Hostname: page-component-745bb68f8f-b95js Total loading time: 0 Render date: 2025-01-11T05:45:01.309Z Has data issue: false hasContentIssue false
  • English
  • Français

Fatigue Increases the Risk of Injury From Sharp Devices in Medical Trainees Results From a Case-Crossover Study

Published online by Cambridge University Press:  02 January 2015

David N. Fisman ,
Anthony D. Harris ,
Michael Rubin ,
Gary S. Sorock  and
Murray A. Mittleman
David N. Fisman*
Affiliation:
Drexel University School of Public Health, Philadelphia, Pennsylvania, Baltimore, Maryland
Anthony D. Harris
Affiliation:
University of Maryland, Baltimore, Maryland
Michael Rubin
Affiliation:
University of Utah, Salt Lake City, Boston, Massachusetts
Gary S. Sorock
Affiliation:
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Murray A. Mittleman
Affiliation:
Harvard School of Public Health and Beth Israel Deaconess Medical Center, Boston, Massachusetts
*
Drexel University School of Public Health, 1505 Race St., Mail Stop 660, Philadelphia, PA 19102-1192 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Extreme fatigue in medical trainees likely compromises patient safety, but regulations that limit trainee work hours have been controversial. It is not known whether extreme fatigue compromises trainee safety in the healthcare workplace, but evidence of such a relationship would inform the current debate on trainee work practices. Our objective was to evaluate the relationship between fatigue and workplace injury risk among medical trainees and nontrainee healthcare workers.

Design.

Case-crossover study.

Setting.

Five academic medical centers in the United States and Canada.

Participants.

Healthcare workers reporting to employee healthcare clinics for evaluation of needlestick injuries and other injuries related to sharp instruments and devices (sharps injuries). Consenting workers completed a structured interview about work patterns, time at risk of injury, and frequency of fatigue.

Results.

Of 350 interviewed subjects, 109 (31%) were medical trainees. Trainees worked more hours per week (P < .001) and slept less the night before an injury (P < .001) than did other healthcare workers. Fatigue increased injury risk in the study population as a whole (incidence rate ratio [IRR], 1.40 [95% confidence interval {CI}, 1.03-1.90]), but this effect was limited to medical trainees (IRR, 2.94 [95% CI, 1.71-5.07]) and was absent for other healthcare workers (IRR, 0.97 [95% CI, 0.66-1.42]) (P = .001).

Conclusions.

