EXECUTIVE SUMMARY

Surgical noise can affect OR staff’s performance and patient safety.

  • The authors of a research project found the average noise level in one OR was 68 decibels, with a maximum average noise level of 87 decibels, which is about as loud as a hairdryer.
  • The peak noise level was comparable to the sound of a bulldozer.
  • Programs to reduce OR noise would focus on reducing decibel levels during the critical times of intubation, extubation, surgical count, and whenever there is an emergency event.

Surgeons, nurses, and other OR staff work in one of the noisiest clinical areas, and the volume could affect patient safety and employees’ health, according to recent research.1

“The research started with a clinical concern I had experienced in the OR about noise because of patient safety,” says Glendyle Levinskas, BSN, RN, CNOR, staff nurse in the OR at Vanderbilt University Medical Center. “The literature showed that noise impacts patients and staff performance. I had a concern about noise impacting the performance of providers, and thought this was a clinical concern that needed to be addressed.”

Levinskas worked on a study protocol, received approval from an institutional review board (IRB), and then conducted a noise assessment in an OR to obtain baseline levels. The assessment revealed many sources of noise production: ventilation-producing noise, music, conversations among OR staff, and sounds from procedures.

ORs feature louder air exchange than any other room in a hospital. That, on top of sounds from instruments, suction, and people moving around, opening and closing doors. “It’s a symphony of noise, and it impacts us as we care for our patients,” Levinskas observes.

Nurses, surgeons, anesthesia providers, and others in the OR have to talk with each other to complete the work, and there are a lot of people in the OR, says Elizabeth Card, MSN, APRN, FNP, nursing research consultant at Vanderbilt University Medical Center.

Researchers consulted with a research engineer about how to cut the sound. She used an iPhone with a sound measurement app and meter to measure the noise. “It was a pretty scientific measuring device that measures only decibels,” Card shares.

“There was an external microphone on the iPhone, and we brought it into the OR, with the speech and hearing department, and compared the sound level app with other sound meters. It was comparable in results,” Levinskas adds.

They measured the noise level at some critical times in surgery, including when there is an instrument count and when there is anesthesia extubation. They measured the levels during multiple surgical specialties.

The average noise level of the OR was 68 decibels, and the average maximum noise level was 87 decibels, which is close to the sound of a hairdryer. The peak noise level, which is a spike of noise, was 106 decibels, comparable to the sound of a bulldozer.

“We tested noise levels at different times and on different days, and we did measurements for almost a month [March to April 2018],” Levinskas says. “After the results and assessment, we organized a noise reduction task force. We had discussions and did a review of the literature to see what are the ways to decrease operating room noise.”

They reviewed information from the Association of periOperative Registered Nurses (AORN), the American College of Surgeons, and other organizations. “Then, we did another surveillance of multidisciplinary members of what is the expected way to decrease noise, and we had input from staff on focusing on strategies,” Levinskas says. “We synthesized the results and discussed the things we wanted to include in noise reduction in the OR.”

The focus became reducing noise during the critical times of intubation, extubation, surgical count, and whenever there is an emergency event.

Addressing OR noise can be controversial when the subject is raised, especially when it comes to music. “People would ask if we were going to take out the music in the OR,” Levinskas says.

Sensitive to the controversy, investigators met with surgeons and the multidisciplinary task force to brainstorm ways to reduce noise during critical times in the OR. A popular idea was quiet time at critical moments during a procedure, including cutting off all music. The surgeons talked about their music, acknowledging these sounds can positively affect their performance. But they also agreed to turn off the music at critical times.

Other noises that can be reduced include the sounds from people entering and exiting the OR. For example, people who enter the OR to bring in supplies often carry walkie-talkies. When these are left on full volume, there might be a call for them while they are in the OR. This can disrupt communication and raise the noise level during critical junctures. The task force suggested people turn down their walkie talkie volume control when they enter the OR.

Another noise-producer is the handling of metal instruments. “Part of the [solution] is to educate staff to handle those instruments quietly,” Levinskas offers.

The goal is for staff to handle certain noisy activities quietly without allowing these volume changes to interrupt their workflow. “Also, we can have conversations in the operating room, but in critical times, there should be no conversations that are not related to patient care,” Levinskas says.

For surgery centers that are renovating their ORs or are building a new facility, they should consider purchasing equipment that produces less noise. Levinskas talked with engineers about ventilation changes that could reduce the sound volume. Another potential change involves finding vent covers that are less noisy, Card notes. Still another solution is finding computers and other electronic devices that produce less noise. Administrators could install a visual meter that lets staff know how high the sound decibel level is in the OR. This innovation could be placed somewhere on the wall, using color-coded cues to show when noise levels are too high during critical times.

The OR team could use select code words when a critical point in the procedure is beginning, indicating to everyone that they need to lower the volume. When they hear the code words or phrase, staff can turn off the music and stop casual conversations. “We came up with the phrase, ‘sound check,’” Levinskas says. Her group voted on the phrase “sound check,” in reference to Vanderbilt’s home of Nashville, TN — “Music City USA.”

“That’s why that particular phrase was so well received,” Card says. “It’s a fun thing, rather than a command.”

Empowering staff to help make these choices is important. “The heart of our noise reduction program is for everyone to be quiet, engaged, and focused,” Levinskas says. “I like to empower nurses. We might feel like we’re ordinary nurses, but we can make a big difference and change for patients’ safety.”

REFERENCE

  1. Levinskas G, Card E, Kildgore C, et al. Operating room (OR) noise is a health and safety risk: A real time measurement of noise level during critical times of surgery and multidisciplinary staff’s noise perception in Vanderbilt adult OR. 2019. Presented at the Association of periOperative Registered Nurses National Conference. https://bit.ly/3dGuZfQ.