Noise Pollution in Hospitals and its Impacts on the Health Care Community and Patients

Olivia C Coiado – coiado@illinois.edu
Twitter: @oliviacoiado
Instagram: @oliviacoiado

Department of Biomedical and Translational Sciences, Carle Illinois College of Medicine, Department of Bioengineering, University of Illinois Urbana-Champaign, Urbana, Illinois, 61801, United States

Erasmo F. Vergara
Laboratory of Vibration and Acoustics, Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil.

Lizandra G. Lupi Vergara
Laboratory of Ergonomics, Department of Production and Systems Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil.

Popular version of 3pNS4-Noise Pollution in Hospitals and its Impacts on the Health Care Community and Patients, presented at the 183rd ASA Meeting.

If you ever had to be hospitalized in your life, you probably know that spending a night in a hospital room and getting some sleep is almost an impossible mission! Why? Noise in hospitals is a common problem for patients, families and teams of professionals and employees. Most of a hospital’s environment is affected by the sounds of equipment and machines with high sound pressure levels (SPL) or “noise”.
What can we do?

Fig 1: Sound pressure meter positioned in front of the reception desk in Brazil.

We used a sound pressure meter (Fig. 1) to record noise of medical equipment such as machines, medical devices, tools, alarms used in the medical activities in hospitals in Brazil and in the United States. SPLs inside hospitals may have high average values, higher than 60 decibels (dB), with peak SPL values of 100 dB and may not meet the international requirements. The World Health Organization (WHO) suggests that the average SPL in hospitals should be around 35 dB during the day and 30 dB at night. SPLs above 65 dB can cause behavioral disorders and affect the quality of sleep and cause changes in the physiological responses to stress in hospitalized patients. High noise levels exceeding 55 dB can affect both patients and staff. The noise effects can cause memory lapses and mental exhaustion in performing tasks, exposing technical and support teams to risks, accidents and errors in the performance of their work. For instance, a plane taking off (Fig. 2) can reach up to 100 dB and a noisy hospital environment can reach up to 70 dB, more than double of the noise recommended by the WHO!

Figure 2: Image adapted from Bayo, Garcia and Garcia 1989.

Our research considered both quantitative aspects, through numerical and qualitative descriptors (subjective and psychological assessment of patients, medical staff, employees, etc.), to assess noise pollution in hospitals. Our model analyzed the relationship between the acoustic characteristics of the environment and people’s sound perception.
We interviewed 47 people in a Brazilian Hospital, the responses were collected from nurses, nursing assistants, doctors, and other staff members. 60% of the participants responded that they needed to speak louder and felt discomfort with the noise in the work environment, 57% said they felt discomfort with the noise coming from the medical equipment, 72% of the participants said the work environment is moderately or very noisy. The next phase of our research is to repeat the same measurements in a United Stated Hospital and compare the results. Then we can make a reflection, what can we do to reduce the effects of noise pollution in hospitals? How to reduce the noise coming from medical equipment? Our “dream” is to provide a more comfortable environment for patients and the health community. Hoping they can finally get a good night of sleep in Brazil in the U.S or any other hospital in the world.

The safe noise level to prevent hearing loss is probably lower than you think

Daniel Fink – djfink01@aol.com
Twitter: @QuietCoalition

Board Chair, The Quiet Coalition, 60 Thoreau Street Suite 261, Concord, MA, 01742, United States

The Quiet Coalition is a program of Quiet Communities, Inc.

Popular version of 3pNS1-What is the safe noise level to prevent noise-induced hearing loss?, presented at the 183rd ASA Meeting.

Ear structures including outer, middle, and inner ear. Image courtesy of CDC

If something sounds loud, it’s too loud, and your auditory health is at risk. Why? The safe noise exposure level to protect your hearing- to prevent noise-induced hearing loss (NIHL) and other auditory disorders like tinnitus, also known as ringing in the ears, might be lower than you think. Noise damages delicate structures in the inner ear (cochlea). These include minuscule hair cells that actually perceive sound waves, transmitted from the air to the ear drum, then from bones to the fluid in the cochlea.

