Purpose: Excessive noise impacts most ORs; compromising safety of patients and staff. Recently, Vanderbilt Medical Center (VMC) OR noise level measurement was high (68-87 dBA) above safe range recommendation of Environmental Protection Agency (EPA) of 45 dBA for hospitals. Additionally, 47% of staff claimed that noise caused stress and distraction. Several published studies found the negative effects of noise but lacked noise reduction strategies. Perioperative & regulatory healthcare agencies recognizes OR noise as a safety hazard and calls to minimize it. The purpose of this literature review is to identify noise reduction strategies and organizations' recommendations.Literature Review: Research indicates noise negatively impacts staff's health and surgical patient safety. Noise can cause distractions, miscommunication, negatively impacts novice surgeons' performance, increases perceived workload and increases surgical site infection. Noise causes stress, cardiovascular diseases and risk of hearing loss.Research Question/Hypothesis: What are the effective OR noise reduction strategies based on literature review & recommendations?Conceptual Framework: Strong evidence shows noise negatively impacts but noise reduction strategies is limited, which is much needed to address the noise problem.Methodology: Conducted extensive literature review using electronic databases: Cochrane, CINAHL, PubMed and Google Scholar published in English from 2009-2019. The text words used to search were: OR, surgery, perioperative, noise reduction, reduce noise, quiet zone, sterile cockpit. Identified references was tabulated and eliminated noise reduction related to other sciences, solely pertinent to OR. Only effective strategies that resulted in noise reduction were included and multi-perioperative agencies recommendations.Data Analysis: Synthesized, leveled and tabulated relevant literature and evaluated the quality of evidence according to AORN Research Evidence Appraisal Tool.
Results: Identified 8 studies with the search criteria, only 5 met the inclusion criteria and 5 organizations that recommends OR noise reductions. The distinct and prevalent effective noise reduction strategies are multidisciplinary involvement & education, behavioral & environmental interventions & no interruption zone (NIZ) during critical times of surgery. To leadership establish policy, implement, measure noise levels & foster safety culture while for surgeons to be sensitive in music selection.Conclusion/
Discussion: Multidisciplinary staff involvement, education and culture of safety are the key effective noise reduction strategies based on evidence. Importantly, recognizing and respectful of OR team member's critical time is more impactful to patient safety. Using these strategies can reduce OR noise in VMC and create a safe place for patients and staff.Perioperative Nursing Implications: Nurse initiative to find evidence-based solutions is a catalyst for patient safety.