Better sound environments for doctors and nurses in the Czech Republic

One of our editors in the Czech Republic (CZ), Iveta Kralova, was recently part of an intervention study to create better sound in an eye clinic in Hradec Kralove. Here follows her experience in a country where acoustic standards for healthcare are lacking and where a lot of buildings are too loud to heal.

Many studies have already shown the impact of sound on human behavior and productivity. Noise pollution has become a worldwide threat that negatively affects people´s health including psychical comfort. Although healthcare facilities provide care and take care of our health, often they do not meet the needs of patients and staff concerning the sound environment.

I visited the senior consultant Mr. Daniel Horecky and the nurses at The Eye Clinic for the first time in the Summer of 2020. We talked about noise levels, echoes, and reasons for the long reverberation times. We also discussed the influence of noise on staff tiredness, and nervousness and I introduced possible ideas to improve the sound comfort in rooms. They listened to me with a certain level of distrust…… I am used to it.  //Iveta Kralova

We cannot leave the responsibility of good room acoustics to the end-users – the buildings should be constructed to support healthcare activities already when they are ready for usage.

Better sound or Noise pollution

The population in the CZ is increasingly exposed to noise pollution. Noise has become part of both life outdoors and indoors and uncomfortable sound environments are almost a tradition in hospitals. It should be mentioned that both staff and patients in CZ often express that ‘this is just the way it is because they rarely can make comparisons (to another experience).

There are even small rooms inside hospitals where detrimental sound reflections can occur and poor room acoustics are not just part of the reality in large rooms. A sound field is influenced by many factors. Often, we are still not educated enough to be aware of it – or we are not interested in the topic because acoustics is simply elusive.

Hygienic requirements first

The choice of suitable building material is crucial in healthcare. Hygienic demands are placed before all other aspects – and for a good reason. Infection control saves lives! Therefore, it is necessary to use only materials which are cleanable, robust, and have a hard surface.  Unfortunately, the sound-reflective hard surfaces often challenge acoustic comfort.

As we know, sound is energy that spreads inside a space in different directions and bounces off hard surfaces when there isn’t any absorbing material crossing the energy path, the sound energy builds up and stays in the room for a long time, and creates unpleasant and unsupportive echoes and the noise levels accelerate.

Iva Pospíšilová, the head nurse of The Eye Clinic in Hradec Králové, describes the situation before a treatment:

 In the operating room, we perform regular disinfection of the walls including the ceiling. We struggled with the panels before. They were not firmly fixed, so they moved and lifted in different ways. 

 Courage paid off

When building hospitals and other medical facilities in CZ, the usual procedures are followed, but they don’t always correspond to the real demands of a healthy indoor environment. It is often a misconception that the facilities must be built in the same way that has been done for decades due to the high hygienic demands. We need to think more about our mental balance and care about interior acoustics which act on our mental health.

The management of The Eye Clinic finally agreed to be part of the study because they wanted to create better working conditions for the staff.  When they got more knowledge about how sound affects people, they were thrilled and full of expectations. Finally, when the altered acoustics were done, the new sound environment was a big surprise for them!

Description of the operating room

The operating room has an area of 26m2. The activities are both full eye surgeries and minor adjustments/eye corrections. The special equipment includes microscopes, stainless steel tables, chairs, monitors, and other technologies and necessary aids. There are usually 3-4 people present during surgery in the operating room.

Originally, the room was treated by ceiling panels which were capable to absorb only 10% of incoming sound energy.

 Measurement of room acoustics parameters

Several acoustic parameters were investigated – both reverberation time, STI, and general sound pressure levels.

Reverberation time decreased after the treatment, as expected. The RT curve is within the tolerance range after installing a new ceiling with a higher classification according to ISO 11654 – see the graph.

It is also worth having a look at the decrease in the sound pressure level. After installing the new ceiling, the SPL decreased by 3.1 dB.

Do we need to understand each other?

An exchange of information is crucial for surgeries. It is not safe to miss the information which can lead to mistakes. Therefore, speech intelligibility is very important and should always be prioritized as much as reverberation time and sound pressure level (probably even higher in healthcare facilities?).

 

Even though speech intelligibility is not defined in the Czech standards for healthcare facilities, measurements were performed. The STI values before the treatment changed remarkably after installing the new acoustic ceiling and the values went to equal to ‘good’ and even ‘excellent’.

Better sound – reaction to the change

 During the first operating procedure after the renovation of the ceiling, I immediately noticed a change for a better in terms of sound absorption and resonance, which was significantly reduced. Due to the fact we play music in there, I can say it has a softer sound and doesn´t resonate. //MUDr. Daniel Horecký

Watch this video and learn more about the intervention here: