Whitham Megan D, Casali John G, Smith Gabrielle K, Allihien Alexis L, Wright Brett W, Barter Shannon M, Urban Amanda R, Dudley Donald J, Fuller Robert R
Department of Obstetrics and Gynecology, University of Virginia School of Medicine, Charlottesville, VA (Drs Whitham, Smith, Allihien, and Wright, Ms Urban, and Drs Dudley and Fuller).
Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University, Blacksburg, VA (Drs Casali and Barter).
Am J Obstet Gynecol MFM. 2023 May;5(5):100887. doi: 10.1016/j.ajogmf.2023.100887. Epub 2023 Feb 11.
Cesarean delivery is the most common major surgery worldwide. Noise in healthcare settings leads to impaired communication and concentration, and stress among healthcare providers. Limited information is available about noise at cesarean delivery.
This study aimed to achieve a comprehensive analysis of noise that occurs during cesarean deliveries. Sound level meters are used to determine baseline noise levels and to describe the frequency of acute noise generated during a cesarean delivery that will cause a human startle response. Secondarily, we aimed to evaluate the effectiveness of a visual alarm system in mitigating excessive noise.
We completed a preintervention/postintervention observational study of noise levels during cesarean deliveries before and after introduction of a visual alarm system for noise mitigation between February 15, 2021 and August 26, 2021. There were 156 cases included from each study period. Sound pressure levels were analyzed by overall case median decibel levels and by time epoch for relevant phases of the operation. Rapid increases in noise events capable of causing a human startle response, "startle events," were detected by retrospective analysis, with quantification for baselines and analysis of frequency by case type. Median noise levels with interquartile ranges are presented. Data are compared between epochs and case characteristics with nonparametric 2-tailed testing.
The median acoustic pressure for all cesarean deliveries was 61.8 (58.8-65.9) (median [interquartile range]) dBA (A-weighted decibels). The median dBA for the full case time period was significantly higher in cases with neonatal intensive care unit team presence (62.1 [60.5-63.9]), admission to the neonatal intensive care unit (62.0 [60.4-63.9]), 5-minute Apgar score <7 (62.2 [61.1-64.3]), multiple gestations (62.6 [62.0-64.2]), and intraoperative tubal sterilization (62.8 [61.5-65.1]). The use of visual alarms was associated with a statistically significant reduction of median noise level by 0.7 dBA, from 61.8 (60.6-63.5) to 61.1 (59.8-63.7) dBA (P<.001).
The noise intensities recorded during cesarean deliveries were commonly at levels that affect communication and concentration, and above the safe levels recommended by the World Health Organization. Although noise was reduced by 0.7 dBA, the reduction was not clinically significant in reaching a discernible amount (a 3-dB change) or in reducing "startle events." Isolated use of visual alarms during cesarean deliveries is unlikely to be a satisfactory noise mitigation strategy.
剖宫产是全球最常见的大手术。医疗环境中的噪音会导致沟通和注意力受损，以及医护人员产生压力。关于剖宫产时的噪音信息有限。
本研究旨在全面分析剖宫产过程中出现的噪音。使用声级计确定基线噪音水平，并描述剖宫产过程中产生的会引起人体惊吓反应的急性噪音频率。其次，我们旨在评估视觉警报系统在减轻过度噪音方面的效果。
我们在2021年2月15日至2021年8月26日期间，对引入用于减轻噪音的视觉警报系统前后的剖宫产术中噪音水平进行了干预前/干预后观察性研究。每个研究阶段纳入156例病例。通过总体病例中位数分贝水平以及手术相关阶段的时间段来分析声压水平。通过回顾性分析检测能够引起人体惊吓反应的噪音事件（“惊吓事件”）的快速增加，并对基线进行量化以及按病例类型分析频率。呈现四分位间距的中位数噪音水平。使用非参数双尾检验比较不同时间段和病例特征之间的数据。
所有剖宫产的声压中位数为61.8（58.8 - 65.9）（中位数[四分位间距]）dBA（A加权分贝）。在有新生儿重症监护病房团队在场的病例（62.1 [60.5 - 63.9]）、入住新生儿重症监护病房的病例（62.0 [60.4 - 63.9]）、5分钟阿氏评分<7的病例（62.2 [61.1 - 64.3]）、多胎妊娠的病例（62.6 [62.0 - 64.2]）以及术中输卵管绝育的病例（62.8 [61.5 - 65.1]）中，整个病例时间段的dBA中位数显著更高。使用视觉警报与中位数噪音水平在统计学上显著降低0.7 dBA相关，从61.8（60.6 - 63.5）降至61.1（59.8 - 63.7）dBA（P <.001）。
剖宫产过程中记录的噪音强度通常处于影响沟通和注意力的水平，且高于世界卫生组织推荐的安全水平。尽管噪音降低了0.7 dBA，但这种降低在达到可察觉量（3分贝变化）或减少“惊吓事件”方面在临床上并不显著。剖宫产时单独使用视觉警报不太可能是一种令人满意的噪音减轻策略。
