Hospitals, medical suites, healthcare, well-being and aged care facilities are all exposed to noise pollution. Research has been showing the problems caused by noise, which include:
• high blood pressure and increased heart rate in workplaces,
• increased errors and staff attrition in hospitals, and
• a lack of speech privacy in professional offices and suites.
Furthermore, the noise generated by the hospital staff, the communication and circulation of patients, patient care teams and families contribute to the epidemic of noise in healthcare, which factors as one of the biggest complaints of both patients and staff.
Regardless of where the patient is, noise generated by equipment and other people tends to dominate the hospital’s acoustical experience.
Sources of noise pollution
Noise pollution can be defined as unwanted sound, which is when sound either interferes with normal activities or disrupts or diminishes one’s quality of life. Noise pollution can be external (from outside) or internal (from inside). In the context of a healthcare facility, external noise includes traffic, deliveries and sirens. Internal noise can include ventilator noise and alarms, suctioning, heart monitor alarms, nebulizers, pulse oximeter tones and alarms, telephones ringing, air conditioning, television, radio, banging, rubbish bin or trolley noises, intercoms, staff bleeps, talking (staff, nurses), visitors, fellow-patients, and general activities. These sources of noise pollution have varying impacts on patients.
Exposure to prolonged or excessive noise has been shown to cause a range of health problems ranging from stress, poor concentration, productivity losses in the workplace, and communication difficulties and fatigue from lack of sleep, to more serious issues such as cardiovascular disease, cognitive impairment, tinnitus and hearing loss.
Patient Health, Wellbeing & Recovery
The consequences of noise on hospitalized patients are well documented and have a negative impact on a patient’s physiological health, increasing their chances of being readmitted to the hospital. (I. Hagerman, 2005). It has also been implicated in the development of intensive care psychosis, hospitalization induced stress, increased pain sensitivity, high blood pressure, and poor mental health.
Depending on the condition of the patient and the level of care, poor acoustical conditions may impact recovery and healing processes in different ways. In a physiological response to noise, adult patients in a general ward can experience startle reflexes, increased blood pressure and higher respiratory rates which may lead to irritation, impaired pain tolerance, confusion, irritation and delirium. (Claudia Giliberti, 2015) Noise can also cause significant sleep disruption, which is also closely associated with cardiovascular stress, impaired immune function and catabolic metabolism. These effects are particularly significant in Intensive Care Units (ICU) where noise has been reported to be associated with a greater requirement for sedation and anaesthesia. (Avinash Konkani, 2012)
Other studies in the intensive care unit (ICU) have shown that patients exposed to noise pollution have decreased oxygen saturation (increasing need for oxygen support therapy), elevated blood pressure, increased heart and respiration rate, and worsened sleep. Further, there is strong evidence that noise increases stress in adult patients, heightening blood pressure and heart rate. The obvious problem, sleep loss, leads to slower recovery times and a greater likelihood of readmission to the hospital.
Another consideration is sleep medication. A Dutch study found that patients who used sleep medication for at least 5 days in hospital continued to use the medication at home, whereas those who did not use the medication in hospital did not use it at home.
The healthcare environment where noise is potentially the more deleterious is the Neonatal Intensive Care Unit (NICU). Besides the cardiovascular effects that are well documented for adults, newborn or premature babies are more vulnerable to acoustic stimuli. In these patients, noise has been associated with more serious consequences, such as apnea, hypoxemia, the elevation of cranial pressure and modulation of neuroendocrine and immune systems. (B. H. Morris, 2000) (E. M. Wachman, 2011)
Furthermore, stress responses may increase the risk of adverse effects like growth impairment, auditive deficits, retinopathy, and affect many other early development processes. (A. Almadhoob, 2015)
Parental communication with newborns, namely the ability of the baby to recognize and relate to the mother’s voice, is fundamental for attachment processes and is also affected by surrounding noise, leading to disruption to the baby’s wellbeing. (Vera Santos, 2018)
Staff Productivity & Errors
Besides the effect on patients, high noise levels also affect healthcare professionals, contributing to distraction and memory loss which may lead to accidents and errors. (M. Shahheidari, 2012)
Excessive noise in hospitals reduces the intelligibility of speech and impairs communication, causing annoyance, irritation, fatigue and reducing the quality and safety of healthcare. Noise pollution increases the likelihood of mistakes and is one of the risk factors for staff burnout. Working in a noisy environment leads to unclear communications which can increase generating errors. Further, distracting noise reduces staff concentration and disrupts cognitive functioning. Staff can also suffer the same stress and physiological changes that patients suffer – increased blood pressure and heart rate. All of these problems contribute to a reduction in staff productivity as well as staff and patient satisfaction.
Privacy considerations
Acoustics impact perceptions of privacy, comfort, safety, and security for patients and their families. (Acoustics in Healthcare Environments, 2010)
Noise pollution has an adverse effect on healthcare facility compliance with privacy and Work Health & Safety legislation and guidelines. There are many options to help reduce noise, although the effectiveness of the method, safety and sustainability issues must be taken into consideration for each space.
Another key factor in the comfort of your patients is privacy. Poor acoustic privacy is proven to be a contributor to poor health outcomes. This is due to increased disturbances and intrusions, but mainly through its effects on communication. Patients have been identified to withhold important information, or not state their true emotions in confidence where they think they may be overheard by others to avoid embarrassment – which can in some cases be crucial health information needed to treat them. The acoustics of hospitals is acknowledged as very important in writing, although it is not consistent in the current national programs affecting the procurement and ongoing management as such. Current hospital design guidance on new developments and refurbishments do not appropriately address these areas of patient complaint and impacts or provide objective requirements which can be integrated into future facilities.
Legal considerations & Privacy
Australia’s States and Territories have their own health records legislation directing the collection and storage of health information e.g. Queensland has the Information Privacy Act 2009 (Qld) (IP Act), which states that healthcare providers protect the privacy of personal information. This is inclusive of when personal information is collected verbally, e.g. when a patient talks to a doctor during a consult.
Information Privacy Principles
IPP 4 – The agency must ensure personal information is protected against loss, unauthorised access or other misuse. The safeguards must be ‘adequate to provide the level of protections that can reasonably be expected to be provided’.
Noise pollution does not directly impact speech privacy, although eliminating noise can lead to speech privacy problems, in particular in new or retrofitted sustainable buildings where typically noise is reduced. It is of key importance that in any design considerations speech privacy and the health provider’s legal obligations are taken into consideration.
Speech intelligibility and privacy issues are other significant concerns for healthcare environments where clear communication between professionals and patients is paramount. (Acoustics in Healthcare Environments, 2010)