Long work hours and sleep deprivation among medical trainees result in fatigue, which is associated with a 3-fold increase in the risk of sharps injury. Efforts to reduce trainee work hours may result in reduced risk of sharps-related injuries among this group.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 1 , January 2007 , pp. 10 - 17
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Niederee, MJ, Knudtson, JL, Byrnes, MC, Helmer, SD, Smith, RS. A survey of residents and faculty regarding work hour limitations in surgical training programs. Arch Surg 2003;138:663–669.CrossRefGoogle ScholarPubMed
2. Daugherty, SR, Baldwin, DC Jr, Rowley, BD. Learning, satisfaction, and mistreatment during medical internship: a national survey of working conditions. JAMA 1998;279:1194–1199.CrossRefGoogle ScholarPubMed
3. Defoe, DM, Power, ML, Holzman, GB, Carpentieri, A, Schulkin, J. Long hours and little sleep: work schedules of residents in obstetrics and gynecology. Obstet Gynecol 2001;97:1015–1018.Google ScholarPubMed
4. Smith-Coggins, R, Rosekind, M, Hurd, S. Relationship of day versus night sleep to physician performance and mood. Ann Emerg Med 1994;24:928–934.CrossRefGoogle ScholarPubMed
5. Rollinson, DC, Rathiev, NK, Moss, M, et al. The effects of consecutive night shifts on neuropsychological performance of interns in the emergency department: a pilot study. Ann Emerg Med 2003;41:400–406.CrossRefGoogle ScholarPubMed
6. Jacques, CH, Lynch, JC, Samkoff, JS. The effects of sleep loss on cognitive performance of resident physicians. J Fam Pract 1990;30:223–229.Google ScholarPubMed
7. Lockley, SW, Cronin, JW, Evans, EE, et al. Effect of reducing interns' weekly work hours on sleep and attentional failures. N Engl J Med 2004;351:1829–1837.CrossRefGoogle ScholarPubMed
8. Landrigan, CP, Rothschild, JM, Cronin, JW, et al. Effect of reducing interns' work hours on serious medical errors in intensive care units. N Engl J Med 2004;351:1838–1848.CrossRefGoogle ScholarPubMed
9. Barger, LK, Cade, BE, Ayas, NT, et al. Extended work shifts and the risk of motor vehicle crashes among interns. N Engl J Med 2005;352:125–134.CrossRefGoogle ScholarPubMed
10. Gaba, D, Howard, S. Fatigue among clinicians and the safety of patients. N Engl J Med 2002;347:1249–1255.CrossRefGoogle ScholarPubMed
11. Sexton, JB, Thomas, EJ, Helmreich, RL. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ 2000;320:745–749.CrossRefGoogle Scholar
12. Goode, JH. Are pilots at risk of accidents due to fatigue? J Safety Res 2003;34:309–313.CrossRefGoogle ScholarPubMed
13. Philibert, I, Friedmann, P, Williams, WT. New requirements for resident duty hours. JAMA 2002;288:1112–1114.CrossRefGoogle ScholarPubMed
14. Johnson, T. Limitations on residents' working hours at New York teaching hospitals: a status report. Acad Med 2003;78:3–8.CrossRefGoogle ScholarPubMed
15. Romano, M. Lightening their load: as teaching hospitals grapple with new rules limiting residents' hours on the job, cost and management issues remain among the challenges. Mod Healthc 2003;33:32–35, 47.Google ScholarPubMed
16. Fletcher, KE, Davis, SQ, Underwood, W, Mangurlkar, RS, McMahon, LF, Saint, S. Systematic review: effects of resident work hours on patient safety. Ann Intern Med 2004;141:851–857.CrossRefGoogle ScholarPubMed
17. Lowenstein, J. Where have all the giants gone? Reconciling medical education and the traditions of patient care with limitations on resident work hours. Perspect Biol Med 2003;46:273–282.CrossRefGoogle ScholarPubMed
18. Charap, M. Reducing resident work hours: unproven assumptions and unforeseen outcomes. Ann Intern Med 2004;140:814–815.CrossRefGoogle ScholarPubMed
19. Panlilio, AL, Orelien, JG, Srivastava, PU, Jagger, J, Cohn, RD, Cardo, DM. Estimate of the annual number of percutaneous injuries among hospital-based healthcare workers in the United States, 1997-1998. Infect Control Hosp Epidemiol 2004;25:556–562.CrossRefGoogle ScholarPubMed
20. National Institute of Occupational Safety and Health. Alert: Preventing Needlestick Injuries in Healthcare Settings. Document 2000-108. Washington, DC: Department of Health and Human Services; 1999.Google Scholar
21. Henry, K, Campbell, S. Needlestick/sharps injuries and HIV exposure among health care workers: national estimates based on a survey of U.S. hospitals. Minn Med 1995;78:41–44.Google ScholarPubMed
22. Cardo, DM, Culver, DH, Ciesielski, CA, et al. Centers for Centers for Disease Control and Prevention Needlestick Surveillance Group. A case-control study of HIV seroconversion in health care workers after percutaneous exposure. N Engl J Med 1997;337:1485–1490.CrossRefGoogle Scholar
23. Jagger, J, Puro, V, De Carli, G. Occupational transmission of hepatitis C virus. JAMA 2002;288:1469–1471.Google ScholarPubMed
24. Lanphear, B, Linemann, C, Cannon, C, DeRonde, M, Pendy, L, Kerley, L. Hepatitis C virus infection in healthcare workers: risk of exposure and infection. Infect Control Hosp Epidemiol 1994;15:745–750.CrossRefGoogle ScholarPubMed
25. Petrosillo, N, Puro, V, Ippolito, G, et al. Hepatitis B virus, hepatitis C virus and human immunodeficiency virus infection in health care workers: a multiple regression analysis of risk factors. J Hosp Infect 1995;30:273–281.CrossRefGoogle ScholarPubMed
