Impact of sound levels and patient-related factors on sleep of patients in the intensive care unit: a cross-sectional cohort study

Abstract Sleep disruption is common in patients in the intensive care unit (ICU). The aim of the study was to measure sound levels during sleep-protected time in the ICU, determine sources of sound, assess the impact of sound levels and patient-related factors on duration and quality of patients' sleep. The study was performed between 2018 and 2019. A commercially available smartphone application was used to measure ambient sound levels. Sleep duration was measured using the Patient's Sleep Behaviour Observational Tool. Sleep quality was assessed using the Richards-Campbell Sleep Questionnaire (RCSQ). The study population comprised 18 (58%) men and 13 (42%) women. There were numerous sources of sound. The median duration of sleep was 5 (IQR 3.5–5.7) hours. The median score on the RCSQ was 49 (IQR 28–71) out of 100 points. Sound levels were negatively correlated with sleep duration. The cut-off peak sound level, above which sleep duration was shorter than mean sleep duration in the cohort, was 57.9 dB. Simple smartphone applications can be useful to estimate sound levels in the ICU. There are numerous sources of sound in the ICU. Individual units should identify and eliminate their own sources of sound. Sources of sound producing peak sound levels above 57.9 dB may lead to shorter sleep and should be eliminated from the ICU environment. The sound levels had no effect on sleep quality.

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Impact of a Pharmacist-Led Intensive Care Unit Sleep Improvement Protocol on Sleep Duration and Quality

Annals of Pharmacotherapy ◽

10.1177/1060028020973198 ◽

2020 ◽

pp. 106002802097319

Author(s):

Jessica L. Andrews ◽

Patricia R. Louzon ◽

Xavier Torres ◽

Eric Pyles ◽

Mahmood H. Ali ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Sleep Quality ◽

Sleep Duration ◽

Sleep Time ◽

Protocol Implementation ◽

Mechanically Ventilated ◽

Activity Tracker ◽

The Impact ◽

Perceived Sleep Quality

Background: Sleep improvement protocols are recommended for use in the intensive care unit (ICU) despite questions regarding which interventions to include, whether sleep quality or duration will improve, and the role of pharmacists in their development and implementation. Objective: To characterize the impact of a pharmacist-led, ICU sleep improvement protocol on sleep duration and quality as evaluated by a commercially available activity tracker and patient perception. Methods: Critical care pharmacists from a 40-bed, mixed ICU at a large community hospital led the development and implementation of an interprofessional sleep improvement protocol. It included daily pharmacist medication review to reduce use of medications known to disrupt sleep or increase delirium and guideline-based recommendations on both environmental and nonpharmacological sleep-focused interventions. Sleep duration and quality were compared before (December 2018 to December 2019) and after (January to June 2019) protocol implementation in non–mechanically ventilated adults using both objective (total nocturnal sleep time [TST] measured by an activity tracker (Fitbit Charge 2) and subjective (patient-perceived sleep quality using the Richards-Campbell Sleep Questionnaire [RCSQ]) measures. Results: Groups before (n = 48) and after (n = 29) sleep protocol implementation were well matched. After protocol implementation, patients had a longer TST (389 ± 123 vs 310 ± 147 minutes; P = 0.02) and better RCSQ-perceived sleep quality (63 ± 18 vs 42 ± 24 mm; P = 0.0003) compared with before implementation. Conclusion and Relevance: A sleep protocol that incorporated novel elements led to objective and subjective improvements in ICU sleep duration and quality. Application of this study may result in increased utilization of sleep protocols and pharmacist involvement.

