title: An investigation of sound levels on intensive care units with reference to the WHO guidelines.
abstract: BACKGROUND
  Patients in intensive care units (ICUs) suffer from sleep deprivation arising from nursing interventions and ambient noise. This may exacerbate confusion and ICU-related delirium. The World Health Organization (WHO) suggests that average hospital sound levels should not exceed 35 dB with a maximum of 40 dB overnight. We monitored five ICUs to check compliance with these guidelines.
  
  
  METHODS
  Sound levels were recorded in five adult ICUs in the UK. Two sound level monitors recorded concurrently for 24 hours at the ICU central stations and adjacent to patients. Sample values to determine levels generated by equipment and external noise were also recorded in an empty ICU side room.
  
  
  RESULTS
  Average sound levels always exceeded 45 dBA and for 50% of the time exceeded between 52 and 59 dBA in individual ICUs. There was diurnal variation with values decreasing after evening handovers to an overnight average minimum of 51 dBA at 4 AM. Peaks above 85 dBA occurred at all sites, up to 16 times per hour overnight and more frequently during the day. WHO guidelines on sound levels could be only achieved in a side room by switching all equipment off.
  
  
  CONCLUSIONS
  All ICUs had sound levels greater than WHO recommendations, but the WHO recommended levels are so low they are not achievable in an ICU. Levels adjacent to patients are higher than those recorded at central stations. Unit-wide noise reduction programmes or mechanical means of isolating patients from ambient noise, such as earplugs, should be considered.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Darbyshire
authors.forename: J Duncan
authors.initials: JD
authors.lastname: Young
mesh_terms: D004781:Environmental Exposure / Q000517:prevention & control* / Q000592:standards*; D017408:Guidelines as Topic / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D009622:Noise / Q000009:adverse effects / Q000517:prevention & control*; D012892:Sleep Deprivation / Q000175:diagnosis / Q000209:etiology; D014944:World Health Organization