Hospital noise exposure: a systematic review of levels, sources, and effects on patients and staff.

INTRODUCTION: Noise is often underestimated as a hospitalrelated hazard. This systematic review aimed to assess noise levels in hospitals, their sources, and the associated physiological and psychological impacts on the hospital community. MATERIALS AND METHODS: A literature search was conducted through PubMed, ProQuest, Ovid, and Scopus without language or date restrictions. Studies in all languages were considered, non-English articles were assessed using machine translation, although none met the inclusion criteria. This review was registered in PROSPERO under registration number CRD42025112689. Quantitative, qualitative, and mixed-method study designs that assessed hospital noise levels, sources, or effects were included. Risk of bias was appraised using the Joanna Briggs Institute (JBI) critical appraisal tools based on study designs, and the data were synthesised narratively. RESULTS: Eighteen studies were included in the qualitative synthesis, which consisted of cross-sectional (n=10), cohort (n=7), and qualitative (n=1) designs conducted across various countries. Noise levels frequently exceeded World Health Organization (WHO) limits, with mean equivalent levels (LAeq) ranging from 43 to 75.8 dB(A) and peak levels (LAFmax) reaching 100 dB(A). Intensive Care Units (ICUs) and Emergency Departments (EDs) were consistently reported as the noisiest departments. The physiological and psychological impacts experienced by the hospital community included stress, sleep disturbances, annoyance, elevated heart rate, and headaches. In chronic cases, noiseinduced hearing loss (NIHL) was diagnosed particularly in hospital staff from the maintenance and service department. The principal noise sources were medical equipment alarms and staff communication. CONCLUSION: Hospital noise levels consistently exceed recommended limits, posing both clinical and occupational risks. Noise should be considered a health and safety concern requiring institutional management. An integrated approach combining acoustic engineering, administrative policies, staff behavioural training, and continuous monitoring is essential to foster a safer hospital environment.