Mozart or Def Leppard? Noise in the Operating Room

The operating room (OR) can be a noisy place. Ambient noise in an empty OR is usually about 30 to 35 decibels from ordinary electronic buzz and equipment sounds. Add anesthesia equipment, electronic signals like beeps and buzzes, instruments (eg, drills and suction devices), work-related and personal conversation, and even music to the background, and the noise level can exceed 65 decibels and sometimes approach 120 decibels. (Note that more than 60% of OR personnel listen to music regularly.) Drills and saws can escalate noise to 140 decibels.

Noise affects communication, and poor communication is a leading cause of error in the OR. During surgeries, medical professionals may look for visual cues from others to enhance aural reception, but surgical masks obscure many helpful facial expressions and prevent lip-reading.

Now, a study published in the Journal of the American College of Physicians has examined noise in the OR with respect to surgeons’ ability to hear and concentrate. They observed 15 University of Kentucky Medical Center surgeons who had normal hearing. The surgeons had 1 to 30 years of operative experience (mean = 6 years). The researchers tested the surgeons' ability to understand and repeat words in conditions emulative of four different OR environments: (1) quiet, (2) filtered noise through a mask, (3) background noise without music, and (4) background noise with music.

The findings indicate that noise’s impact is great when the surgeon is tasked, meaning when the surgeon must concentrate on a specific decision or procedure. Study participants were less able to hear and comprehend in ORs when music played than in quiet ORs. As the OR’s auditory environment became more complex, the potential for communication errors seemed to increase. The researchers report that surgeons, nurses, anesthesia personnel, scrub assistants, and other workers are engaged in complex tasks in the OR, and adding an additional or unexpected task increased the potential for miscommunication. This was especially true if the communication scored low in word predictability.

When music is played in the OR, staff should be aware of the potential for critical or unpredictable information to be lost or misunderstood. Reducing ambient noise in ORs may increase patient safety and reduce error. In addition, long-term exposure to high noise levels can cause hearing loss for employees.