Hospital Noise

Noise in hospitals? The Robert Wood Johnson Foundation is listening

Photo credit: Sara Star NS licensed under CC BY-SA 2.0

by David M. Sykes, Vice Chair, The Quiet Coalition

For those of us who’ve been working for decades on the tough problem of noise in hospitals—specifically the effects of that noise on patients, physicians, families, and staff—news that the Robert Wood Johnson Foundation supported the work of popular podcast 99% Invisible’s inquiry into this problem begets mixed emotions. Finally, major foundations are listening!

Believe me, we welcome their interest! What better place to study the effects of noise on human health than in hospitals? If any professional group is able to carefully examine health effects and tease apart causality, shouldn’t it be medical professionals, both clinicians and researchers?

My colleagues and I have been enthusiastic about working with hospital staffs on noise and health for 18 years now. But frankly, it’s been extremely difficult to find foundations and government agencies willing to fund this kind of trans-disciplinary work. Why? Because it’s expensive and hard to assemble a team of researchers drawn from several different disciplines like medicine and acoustical science–the two groups barely speak the same language. But one of our proudest efforts did just that, the so-called Harvard Sleep Study, and it has become important because of its rarity.

That study, which began in 2006 and was published in 2012, discovered and described something we all know intuitively: that individual sounds, like musical notes, or alarm noises, or mechanical equipment or passing aircraft, are very different from each other and can’t be described with a single metric like the decibel rating. Indeed, the ability of a particular noise to arouse you from sleep depends more on the characteristics of that sound, rather than it’s decibel rating.

The decibel rating scheme records only sound-energy levels—that’s the energy that can physically harm your ears and your auditory system. But the decibel rating scheme does not, and indeed cannot, account for other noise effects such as a stress reaction, which can lead to cardiovascular problems or annoyance.  For example, a neighbor’s barking dog, a passing aircraft, or someone using a leaf blower near your house may be very annoying and may even disrupt your sleep, but is it loud enough to harm your hearing?

So it should come as no surprise that there is an alternative approach to measuring the many effects of noise. This alternative approach, called psychoacoustics, has been around nearly as long as the decibel rating scheme, but while it’s been embraced outside the U.S., it has had virtually no effect in this country. Psychoacoustics, also called supplemental metrics, emerged in the U.S. seven decades ago, but then emigrated to the European Unon. The classic work in this field is called “Psychoacoustics” by Fastl and Zwicker.

In the U.S., work on psychoacoustics had virtually no effect on the field of noise control until last year, when Congress included a requirement in the Federal Aviation Administration Reauthorization Act that the Department of Transportation and the FAA begin using alternative metrics in their evaluations of the effects of noise on people in neighborhoods under airport flight paths.

If you’ve installed a free sound meter app on your smartphone, all you can measure is decibels (dB). At best you might be able to measure decibels with different weightings, e.g., dBA, dBB and dBC (the A, B and C versions adjust the dB scale to approximate human hearing or other dimensions of sound). But if you own a professional sound level meter, you can probably choose either one of the decibel scales, or an alternative called Sone. Do decibels and Sone measure the same things? in a word, no. Psychoacoustics measurements account for a variety of different aspects of sounds well beyond sound pressure levels.

The difference is as great, for example, as using a thermometer to take your body temperature versus using standard instruments to collect all of your vital signs and take a sample of your blood. That thermometer that takes your body temperature is a single indicator. The rest of your vital signs are something else entirely.

It’s exciting that the Robert Wood Johnson Foundation funded a podcast that considers metrics beyond decibels and considers some of the other vital signs that determine how the hospital soundscape affects patients and staff. Curiously, the researchers cited in this podcast don’t appear to be aware that there is already a well-defined, long-established set of metrics for doing so. One hopes they are not wasting time—and a foundation’s money–“reinventing the wheel,” ignoring the methods developed over many decades in the field of psychoacoustics.

David Sykes chairs several professional organizations in acoustical science: QCI Healthcare Acoustics Project, ANSI Committee S12-WG44, the Rothschild Foundation Task Force on Acoustics, and the FGI Acoustics Committee. He is lead author of “Sound & Vibration 2.0” (Springer, 2012), a contributor to the NAE’s “Technology for a Quieter America” and the GSA’s “Sound Matters,” and co-founded the Laboratory for Advanced Research in Acoustics at Rensselaer Polytech. A graduate of UC-Berkeley with advanced degrees from Cornell, he is a frequent organizer of professional conferences in the U.S., Europe, Asia and the Middle East.

