What is it about?
Unfortunately, significant noise pollution exists in the ICUs. The sound levels reported in published studies are much higher than what is currently recommended by the EPA. At C.S. Mott Children's Hospital in Ann Arbor, Michigan, the Pediatric Delirium Team implemented a delirium bundle focused on improving the ICU environment at night to offer better quality of sleep. The bundle is a bedside nursing checklist aimed at modifying human behavior to lower noise levels in patient rooms. We found that compliance with the bundle led to a significant noise reduction that can be perceived as half the loudness with hourly nighttime average sound levels meeting the EPA standards.
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Why is it important?
Poor sleep quality is thought to be a major iatrogenic risk factor for the development of ICU delirium. Studies that implemented a delirium bundle aimed at noise reduction in the ICU led to less occurrence of delirium. This article is the first to report the reduction of noise by modifying human behavior to sound levels that meet the EPA standards. By creating a less disruptive environment for sleep, there is a potential to lower prevalence of delirium. One in 4 critically ill children could develop delirium, a condition that is associated with increased hospital days, higher direct medical cost, and increased mortality rate. Therefore, preventing iatrogenic risk factors for delirium is crucial and necessary for the neurological care of the critically ill.
Perspectives
This article is an important first step to combating one of the most common iatrogenic conditions in the ICU: inadequacy of restful sleep. Poor sleep not only has negative impact on neurocognitive function but also on the immune, endocrine, and musculoskeletal systems. I feel every reader can agree that there is no harm in improving sleep, and it only has positive influences in the ICU. The compliance with the pediatric delirium bundle implemented was high due to the simplicity of the paper checklist. This bundle can be used at any hospital, and we should take every step to promote a healing environment for our critically ill patients.
Yu Kawai
Mayo Clinic
Read the Original
This page is a summary of: Quality Improvement Initiative to Reduce Pediatric Intensive Care Unit Noise Pollution With the Use of a Pediatric Delirium Bundle, Journal of Intensive Care Medicine, September 2017, SAGE Publications,
DOI: 10.1177/0885066617728030.
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