Noise level in intensive care units of a public university hospital in Santa Marta (Colombia)

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"apellidos" => "Homar-Ramírez" ] 16 => array:1 [ "colaborador" => "in representation of the Trauma and Neurointensive Care Working Group of the SEMICYUC" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173572716300376?idApp=WMIE" "url" => "/21735727/0000004000000007/v2_201704100038/S2173572716300376/v2_201704100038/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Noise level in intensive care units of a public university hospital in Santa Marta (Colombia)" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "403" "paginaFinal" => "410" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A.P. Garrido Galindo, Y. Camargo Caicedo, A.M. Vélez-Pereira" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A.P." "apellidos" => "Garrido Galindo" ] 1 => array:2 [ "nombre" => "Y." 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"apellidos" => "Vélez-Pereira" "email" => array:1 [ 0 => "avelezpereira@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Grupo de Investigación en Modelación de Sistemas Ambientales, Programa de Ingeniería Ambiental y Sanitaria, Universidad del Magdalena, Santa Marta, Colombia" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nivel de ruido en unidades de cuidado intensivo de un hospital público universitario en Santa Marta (Colombia)" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3311 "Ancho" => 1658 "Tamanyo" => 349546 ] ] "descripcion" => array:1 [ "en" => "Hourly averages of the acoustic parameters. (a) Adult intensive care unit. (b) Pediatric intensive care unit. (c) Neonatal intensive care unit of the hospital. dBA: decibels A; LAeq: equivalent noise level; LAmax: maximum noise level; LA90: noise level below which 90% of the measurements are found." ] ] ] "textoCompleto" => "IntroductionIn hospitals, intensive care units (ICUs) are regarded as areas exposed to noise produced by medical equipment and human activity. Excessive noise levels can lead to stress and delirium among the patients admitted to such Units,<a class="elsevierStyleCrossRefs" href="#bib0195">1–4</a> as well as to fatigue and stress among the healthcare personnel.<a class="elsevierStyleCrossRefs" href="#bib0215">5–7</a>The literature shows that approximately 50% of all patients develop important sleep disturbances during their stay in the ICU. In this regard, noise reduces the duration and number of rapid eye movement (REM) periods,<a class="elsevierStyleCrossRef" href="#bib0230">8</a> with an impact upon the physiological and psychological wellbeing of critical patients in the form of metabolic, endocrine and immune alterations.<a class="elsevierStyleCrossRef" href="#bib0205">3</a>In the case of newborn infants admitted to such Units, it has been estimated that continuous and persistent exposure to excessive noise can lead to hearing loss, increased intracranial pressure, stress, arterial hypertension, metabolic instability, sleep disturbances, irritability and loss of appetite, particularly among premature infants.<a class="elsevierStyleCrossRefs" href="#bib0235">9–11</a>The literature reports mean a noise level in ICUs of 68 decibels A (dBA). As illustrative examples, an Austrian hospital recorded an average of 60–65dBA, while a University Hospital in Valencia (Spain) recorded a level of 55dBA. In a Children's Hospital in Cincinnati (USA) the mean noise level was found to be 71.9dBA, while in the ICU of the Hospital of Manitoba (Canada) the level was 68dBA.<a class="elsevierStyleCrossRefs" href="#bib0250">12,13</a> In adult ICUs (AICUs), the reported mean equivalent noise level (LAeq) was 52–84dBA,<a class="elsevierStyleCrossRefs" href="#bib0260">14–16</a> while in pediatric ICUs (PICUs), the literature describes levels in the range of 48–72dBA.<a class="elsevierStyleCrossRefs" href="#bib0275">17–20</a> Lastly, the noise levels in neonatal ICUs (NICUs) are reported to range between 45 and 90dBA.<a class="elsevierStyleCrossRefs" href="#bib0245">11,21–24</a>The present study was carried out to assess the equivalent continuous noise levels in three ICUs of a hospital in the city of Santa Marta (Colombia), and to evaluate the existence of differences or similarities among the analyzed Units –taking into account the repercussions of excessive noise upon critical patients admitted to the ICU.Material and methodsStudy settingThe study was carried out in a university hospital in the city of Santa Marta (Colombia), with three general ICUs (no differentiation being made according to disease type) classified as AICU, PICU and NICU. The AICU cares for adults and young individuals over 15 years of age and has 19 beds with a mean occupation of 10±2 patients and an attending personnel of 7±3 professionals. The PICU in turn cares for patients between 31 days and 14 years of age and has 7 beds with a mean occupation of 3±2 patients and an attending personnel of 5±1 professionals. Lastly, the NICU cares for newborn infants between 0 and 31 days of age and has 14 cribs with a mean occupation of 8±1 patients and an attending personnel of 4±0 professionals.<a class="elsevierStyleCrossRef" href="#bib0315">25</a>The ICUs operate in three shifts: morning (7:00–13:00h), afternoon (13:00–19:00h) and night (19:00–7:00h+1). Two family visiting periods of 20min each have been established: at 11:00h and 17:00h. In the NICU and PICU there are 8 feeding times per day at intervals of 3h, starting at 00:00h, while the AICU has three feeding times: at 8:00h, 12:00h and 18:00h.Each ICU is staffed by a specialized physician who conducts a round of the Unit three times a day. In the AICU the rounds take place at 9:00h, 14:00h and 20:00h, while in the PICU and NICU they take place at 7:15h, 14:00h and 20:00h. In addition, the general practitioners in each ICU conduct their rounds at the patient bedside at the times of change in shift.The procedures carried out in each ICU vary according to the requirements of the general practitioner and/or specialist, with no specific scheduling of such procedures. In effect, the latter are carried out in the course of each shift as requested by the medical personnel. The most common procedures are the collection of samples for laboratory tests, electrocardiograms, X-rays, the placement of central venous catheters, and interconsultation with the Ear, Nose and Throat, Nephrology and Urology Departments, among others, depending on the patient diagnosis.Sampling designThe present study comprises an analytical, observational and non-interventional design with follow-up over time. It is therefore defined as an analytical study with non-longitudinal follow-up (follow-up study).Continuous sampling was carried out in each ICU during 20 days, based on the methodology described by Vélez-Pereira<a class="elsevierStyleCrossRef" href="#bib0200">2</a>. In the case of the AICU, the measurement campaign took place between 19 August and 8 September 2012; in the PICU it took place between 15 September and 5 October 2012; and in the NICI it took place between 23 March and 12 April 2013. The noise levels were recorded using a Casella type I sound level meter (model CEL-633-C1K1) programmed to record data every 60s using filter frequency in A-weighting and Fast mode. The recorded acoustic parameters included LAeq,1h (to establish the noise level in 1h), percentile 90 (LA90, to establish the background noise level), and LAmax (to establish the maximum values).The sound level meter was positioned in each ICU considering the descriptions of Vélez-Pereira,<a class="elsevierStyleCrossRef" href="#bib0200">2</a> the conditions and internal dynamics of the ICU, and the authorizations and recommendations of the medical coordinators with the purpose of affecting the activities in the ICUs as little as possible. In the AICU we established a distance of 55cm from the ceiling and 123cm from the wall; in the PICU the distance was 55cm from the ceiling and 540cm from the wall; and in the NICU the distance was 60cm from the ceiling and 215cm from the wall.Data processing and statistical analysesEquivalent continuous levelMicrosoft Excel® was used for noise data integration under 1-h intervals corresponding to the acoustic parameters investigated in each ICU (LAeq, LAmax and LA90). This allowed us to analyze the variability associated to hourly or daily cycles in the course of the sampling time. The integrated mean was obtained by applying Eq. <a class="elsevierStyleCrossRef" href="#eq0005">(1)</a>:<a class="elsevierStyleCrossRef" href="#bib0200">2</a><elsevierMultimedia ident="eq0005"></elsevierMultimedia>where i corresponds to observation of the A-weighted equivalent continuous level reported in the hourly interval j, and n is the total number of observations i in the hour j.Statistical analysisThe statistical analysis was carried out with the IBM SPSS® version 20 statistical package, using the hourly averages of each ICU. Analysis of variance (ANOVA)<a class="elsevierStyleCrossRefs" href="#bib0200">2,23,26,27</a> was used to identify statistically significant differences in the hourly averages. In addition, nested ANOVA was used to compare the three ICUs, with a view to identifying statistically significant differences between the results obtained in the three units and determining which factor exerts the strongest impact upon variance (hour and ICU). Lastly, and in order to establish the possible incidence of the Hawthorne effect among the healthcare personnel, an ANOVA was performed of the first 5 days of sampling versus the remaining 15 days.ResultsOn comparing the integrated mean hourly values of the three ICUs (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), the highest LAeq,1h values were seen to correspond to the PICU, with a noise level variation range of 57.07±3.07–65.72±2.46dBA, followed by the NICU, with levels of 59.54±2.41–65.33±1.77dBA, and the AICU, with levels of 57.40±1.14–63.47±2.13dBA. This information was confirmed by performing an ANOVA of the data, where a significant difference between ICUs was identified, influenced mainly by the time variation in the course of the day, with an F-ratio=116.02 and p=0.00 (critical p-value=0.05), and 95% significance level.