26. Jagger, J, Bentley, M, Juillet, E. Direct cost of follow-up for percutaneous and mucocutaneous exposures to at-risk body fluids: data from two hospitals. Adv Expo Prev 1998;3:1–3.Google Scholar
27. Wong, JB, Poynard, T, Ling, MH, Albrecht, JK, Pauker, SG. Cost-effectiveness of 24 or 48 weeks of interferon a-2b alone or with ribavirin as initial treatment of chronic hepatitis C. International Hepatitis Interventional Therapy Group. Am J Gastroenterol 2000;95:1524–1530.Google ScholarPubMed
28. Pinkerton, SD, Holtgrave, DR, Pinkerton, HJ. Cost-effectiveness of che-moprophylaxis after occupational exposure to HIV. Arch Intern Med 1997;157:1972–1980.CrossRefGoogle Scholar
29. Perry, J, Parker, G, Jagger, J. EPINet report:2001 percutaneous injury rates. Adv Expo Prev 2003;6:33–36.Google Scholar
30. Fisman, D, Harris, A, Sorock, G, Mittleman, M. Sharps-related injuries in health care workers: a case-crossover study. Am J Med 2003;114:688–694.CrossRefGoogle ScholarPubMed
31. McCormick, RD, Meisch, MG, Ircink, FG, Maki, DG. Epidemiology of hospital sharps injuries: a 14-year prospective study in the pre-AIDS and AIDS eras. Am J Med 1991;91:301S–307S.CrossRefGoogle ScholarPubMed
32. Pettit, L, Gee, S, Begue, R. Epidemiology of sharp object injuries in a children's hospital. Pediatr Infect Dis J 1997;16:1019–1023.CrossRefGoogle ScholarPubMed
33. Perry, J, Jagger, J. Healthcare worker blood exposure risks: updating the statistics. In: Jagger, J, Perry, J, eds. Preventing Occupational Exposures to Bloodborne Pathogens: Articles from Advances in Exposure Prevention, 1994–2003. 1st ed. Charlottesville, VA: International Healthcare Worker Safety Center; 2004:203–207.Google Scholar
34. Choudhury, RP, Cleator, SJ. An examination of needlestick injury rates, hepatitis B vaccination uptake and instruction on “sharps” technique among medical students. J Hosp Infect 1992;22:143–148.CrossRefGoogle ScholarPubMed
35. Waterman, J, Jankowski, R, Madan, I. Under-reporting of needlestick injuries by medical students. J Hosp Infect 1994;26:149–150.CrossRefGoogle ScholarPubMed
36. Melzer, SM, Vermund, SH, Shelov, SP. Needle injuries among pediatric housestaff physicians in New York City. Pediatrics 1989;84:211–214.CrossRefGoogle ScholarPubMed
37. Maclure, M. The case-crossover design: a method for studying transient effects on the risk of acute events. Am J Epidemiol 1991;133:144–153.CrossRefGoogle ScholarPubMed
38. Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens; needlesticks and other sharps injuries; final rule. Fed Regist 2001;66:5318–5325.Google Scholar
39. Maclure, M, Mittleman, MA. Should we use a case-crossover design? Annu Rev Public Health 2000;21:193–221.CrossRefGoogle ScholarPubMed
40. Fleiss, J. Sampling methods. I. Naturalistic or cross-sectional studies. In: Fleiss, J. Statistical Methods for Rates and Proportions. 2nd ed. New York, NY: John Wiley and Sons; 1981:56–62.Google Scholar
41. Streiner, D, Norman, G. Validity. In: Streiner, D, Norman, G. Health Measurement Scales. 2nd ed. Oxford, United Kingdom: Oxford University Press; 1995:144–162.Google Scholar
42. Hosmer, D Jr, Lemeshow, S. Applied Logistic Regression. New York, NY: John Wiley and Sons; 1989.Google Scholar
43. Rothman, K, Greenland, S. Applications of stratified analysis methods. In: Rothman, K, Greenland, S, eds. Modern Epidemiology. 2nd ed. Philadelphia, PA: Lippincott-Raven; 1998:278–300.Google Scholar
44. Greenland, S, Robins, J. Estimation of a common effect parameter from sparse follow-up data. Biometrics 1985;41:55–68.CrossRefGoogle ScholarPubMed
45. Rothman, K, Greenland, S. Introduction to stratified analysis. In: Rothman, K, Greenland, S, eds. Modern Epidemiology. 2nd ed. Philadelphia, PA: Lippincott-Raven; 1998:253–277.Google Scholar
46. Greenland, S, Robins, JM. Conceptual problems in the definition and interpretation of attributable fractions. Am J Epidemiol 1988;128:1185–1197.CrossRefGoogle ScholarPubMed
47. Brensilver, JM, Smith, L, Lyttle, CS. Impact of the Libby Zion case on graduate medical education in internal medicine. Mt Sinai J Med 1998;65:296–300.Google ScholarPubMed
48. Morrow, PC, Crum, MR. Antecedents of fatigue, close calls, and crashes among commercial motor-vehicle drivers, J Safety Res 2004;35:59–69.CrossRefGoogle ScholarPubMed
49. Caruso, CC, Hitchcock, EM, Dick, RB, Russo, JM, Schmidt, JM. Overtime and Extended Work Shifts: Recent Findings on Illnesses, Injuries, and Health Behaviors. Cincinnati, OH: National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2004. Available at: http://www.cdc.gov/niosh/docs/2004-143/pdfs/2004-143.pdf. Accessed December 2, 2005.Google Scholar
50. Simpson, CL, Severson, RK. Risk of injury in African American hospital workers. J Occup Environ Med 2000;42:1035–1040.CrossRefGoogle ScholarPubMed
51. Patel, SM, Johnson, S, Belknap, SM, Chan, J, Sha, BE, Bennett, C. Serious adverse cutaneous and hepatic toxicities associated with nevirapine use by non-HIV-infected individuals. J Acquir Immune Defic Syndr 2004;35:120–125.CrossRefGoogle ScholarPubMed
52. Fisman, DN, Mittleman, MA, Sorock, GS, Harris, AD. Willingness to pay to avoid sharps-related injuries: a study in injured health care workers. Am J Infect Control 2002;30:283–287.CrossRefGoogle ScholarPubMed
53. Jury orders Yale to pay $12.2 million to doctor with HIV. AIDS Policy Law 1998;13:8.Google Scholar