as to when noise levels exceed
•Educate staff on sources of noise,
their impact on patient and
staff safety, and noise reduction
•Consider equipment alternatives
that produce less noise.
•Evaluate the physical
environment and implement
means for attenuating noise. For
example, minimize dropping
instruments into instrument
•Add simulation and training to
enhance focused attention skills
in the presence of continuous
and intermittent noise and
•Consider simulation training to
model strategies for reducing
noise (such as equipment use,
communication techniques, and
speaking up to reduce noise).
The newsletter also
recommends actions that can
be taken to support decreased
noise in the work environment,
such as the following: 7
•Foster a safety culture in which
staff feel empowered and
comfortable speaking up and
asking for silence.
•Establish a code of conduct to
minimize noise and distraction
(for example, policies regarding
unnecessary conversation, use of
phones and pagers, use of music,
and so on).
•Consult staff to understand
resource needs for cellphones,
pagers, and tablets, and establish
policies around them. Minimize
tones that are similar to monitors
and alarms within the OR.
•Practice effective team
communication strategies to
ensure the receiver has heard and
understood what has been said.
The Quick Safety issue also
provides details on studies
pertaining to noise levels
and consequences during
the anesthesia period, as
well as hernia repairs. ♦
The thoughts and opinions
expressed in this column are
solely those of Dr. Pellegrini and
do not necessarily reflect those
of The Joint Commission or the
American College of Surgeons.
1. The Joint Commission. Minimizing
noise and distractions in the OR and
procedural units. Quick Safety, Issue
35. August 2017. Available at: www.
in_OR_FINAL.pdf. Accessed August
2. Association of periOperative
Registered Nurses. AORN position
statement on managing distractions
and noise during perioperative patient
care. AORN J. 2014; 99( 1): 22-26.
3. Hogan L, Harvey RL. Creating
a culture of safety by reducing
noise levels in the OR. AORN J.
4. McNeer RR, Bennett CL, Dudaryk
R. Intraoperative noise increases
perceived task load and fatigue
in anesthesiology residents: A
simulation-based study. Anesth Analg.
5. Keller S, Tschan F, Beldi G, Kurmann
A, Candinas D, Semmer NK. Noise
peaks influence communication in
the operating room: An observational
study. Ergonomics. 2016; 59( 12):1541-
6. Pereira BM, Pereira AM, Correia Cdos
S, Marttos AC Jr, Fiorelli RK, Fraga
GP. Interruptions and distractions
in the trauma operating room:
Understanding the threat of human
error. Rev Col Bras Cir. 2011; 38( 5):292-
7. Persoon MC, Broos HJ, Witjes JA,
Hendrikx AJ, Scherpbier AJ. The effect
of distractions in the operating room
during endourological procedures.
Surg Endosc. 2011; 25( 2):437-443.
According to the Environmental Protection Agency, the recommended
level for continuous background noise in hospitals is 45dB, but a study
measuring noise levels during OR trauma procedures found an average
noise level of approximately 85dB—ranging from 40dB to 130dB.
OC T 2017 BULLETIN American College of Surgeons
A LOOK AT THE JOINT COMMISSION