Hospital noise still a problem? What’s being done?

This photo has been released into the public domain by its author, Tomasz Sienicki

by David M. Sykes, Vice Chair, The Quiet Coalition

This news story asserts that noise in hospitals is steadily increasing. In fact, the trend is actually the other way: for over a decade now, hospitals have been struggling to get this problem under control. And the Affordable Care Act is helping.

How? ACA includes something called the HCAHPS—patient-centered care survey that hospitals are required to send out to every patient within a few days of a hospital stay, and results of this survey are available to the public. The HCAHPS survey is a short one, about 20 questions, including one called the “noise-at-night question” that asks former patients whether their room quiet at night.

Guess what? That question gets the WORST response every time! That’s been an eye-opener for the people who run hospitals–their boards of directors–because before ACA and HCAHPS nobody really cared what patients thought. Now hospitals’ federal reimbursements are linked to their HCAHPS scores. So a big wake-up call went down from hospital board rooms to the clinical staffs—“fix the noise problems, we can’t afford negative patient reviews because they reduce our hospital’s profit margins!”

But what can they do to fix the noise problems? Lots. I’m proud to say that I lead a U.S. national group that has been working on the hospital noise problem since 2005–that’s 15 years–called the Healthcare Acoustics Project, an independent, all-volunteer community of professionals that develops national and international codes and standards for the health care industry. HAP published the first “comprehensive national criteria for noise control in American hospitals and healthcare facilities” in 2010, and we’ve been steadily improving those criteria ever since. Now they’re embedded in the building codes in most of the U.S. and administered by each state’s building code authorities.

So next time you or a loved one is hospitalized, take a close look and a careful listen to noise and privacy levels in their sleeping quarters. If it’s noisy, COMPLAIN LOUDLY and mention that you know about the HCAHPS survey.

We’re pretty certain you’ll get a response pretty quickly. Because patients now have an effective voice thanks to the patient-centered care movement!

In addition to serving as vice chair of the The Quiet Coalition, David Sykes chairs several professional organizations in acoustical science: The Healthcare Acoustics Project (HAP, a division of Quiet Communities Inc.), American National Standards Institute Committee S12, Workgroup 44, The Rothschild Foundation Task Force on Acoustics, and the FGI Acoustics Working Group—a partner of the American Hospital Association and the American Institute of Architects. He is lead author of “Sound & Vibration 2.0 (2012, Springer-Verlag), a contributor to the National Academy of Engineering report “Technology for a Quieter America,” and to the US-GSA publication “Sound Matters,” and co-founded the Laboratory for Advanced Research in Acoustics (LARA) at Rensselaer Polytechnic Institute. He recently retired from the board of directors of the American Tinnitus Association. A graduate of the University of California/Berkeley with graduate degrees from Cornell University, he is a frequent organizer of and speaker at professional conferences in the U.S., Europe, Asia, and the Middle East.

Hospital noise is bad for health

by Arline L. Bronzaft, Ph.D., Board of Directors, GrowNYC, and Co-founder, The Quiet Coalition

In a 2017 presentation, referring to an earlier paper I had written with Rita Wynne Herzig in 1999, I noted that hospital noise was a serious problem for patients and staff and that not enough has been done to reduce sound levels in hospitals. Suggestions to lessen hospital sounds included better design and quieter equipment.

A recent article, “Noise Pollution in Hospitals,” underscores the fact that noise still remains a hazard for hospital patients and staff. The authors of a study linking sleep loss to increased feelings of pain would agree, as they use their findings to call for lower sound levels in hospitals. In fact, they suggested the distribution of earplugs to patients to lessen the sounds and improve their sleep. But researchers who have studied the impacts of noise on health for many years know that it is best to reduce noise at the source. Some ways to reduce hospital noise can be found at Dr. Susan E. Mazer’s blog.

Dr. Arline Bronzaft is a researcher, writer, and consultant on the adverse effects of noise on mental and physical health. She is co-author of “Why Noise Matters,” author of “Listen to the Raindrops” (children’s book illustrated by Steven Parton), and has written extensively about noise in books, encyclopedias, academic journals, and the popular press.  In addition, she is a Professor Emerita of the City University of New York and Board member of GrowNYC.

