title: A descriptive study of noise in the neonatal intensive care unit: ambient levels and perceptions of contributing factors.
abstract: OBJECTIVE
  To examine the baseline acoustic environment in several mid-Atlantic region neonatal intensive care units (NICUs) and investigate the perceived factors contributing to noise levels in these NICUs.
  
  
  METHODS
  Quantitative data were collected from 3 urban, mid-Atlantic level IIIB and level IIIC NICUs. Qualitative data were collected via interview from 2 RNs employed in each of the study NICUs.
  
  
  METHODS
  This was an exploratory descriptive study utilizing a mixed-methods approach. A quantitative method was used for sound-level data collection, and a qualitative method was utilized during interviews with nurses to examine perceptions of factors contributing to noise.
  
  
  METHODS
  Ambient sound levels, measured in decibels, were taken at 5-minute intervals over a 2-hour period during both day and night shifts in a central location at each NICU. In addition, nurses were interviewed using a standardized interview questionnaire, and these interviews were then reviewed to determine themes regarding perceived factors contributing to sound levels.
  
  
  METHODS
  Hourly mean sound levels in each NICU ranged from 53.9 dB to 60.6 dB, with no statistically significant difference between noise levels recorded on day shift versus night shift, and no statistically significant difference among sites. Qualitative data showed that nurses' believed day shift to be louder than night shift and many perceived their own NICU as "pretty quiet." Key contributing factors to increased sound levels were stated as monitors or alarms, performing invasive procedures, presence of family, nurses or doctors giving report or rounds, and ringing phones.
  
  
  RESULTS
  Noise levels were found to be above the American Academy of Pediatrics-recommended 45-dB level and often louder than the 50-dB level, which should not be exceeded more than 10% of the time. The recommended impulse maximum of 65 dB was also exceeded. Environmental Protection Agency recommendations for hospitals include sound levels no louder than 35 dB on night shift; this standard was also violated.
  
  
  CONCLUSIONS
  Elevated sound levels need to be addressed in individual NICUs around the country. Further exploratory studies, as well as research regarding effective methods of decreasing sound levels in the NICU environment, are necessary. NICUs can implement behavioral and structural changes that can decrease the sound levels in the NICU environment and decrease the potential for exposure of patients to the harmful physiological effects of increased sound levels.
authors.affiliation: NICU, Hospital of the University of Pennsylvania, Philadelphia 19104, ashleye@nursing.upenn.edu
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Darcy
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Hancock
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Ware