SILENCE Chris McElroy, Altro Specification Consulta

Much time and effort have been devoted, in recent years, to enhancing the wellbeing of patients and staff by updating hospital air conditioning and rethinking interior design. Despite these improvements, however, hospitals continue to be affected adversely by growing problems with excess noise.

Researchers at John Hopkins University identified that average daytime sound pressure levels in hospitals increased from 57dB in 1960 to 70 dB in 2006, with a rise in average night time levels from 42dB to 60dB. These levels have exceeded World Health Organisation guidelines for a good night’s sleep (up to 30dB background noise, with no peaks over 45dB) for many years, and continue to worsen. The researchers describe the problem as ‘universal’, affecting hospitals irrespective of their design, architecture and clinical activities.

These levels of noise have a significant impact, of course, on patient recovery times, quality of care, and staff wellbeing. Noise is typically responsible for poor sleep quality in patients, affecting the patient’s ability to rest, heal and recover, and has been linked to ICU psychosis, hospitalisation-induced stress, increased pain sensitivity, high blood pressure and poor mental health – increasing pressure on the NHS.

Excess noise is also associated with elevated levels of stress among staff, affecting performance and wellbeing, compromising caring behaviour, and contributing to burnout. Research by Heriot Watt University also states that additional workplace pressures placed on staff by excess noise, and the accompanying negative impacts on speech intelligibility, can


be linked with an increase in medical errors, making acoustic performance a potential factor in clinical outcomes in acute treatment areas, and hospital sites as a whole.

Acoustic performance is, of course, taken into consideration when designing new hospital buildings, and there are guidelines to ensure standards are maintained. In the UK, the overall requirements are outlined in the Health Building Note 00-01: General Design guidance for healthcare buildings. This document should to be consulted alongside the Department of Health Technical Memorandum 08-01: Acoustics, which explains the requirements in greater detail. It states, for example, that washable, acoustically-absorbent materials may be required in some areas to support the hospital’s infection- control regime. It requires that impact sound is controlled at source, advising that internal planning of buildings should ensure that heavily-trafficked corridors are not placed near wards. A weighted standardised impact sound pressure level (L' nT,w) of 65dB is considered a reasonable maximum value for floors over noise-sensitive areas. It also recommends that individual areas may require additional sound reduction (for example, floors over multi-sensory rooms).

NOISE REDUCTION SOLUTIONS Whilst recently-constructed hospitals may have been designed to comply with these guidelines, many health estates managers are faced with the need to tackle problems of excess noise in older hospital buildings, requiring improvements in acoustic performance without alteration to the fabric of the building. There are noise reduction solutions,

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