Figure 1. Normal hair cells (left) and hair cells damaged by noise (right). Image courtesy of CDC

[A little detail about sound and its measurement. Sound is defined as vibrations that travel through the air and can be heard when they reach the ear. The terms sound and noise are used interchangeably, although noise usually has a connation of being unpleasant or unwanted. Sound is measured in decibels. The decibel scale is logarithmic, meaning that an increase in sound or noise levels from 50 to 60 decibels (dB) indicates a 10-times increase in sound energy, not just a 20% increase as might be thought. A-weighting (dBA) is often used to adjust unweighted sound measurement to reflect the frequencies heard in human speech. This is used in occupational safety because the inability to understand speech after workplace noise exposure is the compensable industrial injury.]

Many audiologists still use the industrial-strength 85 dB noise level as the level at which auditory damage begins. This is incorrect. The 85 dBA noise level is the National Institute for Occupational Safety and Health (NIOSH) recommended occupational noise exposure level (REL). This does not protect all exposed workers from hearing loss. It is certainly not a safe noise level for the public. Because of the logarithmic decibel scale, 85 decibel sound has approximately 30 times more sound energy than the Environmental Protection Agency’s 70 decibel safe sound level, not about 20% as might be thought.

The EPA adjusted the NIOSH REL for additional exposure time- 24 hours a day instead of only 8 hours at work, 365 days a year instead of 240 days- to calculate that 70 dB average noise exposure for a day would prevent noise-induced hearing loss. This is the only evidence-based safe noise level I have been able to find.

But the real safe noise level to prevent NIHL must be lower than 70 dB. Why? EPA used the 40-year occupational exposure in its calculations. It didn’t adjust for lifetime exposure (approaching 80 years in the United States before the COVID pandemic). NIHL comes from cumulative noise exposure. This probably explains why so many older people have trouble hearing, the same way additional years of sun exposure explains the pigmentation changes and wrinkles in older people.

My paper explains that the NIOSH REL, from which EPA calculated the safe noise level, was based on studies of workers using limited frequency audiometry (hearing tests), only up to 4000 or 6000 Hertz (cycles per second). More sensitive tests of hearing, such as extended-range audiometry up to 20,000 Hertz, shows auditory damage in people with normal hearing on standard audiometry. Tests of speech in noise- how well someone can hear when background noise is added to the hearing test- also show problems understanding speech, even if standard audiometry is normal.

The actual noise level to prevent hearing loss may be as low as 55 dBA. This is the noise level needed for the human ear to recover from noise-induced temporary threshold shift, the muffling of sound one has after exposure to loud noise. If you’ve ever attended a rock concert or NASCAR race and found your hearing muffled the next morning, that’s what I’m talking about. (By the way, there is no such thing as temporary hearing loss. The muffling of sound, or temporary ringing in the ears after loud noise exposure, indicates that permanent auditory damage has occurred.)

55 dB is pretty quiet and would be difficult to achieve in everyday life in a modern industrialized society, where average daily noise exposures are near 75 dB. But I hope that if people know the real safe noise level to prevent hearing loss, they will avoid loud noise or use hearing protection if they can’t.

4aPPa24 – Effects of meaningful or meaningless noise on psychological impression for annoyance and selective attention to stimuli during intellectual task – Takahiro Tamesue

Effects of meaningful or meaningless noise on psychological impression for annoyance and selective attention to stimuli during intellectual task

Takahiro Tamesue – tamesue@yamaguchi-u.ac.jp
Yamaguchi University
1677-1 Yoshida, Yamaguchi
Yamaguchi Prefecture 753-8511
Japan

