Noise In The Operating Room

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By : Grace Mathenge

Mater Misericordiae Hospital

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INTRODUCTION

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• OR's are noisy even when unoccupied and increase progressively with entry of staff
• Noise in the ORs has impact both to patients and staff well being.
• Intra-operative noise causes distractions during surgery
• Noise comes from various sources.
• Authors label noise as the 3^rd pollution along with air and water

• WHO recommendation for noise in hospital is 30-40 Decibels

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SOURCES OF NOISE IN THE OR

• Comes from staff and equipment
• Movement of equipment, and dropping metal instruments
• Surgical equipment /devices( beds, drills, Diathermy & monitor)
• Staff conversation not revolving around the patient/procedure
• Ventilation beepers and gas alarms
• Air conditioning systems and suction apparatus
• Telephones and music
• Monitors are a host to great many alarms and alerts
• Traffic in and out of theatres

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Cont.…..

• Its not realistic to eliminate noise in OR.
• The Peri-op recommendation is minimizing noise/distractions
• Futuristic surgical equipment are quieter than older models
• OR behaviour can be corrected to minimize noise
• General rules have not been successful in noise reduction

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SILENCE COCKPIT RULE PERIOD OF SILENCE

• Non essential conversation and activities are prohibited during critical phase
• Concentration is key during
• Time out periods
• Critical dissections
• Surgical counts
• Medication preparation/administration
• Confirming and opening implants
• Induction into and emergence from anaesthesia
• Care and handling of specimens.

Cont. ……….

• Some hospitals have distraction free induction zone
• Stretcher movement while transferring the patient & Staff conversation at the end of surgery may be the reason for nosier environment
• Ortho hammers and drills can be noisy (thank technology on the battery charged drills)
• The higher the noise, the higher the stress levels
• Acoustic distraction( telephone, mobiles, radio and external noises.

IMPACT OF NOISE IN THE OR

Occupational health:

• Has short & long term effects
• There are predisposing individual factors
• High noise levels cause tinnitus and hearing loss
• Anaesthetised patients may be vulnerable to acoustic trauma.
• Acoustic distractions were linked to higher levels of stress experienced by surgeons/anaesthetists
• Intra-operative noise increases the surgeons mental workload required by task e.g. thinking, deciding calculating and remembering

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Cont.…..

Communication:

• Communication failures during surgery are common
• One of the leading root cause of errors/poor patient outcome

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Cognition:

• Moderate/chronic exposure can hamper psychomotor intellectual attention and memory
• This is apparent when Individual exposed to irrelevant speech while engaged in mental activity that rely on working memory(multitasking)

Performance

• There is little evidence to demonstrate direct association between excessive OR noise and poor surgical outcome.
• Anaesthesiologists are affected by noisy equipment around them
• Noisiest times occur during critical components of a case
• In one study 84% of anaesthesiologists reported being affected by the noise levels
• Noise is top complaint among hospital patients during induction

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MUSIC IN THE OPERATING ROOM

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Is music allowed in the OR?

• Music is a special type of noise
• First introduced in 1914 to relieve anxiety of patients
• Music for most surgeons is as important as the instruments used to operate
• Some anaesthetists feel it can reduce ease and accuracy of performing their tasks

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Who decides the music in the OR?

• Generally chosen by the lead surgeon
• Roughly played 62-72% of time in the OR

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POSITIVE EFFECTS

Why is music played in the OR?

• Effects of music to theatre users are immense (positive, neutral, negative)
• If used appropriately:
• Prevent distractions
• Enhance speed and accuracy
• Minimize annoyance
• Reduce stress levels and lift mood
• Makes OR a pleasant work environment

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TO PATIENTS

• Enhances pain tolerance
• Reduce analgesia requirement by patients post operatively
• Masks effects on worrying sounds
• Reduce or diminish patients’ anxiety
• Masks alarms

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SUMMARY

• much of the noise is generated by personnel and it’s avoidable
• Follow rules such as sterile cockpit to minimize noise in the OR
• Leaders/managers should organize behavioural training to minimize staff-created noise
• Search for new instruments designs that produce less noise
• Effective multidisciplinary teamwork is required to reduce noise
• Signages like “ SILENCE PLEASE” may help
• The selection of music and the manner its delivered play a key role in its effect.

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Thank you

(Erokamano)