ACOUSTICS IN HOSPITALS

PRESENTED BY
 PURPOSE OF STUDY

To examine how different aspects of sound noise, speech

privacy, speech intelligibility, and music impact patient and
staff outcomes in healthcare settings and the specific
environmental design strategies that can be used to improve the
acoustical environment of healthcare settings.

Hospitals are extremely noisy, and noise levels in most hospitals

far exceed recommended guidelines. The high ambient and peak
noise levels in hospitals have serious

impacts on patient and staff outcomes ranging from sleep loss

and elevated blood pressure among patients to emotional
exhaustion and burnout in staff.

At the same time, a poor acoustical environment impedes effective

communication between patients and staf and between staff
 NOISE
Noise, which is widely defined as unwanted sound, can be
harmful to patient and staff health.
Noise in a hospital affects both doctors and patients and raises
the risk of medical error.
Hospitals are extremely noisy, and noise levels in most hospitals
far exceed recommended guidelines. The high ambient and peak
noise levels in hospitals have serious.
The introduction of loudspeaker, radio, television and call systems
also increase the noise.
In most hospitals, windows to the open air and fanlights to the
corridors are usually open for the purpose of ventilation.
Noise control in the hospital is made much more difficult by the
extensive use of hard washable surfaces which reflect and
intensify the noise.
The world health organization (who) guideline values for
continuous background noise in hospital patient rooms are 35
INDOOR SOURCES SOURCES OF NOISE

A hospital is a complex building with many

services and the numerous internal sources
of structure-borne and air-borne noises are
grouped into three main categories:
a) Noise consequent upon hospital routines.
This
category includes sources which transmit
noise through both structure-borne and
airborne
paths, many of which maybe quite near
to patients particularly those in wards, such
as the following:
1) Wheeled trolleys of various kinds, for
food and medical supplies,
2) Sterilizing equipment,
3) Sluice room equipment including bedpan
washers,
4) Ward kitchen equipment,
5) Footsteps,
6) Doors banging,
7) The handling of metal or glass equipment,
b) Loudspeaker, radio or television, audible
call
system, telephone bells and buzzers, and
other
air-borne noises, such as loud conversation;

c) Noises from fixed or mobile equipment

and
services not directly concerned with hospital
routines. These include all the fixed services
as given below:
1) Plumbing and sanitary fittings,
2) Steam hot and cold water and heating
pipes,
3) Ventilation shafts and ducts,
4) Fans,
5) Boilers,
6) Pumps,
7) Air compressors,
8) Pneumatic tubes,
9) Electrical and mechanical motors and
equipment,
OUTDOOR SOURCES
This may be classified into two main
categories:
a) Noise from sources outside the hospital
premises, for example, traffic and industrial
noises,
b) Noise from sources outside the building
but usually within the control of the hospital
authority, for example, ambulances, motor-
cars and service vehicles, fuel and stores
deliveries, laundries, refuse collection, trucks
OTHER NOISES
and trolleys.
1) Overhearing by flanking transmission of
sound over partitions is a frequent
complaint, for example between waiting
areas and consultants' offices.
2) The transmission of sound energy via
paths which bypass the partition is known
as, flanking transmission.
3) It can occur because, The sealing of the
panel around its perimeter is inadequate or
 MAJOR FACTORS OF NOISE
In hospital premises there are many noise sources present. Staf
conversation in particular is a major source of loud noises in the
hospital unit.

Environmental surfaces in hospitalswalls, floor, and ceiling

tend to be sound-reflecting rather than sound-absorbing.
This aggravates the noise problem in hospitals. Sound-reflecting
surfaces cause noise to propagate considerable distances,
traveling down corridors and into patient rooms and adversely
affecting patients and staff over larger areas

When acoustic conditions are characterized by long

reverberation times, echoes cause blending and overlapping of
sounds, resulting in reduced speech intelligibility. To make
themselves heard, staff members raise their voices, thereby
increasing the noise problem even further.
 EFFECT OF NOISE

Quiet time is especially important in ICU environments

where loud noise levels decrease oxygen saturation
(increasing need for oxygen support therapy), elevate
blood pressure, increase heart and respiration
rate, and worsen sleep.

During the bad acoustical

conditions pulse amplitudes
may be higher among patients.
 SITE PLANNING
Hospital sites should be placed far
away from outside sources and also
accessible and available from other
areas.

The building should be so arranged

on the site that sensitive areas like
wards, consulting and treatment
rooms, operating theatres and staff
bedrooms are placed away from
outdoor sources of noise, if possible,
with their windows overlooking areas
of acoustic shadow.
 Special care in overall planning and internal
planning against noise is required in the
planning within the building of units which are
themselves potential noise sources, for
example, children's wards and outpatients'
departments, parts of which require protection
against noise.

Unloading bays, refuse disposal areas, boiler

houses, workshops and laundries are examples
of service units which should be as far from
sensitive areas as possible.

