A Quality Improvement Initiative to Reduce the Noise Levels in a Tertiary Care Neonatal Intensive Care Unit

Abstract

Objective

Noise hazard is the issue of most tertiary care due to various paraphernalia and human factors. Recently, our observation has suggested that the new generation of neonatal intensive care unit (NICU) staff and residents are not sensitive to protocols of noise control and maintaining a silent environment in the NICU. Hence, this quality improvement (QI) project was undertaken.

Methods

The QI team identified the potential sources of noise in the NICU through fishbone analysis in the baseline phase. Noise levels were recorded by a digital sound pressure level meter. Stepwise Plan-Do-Study-Act (PDSA) cycles were conducted over 8 weeks, and the strategies to reduce noise levels targeted behavioural and environmental modification. Further noise levels were assessed for 4 weeks in the post-intervention phase.

Results

Average noise levels decreased from the baseline 63.3 ± 3.09 dB to 54.3 ± 1.51 dB (14.2% decline) in the post-intervention phase with a highly significant P value (<.0001). The peak noise levels decreased from a baseline 110.6 ± 2.94 dB to 76.9 ± 1.65 dB in the post-intervention phase with a highly significant P value (<.0001). During the day shift, average noise levels decreased from 63.8 to 54.7dB; night shift noise levels decreased from 62.9 to 53.8 dB. Peak noise levels were decreased from 112 and 108.7 dB to 78.1 and 75.7 dB during the day and night shifts, respectively.

Conclusion

Effective implementation of targeted behavioural and environmental strategies through a stepwise PDSA-driven approach decreased the noise levels in the tertiary care NICU by 14.2% from baseline.