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The Correlation Between Humidity, Temperature, and Noise With Sleep Quality at Intensive Care Unit (ICU)

INDONESIAN NURSING JOURNAL OF EDUCATION AND CLINIC (INJEC) ◽

10.24990/injec.v5i1.269 ◽

2020 ◽

Vol 5 (1) ◽

pp. 60

Author(s):

Sri Suparti ◽

Jebul Suroso

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Sleep Quality ◽

Sound Level ◽

P Value ◽

Poor Sleep ◽

Quality Of Sleep ◽

Cross Sectional ◽

Temperature And Humidity

Introduction: Temperature, humidity, and noise are factors that affect sleep quality. The objective of the research is to determine the effect of humidity, temperature, and room noise on sleep quality of (Intensive Care Unit) ICU patients. Methods: A quantitative research with the cross-sectional approach, involving 84 patients taken by consecutive sampling, with the inclusion criteria of at least having already spent more than two days in ICU, having age between 20-70 years, and being conscious and cooperative. The patients were observed using observation sheets and The Richards-Campbell Sleep Questionnaire (RCSQ). A thermohygrometer and sound level meter for noise recording were used to measure the temperature and humidity. Simple linear regression was used to analyze the data. Results: It was found out that the average sleep quality of patients in the intensive room was 28.51, which categorized as poor sleep quality; the mean humidity in ICU was 56.98; the room temperature was 26.40, and the noise was 66.01. The noise level at the ICU significantly affected the patients’ sleep quality (p-value = 0.020 <0.05), while temperature and humidity did not influence the patients' sleep quality. Conclusion: Most of the respondents had a poor quality of sleep. Controlling the conversation and activities among staff, using earplugs, and modifying the alarm can be done to reduce the noise at the ICU to enhance the quality of sleep of the patients.

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Level and Noise Sources in the Neonatal Intensive Care Unit of a Reference Hospital

Investigación y Educación en Enfermería ◽

10.17533/udea.iee.v38n3e13 ◽

2020 ◽

Vol 38 (3) ◽

Author(s):

Alma Damaris Hernández-Salazar ◽

Josefina Gallegos-Martínez ◽

Jaime Reyes-Hernández

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Environmental Noise ◽

Sound Level ◽

Noise Sources ◽

Cross Sectional ◽

Reference Hospital ◽

And Shifts

Objective. Determine the level of environmental and periauricular noise in preterm babies and identify the sources generating noise in the Neonatal Intensive Care Unit -NICU- of a reference hospital in San Luis Potosí, Mexico. Methods. Cross-sectional and analytic study of the measurement of the level of environmental noise in five critical areas of the NICU, according with the method of measurement of noise from fixed sources by the Mexican Official Norm and periauricular at 20 cm from the preterm patient’s pinna. The measurements were carried out during three representative days of a week,morning, evening and nocturnal shifts. A STEREN 400 sound level meter was used with 30 to 130 dB range of measurement and a rate of 0.5 s. Results. The average level of periauricular noise (64.5±1.91dB) was higher than the environmental noise (63.3±1.74 dB) during the days and shifts evaluated. The principal noise sources were activities carried out by the staff, like the nursing change of shift and conversations by the staff, which raised the level continuously or intermittently, operation of vital support equipment (alarms) and incidences (clashing of baby bottles and moving furnishings) producedsudden rises of noise. Conclusions. Environmental and periauricular noise in NICU exceeds by two and almost three times the 45 dB during the day and 35 dB at night from the norm in hospitals. It is necessary to implement permanent noise reduction programs to prevent sequelae in the preterm infant and professional burnout in the nursing staff.

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Nosocomial infections in a pediatric surgical intensive care unit: An unicentric cross-sectional study

Medicinski pregled ◽

10.2298/mpns2104112p ◽

2021 ◽

Vol 74 (3-4) ◽

pp. 112-116

Author(s):

Marina Pandurov ◽

Izabella Fabri-Galambos ◽

Andjela Opancina ◽

Anna Uram-Benka ◽

Goran Rakic ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Nosocomial Infections ◽

