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

  • David N. Fisman (a1), Anthony D. Harris (a2), Michael Rubin (a3), Gary S. Sorock (a4) and Murray A. Mittleman (a5)...
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.

Copyright
Corresponding author
Drexel University School of Public Health, 1505 Race St., Mail Stop 660, Philadelphia, PA 19102-1192 (df62@drexel.edu)
References
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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;138:663669.
2. Daugherty SR, Baldwin DC Jr, Rowley BD. Learning, satisfaction, and mistreatment during medical internship: a national survey of working conditions. JAMA 1998;279:11941199.
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;97:10151018.
4. Smith-Coggins R, Rosekind M, Hurd S. Relationship of day versus night sleep to physician performance and mood. Ann Emerg Med 1994;24:928934.
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;41:400406.
6. Jacques CH, Lynch JC, Samkoff JS. The effects of sleep loss on cognitive performance of resident physicians. J Fam Pract 1990;30:223229.
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;351:18291837.
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;351:18381848.
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;352:125134.
10. Gaba D, Howard S. Fatigue among clinicians and the safety of patients. N Engl J Med 2002;347:12491255.
11. Sexton JB, Thomas EJ, Helmreich RL. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ 2000;320:745749.
12. Goode JH. Are pilots at risk of accidents due to fatigue? J Safety Res 2003;34:309313.
13. Philibert I, Friedmann P, Williams WT. New requirements for resident duty hours. JAMA 2002;288:11121114.
14. Johnson T. Limitations on residents' working hours at New York teaching hospitals: a status report. Acad Med 2003;78:38.
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;33:3235, 47.
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;141:851857.
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;46:273282.
18. Charap M. Reducing resident work hours: unproven assumptions and unforeseen outcomes. Ann Intern Med 2004;140:814815.
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;25:556562.
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.
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;78:4144.
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;337:14851490.
23. Jagger J, Puro V, De Carli G. Occupational transmission of hepatitis C virus. JAMA 2002;288:14691471.
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;15:745750.
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;30:273281.
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;3:13.
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;95:15241530.
28. Pinkerton SD, Holtgrave DR, Pinkerton HJ. Cost-effectiveness of che-moprophylaxis after occupational exposure to HIV. Arch Intern Med 1997;157:19721980.
29. Perry J, Parker G, Jagger J. EPINet report:2001 percutaneous injury rates. Adv Expo Prev 2003;6:3336.
30. Fisman D, Harris A, Sorock G, Mittleman M. Sharps-related injuries in health care workers: a case-crossover study. Am J Med 2003;114:688694.
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;91:301S307S.
32. Pettit L, Gee S, Begue R. Epidemiology of sharp object injuries in a children's hospital. Pediatr Infect Dis J 1997;16:10191023.
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; 2004:203207.
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;22:143148.
35. Waterman J, Jankowski R, Madan I. Under-reporting of needlestick injuries by medical students. J Hosp Infect 1994;26:149150.
36. Melzer SM, Vermund SH, Shelov SP. Needle injuries among pediatric housestaff physicians in New York City. Pediatrics 1989;84:211214.
37. Maclure M. The case-crossover design: a method for studying transient effects on the risk of acute events. Am J Epidemiol 1991;133:144153.
38. Occupational Safety and Health Administration. Occupational exposure to bloodborne pathogens; needlesticks and other sharps injuries; final rule. Fed Regist 2001;66:53185325.
39. Maclure M, Mittleman MA. Should we use a case-crossover design? Annu Rev Public Health 2000;21:193221.
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; 1981:5662.
41. Streiner D, Norman G. Validity. In: Streiner D, Norman G. Health Measurement Scales. 2nd ed. Oxford, United Kingdom: Oxford University Press; 1995:144162.
42. Hosmer D Jr, Lemeshow S. Applied Logistic Regression. New York, NY: John Wiley and Sons; 1989.
43. Rothman K, Greenland S. Applications of stratified analysis methods. In: Rothman K, Greenland S, eds. Modern Epidemiology. 2nd ed. Philadelphia, PA: Lippincott-Raven; 1998:278300.
44. Greenland S, Robins J. Estimation of a common effect parameter from sparse follow-up data. Biometrics 1985;41:5568.
45. Rothman K, Greenland S. Introduction to stratified analysis. In: Rothman K, Greenland S, eds. Modern Epidemiology. 2nd ed. Philadelphia, PA: Lippincott-Raven; 1998:253277.
46. Greenland S, Robins JM. Conceptual problems in the definition and interpretation of attributable fractions. Am J Epidemiol 1988;128:11851197.
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;65:296300.
48. Morrow PC, Crum MR. Antecedents of fatigue, close calls, and crashes among commercial motor-vehicle drivers, J Safety Res 2004;35:5969.
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.
50. Simpson CL, Severson RK. Risk of injury in African American hospital workers. J Occup Environ Med 2000;42:10351040.
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;35:120125.
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;30:283287.
53. Jury orders Yale to pay $12.2 million to doctor with HIV. AIDS Policy Law 1998;13:8.
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