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Noise in a university operating theatre during the course of pediatric surgical procedures.

Dheidan Alshammari, Marina Sica, Samah Osailan, Vu Hong Tuan, Isabelle Talon, Anne Schneider, Pierre Kuhn, Claire Zores, Raphael Moog, Francois Becmeur

Objective: To measure the level of noise in our university operating room and to identify different phases during the course of surgical procedures in which noise level exceeding 40 decibels (National Recommendation). Method: This was a prospective randomized single blinded study for a period of 5 months starting from January 2016. A sonometer was placed randomly in the different operating theatres. Its presence did not mean that it should work. Recording started from the patient’s entry to the operating theatre and ended upon his/her exit. We divided our period in three different types: P1 (from the entry of the patient until the start of surgical procedure); P2 (from the surgical incision to the end of the procedure); P3 (from the completion of closure till the exit from the OR). Strict inclusion criteria (general pediatric surgery case, elective surgery, during normal working hours, operations performed by board certified surgeons) and exclusion criteria (non-general pediatric surgery cases, emergency case, after hours, resident performing the procedure as first surgeon) were applied. Results: The sonometer was present in a total of 64 operations. It was recording in 26 operations. The surgical procedures were: 54% open surgery, 34% laparoscopic surgery and 12% were endoscopic procedures. The total recorded time was 2419 minutes, around 40.4 hours. The average P1 time was 25’, P2 65’ and P3 7’. T test was performed and found the average to be significantly P value <0.0001 from the 40 dBA recommended limit. LEQ noise level was 56.48 dBA during P1, 53.14 dBA during P2 and 55.50 dBA during P3. We registered 813 incidents or sudden noise peaks >70 dBA during P1, 912 incidents during P2 and 293 incidents during P3. Most often the incidents were due to conversations within the staff at the level >75 dBA. Only 1.5% incidents were more than 80 dBA. More rarely we registered sounds of bells from cellular phones sometimes more than 90 dBA. Conclusion: It is as if there is a first period with excited staff before the beginning of surgery. Then, a second period follows, where the staff is quitter due to required concentration: it looks like the major period of the surgical procedure. The third period, at the end of the surgical act, looks like a moment of relaxation with a noisy ambiance. By this point of view, noisy distractions, considered to be a main cause of perioperative incidents, appear to be related to the level of staff seriousness.