The Impact of Noise in the Intensive Care Unit

  • R. J. Pugh
  • C. Jones
  • R. D. Griffiths


Noise may be defined simply as “unwanted sound” [1]. The World Health Organization (WHO) recommends that the average background noise in hospitals should not exceed 30 A weighted decibels (dB [A]), and that peaks during the night-time should be less than 40 dB(A) [1]. Noise in hospitals and particularly in intensive care units (ICUs), frequently exceeds these values [2]–[4]. The United States Environmental Protection Agency in fact defines noise as “any sound that may produce an undesired physiological or psychological effect in an individual or group”. Noise affects both staff and patients. It may impede concentration and cognitive function [5, 6]. It interferes with effective communication and may thus increase the risk of accidents [5, 7]. The critically ill are particularly sensitive to the disruption of sleep by noise [8]. In addition, and especially for the elderly and hard of hearing, noise may hinder communication and impair understanding of their environment. It may also potentially contribute to the abnormal thought processes and behavior associated with ICU delirium [9].


Intensive Care Unit Pediatric Intensive Care Unit Hearing Impairment Sleep Disruption Critical Care Nurse 
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  1. 1.
    Berglund B, Lindvall T, Schwela DH (1999) Guidelines for Community Noise. World Health Organization, GenevaGoogle Scholar
  2. 2.
    Balogh D, Kittinger E, Benzer A, Hackl JM (1993) Noise in the ICU. Intensive Care Med 19:343–346PubMedCrossRefGoogle Scholar
  3. 3.
    Meyer TJ, Eveloff SE, Bauer MS, Schwartz WA, Hill NS, Millman RP (1994) Adverse environ mental conditions in the respiratory and medical ICU settings. Chest 105:1211–1216PubMedGoogle Scholar
  4. 4.
    Freedman NS, Gazendam J, Levan L, Pack AI, Schwab RJ (2001) Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit. Am J Respir Crit Care Med 163:451–457PubMedGoogle Scholar
  5. 5.
    Office of the Scientific Assistant Office of Noise Abatement and Control, U.S. Environmental Protection Agency (1979) Noise Effects Handbook. National Association of Noise Control Officials, Florida, EPA 500-9-82-106Google Scholar
  6. 6.
    Murthy VS, Malhotra SK, Bala I, Raghunathan M (1995) Detrimental effects of noise on anaesthetists. Can J Anaesth 42:608–611PubMedCrossRefGoogle Scholar
  7. 7.
    Blomkvist V, Eriksen CA, Theorell T, Ulrich R, Rasmanis G (2005) Acoustics and psychosocial environment in intensive coronary care. Occup Environ Med 62:e1–8PubMedCrossRefGoogle Scholar
  8. 8.
    Gabor JY, Cooper AB, Crombach SA, et al (2003) Contribution of the intensive care unit environment to sleep disruption in mechanically ventilated patients and healthy subjects. Am J Respir Crit Care Med 167:708–715PubMedCrossRefGoogle Scholar
  9. 9.
    Hansell HN (1984) The behavioural effects of noise on man: the patient with “intensive care unit psychosis”. Heart Lung 13:59–65PubMedGoogle Scholar
  10. 10.
    The European Parliament and Council of the European Union (2003) Directive 2003/10/EC of the European Parliament and of the Council of 6 February 2003 On the Minimum Health and Safety Requirements Regarding the Exposure of Workers to the Risks Arising from Physical Agents (Noise). Official Journal of the European Union L042:38–44Google Scholar
  11. 11.
    Kahn DM, Cook TE, Carlisle CC, Nelson DL, Kramer NR, Millman RP (1998) Identification and modification of environmental noise in an ICU setting. Chest 114:535–540PubMedGoogle Scholar