Why hospitals should let you sleep

Photo credit: Ivan Obolensky from Pexels

by Daniel Fink, MD, Chair, The Quiet Coalition

This piece by Austin Frakt in the New York Times discusses the need for hospital patients to get more sleep, and the many things that disrupt a patient’s sleep when they are in the hospital. The list of culprits is obvious: alarm noise, carts in the hall, blood draws, vital signs measurements, and so on.

Uninterrupted sleep is important for everyone, not just hospital patients. Anything that interrupts sleep–horns, sirens, road traffic noise, train horns, aircraft noise, horn-based alerts, patrons exiting a nightclub or bar at closing time–is a health hazard.

I have no doubt that if enough people complain to enough elected officials about health problems caused by noise, governments at the local, state, and national levels will take action to make our cities and towns quieter.

It worked for smoke-free restaurants, workplaces, airplanes, and in some states even smoke-free beaches and parks.

Let’s all resolve to work together for a quieter world in the New Year.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He is the founding chair of The Quiet Coalition, an organization of science, health, and legal professionals concerned about the impacts of noise on health, environment, learning, productivity, and quality of life in America. Dr Fink also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.

Hospitals can be made quieter

by Daniel Fink, MD, Chair, The Quiet Coalition

This BBC report informs us that hospitals can become quieter. Anyone who has been in a hospital–and I have spent decades working in them–knows that despite signs encouraging quiet, they have become noisier. And studies document that, too.

But with a little effort, they can be made quieter.

Most people aren’t aware of major efforts–coordinated over the last several years and involving specialty societies and expert groups setting goals and developing standards to be implemented by hospitals, health care professionals, emergency services responders, and an informed public–that have dramatically improved medical care and patient outcomes for serious medical problems. When someone calls 911 to report a heart attack or stroke, an entire team is mobilized to treat the patient with clot-busting drugs as quickly as possible, ideally within only 60 minutes of the event. These “Code White”, “Code Stroke”, or “Stroke Attack” programs mean that the patient usually walks out of the hospital not only alive but with minimal or even no residual effects from the heart attack or stroke.

If the health care system can organize itself to treat these serious medical problems so quickly that the patients recover without harm, it should be able to work towards making hospitals and other health care facilities quieter. This isn’t rocket science. It’s basic acoustic engineering.

Members of The Quiet Coalition also serve on committees for the Facilities Guidance Institute, which sets standards for health care facilities. There are guidelines and standards for noise levels. The next edition of the guidelines, set to be published in 2022, will address the noise issue more vigorously.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He is the founding chair of The Quiet Coalition, an organization of science, health, and legal professionals concerned about the impacts of noise on health, environment, learning, productivity, and quality of life in America. Dr Fink also is the interim chair of Quiet Communities’ Health Advisory Council, and he served on the board of the American Tinnitus Association from 2015-2018.

MRIs are dangerously noisy

Photo credit: liz west licensed under CC BY 2.0

by Daniel Fink, MD, Chair, The Quiet Coalition

MRI noise is in the news in two recent reports.

People magazine reported the story of a woman who suffered permanent auditory damage from an MRI, developing hyperacusis (a sensitivity to noise, which causes pain) and tinnitus. The Quiet Coalition’s Bryan Pollard, an expert on hyperacusis, is quoted in the article.

And researchers from SUNY Buffalo and China wrote about MRI noise in The Hearing Journal.

Standard MRIs produce noise in the 110-115 decibel range, and newer more powerful MRIs are even louder. Knowing this, I have several quibbles with the information in The Hearing Journal article. Namely, the article cites occupational noise exposure standards, but these use A-weighted decibels (dBA) to reflect the frequencies of human speech. MRI noise is low frequency noise, so occupational noise limits may not protect hearing adequately. And occupational standards are not safe standards for the public. At least 25% of workers exposed to sound at occupational noise exposure standards will develop hearing loss.

Most importantly, for many people the auditory damage caused by MRI noise isn’t hearing loss but tinnitus and hyperacusis, as in the People magazine article. Exactly how noise causes tinnitus and hyperacusis isn’t yet known, but the mechanisms are likely different from cochlear hair cell damage causing noise-induced hearing loss.

