ThinkingSound and noise in healthcare: There’s no excuse for inaction

Mai-Britt Beldam, from Ecophon, explains the damaging impact have on hospital patients and staff.
Content Team4 weeks ago16 min

In 2016, a group of Swedish researchers revealed that staff members in a select group of hospitals knew little about the impact of sound and noise in healthcare, particularly how sound affects patients or even themselves[1].

‘Unnecessary noise is the most cruel absence of care which can be inflicted upon either the sick or well!’

Florence Nightingale in Notes on Nursing, 1859

Questionnaires were handed out to 1,047 staff members at nine ICUs and none of the respondents answered all ten questions correctly; the average number of correct answers was just four. The question with the lowest proportion of correct answers (just 3%) related to which chronic physiological changes can be linked to noise.

Research shows that hospitals particularly struggle with noise and that chronic physiological changes are linked a bad sound environment. But since the 1960’s, sound and noise in healthcare facilities has been increasing dramatically, both during the day and at night[2]. As the table below shows, we are straying far above the levels recommended by the World Health Organisation.

Actual sound levels in hospitals and WHO guidelines.

Today, hospitals are complex ‘cities’ with a lot of people, a lot of technical equipment and more and more advanced challenges to solve. This might also be the reason why medical staff don’t know exactly how sound affects people; their task is to save lives.

But patients suffer because of sound and noise in healthcare facilities. In short, noise makes it difficult for patients to sleep and rest, and the negative impact can be seen in medication intake[3], hospital readmissions[4] and e.g. heartrates[5]. During acute illness, a bad acoustics environment may have important detrimental physiological effects on rehabilitation[6].

What about the staff?

Let’s think about the millions of people working in hospitals too. They are not in the same fragile situation with a constantly alert sensory system – they are literally having ‘just another day at the office’.

In Scandinavia, building regulations around sound and acoustics are among the strongest in Europe. Despite this, the Danish National Institute of Occupational Health tells us repeatedly that nurses rank in the top five professions who feel most disturbed by sound and noise during their working day (more than 25% of the time)[7].

In addition to this, a project initiated by the Technical University of Denmark in 2017 revealed that in Copenhagen hospitals, 97% of the staff members are sometimes disturbed by noise[8].

What’s behind this issue?

One of the biggest problems today is that the hospital building itself isn’t supporting the activities and events taking place inside. Hygiene requirements for example, mean that hospitals are built with hard, reflective surfaces. Add more people into the equation, along with more equipment and greater complexity (= sound sources), and the sound levels escalate.

Let’s not forget that sound is energy and if it’s not absorbed it will simply build up. Sound travels fast (340 m/sec) and when the surfaces allow it to bounce back and forth it’s not unusual for a sound to live on for more than a second. Just think of Pong, one of the first video games, where a ball continuously bounces back and forth between two paddles.

Pong, one of the very first video games, involves bouncing a ball between two paddles.

What impact does this have?

When we have a lot of sound sources at the same time (as in a hospital) it gets difficult to have a conversation, because the speech sounds are masked by the constant sound energy. And when we can’t hear what is being said (or what we say ourselves), we try to speak up. This happens automatically and creates what is called the ‘Lombard effect’ – a negative spiral where the sound builds up. The sound pressure levels therefore increase and the environment becomes anything but calm and supportive.

What about in operating rooms?

A study at Hvidovre Hospital in Denmark clearly showed the impact of sound and noise in healthcare. Here, three operating rooms were used for a research project. One room was used as a control room, one had acoustic absorbers added to the ceiling and one had acoustic absorbers installed in both the ceiling and walls.

Medical staff were then asked to fill in questionnaires about the sound environment, asking whether they could communicate well and whether they were at risk of making mistakes. The results showed a clear trend; acoustics matter! In the untreated room the staff had a harder time communicating, they felt more stressed and were more likely to make mistakes[9] (fig. 3).

OR4 had no acoustic treatment, OR5 had an acoustic ceiling, OR6 had an acoustic ceiling and acoustic wall panels.

What can be done?

Thankfully today, new acoustic ceiling tiles and wall panels are produced which take care of both hygiene and acoustic demands. ‘Old school’ hard surfaces can also be treated.

And the fact acoustic treatment can support both the activities in the hospital and the hygiene demands means there is no longer an excuse for not taking action. It’s absurd that a building that exists to take care of people could be making it difficult for them to actually heal or, in the case of medical staff, perform.

The research is there, the products are there and the knowledge is there – we just have to prioritise. Trust me, if we can travel to the moon, we can also create great acoustic environments in hospitals.

Enjoyed this article? Find more content on sound and noise in healthcare here.

Written by Mai-Britt Beldam, from Ecophon.


[1] Johansson L, et al.: ‘’Noise in the ICU patient room – staff knowledge and clinical improvements’’. Intensive and Critical Care Nursing (2016).

[2] Busch-Vishniac et al., “Noise Levels in John Hopkins Hospital”, Journal of the Acoustical Society of America, Dec 2005, 118(6), p3629-3645

[3] Hagerman et al: “Influence of intensive coronary care acoustics on the quality of care and physiological state of patients”, International Journal of Cardiology, Volume 98, Issue 2, February 2005

[4] Ibid

[5] Weise, “Investigation of patient perception of hospital noise and sound level measurements: before, during and after renovations of a hospital wing”, Architectural engineering – Dissertations and Student Research, 2010, Paper 4, p7

[6] Hagerman et al: “Influence of intensive coronary care acoustics on the quality of care and physiological state of patients”, International Journal of Cardiology, Volume 98, Issue 2, February 2005

[7] National institute of occupational health – Report: Noise and health 2016

[8] Larsen T, ’’Study of Room Acoustics and Noise at Bispebjerg and Frederiksberg Hospital

[9] Beldam, “Impact of acoustics on staff performance in operation rooms”, Internoise, Madrid, 2019

Content Team

Work in Mind is a content platform designed to give a voice to thinkers, businesses, journalists and regulatory bodies in the field of healthy buildings.

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