  12. 12.
    Morrison WE, Haas EC, Shaffner DH, Garrett ES, Fackler JC (2003) Noise, stress, and annoyance in a pediatric intensive care unit. Crit Care Med 31:113–119PubMedCrossRefGoogle Scholar
  13. 13.
    Tsiou C, Eftymiatos D, Theodossopoulou, Notis P, Kiriakou (1998) Noise sources and levels in the Evgenidion Hospital intensive care unit. Intensive Care Med 24:845–847PubMedCrossRefGoogle Scholar
  14. 14.
    Carvallho WB, Pedreira ML, de Aguiar MA (2005) Noise level in a pediatric intensive care unit. J Pediatr (Rio J) 81:495–498CrossRefGoogle Scholar
  15. 15.
    Al-Samsam RH, Cullen P (2005) Sleep and adverse environmental factors in sedated mechanically ventilated pediatric intensive care patients. Pediatr Crit Care Med 6:562–567PubMedCrossRefGoogle Scholar
  16. 16.
    Berens RJ, Weigle CG (1995) Noise measurements during high-frequency oscillatory and conventional mechanical ventilation. Chest 108:1026–1029PubMedGoogle Scholar
  17. 17.
    Moore MM, Nguyen D, Nolan SP, et al (1998) Interventions to reduce decibel levels on patient care units. Am Surg 64:894–899PubMedGoogle Scholar
  18. 18.
    Cooper AB, Thornley KS, Young GB, Slutsky AS, Stewart TE, Hanly PJ (2000) Sleep in critically ill patients requiring mechanical ventilation. Chest 117:809–818PubMedCrossRefGoogle Scholar
  19. 19.
    Freedman NS, Kotzer N, Schwab RI (1999) Patient perception of sleep quality and etiology of sleep disruption in the intensive care unit. Am J Respir Crit Care Med 159:1155–1162PubMedGoogle Scholar
  20. 20.
    Parthasarathy S, Tobin MJ (2004) Sleep in the intensive care unit. Intensive Care Med 30:197–206PubMedCrossRefGoogle Scholar
  21. 21.
    Bourne RS, Mills GH (2004) Sleep disruption in critically ill patients — pharmacological considerations. Anaesthesia 59:374–384PubMedCrossRefGoogle Scholar
  22. 22.
    Krachman SL, D’Alonzo GE, Criner GJ (1995) Sleep in the intensive care unit. Chest 107:1713–1720PubMedGoogle Scholar
  23. 23.
    Jones C, Griffiths RD, Humphris G (2000) Disturbed memory and amnesia related to intensive care. Memory 8:79–94PubMedCrossRefGoogle Scholar
  24. 24.
    Topf M, Davis JE (1993) Critical care unit noise and rapid eye movement (REM) sleep. Heart Lung 22:252–258PubMedGoogle Scholar
  25. 25.
    Aaron JN, Carlisle CC, Carskadon MA, Meyer TJ, Hill NS, Millman RP (1996) Environmental noise as a cause of sleep disruption in an intermediate respiratory care unit. Sleep 19:707–710PubMedGoogle Scholar
  26. 26.
    Russell S (1999) An exploratory study of patients’ perceptions, memories and experiences of an intensive care unit. J Adv Nurs 29:783–791PubMedCrossRefGoogle Scholar
  27. 27.
    Hagerman I, Rasmanis G, Blomkvist V, Ulrich R, Eriksen CA, Theorell T (2005) Influence of intensive coronary care acoustics on the quality of care and physiological state of patients. Int J Cardiol 98:267–270PubMedCrossRefGoogle Scholar
  28. 28.
    Kim DW, Kil HY, White PF (2001) The effect of noise on the bispectral index during propofol sedation Anesth Analg 93:1170–1173PubMedCrossRefGoogle Scholar
  29. 29.
    Halpern NA, Pastores SM, Price JB, Alicea M (1999) Hearing loss in critical care: an unappreciated phenomenon. Crit Care Med 27:211–219PubMedCrossRefGoogle Scholar
  30. 30.
    Campbell VA, Crews JE, Moriarty DG, Zack MM, Blackman DK (1999) Surveillance for sensory impairment, activity limitation, and health-related quality of life among older adults-United States 1993–1997. MMWR CDC Surveill Summ 48:131–156PubMedGoogle Scholar
  31. 31.
