Rangaswamy DR, Kamble N, Veeramachaneni A. Quieting the neonatal intensive care unit: A quality improvement initiative. World J Clin Pediatr 2024; 13(3): 96018 [PMID: 39350907 DOI: 10.5409/wjcp.v13.i3.96018]
Corresponding Author of This Article
Darshan Rajatadri Rangaswamy, DNB, MBBS, MD, MNAMS, Assistant Professor, Department of Pediatrics, Subbaiah Institute of Medical Sciences, NH-13, Purle, Shimoga, 577222, Karnataka, India. rajatadri93@gmail.com
Research Domain of This Article
Pediatrics
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Darshan Rajatadri Rangaswamy, Niranjan Kamble, Amulya Veeramachaneni, Department of Pediatrics, Subbaiah Institute of Medical Sciences, Shimoga 577222, Karnataka, India
Author contributions: Rangaswamy DR and Kamble N conceptualized and designed the study, coordinated and supervised data collection, drafted the initial manuscript, and reviewed and revised the manuscript; Veeramachaneni A designed the data collection instruments, collected data, conducted the initial analyses, and reviewed and revised the manuscript; All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work; Rangaswamy DR is the Guarantor for this paper.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Subbaiah Institute of Medical Sciences [Approval number: IEC-SUIMS/70Nov/23].
Informed consent statement: Waiver of consent was granted by the IEC.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Dataset available from the corresponding author upon reasonable request at rajatadri93@gmail.com. Participants consent was not obtained, in line with no participant-related data being collected and with the dataset containing sound values.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Darshan Rajatadri Rangaswamy, DNB, MBBS, MD, MNAMS, Assistant Professor, Department of Pediatrics, Subbaiah Institute of Medical Sciences, NH-13, Purle, Shimoga, 577222, Karnataka, India. rajatadri93@gmail.com
Received: April 24, 2024 Revised: May 18, 2024 Accepted: June 5, 2024 Published online: September 9, 2024 Processing time: 127 Days and 16.2 Hours
Abstract
BACKGROUND
The neonatal intensive care unit (NICU) is vital for preterm infants but is often plagued by harmful noise levels. Excessive noise, ranging from medical equipment to conversations, poses significant health risks, including hearing impairment and neurodevelopmental issues. The American Academy of Pediatrics recommends strict sound limits to safeguard neonatal well-being. Strategies such as education, environmental modifications, and quiet hours have shown to reduce noise levels. However, up to 60% of the noises remain avoidable. High noise exposure exacerbates physiological disturbances, impacting vital functions and long-term neurological outcomes. Effective noise reduction in the NICU is crucial for promoting optimal neonatal development.
AIM
To measure the sound levels in a NICU and reduce ambient sound levels by at least 10% from baseline.
METHODS
A quasi-experimental quality improvement project was conducted over 4 mo in a 20-bed level 3 NICU in a tertiary care medical college. Baseline noise levels were recorded continuously using a sound level meter. The interventions included targeted education, environmental modifications, and organizational changes, and were implemented through three rapid Plan-Do-Study-Act (PDSA) cycles. Weekly feedback and monitoring were conducted, and statistical process control charts were used for analysis. The mean noise values were compared using the paired t-test.
RESULTS
The baseline mean ambient noise level in the NICU was 67.8 dB, which decreased to 50.5 dB after the first cycle, and further decreased to 47.4 dB and 51.2 dB after subsequent cycles. The reduction in noise levels was 21% during the day and 28% at night, with an overall decrease of 25% from baseline. The most significant reduction occurred after the first PDSA cycle (mean difference of −17.3 dB, P < 0.01). Peak noise levels decreased from 110 dB to 88.24 dB after the intervention.
CONCLUSION
A multifaceted intervention strategy reduced noise in the NICU by 25% over 4 months. The success of this initiative emphasizes the significance of comprehensive interventions for noise reduction.
Core Tip: In our neonatal intensive care unit study, we addressed the problem of high noise levels that can negatively affect the health and development of neonates. We implemented a multifaceted approach of targeted education, environmental modifications, and organizational changes. As a result, we reduced the noise levels by up to 25% over 4 mo. Although we did not assess clinical outcomes, our study provides a foundation for future research and emphasizes the need to maintain optimal noise levels for the well-being of neonates.
