Research| Volume 36, ISSUE 1, P54-58, February 2021

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The Effect of Noise Levels in the Operating Room on the Stress Levels and Workload of the Operating Room Team

Published:October 16, 2020DOI:



      The research was conducted to evaluate the noise levels and the effect of noise on the workload and stress levels of the operating room (OR) staff of a public hospital.


      Descriptive and cross-sectional study.


      The data were obtained by measuring ambient noise during 403 orthopaedic, urological, and general surgeries on weekdays between July and October 2019. We measured the noise by dividing the surgery into three phases. These phases are as follows: from the entry of the patient, induction of anesthesia, and preparation of the surgical area until the start of the procedure (Phase I), from the incision until the completion of closure and dressing application (Phase II), from the completion of closure and dressing application until the exit of the patient (Phase III). Furthermore, the workload and stress levels of 45 OR staff who work in the general surgery, orthopaedics, and urology ORs were measured. Data were collected using a CA 834 noise measurement device, State-Trait Anxiety Inventory (STAI Form TX-I), the National Aeronautics and Space Administration (NASA) Task Load Index Workload Scale, and Information form related to surgery and ORs.


      The noise in the OR was higher than 35 dB, A-weighted [dB(A)], the limit proposed by the World Health Organization for hospitals. Phase I average noise level was 63.00 ± 3.50, Phase II average noise level was 62.94 ± 3.75, and Phase III average noise level was 63.67 ± 2.81. The mean anxiety score was 34.50 ± 6.09. The total workload level was found to be 56.91 ± 15.67. Anxiety scores and workload scores had positive weak and moderate correlations with noise levels (P < .01).


      The noise in the OR was high, and anxiety scores and workload scores correlated positively with noise levels.