Popular version of poster 4aPPa24, “Effects of meaningful or meaningless noise on psychological impression for annoyance and selective attention to stimuli during intellectual task”
Presented Thursday morning, December 1, 2016
172nd ASA Meeting, Honolulu
Open offices that make effective use of limited space and encourage dialogue, interaction, and collaboration among employees are becoming increasingly common. However, productive work-related conversation might actually decrease the performance of other employees within earshot — more so than other random, meaningless noises. When carrying out intellectual activities involving memory or arithmetic tasks, it is a common experience for noise to cause an increased psychological impression of “annoyance,” leading to a decline in performance. This is more apparent for meaningful noise, such as conversation, than it is for other random, meaningless noise. In this study, the impact of meaningless and meaningful noises on selective attention and cognitive performance in volunteers, as well as the degree of subjective annoyance of those noises, were investigated through physiological and psychological experiments.

The experiments were based on the so-called “odd-ball” paradigm — a test used to examine selective attention and information processing ability. In the odd-ball paradigm, subjects detect and count rare target events embedded in a series of repetitive events. To complete the odd-ball task it is necessary to regulate attention to a stimulus. In one trial, subjects had to count the number of times the infrequent target sounds occurred under meaningless or meaningful noises over a 10 minute period. The infrequent sound — appearing 20% of the time—was a 2 kHz tone burst; the frequent sound was a 1 kHz tone burst. In a visual odd-ball test, subjects observed pictures flashing on a PC monitor as meaningless or meaningful sounds were played to both ears through headphones. The most infrequent image was 10 x 10 centimeter-squared red image; the most frequent was a green square. At the end of the trial, the subjects also rated their level of annoyance at each sound on a seven-point scale.

During the experiments, the subjects brain waves were measured through electrodes placed on their scalp. In particular, we look at what is called, “event-related potentials,” very small voltages generated in the brain structures in response to specific events or stimuli that generate electroencephalograph waveforms. Example results, after appropriate averaging, of wave forms of event-related potentials under no external noise are shown in Figure 1. The so-called N100 component peaks negatively about 100 milliseconds after the stimulus and the P300 component positive peaks positively around 300 milliseconds after a stimulus, related to selective attention and working memory. Figure 2 and 3 show the results of event-related potentials for infrequent sound under the meaningless and meaningful noise. N100 and P300 components are smaller in amplitude and longer in latency because of the meaningful noise compared to the meaningless noise.

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Figure 1. Averaged wave forms of evoked Event-related potentials for infrequent sound under no external noise.

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Figure 2. Averaged wave forms of evoked Event-related potentials for infrequent sound under meaningless noise.

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Figure 3. Averaged wave forms of auditory evoked Event-related potentials under meaningful noise.

We employed a statistical method called, “principal component analysis” to identify the latent components. Results of statistical analysis, where four principal components were extracted as shown in Figure 4. Considering the results, where component scores of meaningful noise was smaller than other noise conditions, meaningful noise reduces the component of event-related potentials. Thus, selective attention to cognitive tasks was influenced by the degree of meaningfulness of the noise.

 

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Figure 4. Loadings of principal component analysis

Figure 5 shows the results for annoyance in the auditory odd-ball paradigms. These results demonstrated that the subjective experience of annoyance in response to noise increased due to the meaningfulness of the noise. The results revealed that whether the noise is meaningless or meaningful had a strong influence not only on the selective attention to auditory stimuli in cognitive tasks, but also the subjective experience of annoyance.

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Figure 5. Subjective experience of annoyance (Auditory odd-ball paradigms)

That means that when designing sound environments in spaces used for cognitive tasks, such as the workplace or schools, it is appropriate to consider not only the sound level, but also meaningfulness of the noise that is likely to be present. Surrounding conversations often disturb the business operations conducted in such open offices. Because it is difficult to soundproof an open office, a way to mask meaningful speech with some other sound would be of great benefit for achieving a comfortable sound environment.

