Improving Sleep Quality in the ICU Through a Noise Reduction Time

Background:Poor sleep quality is a common problem in the ICU and has been linked to adverse physiologic conditions including altered immune function, neuroendocrine abnormalities, respiratory muscle weakening, and delirium. Excess noise is a risk factor for poor sleep quality among patients. Sleep quality is often measured using Richards-Campbell sleep questionnaire (RCSQ), and a total RCSQ score of less than 50 indicates poor sleep quality. The World Health Organization (WHO) recommends that noise should be less than 30 decibels during sleeping hours to facilitate restorative sleep in the hospital.The Society of Critical Care Medicine has suggested noise reduction to improve sleep quality among patients in the ICU. This QI project implemented a noise reduction time to improve patients' sleep quality because this Oncology ICU does not currently implement a noise reduction time.Methods:The site of this project was a 16 bed ICU in a tertiary academic hospital offering comprehensive oncology care. This QI project consists of three phases (pre, during, and post implementation of the noise reduction time). Across three phases, two components were involved; 1) assessment of patients' sleep quality using RCSQ, and 2) measurement of noise during between 0000 and 0400 using a smartphone application and calibrated microphone. Staff used a noise reduction protocol that was modified for the oncology ICU from an existing protocol. The modified protocol included environmental changes and behavioral changes to reduce noise. Results:A total of 101 patients were assessed for sleep quality. The mean age of all participants was 57.4 ± 15.9 years. Fifty five percent of the total participants were female. Eighty-five percent of the total participants were Caucasian. Sleep quality was improved from the pre-implementation group RCSQ 39 to an RCSQ of 50 in the implementation group (p<0.01, d=0.54). Noise levels decreased 3.8 dBL during implementation 53.2 dB to 49.4 dB (p<0.01, d = 1.3). Noise levels were also decreased at the 6 weeks follow up 50.4dBL (p=0.02).Conclusions:This was the first QI project in this oncology ICU to attempt to improve sleep quality through the use of a noise reduction time. In this QI project perceived sleep quality was improved through the use of noise reduction time. Although noise levels were decreased the clinical significance of the four-point dB reduction is not known. Our findings reinforce the current evidence that noise reduction may improve sleep quality in the ICU. In the future other ICUs can utilize similar protocols to improve sleep quality and possibly patient outcomes.