A hospital must create a quiet, calm environment for patients by providing a physical setting conducive to recovery and an organizational culture that supports patients and families through the stresses imposed by illness, hospitalization, medical visits, healing and bereavement.

To accomplish this hospital employees must identify internal and external noise factors – is it voices, equipment or the building? The staff must also discern which noise sources are known controllable factors, known uncontrollable factors and unknown uncontrollable factors. The hospital must measure and reduce the noise in patient rooms within defined compliance levels.

Impact of Noise

Noise impacts patients in many ways including:

• Sleep deprivation
• Increased anxiety
• Increase in noise-induced stress
• A “startle reflex” resulting in physiological responses:
  • Facial grimacing
  • Increase in blood pressure
  • Higher respiratory rate
  • Increased heart rate and vasoconstriction

Continuous noise may alter a patient’s memory, increase agitation, lower pain tolerance and lead to feelings of isolation.

Noise may also impact hospital employees causing:

• Stress related symptoms.
• Depression.
• Irritability and decreased concentration in the work place.
• Reduced efficiency and decreased productivity.
• Increased medical and nursing errors.

Using the Noise/Source Matrix

The matrix shown in Table 1 displays the source of noise in various locations of the hospital and records a mean weighted average, providing a clear picture of the noisiest hospital area and the worst noise source and establishing a clear priority of what to fix first.

Interpreting the Stratification Technique

By measuring noise during peak and off peak hospital hours, analysts can detect and correct the noise. Noise meter readings established by a pollution control board offer quantitative readings that help predict, and therefore prevent, future noise problems.

Strategies to Solve Noise Pollution

After identifying the primary sources for noise pollution, the following improvement strategies can be implemented:

1. Establish stringent standards impacting patient safety.
2. Evaluate the current hospital noise through patient satisfaction surveys and by measuring the decibel levels.
3. Review the hospital’s repair and maintenance policy and ensure it reflects the need for equipment to operate effectively and quietly.
4. Conduct an auditory impact query as part of every remodel and construction project, equipment purchase and staff event.
5. Change the ceiling tiles periodically from sound reflecting to sound absorbing tiles allowing patients to sleep better.
6. Convert a centralized nurse station to a decentralized nurse station.
7. Provide curtains and Plexiglas barriers in multi-bed rooms to provide both visual and auditory protection.
8. Use music therapy to replace noxious sounds with pleasant sounds – music improves restfulness and sleep, and induces relaxation.
9. Provide guidance and instruction during staff education and employee orientation sessions on the importance of maintaining appropriate noise levels.
10. Outline specific procedures regarding:
    • Private discussions in public areas
    • Use of pagers and cell phones
    • Nurse call systems
    • Telephone use
11. Place signs and slogans throughout the hospital – silent hospital help healing (SHHH) – and give patients, staff and visitors buttons that show a nurse with her finger to her lips.
12. Use sound meters to record ambient noise level at periodic times throughout the day.
13. Reduce waiting time in the outpatient departments. Schedule consulting times for the patients and fix appointments with the physicians during registration. Reducing the waiting time in turn reduces noise in the outpatient departments.
14. Display the location of offices and consultants at the reception area, and provide directories on each floor to minimize the need for visitors and patients to ask for directions.
15. Use an individual activity network diagram for each student in the hospital and ensure the faculty oversees the students in the clinical setting. This will minimize overcrowding of students in the clinical setting and streamline student activities.
16. Implement a SHHH program to recognize hospital staff and/or departments that excel at providing and maintaining a noise free environment.

Using quantitative and qualitative measures to identify and monitor noise levels in hospitals is critical to hospital efficiency. Reducing noise and maintaining a quiet facility will improve patient care and enhance the reputation of the hospital.