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>In contrast to the above, the three ICUs were found to exhibit similar trends with stable hourly levels between 07:30h and 17:30h, approximately; this was followed by a strong increase at 18:30h, and from 19:00h onwards a decrease was noted in LAeq,1h, extending until approximately 04:30h (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). This was corroborated by the ANOVA of the hourly noise averages, with F=26.07 and p=0.000 (critical p-value=0.05), yielding a significant difference between the hourly averages, with a 95% confidence level. This information was evidenced by the generation of homogeneous groups as established from the cluster analysis applied to the hourly data of the ICU (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The analysis showed the values to be low in the early morning hours in the ICU (1:00–4:00h), with intermediate behavior in the late hours of the day (20:00–0:00h and 5:00h, nocturnal), and finally with the highest and most fluctuating noise values during the daytime (6:00–19:00h, including morning and afternoon).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>On examining the maximum noise values in the ICUs, we found the pattern to be the same as in the case of LAeq,1h–the PICU yielding the highest levels (68.69±3.57–79.06±2.34dBA), followed by the NICU (67.20±2.13–77.65±3.74dBA) and finally the AICU (71.55±2.32–77.22±1.94dBA). However, the values showed less variation than the integrated hourly noise data, with the exception of the NICU, which exhibited a greater range of variability than the other two ICUs, particularly in the early hours of the day. Regarding the ANOVA applied to the maximum noise levels, the type of ICU and time of day were seen to influence variance of the levels, with statistically significant differences (95% confidence level). However, the F-ratio of the hourly period (32.18) was greater than the F-ratio as per Unit (10.89)–thus indicating greater influence of the time of day upon the maximum noise levels in the ICU.On the other hand, in relation to the results of the background noise, the order was found to differ with respect to the previous two acoustic parameters, being headed by the PICU (53.33±3.54–61.96±2.85dBA), followed by the AICU in this case (53.51±1.16–60.26±2.10dBA), and finally the NICU (55.02±2.03–58.70±1.95dBA). However, as can be seen in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, there was greater similarity in the variation of LAeq,1h and LA90, these values being closely comparable among the three ICUs. This situation was not observed in the case of the noise level (LAeq,1h) and maximum level (LAmax). On applying the ANOVA to the background noise data, we again observed the influence of the Unit and time of day upon variation, with a greater influence than in the case of LAmax, though lower for LAeq,1h–with an F-ratio of 76.04 for the parameter ICU, and of 20.22 in the case of the parameter time. In both cases a significant difference was recorded, with a 95% confidence level.All this information was corroborated by the ANOVA applied to the parameters, reflecting the interaction of the type of ICU and the time of day with the recorded noise levels. In this regard, the F-ratio for the interaction of the parameters was 1.09 for LAeq,1h, followed by 2.19 for LAmax and 3.33 for LA90. However, only in the case of the LAmax values did the type of Unit fail to influence the variations, while in the case of LAeq,1h and LA90 the influence in variation of the noise levels was 9.22% and 13.49%, respectively. In the case of the time of day, LAmax was found to influence variance by 36.16%, versus 27.02% in the case of LAeq,1h, and 26.10% in the case of LA90.Lastly, the analysis carried out to determine the presence of the Hawthorne effect showed that only in the case of the PICU could minor modifications be inferred in the behavior of the healthcare personnel or changes in the medical teams in the first days of sampling, since ANOVA only identified significant differences between the LAmax and LA90 values between the first 5 days versus the remaining 15 days (with a 95% level of significance).DiscussionThe analysis of the results obtained reflects the existence of important noise levels in all three ICUs. This is consistent with the data found in the literature, where noise increments have been recorded in ICUs, increasing from 57dBA in the daytime and 42dBA during the nighttime hours in the year 1960 to 72dBA in the daytime and 60dBA during the nighttime hours in the year 2005. This trend is mainly related to the increase in number of medical devices with acoustic alarms that serve as support for the medical activities in the ICU. An additional contributing factor is the noise generated essentially by human factors, including conversations among the personnel members, visits by the families, the falling of objects, opening and closing of doors, etc.<a class="elsevierStyleCrossRefs" href="#bib0235">9,12,28,29</a>On considering the LAeq values obtained and the noise levels contemplated by Resolution 8321 of 1983 of the Colombian Ministry of Health,<a class="elsevierStyleCrossRef" href="#bib0340">30</a> it is clear that none of the three ICUs yielded mean levels of under 45dBA (the limiting level for calm zones) during the sampling period. This situation is also observed in the literature, where the noise limits are frequently seen to be exceeded in ICUs.<a class="elsevierStyleCrossRefs" href="#bib0250">12,31</a> These data are all the more serious considering that the background noise in the ICUs exceeded the maximum levels accepted by Colombian regulations and other international references– including the guidelines of the EPA (45dBA in the daytime and 35dBA at night), the National Institute of Occupational Health and Safety (40dBA in the daytime and 35dBA at night), Royal Decree 1386 of 1989 (40dBA in the daytime and 35dBA at night), the World Health Organization, the American Academy of Pediatrics (35dBA in the daytime and 30dBA at night), and the Chinese Medical Association (45dBA in the morning hours, 40dBA in the afternoon, and 20dBA at night), among others.<a class="elsevierStyleCrossRefs" href="#bib0335">29,32–35</a>Our results show that the highest values of the different acoustic parameters are mainly recorded during the daytime, in the course of medical controls, visits by social workers, nutritionists and epidemiologists, and in the hours close to the changing of shifts in the case of the AICU and PICU. In the case of the NICU, we not only recorded this increase during the mentioned activities and at the changing of shifts, but also observed a slight increase in noise levels every 3h, coinciding with feeding of the newborn infants (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). This is consistent with the observations of González,<a class="elsevierStyleCrossRef" href="#bib0370">36</a> Lawson et al.,<a class="elsevierStyleCrossRef" href="#bib0325">27</a> Knutson<a class="elsevierStyleCrossRef" href="#bib0375">37</a> and Konkani and Oakley,<a class="elsevierStyleCrossRef" href="#bib0330">28</a> where the periods of greater noise in the ICU were correlated to the changing of shifts, the collection of laboratory test samples, visiting and feeding times, and the presence of social workers, nutritionists and physiotherapists.<elsevierMultimedia ident="fig0015"></elsevierMultimedia>The literature shows that noise has an impact upon patient recovery. A number of studies point to noise as one of the stressors underlying lack of sleep and physiological and psychological effects that prolong patient stay in the Unit.<a class="elsevierStyleCrossRefs" href="#bib0205">3,38</a> Although the LAeq,1h values recorded in our three ICUs did not exceed 90dBA (levels above which hearing damage can occur), they were above 65dBA, which is associated to effects upon the hypothalamic-adrenal gland system, with alterations in heart rate and an increased risk of complications in adult patients,<a class="elsevierStyleCrossRef" href="#bib0250">12</a> together with interruptions in the sleep periods that are important for patient recovery.<a class="elsevierStyleCrossRef" href="#bib0205">3</a>The results of the present study show that in relation to the maximum noise levels, the duration of exposure to over 90dBA was brief or inexistent (only 0.42% of the time sampled in the PICU exceeded this level). In the case of 65dBA, the PICU registered this level 33% of the time (equivalent to about 11h a day), followed by the NICU with 29% (equivalent to 9h a day) and the AICU with 4% (equivalent to 1h a day). This information evidences a risk of patient complications– a situation that is all the more critical on analyzing the time period in which the levels exceed the recommended references, since the mean hourly noise values (LAeq,1h) exceeded the recommended limits in 100% of the measured time.It is thus seen that the noise levels recorded in our ICUs could have an impact upon the physiological and psychological wellbeing of the patients, fundamentally as a consequence of the effects described in the literature.