Rangaswamy Darshan Rajatadri, Kamble Niranjan, Veeramachaneni Amulya
Department of Pediatrics, Subbaiah Institute of Medical Sciences, Shimoga 577222, Karnataka, India.
World J Clin Pediatr. 2024 Sep 9;13(3):96018. doi: 10.5409/wjcp.v13.i3.96018.
The neonatal intensive care unit (NICU) is vital for preterm infants but is often plagued by harmful noise levels. Excessive noise, ranging from medical equipment to conversations, poses significant health risks, including hearing impairment and neurodevelopmental issues. The American Academy of Pediatrics recommends strict sound limits to safeguard neonatal well-being. Strategies such as education, environmental modifications, and quiet hours have shown to reduce noise levels. However, up to 60% of the noises remain avoidable. High noise exposure exacerbates physiological disturbances, impacting vital functions and long-term neurological outcomes. Effective noise reduction in the NICU is crucial for promoting optimal neonatal development.
To measure the sound levels in a NICU and reduce ambient sound levels by at least 10% from baseline.
A quasi-experimental quality improvement project was conducted over 4 mo in a 20-bed level 3 NICU in a tertiary care medical college. Baseline noise levels were recorded continuously using a sound level meter. The interventions included targeted education, environmental modifications, and organizational changes, and were implemented through three rapid Plan-Do-Study-Act (PDSA) cycles. Weekly feedback and monitoring were conducted, and statistical process control charts were used for analysis. The mean noise values were compared using the paired -test.
The baseline mean ambient noise level in the NICU was 67.8 dB, which decreased to 50.5 dB after the first cycle, and further decreased to 47.4 dB and 51.2 dB after subsequent cycles. The reduction in noise levels was 21% during the day and 28% at night, with an overall decrease of 25% from baseline. The most significant reduction occurred after the first PDSA cycle (mean difference of -17.3 dB, < 0.01). Peak noise levels decreased from 110 dB to 88.24 dB after the intervention.
A multifaceted intervention strategy reduced noise in the NICU by 25% over 4 months. The success of this initiative emphasizes the significance of comprehensive interventions for noise reduction.
新生儿重症监护病房（NICU）对早产儿至关重要，但常受有害噪音水平困扰。从医疗设备到谈话的过度噪音会带来重大健康风险，包括听力损伤和神经发育问题。美国儿科学会建议设定严格的声音限制以保障新生儿健康。诸如教育、环境改造和安静时段等策略已显示可降低噪音水平。然而，高达60%的噪音仍可避免。高噪音暴露会加剧生理紊乱，影响重要功能和长期神经学预后。NICU中有效的噪音降低对于促进新生儿最佳发育至关重要。
测量NICU中的声音水平，并将环境声音水平从基线降低至少10%。
在一所三级医疗学院的拥有20张床位的三级NICU中进行了一项为期4个月的准实验性质量改进项目。使用声级计连续记录基线噪音水平。干预措施包括针对性教育、环境改造和组织变革，并通过三个快速的计划-实施-研究-改进（PDSA）循环实施。每周进行反馈和监测，并使用统计过程控制图进行分析。使用配对t检验比较平均噪音值。
NICU的基线平均环境噪音水平为67.8分贝，在第一个循环后降至50.5分贝，在随后的循环后进一步降至47.4分贝和51.2分贝。白天噪音水平降低了21%，夜间降低了28%，总体比基线降低了25%。最大降幅发生在第一个PDSA循环后（平均差值为-17.3分贝，P<0.01）。干预后峰值噪音水平从110分贝降至88.24分贝。
多方面干预策略在4个月内将NICU中的噪音降低了25%。该举措的成功强调了综合干预对降低噪音的重要性。
