Noise and stimuli reduction in your NICU?

  1. Reading Anaclaire's post in another thread, and an article in the newest Network issue, made me wonder: What do you/does your facility do to reduce noise and environmental stimuli in the unit? Do any of you have carpeted floors, and if so, are there cleanliness issues? I noticed that this was recommended in the journal, but I've never before heard of carpet in a nursing unit. How often is it cleaned, etc? Do you have padded trashcans? What are they padded with? Do you have mandatory 'quiet' times, or are they random? Dimming lights? Isolette covers? Earmuffs for the babies? Anything you wish to share. ;>)

    Our unit has a problem with this. We have tiled floors (white- who thought of THAT???) that look dirty as soon as they're cleaned. We have mini-blinds on the windows for light filtering, and we use blankets to drape over the cribs/Isolettes for light filtering as well. No dimming lights but you can turn some lights off. Florescent lighting. No muffs. People, no matter what you say or do, tend to get loud at times, especially during shift change, with rounds held at bedside for each baby. We do try, but when you work in a place that refuses to back up your suggestions you're left with few options and have to get creative. Anyone else?
    •  
  2. 9 Comments

  3. by   Heather333
    We are a smaller unit (22 bed Level III) but our unit is set up into pods. Each pod has max of 4-5 babies. Lighting is turned off most of the time (ie except shift change, during procedures) and all isolettes have covers; unless under photo. Our unit was the first in the US to use the Drager system. All equpiment, monitors, and outlets for O2, med air, suction are contained in moveable towers. That way we can move equipment to the baby instead of moving the baby to the equipment.

    We strive to create a neuordevelopmentally friendly environment. Noise, lights and stimuli are kept to a minimum. We have very few kids that end up with IVH's. We have a locked unit so there is not a lot of traffic. We have tile but no carpeting.

    I don't know what your policy is, but our micropreemies are admitted either directly to our Giraffe isolettes or are into an isolette once they are stablized. I think leaving the micro's on a warmer for God knows how long is cruel. That is just setting up for all kinds of problems.

    It is hard to change things when no one wants them changed. At least when you are working, make the most effort to keep your babies from being over stimulated. Even if you have to be a "B" about it.

    Heather
  4. by   dawngloves
    I workd a tele unit that had carpeting in the private rooms. YUCK! YUCK! YUCK! They were SO gross and had to be cleaned after a pt in isolation was d/c. Not to mention the guy with the ruptured varicies, what he did to the carpet!
    Ou trash cans are a bone of contention with me. People just toss bottles in them and BANG!And the big mouths!! GAH!!!
    We now only cover isolettes at night or on unstable babies. Director saw a study that cycled light is best for growth.
  5. by   NicuGal
    We vetoed the carpet...can even imagine that...HAL, puke, whatever else on it EWWWWW! We have tiled floors, light diffusing blinds on the side of the unit with windows. We have dimming lights and doors that close to the outside corridors.

    We use muffs on the big sick kids that are on warmers, the little ones we will a lot of the time either cover their head with a washcloth or cut a blanket and snuggle it around their head to cover their ears. We put quilts on the top of the beds (our volunteers make them ). No writing on the isolette, no finger tapping, no draping yourself over them LOL .

    No padded trashcans...the hospital ID people said that they could grow things.

    We do nursing shift change at the bedside, but if it is a really unstable kid we will step away from the bed. We tend to get loud too, but that is women for ya! LOL.

    With our bigger chronics, we place them on the side with windows and we have "day and night" for them. Otherwise, we are pretty dim most of the time.
  6. by   prmenrs
    There are a lot of approaches to reducing stimuli in NICUs. The 1st step is getting every one to work together--starting w/the docs and nurse managers. Leadership begins @ the top, management has to believe the info that is out there about the benefits of humane treatment of sick infants, and then be committed to changing the practice in their unit. If that important step doesn't happen, it's gonna be real hard to do anything.

    If the option is to replace flooring, I would not use carpet, although it CAN be done (depends on the acuity of the unit) in some circumstances. Instead, I would select GOOD vinyl flooring with a GOOD cushioned underflooring. You can put in rheostats and control lighting in different areas of the unit, so that if you need more lighting on one kid, the others can still rest.