 

2pABa1 – Snap chat: listening in on the peculiar acoustic patterns of snapping shrimp, the noisiest animals on the reef – Ashlee Lillis

Snap chat: listening in on the peculiar acoustic patterns of snapping shrimp, the noisiest animals on the reef

Ashlee Lillis – ashlee@whoi.edu
T. Aran Mooney – amooney@whoi.edu

Marine Research Facility
Woods Hole Oceanographic Institution
266 Woods Hole Road
Woods Hole, MA 02543

Popular version of paper 2pABa1
Presented Tuesday afternoon, November 29, 2016
172nd ASA Meeting, Honolulu

Characteristic soundscape recorded on a coral reef in St. John, US Virgin Islands. The conspicuous crackle is produced by many tiny snapping shrimp.

Put your head underwater in almost any tropical or sub-tropical coastal area and you will hear a continuous, static-like noise filling the water. The source of this ubiquitous sizzling sound found in shallow-water marine environments around the world was long considered a mystery of the sea. It wasn’t until WWII investigations of this underwater sound, considered troublesome, that hidden colonies of a type of small shrimp were discovered as the cause of the pervasive crackling sounds (Johnson et al., 1947).

Individual snapping shrimp (Figure 1), sometimes referred to as pistol shrimp, measure smaller than a few centimeters, but produce one of the loudest of all sounds in nature using a specialized snapping claw. The high intensity sound is actually the result of a bubble popping when the claw is closed at incredibly high speed, creating not only the characteristic “snap” sound but also a flash of light and extremely high temperature, all in a fraction of a millisecond (Versluis et al., 2000). Because these shrimp form large, dense aggregations, living unseen within reefs and rocky habitats, the combination of individual snaps creates the consistent crackling sound familiar to mariners. Snapping is used by shrimp for defense and territorial interactions, but likely serves other unknown functions based on our recent studies.

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Figure 1. Images of the species of snapping shrimp, Alpheus heterochaelis, we are using to test hypotheses in the lab. This is the dominant species of snapping shrimp found coastally in the Southeast United States, but there are hundreds of different species worldwide, easily identified by their relatively large snapping claw.

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Figure 2. Photo showing an underwater acoustic recorder deployed in a coral reef setting. Recorders can be left to record sound samples at scheduled times (e.g. every 10 minutes) so that we can examine the long-term temporal trends in snapping shrimp acoustic activity on the reef.

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Figure 3. Time-series of snap rates detected on two nearby USVI coral reefs for a week-long recording period. Snapping shrimp were previously thought to consistently snap more during the night, but we found in this study location that shrimp were more active during the day, with strong dawn and dusk peaks at one of the sites. This pattern conflicts with what little is known about snapping behaviors and is motivating further studies of why they snap.

Since snapping shrimp produce the dominant sound in many marine regions, changes in their activity or population substantially alters ambient sound levels at a given location or time. This means that the behavior of snapping shrimp exerts an outsized influence on the sensory environment for a variety of marine animals, and has implications for the use of underwater sound by humans (e.g., harbor defense, submarine detection). Despite this fundamental contribution to the acoustic environment of temperate and coral reefs, relatively little is known about snapping shrimp sound patterns, and the underlying behaviors or environmental influences. So essentially, we ask the question: what is all the snapping about?

Recent advances in underwater recording technology and interest in passive acoustic monitoring have aided our efforts to sample marine soundscapes more thoroughly (Figure 2), and we are discovering complex dynamics in snapping shrimp sound production. We collected long-term underwater recordings in several Caribbean coral reef systems and analyzed the snapping shrimp snap rates. Our soundscape data show that snap rates generally exhibit daily rhythms (Figure 3), but that these rhythms can vary over short spatial scales (e.g., opposite patterns between nearby reefs) and shift substantially over time (e.g., daytime versus nighttime snapping during different seasons). These acoustic patterns relate to environmental variables such as temperature, light, and dissolved oxygen, as well as individual shrimp behaviors themselves.

The relationships between environment, behaviors, and sound production by snapping shrimp are really only beginning to be explored. By listening in on coral reefs, our work is uncovering intriguing patterns that suggest a far more complex picture of the role of snapping shrimp in these ecosystems, as well as the role of snapping for the shrimp themselves. Learning more about the diverse habits and lifestyles of snapping shrimp species is critical to better predicting and understanding variation in this dominant sound source, and has far-reaching implications for marine ecosystems and human applications of underwater sound.