Sensitive areas such as operation theatres,

Doctors' consultation rooms, intensive care
units (ICU) require special consideration
against noise control. Apart from outdoor
noise.
 The kitchen is a constant source of both air-
borne and structure-borne noise and should
preferably be in a separate building away
from or screened from the sensitive areas. If
this is not possible and the main kitchens
must form part of a multi-storey building,
noise control is easier if they are placed
below and not above the wards and other
sensitive rooms.

In ward units, the kitchens, sluice rooms,

utility rooms, sterilizing rooms and other
ancillary rooms, which should be placed quite
near to the beds if they are to fulfill their
purposes, which are all sources of noise,
some form of noise baffling between open
wards and rooms of this kind will be needed.
MECHANICAL SYSTEM
DESIGN
Mechanical noise can be controlled using the following techniques:
FAN SELECTION.Centrifugal airfoil, plenum and mixed-flow
fans can be quieter than other types of fans.
DUCT SIZING.Large ducts have a lower friction rate than
smaller ducts, leading to lower airflow and fan noise.
Duct attenuation.Duct silencers with a film lining that
separates the air stream generally used in hospitals.
TERMINAL BOXES.Discharge noise levels produced by VAV
boxes should be address design. The sound-absorptive lining is
often covered with film or a foil lining that reduces the
attenuator's effectiveness. Using parallel-baffle duct silencers
with a film lining can better reduce discharge noise.
VIBRATION ISOLATORS.Conventional vibration isolation
mounts for isolating mechanical equipment, such as springs and

REDUCTION AT
rubber pads, are used in many different types of buildings and
need no specific alteration for health care facilities.

SOURCE
Sound generates with striking of hard materials on the ceiling, walls, and floor, almost all of the sound which
strikes the surfaces is reflected.
Rubber
Silent type curtain rails
Plastic
Mats of rubber or other resilient material on draining boards and
rubber equipment will greatly reduce noise from utility rooms, sluice
rooms and ward kitchens.
The use of plastics or other resilient materials for sinks, draining
boards, utensils and bowls would also reduce the noise.
Many items of equipment especially mobile equipment, such as
trolleys and beds, may be silenced by means of rubber- tiered wheels
and rubber bumper and the provision of resilient floor finishes. The
latter also reduces footstep noise.
Silent type curtain rails, rings and runners should be used.
Lift gates and doors should be fitted with buffers and silent closing
gear. Fans and other machinery should be mounted on suitable resilient
mountings to prevent the spread of noise through the structure.
Noise from water or heating pipes may be reduced by installing
systems which operate at comparatively low pressures and velocities.
Silencing pipes and specially designed flushing action reduce water
closet noise At source and make structural measures easier to apply.
The ventilation system should be designed so as not to create a noise
problem. Silent closers should be fitted to doors.
DAMPING SHEETS
Damping sheetsare self-adhesive sheets used
for sound and vibration damping on metal
panels. The adhesive side is smooth, giving
complete contact with the underlying surface
without air pockets or channels. Damping
sheetsare odorless, wear-resistant and
impregnated to prevent the absorption of water.

Features:
Non-hazardous
non-toxic
Resistant to water and mineral oils
High acoustic loss factor
Areas of usage:

walls

Ceiling

floors
 ALTERATIONS OF MACHINES

Replacing overhead staff paging systems with

wireless headsets.

Reducing the frequency and intensity of medical

alarms.

Installing ambient white-noise machines.

Installing a noise monitor to identify when noise
needs to be diminished.
 Allowing patients to close their doors
and post a "Do Not Disturb" sign.

Providing patients "Quiet Kits" with

sleep masks, earplugs and crossword
puzzles.

Offering headsets for TVs and iPads.

 REDUCTION BY STRUCTURAL MEANS

It is recommended that walls or partitions between rooms should normally

have an insulation value of at least 40 dB. Higher values of insulation of at
least 45 dB are necessary where a noisy room is adjacent to one requiring
quiet.

Solid floors with floating finishes and resilient surfaces are necessary
particularly between wards and other parts of the building.
 REDUCTION BY STRUCTURAL MEANS

Pipe ducts should be completely sealed around the pipes where they pass
through walls or floors. Ducts carrying waste or water pipes should be lined
with sound insulating material to prevent noise from the pipes.