<a class="elsevierStyleCrossRef" href="#bib0230">8</a> The effects associated to noise are subjective and depend on the individual and disease condition involved. It should be noted that the risk of hearing loss or damage is further increased in newborn infants due to the change in environment and their inherent biological vulnerability, since these patients are removed from the safety of the mother to hostile surroundings that increase the risk of hearing alterations.<a class="elsevierStyleCrossRefs" href="#bib0195">1,9,10</a> Nevertheless, in order to establish the direct effects of noise, studies are needed in which health professionals assess and monitor the patients during the period of time in which the noise levels are evaluated in the ICU.Regarding the risk for the health professionals posed by high noise levels in the ICU, the recorded levels fall well short of the 90dBA established for an 8-h period of exposure to noise in the work place<a class="elsevierStyleCrossRef" href="#bib0340">30</a> (AICU presenting 62dBA on average, PICU 66dBA, and NICU 64dBA). According to Garrido Galindo et al.,<a class="elsevierStyleCrossRef" href="#bib0225">7</a> the values recorded pose a moderate to high risk of directly or indirectly affecting emotions and physiological and psychological aspects of the medical and nursing personnel–resulting in the appearance of burnout syndrome.ConclusionsThe lowest LAeq,1h values corresponded to the AICU. The values corresponding to the PICU and NICU were similar, with only some differences during certain hourly intervals. Considering the time at which different activities inherent to the Unit were carried out and the increase in noise levels observed in the figures, a series of activities such as the changing of shifts, visits and patient feeding were seen to exert a possible influence upon the noise levels in the ICU.From the statistical perspective, ANOVA revealed the existence of statistically significant differences between the acoustic parameters in the ICUs–the time of day being the variable with the strongest influence upon the variations in noise level in the Unit.Financial supportThis study was supported by a grant from the Departamento Administrativo de Ciencia, Tecnología e Innovación-Colciencias through the Programa Jóvenes Investigadores e Innovadores, with co-funding from the Universidad del Magdalena.Conflicts of interestThe authors declare that they have no conflicts of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres826554" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec822872" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres826555" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Materiales y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec822873" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study setting" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Sampling design" ] 2 => array:3 [ "identificador" => "sec0025" "titulo" => "Data processing and statistical analyses" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0030" "titulo" => "Equivalent continuous level" ] ] ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Financial support" ] 10 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflicts of interest" ] 11 => array:2 [ "identificador" => "xack277302" "titulo" => "Acknowledgements" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-10-02" "fechaAceptado" => "2015-11-30" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec822872" "palabras" => array:4 [ 0 => "Public health" 1 => "Intensive therapy" 2 => "Noise measurement" 3 => "Environmental health" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec822873" "palabras" => array:4 [ 0 => "Salud pública" 1 => "Terapia intensiva" 2 => "Medición del ruido" 3 => "Salud ambiental" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo evaluate the noise level in adult, pediatric and neonatal intensive care units of a university hospital in the city of Santa Marta (Colombia). DesignA descriptive, observational, non-interventional study with follow-up over time was carried out. Materials and methodsContinuous sampling was conducted for 20 days for each unit using a type i sound level meter, filter frequency in A weighting and Fast mode. We recorded the maximum values, the 90th percentile as background noise, and the continuous noise level. ResultsThe mean hourly levels in the adult unit varied between 57.40±1.14 and 63.47±2.13dBA, with a maximum between 71.55±2.32 and 77.22±1.94dBA, and a background noise between 53.51±1.16 and 60.26±2.10dBA; in the pediatric unit the mean hourly levels varied between 57.07±3.07 and 65.72±2.46dBA, with a maximum of 68.69±3.57–79.06±2.34dBA, and a background noise between 53.33±3.54 and 61.96±2.85dBA; the neonatal unit in turn presented mean hourly values between 59.54±2.41–65.33±1.77dBA, with a maximum value between 67.20±2.13 and 77.65±3.74dBA, and a background noise between 55.02±2.03 and 58.70±1.95dBA. Analysis of variance revealed a significant difference between the hourly values and between the different units, with the time of day exhibiting a greater influence. ConclusionsThe type of unit affects the noise levels in intensive care units, the pediatric unit showing the highest values and the adult unit the lowest values. However, the parameter exerting the greatest influence upon noise level is the time of day, with higher levels in the morning and evening, and lower levels at night and in the early morning." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Materials and methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoEvaluar el nivel de ruido en las unidades de cuidado intensivo adulto, pediátrico y neonatal de un hospital universitario de la ciudad de Santa Marta (Colombia). DiseñoEstudio descriptivo, observacional no intervencionista y con seguimiento a lo largo del tiempo. Materiales y métodosSe realizó un muestreo continuo durante 20 días por cada unidad utilizando un sonómetro tipo i, con filtro de ponderación frecuencial A y temporal Fast. Se registraron los valores máximos, el percentil 90 como ruido de fondo y el nivel continuo de ruido. ResultadosLos niveles medios horarios variaron entre 57,40±1,14-63,47±2,13dBA para la unidad de adultos, con un máximo entre 71,55±2,32-77,22±1,94dBA y un ruido de fondo entre 53,51±1,16-60,26±2,10dBA; para la unidad pediátrica la media horaria se establece entre 57,07±3,07-65,72±2,46dBA, con un máximo de 68,69±3,57-79,06±2,34dBA, y de 53,33±3,54-61,96±2,85dBA de ruido de fondo; finalmente, la unidad neonatal reporta entre 59,54±2,41-65,33±1,77dBA la media horaria, los máximos entre 67,20±2,13-77,65±3,74dBA, y fondo de 55,02±2,03-58,70±1,95dBA. El ANOVA evidenció una diferencia significativa entre los valores horarios y entre las unidades de cuidado intensivo, mostrando una mayor influencia la hora del día. ConclusionesLos niveles de ruido en las unidades de cuidado intensivo se ven afectados por el tipo de unidad; se presentaron los valores más altos en la unidad pediátrica y los más bajos en la de adultos. No obstante, el parámetro que más influye en el nivel es la hora del día, con mayores niveles en la mañana y la tarde, y menores en la noche y la madrugada." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Materiales y métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Garrido Galindo AP, Camargo Caicedo Y, Vélez-Pereira AM. Nivel de ruido en unidades de cuidado intensivo de un hospital público universitario en Santa Marta (Colombia). Med Intensiva. 2016;40:403–410." ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3311 "Ancho" => 1658 "Tamanyo" => 349546 ] ] "descripcion" => array:1 [ "en" => "Hourly averages of the acoustic parameters. (a) Adult intensive care unit. (b) Pediatric intensive care unit. (c) Neonatal intensive care unit of the hospital. dBA: decibels A; LAeq: equivalent noise level; LAmax: maximum noise level; LA90: noise level below which 90% of the measurements are found." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 943 "Ancho" => 1578 "Tamanyo" => 81594 ] ] "descripcion" => array:1 [ "en" => "Cluster plot or homogeneous groups of noise levels in the intensive care units based on the nearest neighbor approach (Euclidian metric distance). AICU: adult intensive care unit; NICU: neonatal intensive care unit; PICU: pediatric intensive care unit." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2261 "Ancho" => 2229 "Tamanyo" => 411187 ] ] "descripcion" => array:1 [ "en" => "Hourly averages of the noise levels contrasted with the times of day and routine activities in the intensive care unit. AICU: adult intensive care unit; NICU: neonatal intensive care unit; PICU: pediatric intensive care unit." ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "LAeq,1h (dBA): 1h equivalent noise level in decibels A; AICU: adult intensive care unit; NICU: neonatal intensive care unit; PICU: pediatric intensive care unit." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Shift \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Time \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col">AICU</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col">PICU</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col">NICU</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LAeq,1h (dBA)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LAeq,1h (dBA)</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LAeq,1h (dBA)</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="6" align="left" valign="top">Morning</td><td class="td" title="table-entry " align="left" valign="top">7:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66.78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.84 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.06 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="6" align="left" valign="top">Afternoon</td><td class="td" title="table-entry " align="left" valign="top">13:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.97 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.92 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">16:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">17:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">18:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="12" align="left" valign="top">Night</td><td class="td" title="table-entry " align="left" valign="top">19:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.93 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.35 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.94 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">20:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">21:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.88 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.86 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">22:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.05 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">23:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.18 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">0:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">1:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">2:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">3:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">4:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57.21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">5:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">60.26 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">6:30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62.56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1390402.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Noise level integrated according to time of day and shifts." ] ] 4 => array:6 [ "identificador" => "eq0005" "etiqueta" => "(1)" "tipo" => "MULTIMEDIAFORMULA" "mostrarFloat" => false "mostrarDisplay" => true "Formula" => array:5 [ "Matematica" => "LAeq,1h=10×log10∑i=1n10(Leqij/10)nj" "Fichero" => "STRIPIN_si1.jpeg" "Tamanyo" => 2666 "Alto" => 40 "Ancho" => 238 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:38 [ 0 => array:3 [ "identificador" => "bib0195" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factores ambientales estresantes percibidos por los pacientes de una Unidad de Cuidados Intensivos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N. 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Noise level in intensive care units of a public university hospital in Santa Marta (Colombia)

Nivel de ruido en unidades de cuidado intensivo de un hospital público universitario en Santa Marta (Colombia)

A.P. Garrido Galindo, Y. Camargo Caicedo, A.M. Vélez-Pereira

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avelezpereira@gmail.com

Corresponding author.

Grupo de Investigación en Modelación de Sistemas Ambientales, Programa de Ingeniería Ambiental y Sanitaria, Universidad del Magdalena, Santa Marta, Colombia

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    "titulo" => "Noise level in intensive care units of a public university hospital in Santa Marta &#40;Colombia&#41;"
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            "entidad" => "Grupo de Investigaci&#243;n en Modelaci&#243;n de Sistemas Ambientales&#44; Programa de Ingenier&#237;a Ambiental y Sanitaria&#44; Universidad del Magdalena&#44; Santa Marta&#44; Colombia"
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        "titulo" => "Nivel de ruido en unidades de cuidado intensivo de un hospital p&#250;blico universitario en Santa Marta &#40;Colombia&#41;"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Hourly averages of the acoustic parameters&#46; &#40;a&#41; Adult intensive care unit&#46; &#40;b&#41; Pediatric intensive care unit&#46; &#40;c&#41; Neonatal intensive care unit of the hospital&#46; dBA&#58; decibels A&#59; LA<span class="elsevierStyleInf">eq</span>&#58; equivalent noise level&#59; LA<span class="elsevierStyleInf">max</span>&#58; maximum noise level&#59; LA<span class="elsevierStyleInf">90</span>&#58; noise level below which 90&#37; of the measurements are found&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In hospitals&#44; intensive care units &#40;ICUs&#41; are regarded as areas exposed to noise produced by medical equipment and human activity&#46; Excessive noise levels can lead to stress and delirium among the patients admitted to such Units&#44;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#8211;4</span></a> as well as to fatigue and stress among the healthcare personnel&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The literature shows that approximately 50&#37; of all patients develop important sleep disturbances during their stay in the ICU&#46; In this regard&#44; noise reduces the duration and number of rapid eye movement &#40;REM&#41; periods&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">8</span></a> with an impact upon the physiological and psychological wellbeing of critical patients in the form of metabolic&#44; endocrine and immune alterations&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In the case of newborn infants admitted to such Units&#44; it has been estimated that continuous and persistent exposure to excessive noise can lead to hearing loss&#44; increased intracranial pressure&#44; stress&#44; arterial hypertension&#44; metabolic instability&#44; sleep disturbances&#44; irritability and loss of appetite&#44; particularly among premature infants&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">9&#8211;11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The literature reports mean a noise level in ICUs of 68 decibels A &#40;dBA&#41;&#46; As illustrative examples&#44; an Austrian hospital recorded an average of 60&#8211;65<span class="elsevierStyleHsp" style=""></span>dBA&#44; while a University Hospital in Valencia &#40;Spain&#41; recorded a level of 55<span class="elsevierStyleHsp" style=""></span>dBA&#46; In a Children&#39;s Hospital in Cincinnati &#40;USA&#41; the mean noise level was found to be 71&#46;9<span class="elsevierStyleHsp" style=""></span>dBA&#44; while in the ICU of the Hospital of Manitoba &#40;Canada&#41; the level was 68<span class="elsevierStyleHsp" style=""></span>dBA&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">12&#44;13</span></a> In adult ICUs &#40;AICUs&#41;&#44; the reported mean equivalent noise level &#40;LA<span class="elsevierStyleInf">eq</span>&#41; was 52&#8211;84<span class="elsevierStyleHsp" style=""></span>dBA&#44;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">14&#8211;16</span></a> while in pediatric ICUs &#40;PICUs&#41;&#44; the literature describes levels in the range of 48&#8211;72<span class="elsevierStyleHsp" style=""></span>dBA&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">17&#8211;20</span></a> Lastly&#44; the noise levels in neonatal ICUs &#40;NICUs&#41; are reported to range between 45 and 90<span class="elsevierStyleHsp" style=""></span>dBA&#46;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">11&#44;21&#8211;24</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The present study was carried out to assess the equivalent continuous noise levels in three ICUs of a hospital in the city of Santa Marta &#40;Colombia&#41;&#44; and to evaluate the existence of differences or similarities among the analyzed Units &#8211;taking into account the repercussions of excessive noise upon critical patients admitted to the ICU&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Material and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study setting</span><p id="par0030" class="elsevierStylePara elsevierViewall">The study was carried out in a university hospital in the city of Santa Marta &#40;Colombia&#41;&#44; with three general ICUs &#40;no differentiation being made according to disease type&#41; classified as AICU&#44; PICU and NICU&#46; The AICU cares for adults and young individuals over 15 years of age and has 19 beds with a mean occupation of 10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2 patients and an attending personnel of 7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3 professionals&#46; The PICU in turn cares for patients between 31 days and 14 years of age and has 7 beds with a mean occupation of 3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2 patients and an attending personnel of 5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1 professionals&#46; Lastly&#44; the NICU cares for newborn infants between 0 and 31 days of age and has 14 cribs with a mean occupation of 