Hospital Length Of Stay ◽

Surgical Intensive Care Unit ◽

Negative Consequences ◽

Surgical Intensive Care ◽

Acinetobacter Baumanii ◽

Cross Sectional ◽

The Impact

Introduction. Nosocomial infections are a common complication in patients hospitalized in intensive care units. The aims of this research were to examine the incidence of nosocomial infections in patients admitted to the pediatric surgical intensive care unit, the impact of hospital length of stay and type of surgical disease on the incidence of nosocomial infections, the frequency of microorganisms causing nosocomial infections and their antibiotic susceptibility profile. Material and Methods. Data on 50 subjects were extracted from the database. The following data were taken from the medical histories of the examinees: age, sex, diagnosis, number of days at the hospital before admission to the intensive care unit, number of days in the intensive care unit, levels of C-reactive protein, applied antimicrobial drugs, isolated microorganisms and their susceptibility to antibiotics. Results. The incidence of nosocomial infections in the study period was 52%. Patients who developed nosocomial infection remained longer in the intensive care unit than those who did not develop it (p = 0.003). Patients with the diagnosis of acute abdomen had a statistically significantly higher incidence of nosocomial infections compared to other patients (p = 0.001). Gram-negative bacteria were the most commonly isolated pathogens (46.8%). Acinetobacter baumanii proved to be the most resistant species in this study, since 80% of the strains did not show sensitivity to any of the tested antibiotics. Conclusion. Nosocomial infections are present in slightly more than half of the patients treated at the pediatric surgical intensive care unit. Patients who developed nosocomial infections stayed longer in the pediatric surgical intensive care unit, which had negative consequences for their health and treatment costs.

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Pharmacotherapeutic follow-up in a respiratory intensive care unit: description and analysis of results

Einstein (São Paulo) ◽

10.1590/s1679-45082018ao4112 ◽

2018 ◽

Vol 16 (2) ◽

Author(s):

Ana Carolina de Souza e Silva ◽

Domingos Sávio de Carvalho Sousa ◽

Eunice Bobô de Carvalho Perraud ◽

Fátima Rosane de Almeida Oliveira ◽

Bruna Cristina Cardoso Martins

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Clinical Pharmacist ◽

Anatomical Therapeutic Chemical ◽

Tertiary Hospital ◽

Cross Sectional Study ◽

Cross Sectional ◽

Respiratory Intensive Care Unit ◽

The Impact

ABSTRACT Objective: To describe and evaluate the pharmacotherapeutic follow-up by a clinical pharmacist in an intensive care unit. Methods: A descriptive and cross-sectional study carried out from August to October 2016. The data were collected through a form, and pharmacotherapeutic follow-up conducted by a clinical pharmacist at the respiratory intensive care unit of a tertiary hospital. The problems recorded in the prescriptions were quantified, classified and evaluated according to severity; the recommendations made by the pharmacist were analyzed considering the impact on pharmacotherapy. The medications involved in the problems were classified according to the Anatomical Therapeutic Chemical Classification System. Results: Forty-six patients were followed up and 192 pharmacotherapy-related problems were registered. The most prevalent problems were missing information on the prescription (33.16%), and those with minor severity (37.5%). Of the recommendations made to optimize pharmacotherapy, 92.7% were accepted, particularly those on inclusion of infusion time (16.67%), and dose appropriateness (13.02%), with greater impact on toxicity (53.6%). Antimicrobials, in general, for systemic use were drug class most often related to problems in pharmacotherapy (53%). Conclusion: Pharmacotherapeutic follow-up conducted by a pharmacist in a respiratory intensive care unit was able to detect problems in drug therapy and to make clinically relevant recommendations.

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Burnout syndrome and its association with anxiety and fear of medical errors among intensive care unit physicians: A cross-sectional study

Anaesthesia and Intensive Care ◽

10.1177/0310057x20902780 ◽

2020 ◽

Vol 48 (2) ◽

pp. 134-142

Author(s):

Polychronis Voultsos ◽

Maria Koungali ◽

Konstantinos Psaroulis ◽

Afroditi K Boutou

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Trait Anxiety ◽

Maslach Burnout Inventory ◽

Cross Sectional Study ◽

Personal Accomplishment ◽

Burnout Syndrome ◽

Related Factors ◽

Cross Sectional ◽

Specific Syndrome

Burnout is a work-specific syndrome with high incidence among intensive care unit personnel. Although several risk factors have been proposed, data regarding the association of anxiety and burnout among intensive care unit physicians are scarce. The aim of this study is to investigate the incidence of burnout and its association with state and trait anxiety and other sociodemographic, behavioural and occupational-related parameters, among intensivists. A population of intensive care physicians was evaluated using the self-completed Maslach Burnout Inventory and the State-Trait Anxiety Inventory Form Y, and data regarding sociodemographic and occupational-related variables were also recorded. From the 98 intensive care physicians addressed, 80 returned fully completed questionnaires; 26.9% of them presented with high emotional exhaustion, 37.5% with high depersonalisation and 41.5% with low personal accomplishment scores. Trait anxiety, fear of having committed a medical error and self-reporting difficulty when having to act accurately were independently associated with high burnout. In conclusion, burnout is common among intensivists and is associated with specific behavioural characteristics and personality traits, but not with work-related factors.

