Scientific Letter
Light and noise: Environmental factors in intensive care units
Factores ambientales de luz y ruido en las unidades de cuidados intensivos
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"Alejandro" "apellidos" => "Bosch" "email" => array:1 [ 0 => "abosch@hsjdbcn.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Anna" "apellidos" => "Falcó" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Marta" "apellidos" => "Santaolalla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "María Carmen" "apellidos" => "Dominguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Iolanda" "apellidos" => "Jordan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Cuidados Intensivos Pediátricos, Hospital Sant Joan de Déu, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Enfermería Fundamental y Medicoquirúrgica, Escuela de Enfermería, Universidad de Barcelona, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Factores ambientales de luz y ruido en las unidades de cuidados intensivos" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Intensive care units (ICUs) are settings characterised by very sophisticated equipment that require specialised facilities and in many instances produce environments with poor natural light and background noise.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1–3</span></a> In these high-tech units, the activities involved in advanced life support and subsequent care may predispose to discomfort. Katherine Kolcaba defined comfort as the state experienced through having the human needs for relief, ease, and transcendence addressed in four contexts: physical, psychospiritual, sociocultural, and environmental.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Aware of the importance of these factors in the care of critically ill patients, we reviewed the standards on light and noise in ICUs and studied the characteristics of these two variables in the PICU of a tertiary care hospital.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We measured environmental light with a CEM DT-1308 light metre in luxes (lx). Measurements were made in the morning and at night and taking into account the three types of lighting that predominate in the unit under study: natural light, white/cool light and warm/yellow light. We defined light colour based on colour temperature expressed as Kelvin (K). Based on this parameter, cool light corresponds to white tones exceeding 5000<span class="elsevierStyleHsp" style=""></span>K (fluorescent lights), while warm light corresponds to yellow tones of less than 3300<span class="elsevierStyleHsp" style=""></span>K (halogen lights).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We measured environmental noise with a PCE-999 type 2 audiometer in decibels (dB). We recorded the noise level every 2<span class="elsevierStyleHsp" style=""></span>h for 6 days.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The references used for comparison were the European Union Lighting Standard for Interior Lighting (EN 12464.1) and, for environmental noise, guidelines of the American Academy of Pediatrics (AAP) and the Council on Environmental Health, as well as the standards proposed by the World Health Organization (WHO). We ought to note that in order to avoid the Hawthorne effect (the alteration of behaviour in subjects aware of being observed) we performed these measurements without the knowledge of the health care staff in the unit.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We collected a total of 28 light measurements and 72 environmental noise measurements. The recommended light levels are 100 to 1000<span class="elsevierStyleHsp" style=""></span>lx during the day and 20<span class="elsevierStyleHsp" style=""></span>lx at night. The median natural light was 51.7 (0–207.2) luxes. As for direct cool lighting, the daytime median was 195.6 (88.1–347.2) luxes compared to 159.6 (57.0–206.7) at night. In comparison, our analysis of indirect warm light resulted in a median of 67.5 (11.4–193.7) luxes during the day versus a median of 27.4 (13.2–72.4) at night. All daytime light measurements complied with the standards, although nighttime luminosity far exceeded the recommended luxes.