8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1 patients and an attending personnel of 4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0 professionals&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">25</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The ICUs operate in three shifts&#58; morning &#40;7&#58;00&#8211;13&#58;00<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; afternoon &#40;13&#58;00&#8211;19&#58;00<span class="elsevierStyleHsp" style=""></span>h&#41; and night &#40;19&#58;00&#8211;7&#58;00<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleSup">&#43;1</span>&#41;&#46; Two family visiting periods of 20<span class="elsevierStyleHsp" style=""></span>min each have been established&#58; at 11&#58;00<span class="elsevierStyleHsp" style=""></span>h and 17&#58;00<span class="elsevierStyleHsp" style=""></span>h&#46; In the NICU and PICU there are 8 feeding times per day at intervals of 3<span class="elsevierStyleHsp" style=""></span>h&#44; starting at 00&#58;00<span class="elsevierStyleHsp" style=""></span>h&#44; while the AICU has three feeding times&#58; at 8&#58;00<span class="elsevierStyleHsp" style=""></span>h&#44; 12&#58;00<span class="elsevierStyleHsp" style=""></span>h and 18&#58;00<span class="elsevierStyleHsp" style=""></span>h&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Each ICU is staffed by a specialized physician who conducts a round of the Unit three times a day&#46; In the AICU the rounds take place at 9&#58;00<span class="elsevierStyleHsp" style=""></span>h&#44; 14&#58;00<span class="elsevierStyleHsp" style=""></span>h and 20&#58;00<span class="elsevierStyleHsp" style=""></span>h&#44; while in the PICU and NICU they take place at 7&#58;15<span class="elsevierStyleHsp" style=""></span>h&#44; 14&#58;00<span class="elsevierStyleHsp" style=""></span>h and 20&#58;00<span class="elsevierStyleHsp" style=""></span>h&#46; In addition&#44; the general practitioners in each ICU conduct their rounds at the patient bedside at the times of change in shift&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The procedures carried out in each ICU vary according to the requirements of the general practitioner and&#47;or specialist&#44; with no specific scheduling of such procedures&#46; In effect&#44; the latter are carried out in the course of each shift as requested by the medical personnel&#46; The most common procedures are the collection of samples for laboratory tests&#44; electrocardiograms&#44; X-rays&#44; the placement of central venous catheters&#44; and interconsultation with the Ear&#44; Nose and Throat&#44; Nephrology and Urology Departments&#44; among others&#44; depending on the patient diagnosis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Sampling design</span><p id="par0050" class="elsevierStylePara elsevierViewall">The present study comprises an analytical&#44; observational and non-interventional design with follow-up over time&#46; It is therefore defined as an analytical study with non-longitudinal follow-up &#40;follow-up study&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Continuous sampling was carried out in each ICU during 20 days&#44; based on the methodology described by V&#233;lez-Pereira<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a>&#46; In the case of the AICU&#44; the measurement campaign took place between 19 August and 8 September 2012&#59; in the PICU it took place between 15 September and 5 October 2012&#59; and in the NICI it took place between 23 March and 12 April 2013&#46; The noise levels were recorded using a Casella type I sound level meter &#40;model CEL-633-C1K1&#41; programmed to record data every 60<span class="elsevierStyleHsp" style=""></span>s using filter frequency in A-weighting and Fast mode&#46; The recorded acoustic parameters included LA<span class="elsevierStyleInf">eq</span>&#44;<span class="elsevierStyleInf">1h</span> &#40;to establish the noise level in 1<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; percentile 90 &#40;LA<span class="elsevierStyleInf">90</span>&#44; to establish the background noise level&#41;&#44; and LA<span class="elsevierStyleInf">max</span> &#40;to establish the maximum values&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The sound level meter was positioned in each ICU considering the descriptions of V&#233;lez-Pereira&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a> the conditions and internal dynamics of the ICU&#44; and the authorizations and recommendations of the medical coordinators with the purpose of affecting the activities in the ICUs as little as possible&#46; In the AICU we established a distance of 55<span class="elsevierStyleHsp" style=""></span>cm from the ceiling and 123<span class="elsevierStyleHsp" style=""></span>cm from the wall&#59; in the PICU the distance was 55<span class="elsevierStyleHsp" style=""></span>cm from the ceiling and 540<span class="elsevierStyleHsp" style=""></span>cm from the wall&#59; and in the NICU the distance was 60<span class="elsevierStyleHsp" style=""></span>cm from the ceiling and 215<span class="elsevierStyleHsp" style=""></span>cm from the wall&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Data processing and statistical analyses</span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Equivalent continuous level</span><p id="par0065" class="elsevierStylePara elsevierViewall">Microsoft Excel<span class="elsevierStyleSup">&#174;</span> was used for noise data integration under 1-h intervals corresponding to the acoustic parameters investigated in each ICU &#40;LA<span class="elsevierStyleInf">eq</span>&#44; LA<span class="elsevierStyleInf">max</span> and LA<span class="elsevierStyleInf">90</span>&#41;&#46; This allowed us to analyze the variability associated to hourly or daily cycles in the course of the sampling time&#46; The integrated mean was obtained by applying Eq&#46; <a class="elsevierStyleCrossRef" href="#eq0005">&#40;1&#41;</a>&#58;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a><elsevierMultimedia ident="eq0005"></elsevierMultimedia>where <span class="elsevierStyleItalic">i</span> corresponds to observation of the A-weighted equivalent continuous level reported in the hourly interval <span class="elsevierStyleItalic">j</span>&#44; and n is the total number of observations <span class="elsevierStyleItalic">i</span> in the hour <span class="elsevierStyleItalic">j</span>&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Statistical analysis</span><p id="par0070" class="elsevierStylePara elsevierViewall">The statistical analysis was carried out with the IBM SPSS<span class="elsevierStyleSup">&#174;</span> version 20 statistical package&#44; using the hourly averages of each ICU&#46; Analysis of variance &#40;ANOVA&#41;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">2&#44;23&#44;26&#44;27</span></a> was used to identify statistically significant differences in the hourly averages&#46; In addition&#44; nested ANOVA was used to compare the three ICUs&#44; with a view to identifying statistically significant differences between the results obtained in the three units and determining which factor exerts the strongest impact upon variance &#40;hour and ICU&#41;&#46; Lastly&#44; and in order to establish the possible incidence of the Hawthorne effect among the healthcare personnel&#44; an ANOVA was performed of the first 5 days of sampling versus the remaining 15 days&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0075" class="elsevierStylePara elsevierViewall">On comparing the integrated mean hourly values of the three ICUs &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; the highest LA<span class="elsevierStyleInf">eq&#44;1h</span> values were seen to correspond to the PICU&#44; with a noise level variation range of 57&#46;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;07&#8211;65&#46;72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;46<span class="elsevierStyleHsp" style=""></span>dBA&#44; followed by the NICU&#44; with levels of 59&#46;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;41&#8211;65&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;77<span class="elsevierStyleHsp" style=""></span>dBA&#44; and the AICU&#44; with levels of 57&#46;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;14&#8211;63&#46;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;13<span class="elsevierStyleHsp" style=""></span>dBA&#46; This information was confirmed by performing an ANOVA of the data&#44; where a significant difference between ICUs was identified&#44; influenced mainly by the time variation in the course of the day&#44; with an <span class="elsevierStyleItalic">F</span>-ratio<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>116&#46;02 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;00 &#40;critical <span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; and 95&#37; significance level&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">In contrast to the above&#44; the three ICUs were found to exhibit similar trends with stable hourly levels between 07&#58;30<span class="elsevierStyleHsp" style=""></span>h and 17&#58;30<span class="elsevierStyleHsp" style=""></span>h&#44; approximately&#59; this was followed by a strong increase at 18&#58;30<span class="elsevierStyleHsp" style=""></span>h&#44; and from 19&#58;00<span class="elsevierStyleHsp" style=""></span>h onwards a decrease was noted in LA<span class="elsevierStyleInf">eq&#44;1h</span>&#44; extending until