Environmental sound in the Neonatal Intensive Care Unit (NICU) is reported as much as 20 decibels higher than in the well-newborn nursery, yet medically fragile premature neonates are exposed to hazardous sound levels over extended periods of time. Current outcome studies suggest that high sound levels may be related to the overall morbidity of the premature population. Moreover, findings suggest that sound intensity not only has negative effects on the neonate, but also can interfere with nursing communication and job performance in the NICU.
Objective: Because few NICU’s have successfully reduced and maintained lower sound levels over time, the purpose of this study was to develop a protocol of care to effectively reduce environmental noise with a model of evidenced-based nursing practice.
Design: The study was a repeated measure, comparative design.
Population, Sample, Setting, Years: Environmental sound level surveys were collected over a 14-month period in a 70-bed tertiary care NICU in Delaware.
Intervention and Outcome Variables: Interventions include an environment assessment, development of a protocol intervention based on the assessed needs and evidenced-based research findings, staff education program, and protocol implementation. The outcome variable is the environmental sound level survey in decibels over time.
Method: A five-step method was followed. The initial NICU sound assessment was completed using a Quest Model 2700, OB-100 Octave Filter Impulse sound level meter while documenting caregiving activities. Activities were classified according to necessity and adaptability to protocol. Evidenced-based research and the environmental assessment guided the development of the protocol to control sources of noise. The protocol outlined specific modifications of caregiving activities and categorized changes in the physical environment based on all factors analyzed. Educational sessions for all NICU and ancillary staff, informational posters on the unit, and staff access to clear guidelines for implementation promoted awareness and cooperation as the protocol was implemented. Intermittent sound level monitoring of the caregiving environment was completed monthly to evaluate progress. The results were presented on the informational posters in the unit so those staff members could monitor their progress in controlling environmental noise.
Findings: A repeated measure analysis tested the effect of the environmental noise protocol intervention over time. The protocol intervention initially decreased environmental noise levels a mean 9.26 decibels. Furthermore, the findings demonstrate a significant lasting effect of decreasing environmental noise a mean 7.82 decibels 14-months after initiating the protocol intervention.
Conclusions: Because medically fragile neonates spend prolonged amounts of time in the NICU, the NICU environment must protect sleep, support physiologic stability, and reduce potential adverse effects on the neonate. The development of this protocol of noise control to maintain lower nursery sound levels was necessary. Evidenced-based research suggests that this protocol must allow nursing interventions of care while encouraging parent-infant interaction.
Implications: In response to the growing concerns over the intensity of the NICU sound environment and potential effects on the neonate, the American Academy of Pediatrics Committee on Environmental Health recommended that NICU sound levels should be monitored and maintained at or below 45 decibels. The implications for practice include intermittent sound level monitoring of the caregiving environment, staff education on how to control noise, and protocol reminders in caregiving areas. Multidisciplinary staff education must focus on the development and institution of protocols of care essential in the care for these infants. Protocols should list specific interventions needed for noise control and be clearly visible at the infant’s bedside to serve as a reminder for caregivers, families, and visitors that premature infants need special environmental considerations and intermittent sound level monitoring would evaluate the effectiveness of the protocol.
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