Maintaining Reduced Noise Levels in a Resource-Constrained Neonatal Intensive Care Unit by Operant Conditioning.

ABSTRACT

Objective: To evaluate the efficacy of operant conditioning in sustaining reduced noise levels in the neonatal intensive care unit (NICU) Design: Quasi-experimental study on quality of care. Setting: Level III NICU of a teaching hospital in south India. Participants: 26 staff employed in the NICU. (7 Doctors, 13 Nursing staff and 6 Nursing assistants). Intervention Operant conditioning of staff activity for 6 months. This method involves positive and negative reinforcement to condition the staff to modify noise generating activities. Main outcome measures: Comparing noise levels in decibel A weighted [dB (A)] before conditioning with levels at 18 and 24 months after conditioning. Decibel A weighted accounts for noise that is audible to human ears. Results: Operant conditioning for 6 months sustains the reduced noise levels to within 62 dB (A) in ventilator room (95% CI 60.4 – 62.2) and isolation room (95% CI 55.8 – 61.5). In the pre-term room, noise can be maintained within 52 dB (A) (95 % CI 50.8 – 52.6). This effect is statistically significant in all the rooms at 18 months (P = 0.001). At 24 months post conditioning there is a significant rebound of noise levels by 8.6, 6.7 and 9.9 dB (A) in the ventilator, isolation and pre-term room, respectively (P=0.001). Conclusion: Operant conditioning for 6 months was effective in sustaining reduced noise levels. At 18 months post conditioning, the noise levels were maintained within 62 dB (A), 60 dB (A) and 52 dB (A) in the ventilator, isolation and pre-term room, respectively. Conditioning needs to be repeated at 12 months in the ventilator room and at 18 months in the other rooms.