Quieting the neonatal intensive care unit: A quality improvement initiative

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.