approximately 04&#58;30<span class="elsevierStyleHsp" style=""></span>h &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; This was corroborated by the ANOVA of the hourly noise averages&#44; with <span class="elsevierStyleItalic">F</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&#46;07 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000 &#40;critical <span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; yielding a significant difference between the hourly averages&#44; with a 95&#37; confidence level&#46; This information was evidenced by the generation of homogeneous groups as established from the cluster analysis applied to the hourly data of the ICU &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The analysis showed the values to be low in the early morning hours in the ICU &#40;1&#58;00&#8211;4&#58;00<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; with intermediate behavior in the late hours of the day &#40;20&#58;00&#8211;0&#58;00<span class="elsevierStyleHsp" style=""></span>h and 5&#58;00<span class="elsevierStyleHsp" style=""></span>h&#44; nocturnal&#41;&#44; and finally with the highest and most fluctuating noise values during the daytime &#40;6&#58;00&#8211;19&#58;00<span class="elsevierStyleHsp" style=""></span>h&#44; including morning and afternoon&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">On examining the maximum noise values in the ICUs&#44; we found the pattern to be the same as in the case of LA<span class="elsevierStyleInf">eq&#44;1h</span>&#8211;the PICU yielding the highest levels &#40;68&#46;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;57&#8211;79&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;34<span class="elsevierStyleHsp" style=""></span>dBA&#41;&#44; followed by the NICU &#40;67&#46;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;13&#8211;77&#46;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;74<span class="elsevierStyleHsp" style=""></span>dBA&#41; and finally the AICU &#40;71&#46;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;32&#8211;77&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;94<span class="elsevierStyleHsp" style=""></span>dBA&#41;&#46; However&#44; the values showed less variation than the integrated hourly noise data&#44; with the exception of the NICU&#44; which exhibited a greater range of variability than the other two ICUs&#44; particularly in the early hours of the day&#46; Regarding the ANOVA applied to the maximum noise levels&#44; the type of ICU and time of day were seen to influence variance of the levels&#44; with statistically significant differences &#40;95&#37; confidence level&#41;&#46; However&#44; the <span class="elsevierStyleItalic">F</span>-ratio of the hourly period &#40;32&#46;18&#41; was greater than the <span class="elsevierStyleItalic">F</span>-ratio as per Unit &#40;10&#46;89&#41;&#8211;thus indicating greater influence of the time of day upon the maximum noise levels in the ICU&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">On the other hand&#44; in relation to the results of the background noise&#44; the order was found to differ with respect to the previous two acoustic parameters&#44; being headed by the PICU &#40;53&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;54&#8211;61&#46;96<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;85<span class="elsevierStyleHsp" style=""></span>dBA&#41;&#44; followed by the AICU in this case &#40;53&#46;51<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;16&#8211;60&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;10<span class="elsevierStyleHsp" style=""></span>dBA&#41;&#44; and finally the NICU &#40;55&#46;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;03&#8211;58&#46;70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;95<span class="elsevierStyleHsp" style=""></span>dBA&#41;&#46; However&#44; as can be seen in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#44; there was greater similarity in the variation of LA<span class="elsevierStyleInf">eq&#44;1h</span> and LA<span class="elsevierStyleInf">90</span>&#44; these values being closely comparable among the three ICUs&#46; This situation was not observed in the case of the noise level &#40;LA<span class="elsevierStyleInf">eq&#44;1h</span>&#41; and maximum level &#40;LA<span class="elsevierStyleInf">max</span>&#41;&#46; On applying the ANOVA to the background noise data&#44; we again observed the influence of the Unit and time of day upon variation&#44; with a greater influence than in the case of LA<span class="elsevierStyleInf">max</span>&#44; though lower for LA<span class="elsevierStyleInf">eq&#44;1h</span>&#8211;with an <span class="elsevierStyleItalic">F</span>-ratio of 76&#46;04 for the parameter ICU&#44; and of 20&#46;22 in the case of the parameter time&#46; In both cases a significant difference was recorded&#44; with a 95&#37; confidence level&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">All this information was corroborated by the ANOVA applied to the parameters&#44; reflecting the interaction of the type of ICU and the time of day with the recorded noise levels&#46; In this regard&#44; the <span class="elsevierStyleItalic">F</span>-ratio for the interaction of the parameters was 1&#46;09 for LA<span class="elsevierStyleInf">eq&#44;1h</span>&#44; followed by 2&#46;19 for LA<span class="elsevierStyleInf">max</span> and 3&#46;33 for LA<span class="elsevierStyleInf">90</span>&#46; However&#44; only in the case of the LA<span class="elsevierStyleInf">max</span> values did the type of Unit fail to influence the variations&#44; while in the case of LA<span class="elsevierStyleInf">eq&#44;1h</span> and LA<span class="elsevierStyleInf">90</span> the influence in variation of the noise levels was 9&#46;22&#37; and 13&#46;49&#37;&#44; respectively&#46; In the case of the time of day&#44; LA<span class="elsevierStyleInf">max</span> was found to influence variance by 36&#46;16&#37;&#44; versus 27&#46;02&#37; in the case of LA<span class="elsevierStyleInf">eq&#44;1h</span>&#44; and 26&#46;10&#37; in the case of LA<span class="elsevierStyleInf">90</span>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Lastly&#44; the analysis carried out to determine the presence of the Hawthorne effect showed that only in the case of the PICU could minor modifications be inferred in the behavior of the healthcare personnel or changes in the medical teams in the first days of sampling&#44; since ANOVA only identified significant differences between the LA<span class="elsevierStyleInf">max</span> and LA<span class="elsevierStyleInf">90</span> values between the first 5 days versus the remaining 15 days &#40;with a 95&#37; level of significance&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">The analysis of the results obtained reflects the existence of important noise levels in all three ICUs&#46; This is consistent with the data found in the literature&#44; where noise increments have been recorded in ICUs&#44; increasing from 57<span class="elsevierStyleHsp" style=""></span>dBA in the daytime and 42<span class="elsevierStyleHsp" style=""></span>dBA during the nighttime hours in the year 1960 to 72<span class="elsevierStyleHsp" style=""></span>dBA in the daytime and 60<span class="elsevierStyleHsp" style=""></span>dBA during the nighttime hours in the year 2005&#46; This trend is mainly related to the increase in number of medical devices with acoustic alarms that serve as support for the medical activities in the ICU&#46; An additional contributing factor is the noise generated essentially by human factors&#44; including conversations among the personnel members&#44; visits by the families&#44; the falling of objects&#44; opening and closing of doors&#44; etc&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">9&#44;12&#44;28&#44;29</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">On considering the LA<span class="elsevierStyleInf">eq</span> values obtained and the noise levels contemplated by Resolution 8321 of 1983 of the Colombian Ministry of Health&#44;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">30</span></a> it is clear that none of the three ICUs yielded mean levels of under 45<span class="elsevierStyleHsp" style=""></span>dBA &#40;the limiting level for calm zones&#41; during the sampling period&#46; This situation is also observed in the literature&#44; where the noise limits are frequently seen to be exceeded in ICUs&#46;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">12&#44;31</span></a> These data are all the more serious considering that the background noise in the ICUs exceeded the maximum levels accepted by Colombian regulations and other international references&#8211; including the guidelines of the EPA &#40;45<span class="elsevierStyleHsp" style=""></span>dBA in the daytime and 35<span class="elsevierStyleHsp" style=""></span>dBA at night&#41;&#44; the National Institute of Occupational Health and Safety &#40;40<span class="elsevierStyleHsp" style=""></span>dBA in the daytime and 35<span class="elsevierStyleHsp" style=""></span>dBA at night&#41;&#44; Royal Decree 1386 of 1989 &#40;40<span class="elsevierStyleHsp" style=""></span>dBA in the daytime and 35<span class="elsevierStyleHsp" style=""></span>dBA at night&#41;&#44; the World Health Organization&#44; the American Academy of Pediatrics &#40;35<span class="elsevierStyleHsp" style=""></span>dBA in the daytime and 30<span class="elsevierStyleHsp" style=""></span>dBA at