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- Variability of noise levels in a portuguese neonatal intensive care unitPublication . Carvalhais, Carlos; Rodrigues, Célia; Xavier, Ana; Silva, Manuela V.; Santos, JoanaThe neonatal intensive care units accommodates patients who are confined to their environment, being exposed to several environmental factors, such as noise. There exist a few official recommendations regarding noise levels within the hospital environment. The World Health Organization (WHO) proposes that the average background noise in hospitals should not exceed 35 dB LAeq for areas where patients are treated or observed and other organizations such the United States Environmental Protection Agency (45 dB(A) daytime / 35 dB(A) night) and the American Academy of Paediatrics, through the Committee on Environmental Health (45 dB(A)). The aim of this study was to investigate the intensity and pattern of noise levels such as variability and their sources within a Portuguese NICU. The study was carried out in a NICU located in the North of Portugal. The measurements were carried out continuously over 24 hours, next the workstation located at the centre of the NICU. Measurements were performed using a sound level meter class 1 (Brüel&Kjær, model 2250) which was verified with an acoustic calibrator class 1 (Brüel&Kjær, model 4231). The results showed that noise levels were excessive in the NICU, exceeding the international recommendations. The average levels were 55.3±5.4 dB(A) for LAeq with the levels ranging between 41.3 dB(A) (recorded at 5:09 a.m.) to 71.60 dB(A) (recorded at 12:58 p.m.). The highest LCpeak level was 104.4 dB (C) (recorded at 6:15 a.m.). For the other acoustic parameters, it was found 84.8 dB(A) for Lmax and 39.6 dB(A) for Lmin. The occurrence of high average noise levels in combination with the variability in noise levels and the frequency of peak noises may contribute to detrimental effects both for premature infants and health care professionals. Average noise levels exceeded those recommended by the WHO. The primary sources of noise were identified as staff conversations and alarms. Further research into strategies to reduce noise, and evaluation of interventions, is required to enhance by one side the therapeutic environment and for other the healthy and safe workplace.
- Good Practices to Reduce Noise Levels in the Neonatal Intensive Care UnitPublication . Alberto Alves Carvalhais, Carlos; Vieira Da Silva, Manuela; Xavier, Ana; Santos, JoanaIndoor environmental conditions in neonatal intensive care units, such noise levels above the recommended, may induce some risks, not only for preterm infants’ development, but also for health care staff. The aim of this work is to summarize some good practices guidelines that can be followed by health care staff in a daily basis, which are intended to promote noise reduction in neonatal intensive care units. It is expected some initial resistance to the implementation of some recommendations, but evidence shows that in general, with training, health care staff should recognize the need of changes.
- Assessment and characterization of sound pressure levels in Portuguese neonatal intensive care unitsPublication . Santos, Joana; Alberto Alves Carvalhais, Carlos; Xavier, Ana; Vieira Da Silva, ManuelaIn NICU, systematic exposure to sound pressure levels above the recommended can affect both neonates and staff. This study aimed to evaluate the sound pressure levels in three Portuguese NICU and the noise perception of staff. The measurements were performed with a sound level meter, considering the location of the main sources of noise and the layout of the units. A questionnaire was applied to assess noise perception of professionals. The staff classified the environment (regarding noise) as ―slightly uncomfortable‖ (41.1%) and 48.4% considered it as ―acceptable‖. In addition, the majority (55.5%) considered ―equipment‖ as the most annoying source of noise. The results showed that noise levels were excessive in all the evaluated areas of the NICUs, exceeding international guidelines, with the levels ranging between 48.7 dBA to 71.7 dBA. Overall, there is a need for more research in order to verify the effectiveness of some actions and strategies to reduce the impact of noise in NICU.
- Covering the incubator top with a padded blanket reduces noise levels inside the incubator? A pilot study during simulated tasksPublication . Carvalhais, Carlos; Rodrigues, Célia; Xavier, Ana; Silva, Manuela V.; Santos, JoanaNoise levels in Neonatal Intensive Care Units may cause physiological stress, which can impact cognitive development and increase length of stay. Several studies performed in NICU, have consistently noted that the recommended noise levels have been exceeded at day and night periods, inclusively inside incubators. The aim for controlling noise levels in the NICU is to preserve a large portion of each hour for infant sleep. Noise levels found in hospitals frequently disturb sleep states and disrupt stable behavioural states in healthy term and preterm infants. This study aims to verify if covering the incubator top with a padded blanket effectively reduces noise levels inside incubators. Noise levels inside incubator were measured during simulated tasks with and without a padded blanket. The study included short measurements (5 up to 10 min.) for the assessment of the sound pressure levels (C-weighted peak sound pressure level (LCpeak), A-weighted equivalent sound pressure level (LAeq), A-weighted, Maximum, Sound Level (Lmax) and A-weighted, Minimum, Sound Level (Lmin)). Measurements were performed using a sound level meter class 1 (Brüel&Kjær, model 2250) which was verified with an acoustic calibrator class 1 (Brüel&Kjær, model 4231). Noise levels inside the incubator covered with a blanket were lower than the incubator without the blanket. The average levels were 52.0±0.9 dB(A) for LAeq, 67.4 dB(A) Lmax and 48.5 dB(A) Lmin with blanket, and 57.8±4.9 dB(A) LAeq, 83.7 dB(A) Lmax, 44.1 dB(A) Lmin. LCpeak levels were also lower in the simulation with the blanket (98.7 and 102.8 dB (C), respectively). In the studied NICU the use of the padded blanket is mandatory mainly for lightning control. Although, it also seems a good practice to minimize noise levels inside incubators. However, noise levels remained higher than the recommended by international agencies. Noise in the neonatal intensive care unit can be detrimental to the health of the hospitalized infant. Isolated strategies of reducing noise include staff training, warning lights, and ear coverings, all of which have had limited success. A combined approach focused on newborn, staff and physical environment may be more effective.