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Assessment of Neonatal Intensive Care Unit Sound Exposure Using a Smartphone Application

American Journal of Perinatology ◽

10.1055/s-0040-1714679 ◽

2020 ◽

Author(s):

Christine Capriolo ◽

Rose M. Viscardi ◽

Karen A. Broderick ◽

Sepideh Nassebeh ◽

Michael Kochan ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Environmental Factors ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Night Shift ◽

Smartphone Application ◽

Single Family ◽

Sound Exposure ◽

The Impact

Objective This study aimed to determine the impact of neonatal intensive care unit (NICU) design and environmental factors on neonatal sound exposures. We hypothesized that monitoring with a smartphone application would identify modifiable environmental factors in different NICU design formats. Study Design Minimum, maximum, and peak decibel (dB) recordings were obtained using the Decibel X phone app, and the presence of noise sources was recorded in each patient space at three NICUs over a 6-month period (December 2017 to May 2018). Data were analyzed by Student's t-test and ANOVA with Bonferroni correction. Data were collected at the University of Maryland Medical Center single family room (SFR) level IV and St. Agnes Healthcare hybrid pod/single family room level III NICU, Baltimore, MD and at Prince George's Hospital Center open-pod design Level III NICU, Cheverly, MD. Results All recordings in the three NICUs exceeded the American Academy of Pediatrics (AAP) recommended <45 dB level. The maximum and peak dB were highest in the open pod format level III NICU. Conversations/music alone and combined with other factors contributed to increased sound exposure. Sound exposure varied by day/night shift, with higher day exposures at the level III hybrid and open pod NICUs and higher night exposures at the level IV SFR NICU. Conclusion Although sound exposure varied by NICU design, all recordings exceeded the AAP recommendation due, in part, to potentially modifiable environmental factors. A smartphone application may be useful for auditing NICU sound exposure in quality improvements efforts to minimize environmental sound exposure. Key Points

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The Impact of Clinical Pharmacist Interventions on Medication Errors Management in the Postoperative Cardiac Intensive Care Unit

Pharmaceutical Sciences ◽

10.34172/ps.2020.88 ◽

2020 ◽

Vol 27 (3) ◽

pp. 433-438

Author(s):

Naser Safaie ◽

Hanieh Azizi ◽

Sajad Khiali ◽

Taher Entezari-Maleki

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Medication Errors ◽

Clinical Pharmacist ◽

Therapeutic Process ◽

Laboratory Data ◽

Cross Sectional ◽

Clinical Pharmacists ◽

Heart Center ◽

The Impact

Background: Medication errors (MEs) frequently occur in intensive care unit (ICU) admittedpatients. The present study aimed to evaluate the frequency and types of MEs in an open heartsurgery heart ICU and clinical pharmacists’ role in the management of them. Methods: This cross-sectional, observational study was performed from October 2016 toMarch 2017 in the Shahid Madani Heart Center. A clinical pharmacist reviewed patients’ files,laboratory data, and physician orders during morning hours. All of the MEs and the clinicalpharmacies’ recommendations for the management of them were analyzed. Results: A total of 311 MEs were observed in the medical files of 152 patients. The rate of MEswas 2.04 errors per patient and 0.19 errors per ordered medication. The acceptance rate of MEswas 72.6%. The most type of MEs was ‘forgot to order’ (75 cases, 24.1%) followed by "wrongfrequency" and "adding a drug" in 56 (18%) and 49 (15.8) patients, respectively. Most MEs wereinsignificant. Conclusion: MEs occur at different stages of the therapeutic process in the postoperative cardiacintensive care unit, and clinical pharmacists play an essential role in detecting and managingMEs.