night&#41;&#44; and the Chinese Medical Association &#40;45<span class="elsevierStyleHsp" style=""></span>dBA in the morning hours&#44; 40<span class="elsevierStyleHsp" style=""></span>dBA in the afternoon&#44; and 20<span class="elsevierStyleHsp" style=""></span>dBA at night&#41;&#44; among others&#46;<a class="elsevierStyleCrossRefs" href="#bib0335"><span class="elsevierStyleSup">29&#44;32&#8211;35</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Our results show that the highest values of the different acoustic parameters are mainly recorded during the daytime&#44; in the course of medical controls&#44; visits by social workers&#44; nutritionists and epidemiologists&#44; and in the hours close to the changing of shifts in the case of the AICU and PICU&#46; In the case of the NICU&#44; we not only recorded this increase during the mentioned activities and at the changing of shifts&#44; but also observed a slight increase in noise levels every 3<span class="elsevierStyleHsp" style=""></span>h&#44; coinciding with feeding of the newborn infants &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; This is consistent with the observations of Gonz&#225;lez&#44;<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">36</span></a> Lawson et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">27</span></a> Knutson<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">37</span></a> and Konkani and Oakley&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">28</span></a> where the periods of greater noise in the ICU were correlated to the changing of shifts&#44; the collection of laboratory test samples&#44; visiting and feeding times&#44; and the presence of social workers&#44; nutritionists and physiotherapists&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">The literature shows that noise has an impact upon patient recovery&#46; A number of studies point to noise as one of the stressors underlying lack of sleep and physiological and psychological effects that prolong patient stay in the Unit&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">3&#44;38</span></a> Although the LA<span class="elsevierStyleInf">eq&#44;1h</span> values recorded in our three ICUs did not exceed 90<span class="elsevierStyleHsp" style=""></span>dBA &#40;levels above which hearing damage can occur&#41;&#44; they were above 65<span class="elsevierStyleHsp" style=""></span>dBA&#44; which is associated to effects upon the hypothalamic-adrenal gland system&#44; with alterations in heart rate and an increased risk of complications in adult patients&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">12</span></a> together with interruptions in the sleep periods that are important for patient recovery&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">3</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The results of the present study show that in relation to the maximum noise levels&#44; the duration of exposure to over 90<span class="elsevierStyleHsp" style=""></span>dBA was brief or inexistent &#40;only 0&#46;42&#37; of the time sampled in the PICU exceeded this level&#41;&#46; In the case of 65<span class="elsevierStyleHsp" style=""></span>dBA&#44; the PICU registered this level 33&#37; of the time &#40;equivalent to about 11<span class="elsevierStyleHsp" style=""></span>h a day&#41;&#44; followed by the NICU with 29&#37; &#40;equivalent to 9<span class="elsevierStyleHsp" style=""></span>h a day&#41; and the AICU with 4&#37; &#40;equivalent to 1<span class="elsevierStyleHsp" style=""></span>h a day&#41;&#46; This information evidences a risk of patient complications&#8211; a situation that is all the more critical on analyzing the time period in which the levels exceed the recommended references&#44; since the mean hourly noise values &#40;LA<span class="elsevierStyleInf">eq&#44;1h</span>&#41; exceeded the recommended limits in 100&#37; of the measured time&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">It is thus seen that the noise levels recorded in our ICUs could have an impact upon the physiological and psychological wellbeing of the patients&#44; fundamentally as a consequence of the effects described in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">8</span></a> The effects associated to noise are subjective and depend on the individual and disease condition involved&#46; It should be noted that the risk of hearing loss or damage is further increased in newborn infants due to the change in environment and their inherent biological vulnerability&#44; since these patients are removed from the safety of the mother to hostile surroundings that increase the risk of hearing alterations&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1&#44;9&#44;10</span></a> Nevertheless&#44; in order to establish the direct effects of noise&#44; studies are needed in which health professionals assess and monitor the patients during the period of time in which the noise levels are evaluated in the ICU&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Regarding the risk for the health professionals posed by high noise levels in the ICU&#44; the recorded levels fall well short of the 90<span class="elsevierStyleHsp" style=""></span>dBA established for an 8-h period of exposure to noise in the work place<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">30</span></a> &#40;AICU presenting 62<span class="elsevierStyleHsp" style=""></span>dBA on average&#44; PICU 66<span class="elsevierStyleHsp" style=""></span>dBA&#44; and NICU 64<span class="elsevierStyleHsp" style=""></span>dBA&#41;&#46; According to Garrido Galindo et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">7</span></a> the values recorded pose a moderate to high risk of directly or indirectly affecting emotions and physiological and psychological aspects of the medical and nursing personnel&#8211;resulting in the appearance of burnout syndrome&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conclusions</span><p id="par0140" class="elsevierStylePara elsevierViewall">The lowest LA<span class="elsevierStyleInf">eq&#44;1h</span> values corresponded to the AICU&#46; The values corresponding to the PICU and NICU were similar&#44; with only some differences during certain hourly intervals&#46; Considering the time at which different activities inherent to the Unit were carried out and the increase in noise levels observed in the figures&#44; a series of activities such as the changing of shifts&#44; visits and patient feeding were seen to exert a possible influence upon the noise levels in the ICU&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">From the statistical perspective&#44; ANOVA revealed the existence of statistically significant differences between the acoustic parameters in the ICUs&#8211;the time of day being the variable with the strongest influence upon the variations in noise level in the Unit&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Financial support</span><p id="par0150" class="elsevierStylePara elsevierViewall">This study was supported by a grant from the Departamento Administrativo de Ciencia&#44; Tecnolog&#237;a e Innovaci&#243;n-Colciencias through the Programa J&#243;venes Investigadores e Innovadores&#44; with co-funding from the Universidad del Magdalena&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the noise level in adult&#44; pediatric and neonatal intensive care units of a university hospital in the city of Santa Marta &#40;Colombia&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A descriptive&#44; observational&#44; non-interventional study with follow-up over time was carried out&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Materials and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Continuous sampling was conducted for 20 days for each unit using a type <span class="elsevierStyleSmallCaps">i</span> sound level meter&#44; filter frequency in A weighting and Fast mode&#46; We recorded the maximum values&#44; the 90th percentile as background noise&#44; and the continuous noise level&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The mean hourly levels in the adult unit varied between 57&#46;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;14 and 63&#46;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;13<span class="elsevierStyleHsp" style=""></span>dBA&#44; with a maximum between 71&#46;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;32 and 77&#46;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;94<span class="elsevierStyleHsp" style=""></span>dBA&#44; and a background noise between 53&#46;51<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;16 and 60&#46;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;10<span class="elsevierStyleHsp" style=""></span>dBA&#59; in the pediatric unit the mean hourly levels varied between 57&#46;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;07 and 65&#46;72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;46<span class="elsevierStyleHsp" style=""></span>dBA&#44; with a maximum of 68&#46;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;57&#8211;79&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;34<span class="elsevierStyleHsp" style=""></span>dBA&#44; and a background noise between 53&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;54 and 61&#46;96<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;85<span class="elsevierStyleHsp" style=""></span>dBA&#59; the neonatal unit in turn presented mean hourly values between 