Extended Work Duration and the Risk of Self-reported Percutaneous Injuries in Interns

Harvard University, Cambridge, Massachusetts, United States
JAMA The Journal of the American Medical Association (Impact Factor: 35.29). 10/2006; 296(9):1055-62. DOI: 10.1001/jama.296.9.1055
Source: PubMed


In their first year of postgraduate training, interns commonly work shifts that are longer than 24 hours. Extended-duration work shifts are associated with increased risks of automobile crash, particularly during a commute from work. Interns may be at risk for other occupation-related injuries.
To assess the relationship between extended work duration and rates of percutaneous injuries in a diverse population of interns in the United States.
National prospective cohort study of 2737 of the estimated 18,447 interns in US postgraduate residency programs from July 2002 through May 2003. Each month, comprehensive Web-based surveys that asked about work schedules and the occurrence of percutaneous injuries in the previous month were sent to all participants. Case-crossover within-subjects analyses were performed.
Comparisons of rates of percutaneous injuries during day work (6:30 am to 5:30 pm) after working overnight (extended work) vs day work that was not preceded by working overnight (nonextended work). We also compared injuries during the nighttime (11:30 pm to 7:30 am) vs the daytime (7:30 am to 3:30 pm).
From a total of 17,003 monthly surveys, 498 percutaneous injuries were reported (0.029/intern-month). In 448 injuries, at least 1 contributing factor was reported. Lapse in concentration and fatigue were the 2 most commonly reported contributing factors (64% and 31% of injuries, respectively). Percutaneous injuries were more frequent during extended work compared with nonextended work (1.31/1000 opportunities vs 0.76/1000 opportunities, respectively; odds ratio [OR], 1.61; 95% confidence interval [CI], 1.46-1.78). Extended work injuries occurred after a mean of 29.1 consecutive work hours; nonextended work injuries occurred after a mean of 6.1 consecutive work hours. Injuries were more frequent during the nighttime than during the daytime (1.48/1000 opportunities vs 0.70/1000 opportunities, respectively; OR, 2.04; 95% CI, 1.98-2.11).
Extended work duration and night work were associated with an increased risk of percutaneous injuries in this study population of physicians during their first year of clinical training.

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    • "Many studies have been carried out regarding the relationship between sleep disturbance and injury in adults. for example, a number of studies have examined the relationship between insomnia and occupational [12] [13] [14] and driving accidents [15] [16] in adults. However, similar empirical evidence remains sparse for children [17] [18] [19] [20]. "
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    ABSTRACT: Background. A good night's sleep plays a key role in diseases resistance, injury prevention, and mood stability. The objective of this study was to examine relationship between sleep problems and accidental injury occurrences in school-aged children. Method. A retrospective study was conducted for comparing two groups of children. Children who have experienced injuries for at least two times during an academic year are the participants in the injury group (IG) and those who have not experienced any kind of injuries are placed in the noninjury group (NIG). Data was collected through parent-reported sleep patterns and problems using Children's Sleep Habits Questionnaire (CSHQ). Findings. The findings showed that global sleep problems were more in the IG than in the NIG. Multivariate logistic regression analysis showed that the daytime sleepiness and sleep duration are the two major reasons for accidental injury. In addition, significant difference was seen between the sleep patterns of the two groups. Sleep duration was also shorter in the IG, and this group had a greater percentage (63% versus 41.1%) of "short sleepers" (<9 h). Conclusion. There is a significant relationship between injury occurrence and sleep problems and sleep duration in Iranian school-aged children.
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    • "Also the same results were reported by Aghadoost et al., in Kashan (39), and some of the studies from other countries (40, 41). Nevertheless, Ayas et al., studied the risk of self-reported percutaneous injuries in interns and reported that most injuries occurred during the night shifts (42). In the current study, injecting and taking a blood sample from a restless patient and recapping the needles were the most dangerous interventions resulting in needle stick injury. "
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    • "Study participants felt that the senior residents were exposed to less personal harm as a result of the SRRB. This is consistent with previous research showing that prolonged duty hours for residents increase their personal harm risk including needle stick injuries, motor vehicle collisions post-call, and burnout [1,6,9,18,19]. Study participants also felt that the SRRB caused increased conflicting role demands by reducing the senior residents’ ability to spend time with family, perform research, and trade work shifts compared to the traditional system of call. "
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