Impact of Educational and Visual Sign Interventions on Noise Reduction in Neonatal Intensive Care Units (NICUs)

Abstract Background High levels of sound have several negative impacts such as noise-induced hearing loss and delayed growth and development on newborn in NICUs. The American Academy of Pediatrics recommends that NICU sound levels remain below 45 dBA. The aim of this research is to determine the effect of educational and visual sign interventions on noise reduction in Neonatal Intensive Care Units.Methods This Quasi-experimental study (before-after study) was conducted in the NICU of Vali-e-Asr Hospital, Birjand in 2016. A total of 21 participants including NICU doctors and hospital staff could enter the NICU. The sound levels in the NICU were measured by a calibrated digital sound-level meter and placed at a height of 1.5 meters at various stations and three different working shifts. Subsequently, the post-training and visual signs (flags and posters) were utilized at the NICU.Results There was a significant difference in the means of the sound levels between stages 2 and 3 of the study (P=0.009) as well as a significant decrease in the level of sound between stages 2 and 3. The means of the minimum sound level in the morning and night shifts in the three different study periods indicated a significant decline (P<0.05), while in the afternoon shifts the minimum sound levels showed a significant increase which was also significant before and after the intervention (P=0.046). The maximum sound level dropped significantly (P=0.045) in the night shift compared to the three different study periods, as well as in the pre- and post-intervention phases (P=0.04).Conclusions Noise in our NICU was more than the recommended sound levels of 45 dBA. However, educational interventions and warning visual signs seemed effective in reducing sound levels, particularly in the night shift in the NICU station.

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A Quality Improvement Initiative to Increase Hand Hygiene Awareness and Compliance in a Neonatal Intensive Care Unit in Haiti

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmaa029 ◽

2020 ◽

Author(s):

Theony Deshommes ◽

Christian Nagel ◽

Richard Tucker ◽

Lindsay Dorcélus ◽

Jacqueline Gautier ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Hand Hygiene ◽

Neonatal Intensive Care Unit ◽

Neonatal Intensive Care ◽

Educational Interventions ◽

World Health ◽

Quality Improvement Initiative ◽

Patient Contact ◽

Post Intervention

Abstract Introduction Healthcare-associated infections (HCAI) are major causes of morbidity, mortality, increased lengths of stay and are an economic burden on healthcare systems in resources-limited settings. This is especially true for neonates, who are more susceptible with underdeveloped immune systems. Hand hygiene (HH) is a key weapon against HCAI, yet globally, HH compliance remains substandard. This study sought to determine the compliance with HH among healthcare workers (HCWs) in a children’s hospital neonatal intensive care unit (NICU) in Haiti. Methods A HH educational intervention was performed in the NICU, including lectures and posters. Pre- and post-intervention HH data were collected on HCWs and parents using the World Health Organization ‘5 Moments for HH’. Data were analyzed using standard statistical analysis. Results HH increased in all HCW roles but not in parents. Correct HH increased in all groups, including parents. HH was more likely to occur prior to patient contact than after patient contact. Correct HH was more likely to occur with alcohol-based hand rub than with soap and water. Conclusion This study demonstrates that an inexpensive and simple intervention can significantly increase HH compliance in a resource-limited NICU, which may lead to decreased rates of hospital-acquired sepsis. Parents, however, due to cultural norms as well as literacy and language barriers, need targeted educational interventions distinct from those that HCW benefit from.

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

Scientific Reports ◽

10.1038/s41598-020-76314-9 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Piotr F. Czempik ◽

Agnieszka Jarosińska ◽

Krystyna Machlowska ◽

Michał P. Pluta

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Sleep Quality ◽

Sleep Duration ◽

Smartphone Application ◽

Sound Level ◽

Related Factors ◽

Cross Sectional ◽

Sound Levels ◽

The Impact

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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Sibling Visiting in a Neonatal Intensive Care Unit

PEDIATRICS ◽

10.1542/peds.71.5.835 ◽

1983 ◽

Vol 71 (5) ◽

pp. 835-838

Author(s):