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The impact of sleep quality and duration on leptin, appetite, and obesity indices in adults

Medical Journal of Indonesia ◽

10.13181/mji.oa.203707 ◽

2020 ◽

Vol 29 (4) ◽

pp. 417-21

Author(s):

Harry Freitag Luglio Muhammad ◽

Satwika Arya Pratama ◽

Dian Caturini Sulistyoningrum ◽

Maya Nurfitriani Hartono ◽

Emy Huriyati ◽

...

Keyword(s):

Sleep Quality ◽

Dietary Intake ◽

Sleep Duration ◽

The Body ◽

Enzyme Linked Immunosorbent Assay ◽

Poor Sleep ◽

Anthropometric Measures ◽

Cross Sectional ◽

Obesity Indices ◽

The Impact

BACKGROUND Poor sleep duration and quality were previously reported to increase the risk of obesity. This study was aimed to evaluate the impact of sleep quality and duration on leptin, appetite, and adiposity in Indonesian adults. METHODS This cross-sectional study recruited adults in Yogyakarta, Indonesia, in 2016. Sleep quality was assessed using the Pittsburgh sleep quality index, appetite was evaluated using the community nutrition appetite questionnaire, and dietary intake was assessed by interviews using the semi-quantitative food frequency questionnaire. Sleep duration was also asked. Obesity indices were measured using the body mass index (BMI), waist-hip circumference, and percentage of body fat. Leptin was analyzed using the enzyme-linked immunosorbent assay. A Spearman analysis was done to evaluate the correlation between sleep quality, sleep duration, anthropometric measures, dietary intake, appetite, and leptin. RESULTS 244 adults participated in this study. This study showed that lower sleep quality and duration was significantly correlated with higher body weight (r = 0.129, p = 0.043 and r = −0.228, p<0.001), BMI (r = 0.176, p = 0.006 and r = −0.202, p = 0.001), and waist circumference (r = 0.179, p = 0.005 and r = −0.254, p<0.001). There was a correlation between poor sleep quality and higher leptin concentration (r = 0.186, p = 0.004). Sleep quality and duration were not associated with appetite (r = 0.109, p = 0.109 and r = −0.043, p = 0.500). CONCLUSIONS This study found that lower sleep quality was correlated with higher BMI, higher leptin concentration, but not appetite.

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Prevalence of Nosocomial Infections in Intensive Care Units in Shahid Sayyad-E-Shirazi Hospital of Gorgan During 2016-2018

Tabari Biomedical Student Research Journal ◽

10.18502/tbsrj.v2i2.3761 ◽

2020 ◽

Author(s):

Roghieh Golsha ◽

Nadia Ashoori ◽

Mohammad Tajik ◽

Ahmad Sohrabi ◽

Maryam Montazeri

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Nosocomial Infection ◽

Nosocomial Infections ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Cross Sectional ◽

Health Goals ◽

Staphylococcus Epidermis ◽

The Impact

Introduction: Understanding the pattern of infections in the intensive care unit and the correct pattern of antibiotic use is vital in reducing mortality. Identification of risk factors for nosocomial infection and preventive approaches can be effective in reducing the incidence. This study aimed to evaluate the intensive care unit (ICU) acquired infection. Material and Methods: This cross-sectional study was performed on patients admitted to the ICU of Sayyad Shirazi Hospital during 2016-18. All patients' information recorded and analyzed by SPSS version 16. Results: In this study, the nosocomial infection rate was 3.5%, mostly in individuals over 60 years old. Most of the positive cultures were from two sources of urine and then blood. The organisms observed in nosocomial infections were Escherichia coli (16.9%), Staphylococcus epidermis (11.5%), Enterococci, and Enterobacter. The most commonly used antibiotics were vancomycin and then meropenem. Antibiogram results indicated the highest antibiotic resistance (100%) to cefazolin, piperacillin and clindamycin, and 96.8% to ceftriaxone. Vancomycin and amikacin had the lowest resistance. Conclusion: According to the results of this study, the incidence of nosocomial infection is unavoidable, and its control is the most important health goals of medical centers. Proper treatment interventions are needed to reduce the impact of nosocomial infection.

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