were carried out using the statistical package SPSS for Windows, version 15.0 (SPSS Inc, Chicago, IL, USA). The Ethics Committee of each hospital approved the protocol.


  Results Top


In general, noise levels showed a decreasing trend that was more profound in the pulmonary department than in the ICU, both in the evening and night shifts as displayed in [Table 1]. In the morning shift, noise levels were high in the two settings without any significant difference between them. The highest noise levels in the pulmonary ward revealed peaks that sometimes exceeded those of the ICU and were recorded at 1 p.m. during the morning shift of each workday. Noise levels in the two other shifts (evening and night) were significantly lower in the pulmonary ward, with the lowest values recorded at 8 p.m. (46.26 ± 8.16)). This decreasing pattern was also recorded in the ICU in the evening and night shifts, without reaching any statistically significant level [Figure 1].

The mean sound levels recorded in the ICU were significantly higher than those recorded in the ward on almost all weekdays except one [Table 2]. No significant variation was recorded in the ICU noise levels on weekdays. On the other hand, mean sound levels showed an important decrease during the weekend, starting from Friday, in the ward [Figure 2].


  Discussion Top


The results of this study confirm that excessive environmental noise is present in different departments in Greek hospitals. Recorded noise levels were high both in the ward and the ICU, with an unchanged pattern during the two weeks of recording. Although noise levels had a trend to decrease during the night, they were constantly above the highest permitted values for indoor environments. The same observations in day-night changes in noise levels have been reported in hospitals all over the world. [5],[6]

Universally, the ICU environment is the noisiest of all departments in any hospital. This is actually expected because of the medical equipment and the heavy frequent medical and nursing activities, which potentially cause more noise. A previous study from Tsiou et al. has measured noise in a small ICU in Athens, Greece. [7] Our results are in agreement with their findings, confirming that the ICU environment in Greek hospitals can be very noisy, regardless of the size and location of the hospitals.

The noise recordings in the pulmonary ward had different characteristics than those in the ICU and the comparison of the weekly patterns of noise revealed higher noise levels in the ICU, although the difference was not profound on Tuesday. Higher values recorded in the ward during the morning shift were comparable with those of the ICU during the day. Daily noise levels followed the same pattern, with a gradual decline during the evening and night hours. This decline in noise levels in the afternoons and evenings can be attributed to the lower number of working personnel and the lower workload compared to that of the ICU, in which the noise levels always remained high, without any influence of the day of the week or the interchange of staff in work shifts.

Several other studies have documented that noise pollution was present in different hospital facilities outside the ICU. [8],[9],[10],[11] Regarding the noise levels reported in wards, our results showed almost the same pattern [9] with some differences in night noise levels [10] compared to surgical wards in the UK. These differences mostly reflected the disparities among countries in the working schedules, number of staff, and ward architectural layouts. Several studies have also demonstrated this and emphasized the need for interventions to prevent the harmful effects of excessive noise on patients. [12],[13] We believe that our study adds information about the current hospital environment in Greece and highlights the need for implementation of noise reduction strategies.

In conclusion, this study confirms that noise pollution is present in hospitals regardless of the specialty of the medical department. The main practical goals should be to recognize the main sources of noise pollution and intervene appropriately to diminish them and establish an optimal hospital environment

 
  References Top

1.Available from: http://www.who.int/mediacentre/factsheets/fs258/en/ 2/2001.  Back to cited text no. 1    
2.Aaron JN, Carliste CC, Carskardon MA, Meyer TJ, Hill NS, Millman RP. Environmental noise as a cause of sleep disruption in an intermediate respiratory care unit. Sleep 1996;19:707-10.  Back to cited text no. 2    
3.Meyer TJ, Eveloff SE, Bauer MS, Schwartz WA, Hill NS, Millman RP. Adverse environmental conditions in the respiratory and medical ICU settings. Chest 1994;105:1211-6.  Back to cited text no. 3    
4.Gabor JY, Cooper AB, Crombach SA, Lee B, Kadikar N, Bettger HE, et al . Contribution of the intensive care unit environment to sleep disruption in mechanically ventilated patients and healthy subjects. Am J Respir Crit Care Med 2003;167:708-15.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Busch-Vishniac IJ, West JE, Barnhill C, Hunter T, Orellana D, Chivukula R. Noise levels in John Hopkins Hospital. J Acoust Soc Am 2005;118:3629-45.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Otenio MH, Cremer E, Turini Claro EM. Noise level in a 222 bed hospital in the 18th health-region-PR. Rev Bras Otorinolarigolo 2007;73:245-50.  Back to cited text no. 6    
7.Tsiou C, Efthymiatos D, Theodossopoulou E, Notis P, Kiriakou K. Noise source and levels in the Evgenidion Hospital intensive care unit. Intensive Care Med 1998;24:845-7.  Back to cited text no. 7    
8.Schnelle JF, Alessi CA, Al-Samarrai NR, Fricker RD, Ouslander JG. The nursing home at night: Effects of an intervention on noise, light and sleep. J Am Geriatr Soc 1999;47:430-8.  Back to cited text no. 8    
9.Benttley S, Murphy F, Dunley H. Perceived noise in surgical wards and in an intensive care area: An objective analysis. Br Med J 1977;10:1503-6.  Back to cited text no. 9    
10.Christensen M. Noise levels in a general surgical ward: A descriptive study. J Clin Nurs 2005;14:156-64.  Back to cited text no. 10  [PUBMED]  [FULLTEXT]
11.Allaouchiche B, Duffo F, Debon R, Bergeret A, Chassard D. Noise in the postanaesthesia care unit. Br J Anaesth 2002;88:369-73.  Back to cited text no. 11    
12.Kahn DM, Cook TE, Carliste CC, Nelson DL, Kremer NR, Millman RP. Identification and modification of environmental noise in an ICU setting. Chest 1996;114:535-40.  Back to cited text no. 12    
13.Moore MM, Nguyen D, Nolan SP, Robinson SP, Ryals B, Imbrie JZ, et al . Interventions to reduce decibel levels on patient care units. Am Surg 1998;64:894-9.  Back to cited text no. 13  [PUBMED]  

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Correspondence Address:
Venetia Tsara
2nd Chest Clinic “G.Papanikolaou General Hospital, Exohi Thessaloniki, GR 57010
Greece
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1463-1741.44350

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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]

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