BACKGROUND: Sleep is critical to patient recovery in the hospital, hospitalization is not restful, and inpatient sleep deprivation has been linked to poor outcomes. Excessive noise in neonatal intensive care units (NICUs) can interfere with infants' growth, development and healing. Sound levels in many NICUs exceed the recommended levels by the World Health Organization. METHODS: We implemented a unit-based nursing empowerment approach focused on noise reduction strategy in an urban, tertiary academic medical center NICU that included baseline noise measurements. We conducted a survey involving staff and visitors regarding their opinions and perceptions of noise levels in the NICU. Ongoing feedback to staff after each measurement cycle was provided to improve awareness, engagement and adherence with noise reduction strategies. After widespread discussion with active clinician involvement, consensus building and iterative testing, changes were implemented including: lowering of equipment alarm sounds, designated 'quiet times' and implementing a customized education program for staff. INTERVENTIONS: A multi-phase noise reduction quality improvement (QI) intervention to reduce ambient sound levels in a patient care room in our NICUs by 3 dB (20%) over 18 months. RESULTS: The noise in the NICU was reduced by 3 dB from baseline. Mean (s.d.) baseline, phase 2, 3 and 4 noise levels in the two NICUs were: LAeq: 57.0 (0.84), 56.8 (1.6), 55.3 (1.9) and 54.5 (2.6) dB, respectively (P o 0.01). Adherence with the planned process measure of 'quiet times' was >90%. CONCLUSIONS: We implementing a multi-pronged QI initiative resulted in significant noise level reduction in two multi-pod NICUs. It is feasible to reduce noise levels if QI interventions are coupled with active engagement of the clinical staff and following continuous process of improvement methods, measurements and protocols.