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Excessive noise is detrimental to health, and this is especially problematic in the health care setting where noise often exceeds healthy levels established by the World Health Organization. Noisy environments are stressful environments, and stress worsens healing conditions for patients. 

Further, stressed staff cannot easily focus on providing safe patient care. Recent additions to The Center for Health Design’s Knowledge Repository include several new studies on how the built environment can help to resolve noise issues in several distinct space types. Three studies are highlighted here. 

While noise is a concern in any type of health care space, we have to pay special attention to the impact in sensitive spaces like the operating room (OR). Two recent systematic reviews by Fu and colleagues and Mcleod and colleagues examine the effect of noise pollution in the OR on patient outcomes and staff performance. 

These reviews discuss noise-reduction programs through operational changes like limiting conversation but also environmental interventions such as sound reduction devices, reducing OR door openings, innovative equipment design and noise-monitor alarms. 

The first review includes a summary of studies on general noise as well as attitudes toward playing music in the OR. Remarkably, while staff found noise to increase stress, they actually felt their performance improved when sound levels were doubled by music. In the second review, Mcleod et al. propose that noise-reducing measures in learning environments are critically important, and that simulated environments can help medical students refine surgical skills before being exposed to auditory distraction in real-life settings. 

Both reviews highlight findings around the association between lower noise levels and significantly lower postoperative complications.

Another sensitive environment in health care is the neonatal intensive care unit (NICU), where noise can be detrimental to the growth and development of vulnerable preterm infants. Noise can also impact the well-being of parents who are oftentimes spending multiple days and nights in the NICU with their babies. 

In a study out of Canada, Aita and colleagues conducted a pre- and post-evaluation comparing noise (and light) in a former open ward NICU to a new unit with both pods and single-family rooms. In addition to the difference in layout from pre to post, floors were covered in sound-absorbent tiles in the new unit. 

Results showed that, statistically, the sound levels were significantly lower in the new unit as compared with the old unit. Interestingly, there were no significant differences in sound levels between the pods and single-family rooms making up the new unit. 

Noise-reducing measures are often focused on behavioral changes, such as “no-talking rules,” but the design of the environment plays a major role in supporting or hindering noisy behavior, as well as creating a calm, quiet atmosphere for patients, visitors and staff. 

To learn more about research into health care design and noise, as well as many other research projects related to health care facility design, readers should visit The Center for Health Design’s Knowledge Repository. 

Research used for this column

The following citations from The Center for Health Design’s Knowledge Repository of health care design resources were used by the author when writing this column:

• V. X. Fu et al., “The Perception and Attitude toward Noise and Music in the Operation Room: A Systematic Review,” Journal of Surgical Research, 263 (2021): 193–206.
• R. Mcleod et al., “The Impact of Noise in the Operating Theatre: A Review of the Evidence,” The Annals of The Royal College of Surgeons of England, 103, no. 2 (2021): 83–87.
• M. Aita et al., “Comparing Light and Noise Levels before and after a NICU Change of Design,” Journal of Perinatology, 2021, in press.

About this column

“Design Discoveries” highlights research from The Center for Health Design’s Knowledge Repository, a user-friendly library of health care design resources. This research effort is supported by the American Society for Health Care Engineering, the American Institute of Architects, the Academy of Architecture for Health Foundation and the Facility Guidelines Institute.