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        • AORN position statement on managing distractions and noise during perioperative patient care
        AORN Inc.
        2020 (Available at:)
        • Dholakia S.
        • Jeans J.P.
        • Khalid U.
        • Dholakia S.
        • D'Souza C.
        • Nemeth K.
        The association of noise and surgical-site infection in day-case hernia repairs.
        Surgery. 2015; 157: 1153-1156
        • Padmakumar A.D.
        • Cohen O.
        • Churton A.
        • Groves J.B.
        • Mitchell D.A.
        • Brennan P.A.
        Effect of noise on tasks in operating theatres: A survey of the perceptions of healthcare staff.
        Br J Oral Maxillofac Surg. 2017; 55: 164-167
        • van Pelt M.
        • Weinger M.B.
        Distractions in the anesthesia work environment: Impact on patient safety? Report of a meeting sponsored by the anesthesia patient safety foundation.
        Anesth Analg. 2017; 125: 347-350
        • Keller S.
        • Tschan F.
        • Semmer N.K.
        • et al.
        Noise in the operating room distracts members of the surgical team. An observational study.
        World J Surg. 2018; 42: 3880-3887
        • Enser M.
        • Moriceau J.
        • Abily J.
        • et al.
        Background noise lowers the performance of anaesthesiology residents’ clinical reasoning when measured by script concordance: A randomised crossover volunteer study.
        Eur J Anaesthesiol. 2017; 34: 464-470
        • Keller S.
        • Tschan F.
        • Beldi G.
        • Kurmann A.
        • Candinas D.
        • Semmer N.K.
        Noise peaks influence communication in the operating room. An observational study.
        Ergonomics. 2016; 59: 1541-1552
        • Cheriyan S.
        • Mowery H.
        • Ruckle D.
        • et al.
        The impact of operating room noise upon communication during percutaneous nephrostolithotomy.
        J Endourol. 2016; 30: 1062-1066
      1. Minimizing noise and distractions in the OR and procedural units. Joint Commission Quick Safety.
        The Joint Commission, 2017 (Accessed April 13, 2020)
        • Uğurlu Z.
        • Karahan A.
        • Ünlü H.
        • et al.
        The effects of workload and working conditions on operating room nurses and technicians.
        Workplace Health Saf. 2015; 63: 399-407
        • Waterland P.
        • Khan F.S.
        • Ismaili E.
        • Cheruvu C.
        Environmental noise as an operative stressor during simulated laparoscopic surgery.
        Surg Laparosc Endosc Percutan Tech. 2016; 26: 133-136
        • McNeer R.R.
        • Bennett C.L.
        • Dudaryk R.
        Intraoperative noise increases perceived task load and fatigue in anesthesiology residents: A simulation-based study.
        Anesth Analg. 2016; 122: 512-525
        • Gao J.
        • Liu S.
        • Feng Q.
        • et al.
        Quantitative evaluations of the effects of noise on mental workloads based on pupil dilation during laparoscopic surgery.
        Am Surg. 2018; 84: 1951-1956
        • Spielberger C.D.
        • Gorsuch R.L.
        • Lushene R.E.
        STAI Manual for the State-Trait Anxiety Inventory.
        Consulting Psychologists' Press, Palo Alto, California1970
        • Öner N.
        • Le Comte A.
        Handbook of the State-Trait Anxiety Inventory (Süreksizdurumluk/Süreklikaygıenvanteri el Kitabı).
        2nd ed. Boğaziçi University Publications, İstanbul1998
        • Spielberger C.D.
        • Gorsuch R.L.
        • Lushene R.
        • Vagg P.R.
        • Jacobs G.A.
        Manual for the State-Trait Anxiety Inventory (Form Y).
        Mind Garden, Palo Alto, CA1983
        • Hart S.G.
        • Staveland L.E.
        Development of NASA-TLX (Task Load Index): Results of empirical and theoretical research.
        in: Hancock P.A. Meshkati N. Human Mental Workload. North Holland Press, Amsterdam1988
        • Hart S.G.
        NASA-Task Load Index (NASA-TLX); 20 years later.
        (Proceedings of the Human Factors and Ergonomics Society 50th Annual Meeting) Sage Publications, Los Angeles, CA2006: 904-908
        • Wang X.
        • Zeng L.
        • Li G.
        • et al.
        A cross-sectional study in a tertiary care hospital in China: Noise or silence in the operating room.
        BMJ Open. 2017; 7: e016316
        • WHO (World Health Organization)
        Guidelines for Community Noise.
        Geneva, 1999 (Available at:)
        Date accessed: February 22, 2020
        • Yasak K.
        • Vural F.
        Assessment of the environmental and physical ergonomic conditions of ORs in Turkey.
        AORN J. 2019; 110: 517-523
        • Tay B.D.
        • Prabhu I.S.
        • Cousin C.H.S.
        • Cousin G.C.S.
        Occupational exposure to noise in maxillofacial operating theatres: An initial prospective study.
        Br J Oral Maxillofac Surg. 2016; 54: 94-96
        • Kulkarni E.
        • Abdallah Y.
        • Hanseman D.
        • Krishnan D.G.
        How much noise is an oral and maxillofacial surgeon exposed to?.
        J Oral Maxillofac Surg. 2018; 76: 1400-1403
        • Jenkins A.
        • Wilkinson J.V.
        • Akeroyd M.A.
        • Broom M.A.
        Distractions during critical phases of anaesthesia for caesarean section: An observational study.
        Anaesthesia. 2015; 70: 543-548
        • Crockett C.J.
        • Donahue B.S.
        • Vandivier D.C.
        Distraction-free induction zone: A quality improvement initiative at a large academic children's hospital to improve the quality and safety of anesthetic care for our patients.
        Anesth Analg. 2019; 129: 794-803
        • Giv M.D.
        • Sani K.G.
        • Alizadeh M.
        • Valinejadi A.
        • Majdabadi H.A.
        Evaluation of noise pollution level in the operating rooms of hospitals: A study in Iran.
        Interv Med Appl Sci. 2017; 9: 61
        • Peters M.P.
        • Feczko P.Z.
        • Tsang K.
        • van Rietbergen B.
        • Arts J.J.
        • Emans P.J.
        Noise exposure in TKA surgery; oscillating tip saw systems vs oscillating blade saw systems.
        J Arthroplasty. 2016; 31: 2773-2777
        • Hogan L.J.
        • Harvey R.L.
        Creating a culture of safety by reducing noise levels in the OR.
        AORN J. 2015; 102: 410.e1-410.e7
        • Wheelock A.
        • Suliman A.
        • Wharton R.
        • et al.
        The impact of operating room distractions on stress, workload, and teamwork.
        Ann Surg. 2015; 261: 1079-1084