Day-Night Pattern in Accidental Exposures to Blood-Borne Pathogens Among Medical Students and Residents

Abstract

The purpose of this study was to determine whether the occurrence of accidental blood-borne pathogen exposure incidents in medical students and residents in training varies during the 24 h. A retrospective review of reported exposures was conducted in a large urban teaching institution--the University of Texas Health Science Center in Houston--between November 1993 and July 1998. Professional level (year of student or level of resident), time of exposure, means/route of exposure (needle stick, laceration, or splash), and type of medical service were recorded. Analysis of the clock time of the 745 reported blood-borne pathogen exposures showed they occurred more frequently during the day than night. Over the nearly 5-year span, 531 incidents took place between 06:00 and 17:59 in comparison to only 214 between 18:00 and 05:59. To account for the day-night difference in medical student and resident hospital staffing, the data were reexpressed as exposure rates, that is, in terms of the number of events per hour per 1000 medical students and residents. Based on the total number of reported exposures over the almost 5-year span of data collection, the average rate was 40 accidents per hour per 1000 doctors in training during the 12 h daytime span (6:00-17:59). It was 50% greater at night (18:00-05:59), with 60 incidents per hour per 1000 doctors in training. The day-night difference in rate of exposures was statistically significant (p < .04). The relative risk ratio for residents and students when working during the day shift compared to working the night shift was 0.67. This means that doctors in training are at a 1.50 higher risk of sustaining a blood-borne pathogen exposure when working nights than when working days.

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

“…14 Substantial decrements in motor performance and a doubling of errors on a laparoscopic surgery simulator task were found in surgical trainees after a 17-hour night work shift without sleep compared with performance after a non-sleep-deprived night. 7 In our study, rates of PI were much greater during nighttime hours than during the daytime in all locations other than the operating room, consistent with data from Parks et al, 2 although in that study, exposure was based on estimated work schedules rather than a validated measure of work hours. As with extended work duration, we found that fatigue was reported more often as a contributing factor for nighttime compared with daytime injuries, and some of the excess in the nighttime rates may be reflecting the effects of extended work shifts.…”

Association Between Evening Admissions and Higher Mortality Rates in the Pediatric Intensive Care Unit

“…It is unclear whether the present findings are attributable to the observed admission densities or the increased human-error rates during evening hours, as reported in both medical and nonmedical fields. [30][31][32][33] Nevertheless, it is possible to assess prospectively whether changes in the structure of care, process of care, or a combination thereof could negate the observed differences in mortality rates between daytime and nighttime admissions to the PICU.…”

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

“…Notwithstanding these potential confounders, the results are consistent with previous laboratory and field data. 2,3,16 Pressure to perform procedures quickly, which may vary with time of day and in different specialties, may have contributed to our findings. Operating rooms tend to be busier in the daytime than during the nighttime, which could account for the increased rate of injuries in the operating room in the daytime.…”