Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Chan WH(1), Chung PL(1), Ko LF(1), Lam HY(1), Lam KM(1), Yeung MY(1), SY Yu(1)
Affiliation :
(1)Department of Paediatric and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital
Introduction :
Neonatal intensive care unit (NICU) is usually full of sounds from different extraneous sources that often exceed the recommended environmental sound levels in NICU by the World Health Organization (WHO): an hourly average level < 45 decibels and maximum levels < 65 decibels. High environmental sound exerts stress on infants, which increases the consumption of calories and disrupts normal growth and neurodevelopment. These contribute to increase length of stay and health care costs. Thus, improving knowledge and changing behaviors in staff are essential for noise reduction in NICU.
Objectives :
(1)To reduce NICU noise levels; (2) To enhance staff knowledge in noise control; (3) To modify staff behaviors
Methodology :
We used the mobile application ”Decibel X” as the tool for measuring sound levels. We identified the top 10 noise sources using the Decibel X Apps. They were closing incubator portholes, incubator and monitors’ alarms, staff conversation, medical gas, suction machine, IV syringe and infusion machine, intercom ringing and putting bottle of milk on top of incubator. Our improvement strategies included lectures to the nursing staff, a poster of top 10 noises posted in NICU, creation of “Quiet” signage for display in cubicles, scheduling daily quiet time and low lighting hours (1400- 1500). The lectures to the nursing staff covered the importance of noise control in NICU and its health benefits to the infants, the top 10 sound sources in our NICU and the maneuvers to reduce noise (1400- 1500).
The outcome of our continuous quality improvement project was evaluated. Pre- and post-intervention surveys were carried out evaluating the knowledge of the nurses towards noise and noise control in NICU. A checklist on the maneuvers for noise reduction was compiled and based on the checklist we carried out an assessment on nurses’ compliance of noise reduction maneuvers. The post-intervention hourly average sound level was measured using Decibel X Apps.
Result & Outcome :
From July 2023 to November 2023, a total of 37 nurses had completed the pre and post surveys that comprised 80% of our NICU nurses. The post surveys were conducted 2 weeks after improvement strategies. The data showed that mean scores of staff knowledge on noise reduction techniques increased from 52 to 92 (p <0.001). Observational assessments of 30 nurses showed 100% compliance with gentle incubator portholes closing; 93% compliance with turning off the suction machine and oxygen supply after use; 83% compliance with speaking softly. At the end of the project, the hourly average noise level decreased from 69.8 decibels to 49 decibels, a 19.4% reduction.
The staff education and behavioral modifications effectively create a culture change for noise reduction in our NICU. It is significant for reducing stress and supporting neurodevelopment of infants. Therefore, in-service training on noise reduction to all NICU staff and compliance checks regularly should be continued to sustain noise control.
