Noise, stress, and annoyance in a pediatric intensive care unit

Crit Care Med. 2003 Jan;31(1):113-9. doi: 10.1097/00003246-200301000-00018.


Objective: To measure and describe hospital noise and determine whether noise can be correlated with nursing stress measured by questionnaire, salivary amylase, and heart rate.

Design: Cohort observational study.

Setting: Tertiary care center pediatric intensive care unit.

Subjects: Registered nurses working in the unit.

Interventions: None.

Measurements and main results: Eleven nurse volunteers were recruited. An audiogram, questionnaire data, salivary amylase, and heart rate were collected in a quiet room. Each nurse was observed for a 3-hr period during patient care. Heart rate and sound level were recorded continuously; saliva samples and stress/annoyance ratings were collected every 30 mins. Variables assessed as potential confounders were years of nursing experience, caffeine intake, patients' Pediatric Risk of Mortality Score, shift assignment, and room assignment. Data were analyzed by random effects multiple linear regression using Stata 6.0. The average daytime sound level was 61 dB(A), nighttime 59 dB(A). Higher average sound levels significantly predicted higher heart rates (p =.014). Other significant predictors of tachycardia were higher caffeine intake, less nursing experience, and daytime shift. Ninety percent of the variability in heart rate was explained by the regression equation. Amylase measurements showed a large variability and were not significantly affected by noise levels. Higher average sound levels were also predictive of greater subjective stress (p =.021) and annoyance (p =.016).

Conclusions: In this small study, noise was shown to correlate with several measures of stress including tachycardia and annoyance ratings. Further studies of interventions to reduce noise are essential.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Amylases / metabolism
  • Baltimore
  • Child
  • Cohort Studies
  • Health Facility Environment*
  • Heart Rate
  • Humans
  • Intensive Care Units, Pediatric*
  • Irritable Mood
  • Linear Models
  • Multivariate Analysis
  • Noise, Occupational / adverse effects*
  • Nursing Staff, Hospital*
  • Stress, Psychological / etiology*
  • Stress, Psychological / physiopathology


  • Amylases