    McCoy SL, Tun PA, Cox LC, Colangelo M, Stewart RA, Wingfield A (2005) Hearing loss and perceptual effort: downstream effects on older adults’ memory for speech. Q J Exp Psychol A 58:22–33PubMedGoogle Scholar
  32. 32.
    Larsby B, Hallgren M, Lyxell B, Arlinger S (2005) Cognitive performance and perceived effort in speech processing tasks: effects of different noise backgrounds in normal-hearing and hearing-impaired subjects. Int J Audiol 44:131–143PubMedCrossRefGoogle Scholar
  33. 33.
    McGuire BE, Basten CJ, Ryan CJ, Gallagher J (2000) Intensive care unit syndrome. Arch Intern Med 160:906–909PubMedCrossRefGoogle Scholar
  34. 34.
    Ely EW, Shintani A, Truman B, et al (2004) Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 291:1753–1762PubMedCrossRefGoogle Scholar
  35. 35.
    Innouye SK, Bogardus ST, Charpentier PA, et al (1999) A multicomponent intervention to prevent delirium in hospitalized older patients. N Engl J Med 340:669–676CrossRefGoogle Scholar
  36. 36.
    Innouye SK, Viscoli CM, Horwitz RI, Hurst LD, Tinetti ME (1993) A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Ann Intern Med 119:474–481Google Scholar
  37. 37.
    Bentall RP, Taylor JL (2006) Psychological processes and paranoia: implications for forensic behavioural science. Behav Sci Law 24:277–294PubMedCrossRefGoogle Scholar
  38. 38.
    Stein LM, Theinhaus OJ (1993) Hearing impairment and psychosis. Int Psychogeriatr 5:49–56PubMedCrossRefGoogle Scholar
  39. 39.
    Ballard C, Bannister C, Graham C, Oyebode F, Wilcock G (1995) Associations of psychotic symptoms in dementia sufferers. Br J Psychiatry 167:537–540PubMedGoogle Scholar
  40. 40.
    Palmer KT, Griffin MJ, Syddall HE, Davis A, Pannett B, Coggon D (2002) Occupational exposure to noise and the attributable burden of hearing difficulties in Great Britain. Occup Environ Med 59:634–639PubMedCrossRefGoogle Scholar
  41. 41.
    Topf M, Dillon E (1988) Noise-induced stress as a predictor of burnout in critical care nurses. Heart Lung 17:567–574PubMedGoogle Scholar
  42. 42.
    Williams JM (1981) Noise at work. BMJ 283:731–732PubMedGoogle Scholar
  43. 43.
    Walder B, Francioli D, Meyer JJ, Lançon M, Romand JA (2000) Effects of guidelines implementation in a surgical intensive care unit to control nighttime light and noise levels. Crit Care Med 28:2242–2247PubMedCrossRefGoogle Scholar
  44. 44.
    Monsen MG, Edell-Gustafsson UM (2005) Noise and sleep disturbance factors before and after implementation of a behavioural modification programme. Intensive Crit Care Nurs 21:208–19PubMedCrossRefGoogle Scholar
  45. 45.
    Interview 01 At: Accessed Dec 2006
  46. 46.
    Stanchina ML, Abu-Hijleh M, Chaudhry BK, Carlisle CC, Millman RP (2005) The influence of white noise on sleep in subjects exposed to ICU noise. Sleep Med 6:423–428PubMedCrossRefGoogle Scholar
  47. 47.
    Wallace CJ, Robins J, Alvord LS, Walker JM (1999) The effects of earplugs on sleep measures during exposure to simulated intensive care unit noise. Am J Crit Care 8:210–219PubMedGoogle Scholar
  48. 48.
    Byers JF, Smyth KA (1997) Effect of music intervention on noise annoyance, heart rate, and blood pressure in cardiac surgery patients. Am J Crit Care 6:183–191PubMedGoogle Scholar

Copyright information

© Springer Science + Business Media Inc. 2007

Authors and Affiliations

  • R. J. Pugh
    • 1
  • C. Jones
    • 1
  • R. D. Griffiths
    • 2
  1. 1.Intensive Care UnitWhiston HospitalPrescotUK
  2. 2.Division of Metabolic and Cellular Medicine School of Clinical Science Duncan Building, UCDUniversity of LiverpoolLiverpoolUK

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