Fred Schwab ◽

Brenda Tolbert ◽

Stephen Bagnato ◽

M. Jeffrey Maisels

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Direct Observation ◽

Neonatal Intensive Care ◽

Behavioral Patterns ◽

Control Intervention ◽

Significant Difference

The effect of sibling visiting in a neonatal intensive care unit was studied. Sixteen siblings of 13 infants were randomly assigned to a visiting or nonvisiting group. Behavioral patterns were measured by questionnaires administered to the parents and by direct observation and interviews with the children. There were no significant changes in the behavior of the children following the birth of their sibling, and there was no significant difference between the behavior scores of the two groups 1 week after the experimental (or control) intervention. The visiting children did not show signs of fear or anxiety during the visit. These data suggest that sibling visiting to a neonatal intensive care unit is not likely to be harmful and might be beneficial to the siblings and their families.

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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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Effectiveness of application of a manual for improvement of alarms management by nurses in Intensive Care Units

Investigación y Educación en Enfermería ◽

10.17533/udea.iee.v39n2e11 ◽

2021 ◽

Vol 39 (2) ◽

Author(s):

Amirhossein Yousefinya ◽

Camellia Torabizadeh ◽

Farid Zand ◽

Mahnaz Rakhshan ◽

Mohammad Fararooei

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Blood Pressure Monitoring ◽

Post Intervention ◽

Alarm Management ◽

Effective Interventions ◽

Significant Difference ◽

Quasi Experimental ◽

And Control ◽

Time Type

Objective. To evaluate the effects of application of a manual on the improvement of alarms management in Intensive Care Units (ICU). Methods. This quasi-experimental study evaluated the effectiveness of the introduction into of a manual for alarm management and control in the ICU of a hospital in southeastern Iran. The intervention was a 4-hour workshop was on topics related to the adverse effects of alarms, standardization of ECG, oxygen saturation and blood pressure monitoring systems, and the use of ventilators and infusion pumps. Data were collected thorough 200 hours of observation of 60 ICU nurses (100 hours’ pre-intervention and 100 hours’ post-intervention). Response time, type of response, customization of alarm settings for each patient, the person responding to an alarm, and the cause of the alarm were analyzed. Alarms were classified into three types: false, true and technical. Results. The results showed a statistically significant difference between the pre- and post-intervention frequency of alarm types, frequency of monitoring parameters, customized monitoring settings for patients, and individuals who responded to alarms. The percentage of effective interventions was significantly higher for all parameters after the intervention (46.9%) than before the intervention (38.9%). Conclusion. The employment of a manual for management of alarms from electronic equipment in ICUs can increase the frequency of appropriate responses to alarms in these units.

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Coregulation in Salivary Cortisol During Maternal Holding of Premature Infants

Biological Research For Nursing ◽

10.1177/1099800408327789 ◽

2008 ◽

Vol 10 (3) ◽

pp. 226-240 ◽

Cited By ~ 37

Author(s):

Madalynn Neu ◽

Mark L. Laudenslager ◽

JoAnn Robinson

Keyword(s):

Salivary Cortisol ◽

Neonatal Intensive Care ◽

Sound Level ◽

Holding Time ◽

Sound Levels ◽

Ambient Sound ◽

Antenatal Steroids ◽

Postconceptional Age ◽

Research Questions ◽

Cortisol Levels

Purpose: The purpose of this study was to examine coregulation between mothers and preterm infants in hypothalamic-pituitary-adrenocortical (HPA) system activity, as indicated by salivary cortisol levels, while mothers held their infants. The research questions were (a) does mother—infant coregulation in HPA activity occur during holding? and (b) if mother— infant coregulation in HPA activity exists during holding, do type of holding, antenatal steroids, sound level, and maternal touch influence this coregulation? Sample: The sample consisted of 20 mother— infant dyads with infants at a mean postconceptional age of 34.7 weeks (+0.7) and average postnatal age of 15 days (+9) at the time of cortisol sampling. Design: The design was exploratory using convenience sampling. Maternal and infant cortisol levels were obtained at Time 1 (baseline) and Time 2 (end of holding); at each time, the absolute differences in levels between mother and infant were determined. Coregulation was operationalized as less difference between maternal-infant cortisol levels immediately after holding (Time 2) as compared to before holding (Time 1). Results: The two variables with the highest correlation with the Time 1/Time 2 difference score included antenatal steroids and ambient sound level, which were entered into a linear regression equation as predictor variables. A coregulatory relationship in cortisol levels existed between mothers and infants during holding, which was moderated by sound levels. Nurses in the neonatal intensive care unit (NICU) can facilitate the mother—infant relationship, as reflected in coregulatory measures, by promoting a quiet environment, particularly around mothers who are holding their infants.

