Health care teams in operating rooms (ORs) handle high-risk, complex tasks, which require absolute concentration and effective, clear communication between team members. Given the complexities of most ORs, with medical instrumentation and the number of team members present in the room, noise is inescapable.
Noise can serve as a distraction, potentially affecting patient safety. The Joint Commission recently tackled this topic in its August issue of Quick Safety, “Minimizing noise and distractions in the OR and procedural units.”1
High noise levels can lead to the following:
- Ineffective communication
- Diminished signal and speech intelligibility
- Poor performance of complex tasks
- Poor cognitive function and concentration
- Stress, fatigue, and anxiety2-5
The most commonly cited distractions in the OR are conversations unrelated to the procedure or case, telephone calls, pagers, and music.
According to the Environmental Protection Agency, the recommended level for continuous background noise in hospitals is 45 decibels (dB), but a study measuring noise levels during OR trauma procedures found an average noise level of approximately 85dB—ranging from 40dB to 130dB.2,6
Orthopaedic surgery and neurosurgery procedures were listed among those with higher sustained continuous background noise levels with intermittent peak levels exceeding 100dB more than 40 percent of the time.2
Recommended preventive actions
The Quick Safety issue recommends actions that can be taken to address noise levels in the OR, such as the following:2-4
- Create a “no-interruption zone”—also known as a “sterile cockpit”— during critical phases of a procedure, prohibiting nonessential conversation and activities.
- Measure noise levels within the OR to provide evidence for noise-reduction strategies, empirical data reflecting efficacy of such strategies, as well as real-time information to the OR team as to when noise levels exceed recommended levels.
- Educate staff on sources of noise, their impact on patient and staff safety, and noise reduction strategies.
- Consider equipment alternatives that produce less noise.
- Evaluate the physical environment and implement means for attenuating noise. For example, minimize dropping instruments into instrument trays.
- Add simulation and training to enhance focused attention skills in the presence of continuous and intermittent noise and distractions.
- Consider simulation training to model strategies for reducing noise (such as equipment use, communication techniques, and speaking up to reduce noise).
The newsletter also recommends actions that can be taken to support decreased noise in the work environment, such as the following:7
- Foster a safety culture in which staff feel empowered and comfortable speaking up and asking for silence.
- Establish a code of conduct to minimize noise and distraction (for example, policies regarding entering/leaving room, unnecessary conversation, use of phones and pagers, use of music, and so on).
- Consult staff to understand resource needs for cellphones, pagers, and tablets, and establish policies around them. Minimize tones that are similar to monitors and alarms within the OR.
- Practice effective team communication strategies to ensure the receiver has heard and understood what has been said.
The Quick Safety issue also provides details on studies pertaining to noise levels and consequences during the anesthesia period, as well as hernia repairs.
The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.
- The Joint Commission. Minimizing noise and distractions in the OR and procedural units. Quick Safety, Issue 35. August 2017. Available at: www.jointcommission.org/assets/1/23/Quick_Safety_Issue_35_2017_Noise_in_OR_FINAL.pdf. Accessed August 24, 2017.
- Association of periOperative Registered Nurses. AORN position statement on managing distractions and noise during perioperative patient care. AORN J. 2014;99(1):22-26.
- Hogan L, Harvey RL. Creating a culture of safety by reducing noise levels in the OR. AORN J. 2015;102(4):e1-7.
- McNeer RR, Bennett CL, Dudaryk R. Intraoperative noise increases perceived task load and fatigue in anesthesiology residents: A simulation-based study. Anesth Analg. 2016;122(2):512-525.
- Keller S, Tschan F, Beldi G, Kurmann A, Candinas D, Semmer NK. Noise peaks influence communication in the operating room: An observational study. Ergonomics. 2016;59(12):1541-1552.
- Pereira BM, Pereira AM, Correia Cdos S, Marttos AC Jr, Fiorelli RK, Fraga GP. Interruptions and distractions in the trauma operating room: Understanding the threat of human error. Rev Col Bras Cir. 2011;38(5):292-298.
- Persoon MC, Broos HJ, Witjes JA, Hendrikx AJ, Scherpbier AJ. The effect of distractions in the operating room during endourological procedures. Surg Endosc. 2011;25(2):437-443.