ICU Noise Never Stops: Lebanese Nurses Reveal the Hidden Cost of Getting Used to It

Inside every intensive care unit there is a constant, invisible patient: sound. Monitor alarms chirp, ventilators hiss, infusion pumps beep, trolleys rattle, and voices compete with all of it. A new study from Lebanon, published in BMC Public Health, offers one of the most detailed portraits yet of how nurses who work amid this acoustic storm actually experience it, and the findings challenge a comforting assumption that has long shaped hospital thinking: that people simply get used to the noise.

The research team, led by Kawthar Jaber Fadlallah and colleagues at the Center for Collaborative Research Initiatives in Public Health and Saint-Joseph University of Beirut, used an explanatory sequential mixed-methods design, a two-stage approach that pairs breadth with depth. First, they surveyed 228 intensive care nurses across Lebanon between March and June 2025, asking them to rate noise sources and the perceived impact of noise across four domains: subjective perception, emotion, physiology, and performance. Then, between September and October 2025, they conducted semi-structured interviews with 20 nurses purposively selected from the survey respondents, analyzing the transcripts thematically to explain what the numbers showed.

The survey results paint a picture of an environment saturated with machinery. Most noise sources were rated as moderate, but monitor alarms and ventilators stood out as the leading high-level source, cited by half of the nurses. Alarm fatigue, the desensitization that develops when clinicians hear hundreds of alerts per shift, is a well-documented safety concern in critical care, and this study confirms that in Lebanese ICUs the alarm-ventilator duo dominates the soundscape that nurses cannot escape.

Perhaps the most technically interesting finding lies in the impact scores. Across all four domains, the mean scores fell below the midpoint of the scale: subjective perception at 11.0 plus or minus 3.4, emotion at 13.8 plus or minus 4.4, physiology at 14.2 plus or minus 4.3, and performance at 10.6 plus or minus 4.2. On the surface, that might suggest noise is not a severe problem. But the qualitative interviews revealed a subtler and more troubling interpretation. Nurses described getting used to the noise while simultaneously reporting impaired concentration, having to repeat tasks, tinnitus, and headaches that persisted after their shifts ended. Their adaptation, the authors conclude, reflected endurance rather than relief.

This distinction matters scientifically. Habituation to noise is often assumed to be protective, a form of resilience in which the nervous system learns to filter out irrelevant stimuli. But psychophysiological research has long suggested that even when people report no longer noticing a noise, their bodies may still be responding, with elevated stress hormones, disturbed sleep, and cardiovascular strain. The Lebanese nurses’ accounts of tinnitus and post-shift headaches are consistent with that literature: subjective adaptation can coexist with objective wear.

Geography added another layer to the story. In bivariate analysis, the perceived impact of noise varied significantly by region across all four domains, with p-values at or below 0.017. Impact was highest in the Beqaa region and lowest in North Lebanon. The authors link this pattern to the strained context in which Lebanese nurses work, a health system under chronic economic and institutional pressure in a low- and middle-income country setting, where resources for noise mitigation, alarm management technology, and staff support may be scarce or unevenly distributed.

Experience also shaped perception. The perceived impact in the subjective perception domain increased with longer hospital tenure (r = 0.17, p = 0.009) and longer ICU experience (r = 0.13, p = 0.046). That correlation is counterintuitive at first glance: surely veterans should be least bothered by noise. But it aligns with the endurance interpretation. The longer nurses work in the unit, the more they become aware of what the noise is doing to them, even as they learn to function through it. Accumulated exposure appears to sharpen awareness of the toll rather than dull it.

Burnout emerged as a central thread. The mean burnout score of 3.5 plus or minus 1.2 fell exactly at the lower boundary of the band indicating the presence of burnout, meaning a substantial share of the surveyed nurses were already experiencing the emotional exhaustion and reduced professional efficacy that define the syndrome. The interviews connected this to the noise environment indirectly but persuasively: nurses coping with constant auditory stress, cognitive disruption, and physical symptoms described informal, individually driven coping strategies, while institutional responses were inconsistent at best.

That last point may be the study’s most actionable insight. Where hospitals failed to provide systematic noise management, nurses managed noise on their own, improvising solutions that the researchers linked to the broader LMIC context of systemic strain. The authors argue that this pattern supports system-level mitigation rather than reliance on individual habituation. In practice, that could mean alarm customization and tiered alerting to reduce false alarms, sound-absorbing architectural materials, designated quiet periods, staff education on noise behavior, and acoustic monitoring integrated into unit quality metrics, all interventions that have shown promise in critical care research worldwide.

The study has limits worth noting. It measured perceptions rather than objective sound levels, and its cross-sectional design captures a single moment in time, so causal claims about noise causing burnout cannot be firmly drawn. The sample, while geographically broad within Lebanon, reflects one national context during a period of exceptional strain. Still, by combining quantitative scores with the lived accounts of 20 nurses, the research captures something numbers alone cannot: the quiet resignation of professionals who have learned to keep working through a hazard their institutions have not yet learned to control. For intensive care units everywhere, and especially in resource-constrained settings, the message is that adaptation is not a solution. It is a symptom.

Subject of Research: Nurses' perceptions of noise pollution and its health effects in intensive care units in Lebanon

Article Title: Noise pollution in the intensive care unit: a mixed − methods exploration of Lebanese nurses’ perceptions

Article References: Noise pollution in the intensive care unit: a mixed − methods exploration of Lebanese nurses’ perceptions. (n.d.). https://doi.org/10.1186/s12889-026-29813-9

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29813-9

Keywords: noise pollution, intensive care unit, nurses, burnout, occupational health, alarm fatigue, Lebanon, mixed methods, LMIC, tinnitus, ventilators, monitor alarms