 

References

Johnson, M. W., F. Alton Everest, and Young, R. W. (1947). “The role of snapping shrimp (Crangon and Synalpheus) in the production of underwater noise in the sea,” Biol. Bull. 93, 122–138.

Versluis, M., Schmitz, B., von der Heydt, A., and Lohse, D. (2000). “How snapping shrimp snap: through cavitating bubbles,” Science, 289, 2114–2117. doi:10.1126/science.289.5487.2114

 

2aNS – How virtual reality technologies can enable better soundscape design – Chung

How virtual reality technologies can enable better soundscape design.

W.M. To – wmto@ipm.edu.mo
Macao Polytechnic Institute, Macao SAR, China.
A. Chung – ac@smartcitymakter.com
Smart City Maker, Denmark.
B. Schulte-Fortkamp – b.schulte-fortkamp@tu-berlin.de
Technische Universität Berlin, Berlin, Germany.

Popular version of paper 2aNS, “How virtual reality technologies can enable better soundscape design”
Presented Tuesday morning, November 29, 2016
172nd ASA Meeting, Honolulu

The quality of life including good sound quality has been sought by community members as part of the smart city initiative. While many governments have placed special attention to waste management, air and water pollution, acoustic environment in cities has been directed toward the control of noise, in particular, transportation noise. Governments that care about the tranquility in cities rely primarily on setting the so-called acceptable noise levels i.e. just quantities for compliance and improvement [1]. Sound quality is most often ignored. Recently, the International Organization for Standardization (ISO) released the standard on soundscape [2]. However, sound quality is a subjective matter and depends heavily on the perception of humans in different contexts [3]. For example, China’s public parks are well known to be rather noisy in the morning due to the activities of boisterous amateur musicians and dancers – many of them are retirees and housewives – or “Da Ma” [4]. These activities would cause numerous complaints if they would happen in other parts of the world, but in China it is part of everyday life.

According to the ISO soundscape guideline, people can use sound walks, questionnaire surveys, and even lab tests to determine sound quality during a soundscape design process [3]. With the advance of virtual reality technologies, we believe that the current technology enables us to create an application that immerses designers and stakeholders in the community to perceive and compare changes in sound quality and to provide feedback on different soundscape designs. An app has been developed specifically for this purpose. Figure 1 shows a simulated environment in which a student or visitor arrives the school’s campus, walks through the lawn, passes a multifunctional court, and get into an open area with table tennis tables. She or he can experience different ambient sounds and can click an object to increase or decrease the volume of sound from that object. After hearing sounds at different locations from different sources, the person can evaluate the level of acoustic comfort at each location and express their feelings toward overall soundscape.  She or he can rate the sonic environment based on its degree of perceived loudness and its level of pleasantness using a 5-point scale from 1 = ‘heard nothing/not at all pleasant’ to 5 = ‘very loud/pleasant’. Besides, she or he shall describe the acoustic environment and soundscape using free words because of the multi-dimensional nature of sonic environment.

Figure 1. A simulated soundwalk in a school campus.

  1. To, W. M., Mak, C. M., and Chung, W. L.. Are the noise levels acceptable in a built environment like Hong Kong? Noise and Health, 2015. 17(79): 429-439.
  2. ISO. ISO 12913-1:2014 Acoustics – Soundscape – Part 1: Definition and Conceptual Framework, Geneva: International Organization for Standardization, 2014.
  3. Kang, J. and Schulte-Fortkamp, B. (Eds.). Soundscape and the Built Environment, CRC Press, 2016.
  4. Buckley, C. and Wu, A. In China, the ‘Noisiest Park in the World’ Tries to Tone Down Rowdy Retirees, NYTimes.com, from http://www.nytimes.com/2016/07/04/world/asia/china-chengdu-park-noise.html , 2016.