Many sounds are present in hospital environments, including those from beepers, alarms, machines, rolling carts, and conversations, among other sources. These can be severely irritating and at times harmful to patients, depending on their current conditions (i.e., age, hearing ability, medication intake, cultural background, and pre-existing fears and anxieties).1,2 Acoustics in healthcare environments are complex and require a careful, strategic design. Specific acoustical considerations in healthcare settings include supporting patient wellbeing and privacy; supporting communication among staff; and meeting standards and regulation. In recent years, these issues have received much attention. Acoustics are now a key component of healthcare design guidelines; many studies identifying design strategies to improve acoustical conditions in healthcare environments have been conducted; and medical facilities have taken initiatives to improve their acoustic environments
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Creating a comfortable acoustic environment in healthcare environments can play an important role in supporting safety, health, healing, and well-being for all occupants. Additionally, maintaining speech privacy in healthcare settings helps reduce medical errors
as it supports open conversations among patients, families, and staff and influences patient well-being. If patients are not confident that they have complete privacy, they may hesitate to provide complete information about their medical conditions and/or concerns, potentially putting their health at greater risk.
Poor acoustical conditions my have a negative impact on patents’s physiological health and increase their chances of being readmitted to the hospital. Acoustics can also impact perceptions of privacy, comfort, safety, and security for patients and their families. Consider the following examples of how the acoustic environment can impact the physiological and psychological well-being of patients and their families in healthcare settings:
Findings from research on the impact of noise on PCTs have varied. They imply that while PCTs may be able to perform tasks in an environment with a high level of noise, they may have to exert more effort to do so, in turn causing more fatigue. When inadequate acoustic conditions exist, poor psychosocial conditions can occur even for highly-trained and educated PCTs that are prepared to handle stressful conditions.
Speech intelligibility is very important to PCTs in healthcare environments. PCTs need to be able to understand and quickly respond to the many types of auditory signals (e.g., conversations, medical equipment, alarms) in hospital settings. Speech recognition systems often used in healthcare environments rely heavily on appropriate speech signals to operate and all building occupants rely on clear speech intelligibility to understand foreign languages, accents, and varying speech patterns.6 When speech intelligibility is not fully addressed, it may negatively impact patient care and safety.
After acoustical ceiling panels replaced the existing sound reflective ceiling tiles in the main work area and patient rooms in a Swedish hospital, nurses reported lower work demands and less pressure and strain during their afternoon shift (the noisiest shift studied).
Sound can be transmitted to a person’s ear directly from a source (i.e., direct sound), after reflecting off of one or more surfaces (i.e., reflected sound), after passing through a shared, solid, structural component like a wall or ceiling (i.e., transmitted sound), or after bending over and around partitions (i.e., diffracted sound). Architectural design strategies such as placing staff rest areas away from noise sources, and acoustical environment decisions such as specifying quieter alarms and machines can help reduce noise levels in hospitals.
Background noise levels should meet the criteria set by established standard and should be identified at the onset of a project.
Background noise levels should meet the criteria set by established standards and should be identified at the onset of a project. Certain specialized healthcare environments (e.g., spaces where audiometric testing is conducted, sleep disorder clinics) require minimal background noise and distractions.
Acoustic standards are frequently updated to include the newest, most accurate measurement methods. Current standards should always be consulted and spaces should be designed to meet them. Some of the most common measurement methods used in the healthcare design industry are introduced below.
no speech privacy, meaning that all conversations in the space will be clearly intelligible outside of the space.
The acoustic environment is an important consideration at every stage of the design process, but also needs to be considered in the context of other important factors (e.g., lighting, hygiene, temperature).
Understand that many of the design strategies used for infection control in healthcare environments can have a negative effect on the acoustic environment if not carefully considered. For example, hard surfaces are often specified for their cleanability but these surfaces often reflect sound, creating reverberation. Also, high efficiency filtration systems are often required in healthcare systems, but these surfaces require more fan horsepower and create more noise than other systems.
Employ an acoustical engineer at the early stages of the design process for healthcare facilities and regularly consult with this engineer through the post-construction stages to assist with mechanical system design, equipment and building construction specifications, and acoustical testing.
It is important to ensure that the acoustical consultant is asked to assess speech privacy and speech intelligibility in healthcare settings using proven test methods.
Space planning can have a significant impact on the acoustic environment. Determining what spaces will be adjacent to each other and how the space should be laid out takes careful consideration of how specific areas are going to be used, the level of privacy that is needed, and the desired background noise level, among other factors. Consider the following design considerations for space planning:
Decentralize nurses’ station as this may minimize corridor traffic, in turn reducing noise generation and allowing nurses to see and hear their patients more effectively.