59&#46;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;41&#8211;65&#46;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;77<span class="elsevierStyleHsp" style=""></span>dBA&#44; with a maximum value between 67&#46;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;13 and 77&#46;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#46;74<span class="elsevierStyleHsp" style=""></span>dBA&#44; and a background noise between 55&#46;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#46;03 and 58&#46;70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#46;95<span class="elsevierStyleHsp" style=""></span>dBA&#46; Analysis of variance revealed a significant difference between the hourly values and between the different units&#44; with the time of day exhibiting a greater influence&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The type of unit affects the noise levels in intensive care units&#44; the pediatric unit showing the highest values and the adult unit the lowest values&#46; However&#44; the parameter exerting the greatest influence upon noise level is the time of day&#44; with higher levels in the morning and evening&#44; and lower levels at night and in the early morning&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Evaluar el nivel de ruido en las unidades de cuidado intensivo adulto&#44; pedi&#225;trico y neonatal de un hospital universitario de la ciudad de Santa Marta &#40;Colombia&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Dise&#241;o</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo&#44; observacional no intervencionista y con seguimiento a lo largo del tiempo&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Materiales y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un muestreo continuo durante 20 d&#237;as por cada unidad utilizando un son&#243;metro tipo <span class="elsevierStyleSmallCaps">i</span>&#44; con filtro de ponderaci&#243;n frecuencial A y temporal Fast&#46; Se registraron los valores m&#225;ximos&#44; el percentil 90 como ruido de fondo y el nivel continuo de ruido&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Los niveles medios horarios variaron entre 57&#44;40<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;14-63&#44;47<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;13<span class="elsevierStyleHsp" style=""></span>dBA para la unidad de adultos&#44; con un m&#225;ximo entre 71&#44;55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;32-77&#44;22<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;94<span class="elsevierStyleHsp" style=""></span>dBA y un ruido de fondo entre 53&#44;51<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;16-60&#44;26<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;10<span class="elsevierStyleHsp" style=""></span>dBA&#59; para la unidad pedi&#225;trica la media horaria se establece entre 57&#44;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;07-65&#44;72<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;46<span class="elsevierStyleHsp" style=""></span>dBA&#44; con un m&#225;ximo de 68&#44;69<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;57-79&#44;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;34<span class="elsevierStyleHsp" style=""></span>dBA&#44; y de 53&#44;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;54-61&#44;96<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;85<span class="elsevierStyleHsp" style=""></span>dBA de ruido de fondo&#59; finalmente&#44; la unidad neonatal reporta entre 59&#44;54<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;41-65&#44;33<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;77<span class="elsevierStyleHsp" style=""></span>dBA la media horaria&#44; los m&#225;ximos entre 67&#44;20<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;13-77&#44;65<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;74<span class="elsevierStyleHsp" style=""></span>dBA&#44; y fondo de 55&#44;02<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;03-58&#44;70<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;95<span class="elsevierStyleHsp" style=""></span>dBA&#46; El ANOVA evidenci&#243; una diferencia significativa entre los valores horarios y entre las unidades de cuidado intensivo&#44; mostrando una mayor influencia la hora del d&#237;a&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Los niveles de ruido en las unidades de cuidado intensivo se ven afectados por el tipo de unidad&#59; se presentaron los valores m&#225;s altos en la unidad pedi&#225;trica y los m&#225;s bajos en la de adultos&#46; No obstante&#44; el par&#225;metro que m&#225;s influye en el nivel es la hora del d&#237;a&#44; con mayores niveles en la ma&#241;ana y la tarde&#44; y menores en la noche y la madrugada&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Dise&#241;o"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Materiales y m&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0050"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Garrido Galindo AP&#44; Camargo Caicedo Y&#44; V&#233;lez-Pereira AM&#46; Nivel de ruido en unidades de cuidado intensivo de un hospital p&#250;blico universitario en Santa Marta &#40;Colombia&#41;&#46; Med Intensiva&#46; 2016&#59;40&#58;403&#8211;410&#46;</p>"
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Hourly averages of the acoustic parameters&#46; &#40;a&#41; Adult intensive care unit&#46; &#40;b&#41; Pediatric intensive care unit&#46; &#40;c&#41; Neonatal intensive care unit of the hospital&#46; dBA&#58; decibels A&#59; LA<span class="elsevierStyleInf">eq</span>&#58; equivalent noise level&#59; LA<span class="elsevierStyleInf">max</span>&#58; maximum noise level&#59; LA<span class="elsevierStyleInf">90</span>&#58; noise level below which 90&#37; of the measurements are found&#46;</p>"
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      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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            "imagen" => "gr2.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Cluster plot or homogeneous groups of noise levels in the intensive care units based on the nearest neighbor approach &#40;Euclidian metric distance&#41;&#46; AICU&#58; adult intensive care unit&#59; NICU&#58; neonatal intensive care unit&#59; PICU&#58; pediatric intensive care unit&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Hourly averages of the noise levels contrasted with the times of day and routine activities in the intensive care unit&#46; AICU&#58; adult intensive care unit&#59; NICU&#58; neonatal intensive care unit&#59; PICU&#58; pediatric intensive care unit&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">LA<span class="elsevierStyleInf">eq&#44;1h</span> &#40;dBA&#41;&#58; 1<span class="elsevierStyleHsp" style=""></span>h equivalent noise level in decibels A&#59; AICU&#58; adult intensive care unit&#59; NICU&#58; neonatal intensive care unit&#59; PICU&#58; pediatric intensive care unit&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td-with-role" title="table-head ; entry_with_role_rowhead " align="left" valign="top" scope="col">Shift&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">Time&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col">AICU</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col">PICU</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col">NICU</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LA<span class="elsevierStyleInf">eq&#44;1h</span> &#40;dBA&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LA<span class="elsevierStyleInf">eq&#44;1h</span> &#40;dBA&#41;</th><th class="td" title="table-head  " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">LA<span class="elsevierStyleInf">eq&#44;1h</span> &#40;dBA&#41;</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="6" align="left" valign="top">Morning</td><td class="td" title="table-entry  " align="left" valign="top">7&#58;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">8&#58;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9&#58;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#46;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10&#58;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">11&#58;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">12&#58;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;62&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="6" align="left" valign="top">Afternoon</td><td class="td" title="table-entry  " align="left" valign="top">13&#58;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">62&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">14&#58;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">15&#58;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&#46;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">16&#58;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">17&#58;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">64&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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Article information

ISSN: 21735727
Original language: English

DOI:10.1016/j.medine.2015.11.004

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2019 December	66	31	97
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2019 August	54	18	72
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2018 April	26	10	36
2018 March	27	9	36
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2017 July	46	18	64
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