Finally, the authors talk about temporary auditory damage, but many researchers think that any temporary auditory changes indicate that permanent damage has been done.

I can’t find any large-scale studies of auditory problems after MRIs–the equipment manufacturers wouldn’t be excited about funding such a study, and radiologists are interested in the image, not in the patient’s hearing–but anecdotal reports from audiologists indicate that this is a problem for too many people undergoing diagnostic MRIs.

So if you need an MRI, be sure to ask for “dual protection”– ear plugs and ear muffs. NIOSH recommends dual protection for noise exposure over 100 dBA.

And if you suffer auditory damage from an MRI, be sure to file a report with the FDA. That’s the only way the government will be induced to issue appropriate patient safety regulations.

Dr. Daniel Fink is a leading noise activist based in the Los Angeles area. He serves on the board of the American Tinnitus Association, is the interim chair of Quiet Communities’s Health Advisory Council, and is the founding chair of The Quiet Coalition, an organization of science, health, and legal professionals concerned about the impacts of noise on health, environment, learning, productivity, and quality of life in America.

Alarming: No end to hospital noise

by David M. Sykes, Vice Chair, The Quiet Coalition

Three years ago, the voluntary hospital accreditation body in the U.S. known as The Joint Commission issued a “National Patient Safety Goal” about the problem of “alarm fatigue” in American hospitals.  When the Joint Commission speaks, hospitals usually listen because their ability to participate in the Medicare program depends on the Commission’s approval. So what’s happened?

In a word: nothing. Last week, in a paper presented at the Acoustical Society of America meeting in New Orleans, the distinguished researcher and former ASA president Ilene Busch-Vishniac spoke about this continuing failure to address patient safety in hospitals.

What’s alarming about this situation is that 11 years ago Dr. Busch-Vishniac, when she was Dean of Johns Hopkins’ School of Engineering, published a nationally recognized paper on this very problem, a paper that has become a classic in her own field. Furthermore, in 2011 she was recognized for this work and invited by the Food and Drug Administration, the Joint Commission, and the Association for the Advancement of Medical Instrumentation to speak to national leaders of the healthcare profession about this problem at the first national meeting convened to focus on the problem of “alarm fatigue.” Thereafter Dr. Busch-Vishniac has continue to write and speak about the subject, for instance in this piece last year.

Noise in hospitals—of which “alarm fatigue” is the most egregious example—is a problem precisely because it endangers the health and even the survival of the thousands of people whose health is already severely compromised (they are hospitalized, after all). It’s critically important.

What this deplorable situation illuminates is the long-standing refusal of federal, state and local agencies in America to recognize that noise is, as one prominent medical authority stated, “much more than a nuisance.” Indeed, it is a serious public health problem. Why can’t the most “at risk” population in America—people hospitalized for their illnesses—have access to the peace and quiet they need to recover? If you are bothered by noise—from aircraft, or from motorcycles, or from leaf blowers or from any other source—keep in mind that you are not alone: even the sickest among us who are being treated in hospitals cannot escape the din.

Nobody is listening—yet—despite the evidence. In the meantime, we congratulate courageous and stubborn researchers like Dr. Busch-Vishniac who continue to push for change.  We need you, Dr. Busch-Vishniac. The money to fund research is hard to come by, but please don’t give up!

In addition to serving as vice chair of the The Quiet Coalition, David Sykes chairs several professional organizations in acoustical science: The Acoustics Research Council, American National Standards Institute Committee S12, Workgroup 44, The Rothschild Foundation Task Force on Acoustics, and the FGI Acoustics Working Group—a partner of the American Hospital Association. He is the lead author of “Sound & Vibration 2.0 (2012, Springer-Verlag), a contributor to the National Academy of Engineering report “Technology for a Quieter America,” and to the US-GSA guidance “Sound Matters”, and co-founded the Laboratory for Advanced Research in Acoustics (LARA) at Rensselaer Polytechnic Institute. He recently retired from the board of directors of the American Tinnitus Association. A graduate of the University of California/Berkeley with graduate degrees from Cornell University, he is a frequent organizer of and speaker at professional conferences in the U.S., Europe, Asia, and the Middle East.