Create separate, acoustically private spaces for families of patients to gather to reduce noise levels elsewhere in the hospital. Include private meeting rooms for patients, relatives, and healthcare professionals to provide privacy and improve communication between these groups.
Close off nursing and chart stations in intensive, postoperative areas.
Create single-bed (as opposed to multi-bed) patient rooms as they are associated with several positive outcomes including reducing the number of hospital-acquired infections; improving patient sleep and privacy; facilitating better communication with parents and families; improving perceptions of social support; decreasing stress for staff; and improving patient satisfaction. Advocating for single-patient rooms in hospitals (during new construction, expansion, or renovation projects) demonstrates a commitment to meeting patients’ privacy, safety, and dignity needs.
Space planning alone will not result in an adequate acoustic environment. Walls, floors, and ceilings should also be designed to support privacy and minimize noise transmission. Materials and finishes selected for ceilings, walls, and flooring can greatly impact the acoustic environment. Research suggests that using noise-reducing finishes in healthcare settings positively impacts patients’ sleep, privacy, satisfaction, and PCT stress.
However, safety issues, namely smoke, flammability, and cleanliness standards, should also be considered when specifying acoustical materials.
When designing for acoustical privacy it is important to include the composite action of all adjacent building components. The composite sound performance of walls, ceilings, doors and floors will greatly impact the overall sound performance. The combination of individual components’ acoustical performance and installation details will alter the overall performance. The acoustical design properties of some common materials and finishes in healthcare environments are discussed in this section.
Acoustical ceiling panel systems can reduce reverberation times and increase speech intelligibility, potentially improving the psychosocial work environment for PCTs. Selecting the appropriate ceiling for spaces in healthcare environments is important in creating the appropriate speech privacy level.
Oftentimes, different ceilings are needed in different areas. When selecting a ceiling, consider to what degree noises need to be absorbed, blocked, and/or covered (i.e., masked). Consider the following when specifying ceilings in healthcare environments:
When space and logistical considerations permit, incorporate a suspended acoustical ceiling system with sound-absorbing ceiling tiles to promote a satisfactory acoustic environment. When this is not possible or feasible, consider mounting sound absorbing panels directly onto the ceiling and upper walls, as this may still provide significant noise reduction.
Wall construction and surface materials are important for creating an appropriate acoustic environment. Controlling flanking noise from negating the intended performance of any wall assembly is of key importance. Any breaches in a partition will result in a significant drop of acoustical performance.
Consider the following when determining wall construction and specifying wall materials:
Identify details that may have negative impacts on the sound isolation performance of a wall such as back-to-back outlet placement, lowered wall heights, air gaps, wall openings for services, and direct duct runs.4,
For example, a one square inch hole in a 60 STC partition will drop its performance down to a 41 STC.28 .This crack can easily occur at wall-to-wall intersections as well as wall to ceiling interfaces. Another important concept of flanking: where two acoustical partitions meet, it is important to make sure that no gypsum panel membrane is continuous throughout the intersection.
Specify fabric-wrapped wall panels in non-clinical areas of a hospital where regular cleaning is not required, as they are from common activities in healthcare environments, especially in large areas where noise tends to build up more effective and less costly than panels that are encapsulated in film.
It is possible to reduce impact noise generated by footfalls and rolling carts by specifying appropriate flooring materials and finishes. Consider the following when specifying flooring in healthcare environments:
Mechanical equipment noise enters spaces through interior partitions and the façade of the building, through ventilation ducts, and as a result of vibration from mechanical equipment. Mitigating the impact of each requires specific design solutions. To address noise issues related to mechanical systems, consult HVAC engineers and consider the following:
Speech privacy needs should be assessed in spaces in healthcare facilities where patient information is shared (e.g., consultation counters, pharmacies) to assure that privacy and/or confidentiality are provided for patients, families, and PCTs.
Both the background noise level and the noise reduction created by barriers and soundabsorbing finishes need to be considered when addressing speech privacy issues in healthcare settings.
Although normal speech privacy (i.e., PI between 80% and 90%) is sufficient in most commercial settings, many patient areas in healthcare facilities require a confidential level of speech privacy. When an absolute secure level of speech privacy is required, analysis of the way the space is used, the level and amount of spoken communication anticipated how the space is constructed, and the anticipated background noise level all need to be considered.
Adequate speech privacy can be accomplished in open and enclosed spaces through the provision of single-occupancy patient rooms, private discussion areas, effective space planning, appropriate partition placement, room finish
Specification, and sound masking system selection. Consider the following when designing to support privacy and confidentiality in healthcare settings.
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