    People need to be committed to keeping their voices down! Very hard to do. Radios--use CDs to play peaceful music--softly--for the babies, not the staff! Lullabies, classical music ("Mozart for Babies", etc) easy going new age stuff, that sort of thing. You can develop a program to play it @ certain times of the day to remind staff to let the babies rest for an hour or 2--"naptime".

    We did pad trash cans--we used eggcrate mattresses cut to fit, and covered with a trash bag to keep clean. You could put some blankets at the bottom and change them as soiled. Convince the housekeepers to not shake the bags open quite so vigorously--they can be quite noisy. Also, the big cart they took around to empty trash into needed an eggcrate bottom, too. Nothing like a bottle of formula hitting the metal bottom of that gizmo.

    We also used incubator covers. They are VERY good at cutting down stimuli. They can be made by volunteers or purchased.

    The most important step, once the leadership is committed to the project, is the have a nursing committee to work on the whole thing; they can take on projects one @ a time--incubator covers, nesting rolls, swaddling cloths, lighting, flooring, music, etc. ONE THING @ A TIME!

    It's an ambitious thing to do, and I wish you luck. Concentrate on why you're doing this--the babies.
  7. by   Anaclaire
    This is a good thread Kristi!

    I love your post Prmenrs because is speaks volumes! Leadership really has to be committed to change, and the changes must be done slowly as you mentioned through committee involvement. Too much change too fast tends to be less effective, for sure.

    When our manager felt our unit was too loud, be it from voices, buzzers, alarms, trash cans, doors, etc, she found a company that makes devices that record sound in decibels. She had two installed in our unit and they were connected to a light that would light up over the main doorway (where our L&D emergency lights were also) when the noise level became too high. Interestingly, it was mainly voices that caused the thing to light up.

    We also had some new neonatologists come to join our team and they were very into developmental care. They instituted a "Quiet Time" from 2:00 to 4:00 each am and pm. The lights would be turned down as low as possible, no procedures would be scheduled, and we nurses and RTs would do our best to leave the babies alone to rest and have their own quiet time. It worked out great once we all became used to it. It gave us a chance to catch up on charting, restock carts, take breaks, etc. Of course we were busy trying to get all we could done before quiet time began and then were busy again afterwards, but it really worked out very well.

    Our new unit had padded walls and acoustic ceiling tiles. We did have carpet in half the area (mainly the walking area) which was cleaned once a month depending on our census. When the census got low enough to move all the babies to one side of the nursery, we'd do so and call in the carpet cleaner. Then we'd move the babies back to the other side to have the other side cleaned. Our nursery was very, very quiet and had lots of different ways to be lit (from super dim to bright) but I think a thickly padded lineolium tile would have been best.

    Hooray to everyone who embraces developmental care practices!!!
    :angel2: :hatparty:
  8. by   NICU_Nurse
    Anaclaire,
    I'd like to know more about those decibel-recording devices, if you have any more information. Do you happen to know who made them? I'm going to do a search and see if I can pull something up. This is a great idea! A visual reminder would certainly get the point across like nothing else. Thanks for the tip!

    Kristi
  9. by   Anaclaire
    Kristi,

    I'll try to get in touch with my previous NICU manager to see if she is still using the noise device and if so, any info you would need to find one of your own.

    Wish me luck!

    Anaclaire
  10. by   pappyRN
    When I was still working neonatal services it was at an inner city hospital with a very large indigent population as clientele. There were always budget issues and we were frequently being told "it's not in the budget" so a really reasonable way to pad the crashing sound of the trash can lid was to put about three cloth diapers just draped over the front of the trash can. When the lid closed at least the sound was muffled. The diapers were changed by the unit aide when she emptied the trash. Primitive, but cheap!

    Warm personal regards,
    PappyRN
  11. by   Mimi2RN
    We use quilts made by the Volunteers over our isolettes and we only turn on the overhead lights when we have a critical situation.

    Our trash containers are Rubbermaid plastic ones. Our glass baby bottles are rinsed and recycled with the containers in the outer room.

    One problem is noise, especially at report time. Some people don't know how to keep their voices down!

close