San Diego—When it comes to safety in the operating room, critical care pharmacists often focus on the “stat” medications used by the surgical team as a way to ensure patient safety. But a new sudy suggests that noise in the OR frequently exceeds guidelines set by various workplace and patient safety organizations. Thus, it may be time to suggest that your facility take steps to take the volume down a few notches.

The study, from the University of Kentucky (UK), found that nearly 90% of anesthesiologists, and an even greater share of nurses, reported having trouble hearing in the OR.

“We have established enough evidence and data here at the University of Kentucky to state that the noise level does, in fact, exceed health regulatory guidelines, and that most OR staff do perceive that elevated noise levels may have a negative impact on communication and, therefore, on performance,” said Rosalind Ritchie, MD, who presented the findings at the 2013 annual meeting of the Society for Ambulatory Anesthesia (abstract 37).

Many groups have issued guidance on health levels of noise in hospitals, including the Occupational Safety and Health Administration, the Joint Commission, the World Health Organization and the National Institute for Occupational Safety and Health. But these evidently are not closely observed.

In her role as medical director of the Center for Advanced Surgery at UK Healthcare, in Lexington, Dr. Ritchie, an assistant professor of anesthesia, received a patient comment regarding the noise level in the OR, which prompted her to survey surgical staff to determine their level of comfort with the noise, and whether OR noise ever interfered with their ability to perform their jobs effectively. She also measured noise levels in the OR at critical times during a variety of operations.

Perceptions of noise levels may vary by the different roles individuals play in the surgery, Dr. Ritchie explained, and their location in the OR relative to other team members. Of those who responded to the survey, 88% of anesthesiologists and 92% of nurses reported difficulty hearing in the OR—far more than the 35% of surgeons who reported trouble hearing. Similarly, 53.5% of anesthesiologists and 46.2% of nurses compared with 4.3% of surgeons reported that OR noise levels were too high in general.

Noise in the OR also has implications for patient safety, Dr. Ritchie said. “When you add multiple contributing factors such as beepers, cell phones, overheard pages, monitors and music, conversations and instruments, the ability to communicate effectively becomes impaired—critical communications about the patient’s care may be heard incorrectly or not heard at all.” OR staff in her survey stated that they had misheard comments ranging from requests about the positioning of a bed or table to the type and dose of local anesthetic.

“It is my experience that the OR is way too loud, and communication between health care practitioners is handicapped by the noise level,” said Edward Nemergut, MD, an associate professor of anesthesiology and neurosurgery at the University of Virginia Health System, in Charlottesville. “When communication is adversely affected, patient care can suffer.”

Dr. Nemergut moderated a session on patient safety at the recent International Anesthesia Research Society meeting, where Dr. Ritchie’s abstract also was named best in category.

To combat excessive noise levels and increase awareness, Dr. Ritchie and her colleagues have implemented a number of interventions at UK Healthcare. They now have tracking lights in the entrance hallway to the operating suites that change from green to yellow to red when noise levels reach preset decibel limits, and signs posted in the OR remind staff that noise should be kept to a minimum during critical points in surgery. She noted that UK Healthcare also has implemented educational programs and formed a task force to help ensure that the OR environment is optimal for all OR team members.

Dr. Ritchie urges her colleagues around the country to look critically at OR noise levels in their institutions. “I am most confident that this is a growing national problem. I have discussed this with many of my colleagues, and many have indicated that they too perceived noise levels in the operating suite as a growing hazard to patient safety and personnel health. I think guidelines should be instituted by an executive level committee at each hospital.”