Documental laundry analysis was carried out Medical Control and Occupational Health Program and Environmental Risk Prevention Program , noise measurement, anamnesis-applied hearing evaluation, tonal threshold audiometry, acoustic immittance, and transient otoacoustic emission testing. The test of otoacoustic emissions showed no transient responses in 13 subjects with no emissions in some ears. Among all agents that may result in occupational hazard, noise certainly appears as the most frequent one, exposing a larger number of individuals. In relation to the necessary time exposition for triggering noise-induced hearing loss, the highest number of impairing rates occurs between five and seven years, decreasing loss progression rate until fifteen years when it tends to stabilize as long as exposition conditions and absence of other causative factors are kept 2 , 4 , 5.
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Objectives To assess the sound environment in the emergency ward of a general trauma reference hospital in the city of Curitiba, Parana State, Brazil. Ten indoor points in the emergency ward were assessed; the helicopter as well as several available pieces of equipment in the ward were assessed individually. Results Noise levels in sound pressure level ambiance [dBA] ranged from The afternoon period was the noisiest.
The helicopter at dBA and the cast saw at 90 dBA were the noisiest equipment, and the lowest noise level found was the activated oximeter at Conclusion In all assessed points, noise levels were above the comfort levels recommended by the Brazilian Association of Technical Standards , which may harm users' and professionals' health as well as influence professional performance in the emergency ward. Sound pressure levels of the helicopter and cast saw reach high hearing hazard levels, requiring professionals to use individual protection equipment, and point to the need for creation and implementation of effective control measures of noise levels in emergency wards.
Technology is highly valued, especially in health care for patients with serious conditions, and sometimes technology is necessary to save lives. These technologies contribute to increased noise, making environments uncomfortable. The recommendation for hospital areas is that the noise level should not exceed 55 dB. Although there is variation from individual to individual, people are directed to avoid exposure to noise levels that exceed 85 to 90 sound pressure level ambiance [dBA].
The Regulatory Norm NR covers aspects related to environmental conditions and the organization of workplaces. According to the World Health Organization, 5 among the critical effects of noise in hospitals are communication interference, including with warning signs of annoyance and sleep disturbance.
Therefore, this Norm recommends that the equivalent sound pressure level Leq not exceed 35 A-weighted decibel scale dBA in rooms where patients are treated and observed. Special attention to noise levels in the intensive care unit ICU and in operating rooms is recommended. However, studies in hospitals that analyzed the noise in various areas such as the ICU, 6 7 8 9 10 11 12 emergency room ER , material center, surgical center, pharmacy, pediatrics, kitchen, laundry room, 10 corridors, and nursing station 13 showed high levels.
The noise was associated with conversation among professionals, movement of people, and various hospital medical equipment, including acoustic alarms, which are essential to alert professionals to changes in clinical status of patients or malfunctioning devices. In this context, the ER deserves attention because nowadays it contains various hospital medical equipment, a large team of professionals, accident victims and their families, and rescue vehicles, thereby increasing the ambient noise.
The meter was properly calibrated before the tests. The minimum Lmin , maximum Lmax , and Leq were evaluated and expressed in decibels, compensated for on the dBA. Measurements were taken at 10 sites inside the ER: the Advanced Life Support ALS room, ALS anteroom, nursing station, in front of the nursing station, suture room, main corridor, observation room, in front the service windows, reception, tomography and X-ray viewing room, some equipment, and patient transport helicopter.
The steps followed a sequence, with a 2- minute, second evaluation at each site. After going through all the selected locations, the evaluation was done three more times, so that four measurements were taken at each site, with maximum, minimum, and Leq, in the mornings between 7 am and 1 pm , in the afternoon between 1 pm and 7 pm , and at night between 7 pm and 7 am.
During the evaluation, time was measured by a stopwatch and notes were taken about events that altered the measurements. For the helicopter and equipment, a single measurement was performed in the afternoon. The data are presented in table format.
Table 1 shows the noise levels in the ER. The lowest Lmin was detected in the suture room The room was empty. However, we measured the background noise and the highest Lmin occurred in the ALS The highest Lmax was detected in the suture room In the 10 areas assessed, the highest Leq dBA frequency occurred in the afternoon. Table 2 presents the levels of continuous Leq dBA noise found in various equipment operating in the ER.
