Noise Pollution in the Operating Room and How to Avoid It

Medela AG

While hospitals take risk control seriously, there is one area they are overlooking. As numerous studies now show, noise pollution should be seen as a serious safety issue.

“Unnecessary noise is the cruellest absence of care which can be inflicted either on sick or on well.” So said Florence Nightingale in 1859 and, more than a century and a half later, it still holds true. Noise levels are getting worse and they are causing stress, anxiety and might lead to mistakes. Nowhere are these impacts being felt more directly than in the operating theatre where noise levels can exceed 100 decibels i .

The Impact of Noise Technology has transformed the operating room (OR). Although it has made operations safer, it has also greatly increased noise levels. Today, surgical staff are routinely exposed to levels of noise that far exceed officially recommended limits.

Studies find that noise pollution within the operating theatre can reach peaks of 130dBa ii . Recommended noise levels within hospitals should be 45dBa or less which means staff are regularly exposed to harmful levels of noise iii . While hospitals have made great strides with other areas of risk, such as infection control, this remains relatively overlooked. Even so, the impact can be profound, as various studies have found. A literature review from 2016 identifies a number of key problems caused by noise, including iv : • Noise in the OR can lead to permanent psychological stress in staff. • Distractions (e.g. background noise) have a negative impact on communication within the operating room among staff. • All this noise also contributes to surgical errors and poor patient outcomes. An alarming 83% of healthcare staff say they believe noise pollution contributes to surgical error. • 80% felt that noise harmed communication and 77% believed it harmed concentration. Problems can also be caused by the type of noise pollution. A study from Carlos Rogero Degrandi Oliveira and Gilberto Walter Nogueira found that an unexpected noise or some noise coming from an unknown source could cause various reactions. “In temporary exposure,” states the report, “the body returns to normal, corresponding to the primary reaction. If the noise source is maintained or alternated persistent changes may occur v .” Aside from the human toll and the impact on patient health, surgical errors have a very real financial implication. They are likely to lead to longer stays in hospital. According to a study into surgical site infections and their link to noise pollution by Dholakia et al, the additional costs to patients is £243 vi (in UK) and can also lead to compensation claims from patients or their families who have suffered the consequences of a surgical error.

Reducing Noise Pollution Addressing this problem, therefore, should be seen as an important priority by hospitals. Noise reduction programs have the potential to reduce extra costs for e.g. postoperational surgeries significantly. They would minimise errors, lead to shorter hospital stays and improve the wellbeing of staff. They can improve the quality of care being given while simultaneously reducing the strain on healthcare budgets.

This is, then, an issue. Hospitals have a duty to protect their patients and safeguard the health and wellbeing of staff. At the same time, budgets are stretched and they need to minimise spend on additional hospital care. Tackling noise pollution should therefore be seen as a high priority issue. This starts by identifying where the noise is coming from.

Source of Noise Pollution According to the Oliveira study, the biggest source of noise pollution comes from medical devices such as monitors, anesthesia machines, ventilators, air conditioners, conversations and

FIGURE 1 - THE INFOGRAFIC ABOVE SUMMARIZES THE HARMFULNESS OF NOISE POLLUTION IN OPERATIONG ROOMS *1) *2) Source: A.D. Padmakumar et al.,”Effect of noise on tasks in operating theatres”, 2017

what they describe as ‘procedure peculiarities’ vii . Machines and alarms can cause sudden spikes in noise levels, which hinder conversation, affect concentration and cause additional stress.

By designing equipment to produce less noise, therefore, it is possible to significantly reduce noise levels within the operating room. Less noise will mean:

3 Better concentration 3 Easier communication 3 Fewer errors

The Whisper Quiet Future At Medela, we have been addressing this issue with our Basic and Dominant Flex pumps, all of which are equipped with a powerful drive unit

that is whisper quiet. It is less than 40 decibels, which makes it up to four times quieter than comparable solutions. In addition, it offers: • Superior performance and faster suctioning power. • Patented membrane regulator that creates fast vacuum build-up for instant suction. • Hands-free operation thanks to an on/off foot switch. • It is designed to last a lifetime with a five-year warranty. • It is versatile in all forms. The high-vacuum pumps are available in rack, portable or mobile versions with a trolley. • The inner construction simplifies routine checks and can reduce costs. Designed for hospitals, clinics and doctors’ practices, they represent the latest innovation in high performance vacuum solutions. They are quieter, smaller and more flexible than cumbersome and noisy wall mounted vacuums. An independent vacuum avoids overflow into the wall systems and, instead, offers a smooth, consistent and reliable performance.

The Medela Surgical Suction Pump Dominant Flex meets the demands of the modern OR as it is small, quiet and portable. By cutting down on one of the loudest sources of noise in the OR it takes a great stride towards solving noise pollution issues. It reduces noise levels from equipment to below the recommended thresholds for health and effective communication, making it easier and less stressful for staff to carry out their jobs. Equally, it reduces the sudden noise spikes, which come from the operation of surgical equipment.

Evolving Demand Attitudes are changing. Research points to the risks of noise pollution and guidance is being developed. Hospitals are implementing noise reduction programs across their operations. It is important that managers understand not only the risks but also all the available options in their drive to reduce noise.

Yes, education is important and, yes, there are many things which can be done to reduce unnecessary noise. Noise can be disturbing and lead to distraction, increasing stress and making it more difficult for surgical teams to communicate. Situations in the OR which cause distraction and stress might lead to surgical errors and - needless to say - this might put patients at risk and can lead to an increase of the costs of care.

At Medela, we have implemented (with our surgical pumps Basic and Dominant Flex) the gains that can be made: a four-fold decrease in noise pollution, simply by addressing the design of our equipment. Change is coming! Noise pollution, as well as infection control, are increasingly seen as an important safety issue. Hospitals can take measures now to ensure they stay ahead of the trend.

References: i Evaluation of Noise in the Operating Theatre: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5598129/#B9 iI Effect of Noise Pollution on Staff (Padmakumar et al): https://www.ncbi.nlm.nih.gov/pubmed/27810115 iII The Association of Noise and Surgical Site Infection: https://www.ncbi.nlm.nih.gov/pubmed/25737006 iv Effect of Noise Pollution on Staff (Padmakumar et al): https://www.ncbi.nlm.nih.gov/pubmed/27810115 v Occupational Exposure to Noise Pollution in Anesthesiology: http://www.scielo.br/scielo.php?pid=S0034-70942012000200011&script=sci_arttext&tlng=en vi The Association of Noise and Surgical Site Infection: https://www.ncbi.nlm.nih.gov/pubmed/25737006 vii Occupational Exposure to Noise Pollution in Anesthesiology: http://www.scielo.br/scielo.php?pid=S0034-70942012000200011&script=sci_arttext&tlng=en