Archive November 2017 XVIII, No. 11

Safety: Quiet, Please: Noise Distractions in the OR

Silence is golden during the critical stages of surgery.

Erin Lawler

Erin Lawler

BIO

staff members SHHH, SURGERY IN PROGRESS Staff members who are able to concentrate, communicate and work well with one another will provide safer care.

Ever been in a really noisy OR? The surgeon's rock anthem blares, nurses discuss their weekends and the vital signs monitor beeps proof of life — it's so chaotically loud that it's hard to think straight. Yet this sounds like a typical OR, right? That's the problem. You might think excess noise during surgery is normal and acceptable, but just 45 decibels can impact what's heard and communicated among surgical team members. The Joint Commission thought the problem was enough of a concern to issue a recent safety alert centered on eliminating noise distractions in the OR.

The noisiest periods of surgery occur during anesthesia induction and emergence, according to the alert. Orthopedic surgery and neurosurgery are among the noisiest procedures with intermittent peak levels exceeding 100 decibels more than 40% of the time. A prospective study of hernia repairs found that noise levels were substantially higher during the incision closures of patients who developed surgical site infections, suggesting the surgical teams were distracted enough to be noncompliant with aseptic processes. High noise levels in the OR have also been associated with ineffective communication, diminished speech intelligibility, poor performance of complex tasks, poor cognitive function and concentration, stress, fatigue and anxiety.

Turning down the volume
Noise levels can also be a contributing factor to a number of patient safety events, including wrong-site surgery and retained surgical objects. Escalating noise is a pervasive problem in today's ORs and an underrated contributing factor to the never events that continue to happen, so you need to develop a total systems approach to turning down the volume during surgery.

Get a baseline measurement. You can use sound level meters and noise dosimeters to generate empirical data about the sound levels in your ORs. One staff member might not even notice the sounds of her working environment while another might not be able to concentrate in the "din." Noise that's pleasant to one person — AC/DC blasting over the OR's sound system — might be unbearable to someone else. Objective data can help you decide if noise levels are exceeding a safe threshold and determine if you need to address the issue.

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