Among the equipment, the cast saw had the highest measurements The noise of the helicopter was dBA, running for 20 minutes on the landing pad. Abbreviations: AC, air conditioner; Leq, average equivalent level; dBA, compensated for on the A-weighted decibel scale.
Of the various noise sites evaluated Table 1 , the lowest Leq was measured in the suture room Accident victims arrive in this area, and it is also a meeting place for various professional teams that send and receive patients, causing movement of people and equipment and the need for oral communication, which increases sound pressure level.
Few studies analyze the noise in ERs. However, one study evaluating an ER identified the highest Leq, ranging from 65 to 73 dBA, in the triage area. The authors reported the highest level was in the ER and concluded that the human factor is a major source of noise pollution. A study in four emergency units in Phoenix, Arizona, found in hospital A the lowest noise intensity of The author concluded that these levels are sufficient to cause deleterious psychological and secondary physical effects to the team members.
Also, the author reported that reducing the level of ambient noise can improve patient care, reduce stress, and increase employee job satisfaction. The Leq values found in the ER reception area Table 1 ranged from In all sectors, the Leq in the afternoon was higher, ranging from However, a higher Leq variation of The data are in accordance with other findings, 19 where the afternoon shift was considered the loudest, even including the neonatal ICU NICU. However, this study did not corroborate other studies.
The environment of the ER does not have a certain time of increased noise due to several activities that happen according to the demand of the moment. An unstructured observational study in a surgical inpatient unit of 28 beds, made up of four rooms with six beds and one with four beds, concluded that the morning noise level was higher because of the presence of the majority of health professionals and the routine work in the wards hygiene, changing linens, admission and transfer of patients, referral for surgery as well as emergency admissions.
In the present study, the highest Leq occurred in the ALS anteroom. This situation can be explained by the activities at this site i. And because it is a teaching hospital, there is also much movement of health care students adding to the noise. We observed that noise levels altered slightly, reaching maximum values well above 80 dBA as stated in Table 1. A similar study regarding noise in the hospital workplace observed changes in noise due to periodic disturbances caused by the increased flow of people talking loudly, including students, teachers, clients, caregivers, and workers.
Frequent noise caused by trolleys, stretchers, wheelchairs, and phones was also detected. The study evaluated the comfort levels of workers in a hospital ward, as determined by NR, and found that the values were 50 dBA, 51 dBA, and 56 dBA in each ward, 22 which were lower than those detected in the ER.
Noise above the levels considered comfortable can impact overall health and lead to nonperception of important sounds. In a study in which the noise ranged from In Table 2 , the Leq value for the helicopter arrival corresponds to a high risk for hearing professionals who are not properly using protective equipment. The daily maximum permissible exposure values are dBA for 7 minutes; the cast saw at 90 dBA corresponds to a maximum of 4 hours of daily exposure. Besides hearing risk, researchers report that high noise levels can cause behavioral disorders, and sound pressure intensity of 65 dBA can affect the hypothalamus and pituitary, raising the levels of secretion of epinephrine, norepinephrine, and corticosteroids as well as increasing blood pressure and changing heart rate and peripheral vasoconstriction.
Therefore, it appears that the noise levels present in the ER can impact the overall health of the population. The implementation of program promoting health and prevention is recommended.
It is necessary to implement effective measures to control noise in the ER, as well as providing for the satisfactory use of ear protection equipment for employees exposed to noise. Workshops are important to educate the team regarding self-care and improvements in health and work. In all assessed points, noise levels were above the comfort levels recommended by the Brazilian Association of Technical Standards , which may harm users' and professionals' health as well as influence professional performance in the emergency ward.
Leq levels of helicopter and cast saw entail high hearing hazard, requiring professionals to use individual protection equipment, and point to the need of creation and implementation of effective control measures of noise levels in emergency wards. Read article at publisher's site DOI : J Audiol Otol , 23 2 , 10 Apr To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation.
Albizu E 2. Affiliations 2 authors 1. Share this article Share with email Share with twitter Share with linkedin Share with facebook. Free full text. Int Arch Otorhinolaryngol. Published online Aug PMID: Author information Article notes Copyright and License information Disclaimer.
Received May 12; Accepted Jun 1.
Ambient Noise in Emergency Rooms and Its Health Hazards.