The legendary nurse Florence Nightingale once warned about a major cruelty inflicted on sick people: unnecessary noise.
That was more than a century ago. And despite advances in medicine, researchers say today's hospitals are still as noisy as bus stations. Studies show that this constant din is stressful for hospital workers and bad for patients who need rest.
Now, at least one hospital is trying to create some peace and quiet. The pediatric intensive care unit at Johns Hopkins Hospital in Baltimore, Md., recently called on two acoustical engineers, Ilene Busch-Vishniac and James West, both at Johns Hopkins University, to analyze its noise problem.
Neither had any experience in studying hospital noise. But West said that when they walked into the pediatric ICU, they were immediately appalled. "The first time I was here, I said, 'It is impossible for me to work in an environment as noisy as this?'" West recalls.
The clamor starts right inside the unit's main door; in fact, it starts with the door. The electronic gears make a slow grinding noise as it opens and shuts.
Claire Beers, the nurse manager, eyes it with resignation. "That's the regular sound of that door," she says. A few feet away is a noisy workstation where staffers address envelopes, prepare lab samples, answer the phone, and talk with doctors. "This is a very noisy part of the unit," Beers says, as a door slams nearby.
Just down the hall are desperately sick children, but they're surrounded by incessant noise. The pumps and alarms on life support machines; the hum of a vacuum; the clatter of meal trays; patients being wheeled back and forth. And, of course, there's the overhead paging system. If you're not used to it, its loud squawk will make you jump. "I thought they had the worst paging system I'd ever seen or heard anywhere," says Busch-Vishniac.
The two engineers found that the average noise level on this unit was the same, night or day: about 60 decibels. That's like a neighbor's lawn mower wailing outside your window at 6 a.m. Busch-Vishniac says studies show this is typical for all kinds of hospitals, small and large. And noise levels have been steadily rising since the 1960s. "It was clear that there was a problem screaming for attention and that there was very little known about how to attack the problem," she says.
In the past, hospitals tried things like just asking people to speak quietly. But the engineers thought that approach was hopeless. They recommended technological solutions. For example, they found small personal pagers that doctors and nurses can wear around their necks to communicate directly with each other. The staff loved them, and the squawk of the overhead loudspeaker dropped from once every five minutes to once every half hour.
And noise levels will soon drop even more, when the department moves to a new building. It's been designed with lots of quieting features like private consultation rooms. That's a big change in thinking. The design of many modern hospitals actually amplifies noise, says West.
That's because, for hygienic reasons, hospitals now get built with hard, easy-to-clean surfaces. No carpets or sound-muffling panels are allowed. "The hard walls are to sound as a mirror is to light. If sound is free to bounce around, it will do just that," says West .
To trap the sound in one noisy part of the Hopkins cancer center, the two engineers built some sound-absorbing panels out of fiberglass wrapped in a special fabric that can be cleaned easily. These panels were then Velcroed to the ceilings. Nurse manager Anita Reedy says the effect was instantaneous.
"I mean, it was so quiet in here. I walked on the unit. There was no more background or white noise going on," Reedy says. "It was great." Unfortunately, the Velcro didn't stick. The panels fell down after a week. But they're going back up, and the staff can't wait.
West says many hospitals are reluctant to discuss their noise problems publicly. He's pleased that Johns Hopkins is so open about its research, which the engineers have published in the December issue of the Journal of the Acoustical Society of America. "The world will know that Hopkins is interested in this problem," West says. "But more importantly, the world will know that it is a real problem. And I'm not so sure that many people know that."
Noise isn't something that generally people think about if they're headed for a hospital stay. But experts say that when you're packing up your books and your pajamas, it might not be a bad idea to throw in some earplugs.