Kahn D M, Cook T E, Carlisle C C, Nelson D L, Kramer N R, Millman R P
Department of Medicine, Rhode Island Hospital, and Brown University, Providence 02903, USA.
Chest. 1998 Aug;114(2):535-40. doi: 10.1378/chest.114.2.535.
Noise levels in the hospital setting are exceedingly high, especially in the ICU environment. We set out to determine what caused the noises producing sound peaks > or = 80 A-weighted decibels (dBA) in our ICU settings, and attempted to reduce the number of sound peaks > or = 80 dBA through a behavior modification program.
The study was divided into two separate phases: noise identification and a trial of behavior modification. During the noise identification phase we simultaneously recorded sound peaks and the loudest noise heard subjectively by one observer in the medical ICU (MICU) and the respiratory ICU (RICU). During the behavior modification phase of the study we implemented a behavior modification program, geared toward noise reduction, in all of the MICU staff. Sound levels were monitored before and at the end of the behavior modification trial.
The MICU and RICU of a 720-bed teaching hospital in Providence, RI.
All ICU staff during the study period.
Once the noises that were determined to be amenable to behavior modification were identified, a behavior modification program was conducted during a 3-week period in our MICU. Baseline and post-behavior modification noise recordings were compared in 6-h intervals after sites were matched by number of patients in a room and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores.
We identified several causes of sound peaks > or = 80 dBA amenable to behavior modification; television and talking accounted for 49%. We also significantly reduced the 24-h mean peak noise level (p=0.0001), as well as the mean peak noise level (p=0.0001) and the number of sound peaks > or = 80 dBA (p=0.0001) in all 6-h blocks except for the 12 AM to 6 AM period.
We conclude that many of the noises causing sound peaks > or =80 dBA are amenable to behavior modification and that it is possible to reduce the noise levels in an ICU setting significantly through a program of behavior modification.
医院环境中的噪音水平极高，尤其是在重症监护病房（ICU）环境中。我们着手确定在我们的ICU环境中，是什么导致了产生声峰值≥80 A加权分贝（dBA）的噪音，并试图通过一项行为修正计划来减少声峰值≥80 dBA的数量。
该研究分为两个独立阶段：噪音识别和行为修正试验。在噪音识别阶段，我们同时记录了医疗重症监护病房（MICU）和呼吸重症监护病房（RICU）中一个观察者主观听到的声峰值和最大噪音。在研究的行为修正阶段，我们在所有MICU工作人员中实施了一项旨在降低噪音的行为修正计划。在行为修正试验之前和结束时监测声级。
罗德岛州普罗维登斯市一家拥有720张床位的教学医院的MICU和RICU。
研究期间所有ICU工作人员。
一旦确定了可通过行为修正解决的噪音，就在我们的MICU进行了为期3周的行为修正计划。在根据房间内患者数量和急性生理学与慢性健康状况评估II（APACHE II）评分对地点进行匹配后，以6小时为间隔比较基线和行为修正后的噪音记录。
我们确定了几个可通过行为修正解决的声峰值≥80 dBA的原因；电视和交谈占49%。我们还显著降低了24小时平均峰值噪音水平（p = 0.0001），以及除凌晨12点至6点时段外所有6小时时间段内的平均峰值噪音水平（p = 0.0001）和声峰值≥80 dBA的数量（p = 0.0001）。
我们得出结论，许多导致声峰值≥80 dBA的噪音可通过行为修正解决，并且通过行为修正计划可以显著降低ICU环境中的噪音水平。