HVAC ducts can be excellent movers of noise from one room to the next, they
can conduct sound for over a mile. Therefore , it is best to run the main line
through corridors rather than between rooms.
The worst placement is in corners near three
surfaces.
The best placement is away from the walls
REDUCTION BY STRUCTURAL MEANS
 REDUCTION BY STRUCTURAL MEANS

Most surfaces in hospitals should be easily cleanable, so

as to prevent the build-up of bacteria which may cause
cross-infection. Many sound absorbent materials of a
soft nature and difficult to clean are unsuitable for use
in some hospital areas and lose much of their
effectiveness, if painted for hygienic reasons.
Some porous materials with very thin nonporous
coverings (like mineral wool covered with thin plastic
sheets) have good sound absorption and when covered
with a perforated sheet metal facing can be used in
most areas requiring a washable acoustical treatment.
In noisy areas, such as corridors and waiting rooms,
however, a wider choice of absorbents is available.
 REDUCTION BY STRUCTURAL MEANS

In the ward, bed curtains, window curtains, etc. add to the absorbent
properties of the room and help reduce reverberation in otherwise hard
surfaced surroundings.
There is little insulation value in double swing doors and where these are fitted
to a noisy room the opening should be planned so that it is screened from
areas requiring quiet by a baffle lobby lined with absorbent material.
 MATERIALS
Materials play a very important in controlling noise levels in hospital
premises. Some of these are the traditionally used materials and
others are included as a part of advancements in material industry.
Noise-reducing finishes in healthcare settings positively impacts
patients sleep, privacy, satisfaction, and PCT stress.
Walks
EXTERIOR FINISHES
Wall finishes Concrete with light broom finish
Brick Masonry Roofing
Stone Masonry
Wood Siding
Fiberglass composition shingles
Vinyl Siding Metal standing seam
Ethylene propylene diene monomer
Metal Siding (EPDM) single-ply roof system.
Advancement
Advancement
Pre engineered metal building
Pre-engineered metal roof panels, Clay tile,
panels
Soffit, Fascia and Trim Fire-retardant wood shingles.
Wood
Vinyl
Drives
Metal
Concrete paving
Advancement Asphalt paving
Pre engineered metal building
INTERIOR
FINISHES
Ceilings
Glass Fibre Acoustical Ceiling Panels
Highly effective in sound absorption for
open spaces such as corridors

Mineral Fibre Acoustical Ceiling Panels

Ideal for areas requiring both sound
absorption and transmission .

Advancement
Composite Ceiling Panels
It combine a glass fiber facing with a
mineral fiber or gypsum board backing.
These panels have high sound
absorption as well as high sound
transmission loss properties, making
them ideal choices for neonatal intensive
care units (NICUs).`
Wall coverings
Glass or cotton fibre wall
panels
Effective sound absorption
for speech and most care
related activity noise.
Effective in large-ceiling
spaces such as atria to
control noise buildup.

Floor coverings

A floor finish and

subfloor structure can
mitigate noise
transmitted by an
impact, such as
footfalls or cart rolling,
in an adjacent space.

Rubber flooring
Carpet
LITERATURE STUDY
FLORIDA HOSPITAL WIESLEY CHAPEL
Challenge: Patient privacy and unwanted sound transmissions in patient rooms
and public areas
Research: Several nonhospital studies relating
loud noise (e.g., > 70 dB) were with increased
blood pressure and heart rate
Patient Outcomes in the hospital
Noisy periods in hospitals (> 55 dB) caused
anxiety
Overall
Humansound
sounds can elevate
levels heartdid
in hospitals rate
impact the sleep
(particularly conversation noise)
quality & quantity.
Noise can act as a suppressor to rapid eye movement
(REM)
About of patients sleep occurs during the daytime
Staff communication (talking, laughing) & alarms often
reported by patients as being most offensive
Other results
Length of hospital stay was longer for patients exposed
to construction noise
More pain medication required for patients in louder
Solution: To ensure patient privacy and comfort
in all 83 patient rooms, 18 emergency rooms,
hallways, the main lobby, nurses stations, and
operating rooms, sound masking has been done,
accoustical ceilings have been used, proper zoning
has been done, single patient bed rooms have been
given.
Result: Peaceful rooms that allow patients to
speak privately with their family members,
physicians, and clinical staff

SOUND MASKING
Itis theadditionof natural or artificial sound into an environment to cover upunwanted soundby
usingauditory masking. This is in contrast to the technique ofactive noise control. Sound masking
reduces or eliminates awareness of pre-existing sounds in a given area and can make a work
environment more comfortable, while creating speech privacy so workers can better concentrate
and be more productive.
Sound masking can oftenly be confused with white noise. White has a wide range of frequencies
(typically from 20 to 20,000 Hz) generally randomly produced, with equal volume across the entire
range. People perceive it as static with an uncomfortable, hissing quality.
Sound masking also uses a wide range of randomly generated frequencies, but typically narrower
than white noise. Masking signals are usually specified from about 100 to perhaps 6,000 Hz. Also,
the volume of these frequencies isnt equal. Subjectively, sound masking is a far more comfortable
sound than white noise and, when properly implemented, tends to fade into the background.
 CASE STUDY
VIVEKANANDA POLYCLINIC
 CASE STUDY
VIVEKANANDA POLYCLINIC
 CASE STUDY
VIVEKANANDA POLYCLINIC