</p><p id="par0035" class="elsevierStylePara elsevierViewall">When we analysed the environmental noise in the ICU, we found a mean 57.64<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.67<span class="elsevierStyleHsp" style=""></span>dB during the day versus 55.48<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>3.17 at night. Both levels exceed the daytime threshold of 45<span class="elsevierStyleHsp" style=""></span>dB and the nighttime threshold of 35<span class="elsevierStyleHsp" style=""></span>dB recommended by the reviewed standards.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Therefore, we can conclude that in order to improve environmental factors in our unit, we must continue to promote the use of natural light or, in its absence, warm lighting during the day, as these were the types of lighting that corresponded to the lowest lux values and best fit the standards. However, the use of light during the night should be restricted to strictly necessary procedures, as it exceeds the reviewed standards. As for environmental noise, it exceeded the daytime 10<span class="elsevierStyleHsp" style=""></span>dB and the nighttime 20<span class="elsevierStyleHsp" style=""></span>dB recommended by the AAP and the WHO, so we should promote a culture of environmental quiet, limiting all inputs that generate background noise. Continuous monitoring of environmental light and noise may improve the health care staff's awareness of the importance of these environmental factors in the care of critically ill patients, thus promoting a reduction in their levels.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Bosch A, Falcó A, Santaolalla M, Dominguez MC, Jordan I. Factores ambientales de luz y ruido en las unidades de cuidados intensivos. 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| 2022 August | 86 | 54 | 140 |
| 2022 July | 56 | 41 | 97 |
| 2022 June | 63 | 37 | 100 |
| 2022 May | 57 | 42 | 99 |
| 2022 April | 39 | 45 | 84 |
| 2022 March | 92 | 73 | 165 |
| 2022 February | 58 | 36 | 94 |
| 2022 January | 68 | 52 | 120 |
| 2021 December | 45 | 34 | 79 |
| 2021 November | 72 | 34 | 106 |
| 2021 October | 114 | 102 | 216 |
| 2021 September | 66 | 50 | 116 |
| 2021 August | 46 | 42 | 88 |
| 2021 July | 62 | 45 | 107 |
| 2021 June | 47 | 57 | 104 |
| 2021 May | 55 | 43 | 98 |
| 2021 April | 160 | 88 | 248 |
| 2021 March | 55 | 34 | 89 |
| 2021 February | 73 | 23 | 96 |
| 2021 January | 39 | 26 | 65 |
| 2020 December | 50 | 24 | 74 |
| 2020 November | 25 | 17 | 42 |
| 2020 October | 36 | 21 | 57 |
| 2020 September | 27 | 25 | 52 |
| 2020 August | 30 | 28 | 58 |
| 2020 July | 19 | 37 | 56 |
| 2020 June | 36 | 24 | 60 |
| 2020 May | 32 | 17 | 49 |
| 2020 April | 36 | 11 | 47 |
| 2020 March | 24 | 20 | 44 |
| 2020 February | 38 | 17 | 55 |
| 2020 January | 17 | 24 | 41 |
| 2019 December | 32 | 17 | 49 |
| 2019 November | 22 | 5 | 27 |
| 2019 October | 17 | 14 | 31 |
| 2019 September | 17 | 18 | 35 |
| 2019 August | 36 | 18 | 54 |
| 2019 July | 50 | 37 | 87 |
| 2019 June | 17 | 23 | 40 |
| 2019 May | 33 | 52 | 85 |
| 2019 April | 40 | 29 | 69 |
| 2019 March | 45 | 19 | 64 |
| 2019 February | 35 | 6 | 41 |
| 2019 January | 32 | 26 | 58 |
| 2018 December | 44 | 30 | 74 |
| 2018 November | 47 | 37 | 84 |
| 2018 October | 76 | 29 | 105 |
| 2018 September | 35 | 12 | 47 |
| 2018 August | 3 | 0 | 3 |
| 2018 July | 3 | 0 | 3 |
| 2018 June | 5 | 0 | 5 |
| 2018 May | 8 | 0 | 8 |
| 2018 April | 41 | 0 | 41 |
| 2018 March | 47 | 0 | 47 |
| 2018 February | 37 | 0 | 37 |
| 2018 January | 65 | 0 | 65 |
| 2017 December | 60 | 0 | 60 |
| 2017 November | 15 | 0 | 15 |
| 2017 October | 10 | 0 | 10 |
| 2017 September | 16 | 0 | 16 |
| 2017 August | 12 | 0 | 12 |
| 2017 July | 20 | 1 | 21 |
| 2017 June | 30 | 21 | 51 |
| 2017 May | 24 | 8 | 32 |
| 2017 April | 162 | 129 | 291 |
| 2017 March | 8 | 9 | 17 |
Show all