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Psycho-educational interventions focused on maternal or infant sleep for pregnant women to prevent the onset of antenatal and postnatal depression: a systematic review

10.21203/rs.3.rs-40848/v1 ◽

2020 ◽

Author(s):

Natsu Sasaki ◽

Naonori Yasuma ◽

Erika Obikane ◽

Zui Narita ◽

Junpei Sekiya ◽

...

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Maternal Mental Health ◽

Educational Interventions ◽

Control Group ◽

Infant Sleep ◽

Inclusion Criteria ◽

Post Intervention ◽

Maternal Mood ◽

Significant Difference

Abstract Background This systematic review aimed to evaluate randomized controlled trials (RCTs) to examine the effect of maternal and infant sleep intervention during women’s pregnancy for the purpose of preventing perinatal depression. Method A systematic search (from inception – January 28 th , 2019) for RCTs using five electronic databases—the Cochrane Controlled Register of Trials (CENTRAL), Embase, PubMed, PsycINFO and Ichushi Web (Japan Medical Abstracts Society)—was conducted. Twelve investigators independently conducted initial screenings based on title and abstract, and then two researchers performed full-text reviews one by one. A meta-analysis would be conducted if at least three studies were found. However, only two articles that met inclusion criteria, and narrative data synthesis was conducted for these two articles. The study protocol has been registered at PROSPERO (CRD42019119999). Result A total of 13,644 studies were initially searched. After removing duplicates, 10,537 studies were screened, and finally, two studies met the inclusion criteria. In both studies, the intervention was a one-time face-to-face session during pregnancy to deliver the behavioral knowledge and skills for optimizing sleep hygiene for both infant and mother. Effectiveness of the intervention in improving maternal mood was not significant in one study. In the other, there was a significant difference in maternal mood between the intervention and control group. No mood comparison was made between baseline and post-intervention. Conclusion This study found limited evidence to support the effectiveness of sleep intervention for all pregnant women, which means “universal intervention”, to protect maternal mental health. Further well-designed RCTs are needed to confirm these findings.

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Effect of Pressure Injury Prevention Guides Used In a Pediatric Intensive Care

Clinical Nursing Research ◽

10.1177/1054773818817696 ◽

2019 ◽

Vol 29 (4) ◽

pp. 249-255

Author(s):

Gülzade Uysal ◽

Duygu Sönmez Düzkaya ◽

Tülay Yakut ◽

Gülçin Bozkurt

Keyword(s):

Intensive Care ◽

Treatment Group ◽

Injury Prevention ◽

Intervention Group ◽

Pediatric Intensive Care ◽

Control Group ◽

Post Intervention ◽

Significant Difference ◽

Pressure Injury ◽

Pressure Injury Prevention

The aim of this study was to determine the effectiveness of a pressure injury prevention guide used in a pediatric intensive care unit (PICU) on the occurrence of pressure injuries. The design is a pre-post intervention with a control group and a prospective intervention group. Pressure injuries occurred on 9.4% of children in the nontreatment group, and in 3.6% of children in the treatment group. There was a statistically significant difference in the occurrence of pressure injuries between the nontreatment group and the treatment group ( p = .033). The average Braden Q pressure injury score was 12.20 ± 2.280 at the beginning of the intensive care hospitalization, and 13.73 ± 3.312 at discharge in the treatment group ( p < .001). The results show that the risk of pressure injuries was reduced and pressure injuries occurred later when an evidence-based pressure injury prevention guide was used.

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