NIOSH Presents: Research on Managing Fatigue in the Workplace, Lessons Learned

On March 20-23, 2017, thirteen participants from the National Institute for Occupational Safety and Health (NIOSH) and the Centers for Disease Control and Prevention (CDC) attended the 10^th International Conference on Managing Fatigue, in San Diego, California. This year’s conference was the first held in the U.S. since 2009, and was attended by over 260 scientists and industry experts from around the world.

The “Managing Fatigue” conference series, established in 1993, is a continuing forum for research updates and discussions within the fatigue management community. The theme of this year’s conference was “Managing Fatigue to Improve Safety, Wellness, and Effectiveness.” While historically focusing on fatigue in the transportation sector, this evolving series included participants from a variety of sectors this year including natural resources, mining, healthcare, and the military. A summary of the presentations from the NIOSH and CDC participants follows.

Presentations

NIOSH Training for Nurses on Shift Work and Long Work Hours: Development Process and 1 Year Post-Launch Impacts
Claire C. Caruso, PhD, RN, FAAN, NIOSH/DART
Angela Sarver, MS, NIOSH/DART

Nurses and their managers provide vital services to society around the clock but often lack an appreciation of and knowledge about the health and safety risks associated with long work hours and shift work. The scientific community has generated extensive information about the risks and strategies to reduce the risks, but this complex and diverse information has not been translated in a comprehensive and concise way for nurses. The purpose of this project was to develop, pilot test, and disseminate an online, freely available, multimedia, interactive training program to train nurses and their managers on the risks of shift work and long work hours, and strategies to reduce these risks. In 2015, the NIOSH Training for Nurses on Shift Work and Long Work Hours was released.  Desktop and mobile versions of the training are freely available on demand on the NIOSH internet. The training takes about 3.5 hours to complete and can be taken over a series of short time periods if desired.  Evaluation after the first year shows a growing number of people taking the training program. Overall the feedback has been very positive. People who took the training for continuing education certificates showed high rates of passing the post test. Efforts to disseminate the training are continuing.

Truck Driver Sleep Patterns Influence Driving Performance
Guang Xiang Chen, MD, MSc, NIOSH/DSR
Youjia Fang , Virginia Tech Transportation Institute, Virginia Tech
Feng Guo, Virginia Tech Transportation Institute, Virginia Tech
Richard J. Hanowski, Virginia Tech Transportation Institute, Virginia Tech

Fatigued or drowsy driving has been identified as a major cause of truck crashes. A primary reason for occupational fatigue is incompatible timing of duty schedules relative to circadian rhythm and the need for sleep. Age and body mass index (BMI) are also contributing factors to fatigue. The objectives of this study included: (1) to examine truck drivers’ sleep patterns in non-work periods, and (2) to evaluate the associations between sleep patterns and driving performance and risk in the immediate subsequent work period, adjusted for years of commercial truck driving experience, drivers’ age, gender, and BMI. Findings from this study have implications on driver training and crash prevention, for example, educating drivers on the safety benefits of adequate sleep (drivers should aim for at least 7 hours sleep daily), sleep in the time period of 1 a.m. to 5 a.m., and arranging sleep in the later stage of non-working period if drivers work nights. NIOSH has recommended useful sleep tips for truck drivers. Company safety policies can consider incorporating health and wellness programs addressing truck driver obesity, along with other countermeasures to address behind-the-wheel drowsiness such as hours-of-service compliance and the North American Fatigue Management Program.

Understanding Individual, Organizational and Work Environment Factors Associated with Fatigue-Related Road Safety Behaviors among Taxicab Drivers in a Large Metropolitan City in the Southwest U.S.
Cammie Chaumont Menéndez, PhD, NIOSH/DSR
Srinivas Konda, MPH, NIOSH/DSR
Christina Socias-Morales, DrPH, NIOSH/DSR
Marilyn Ridenour, BSN, MBA, MPH, NIOSH/DSR

Violence-related events (such as robberies) and roadway incidents are the leading causes of injury among taxicab drivers. Fatigue is an under-recognized job hazard prevalent in this workforce that is associated with both injury outcomes. Safety training for taxicab drivers varies widely across cities as it is conducted in accordance with municipal ordinances or company policies that augment municipal requirements. NIOSH developed a survey for licensed taxicab drivers that asked about employment characteristics, work schedule, job demands, passenger violence, taxi crashes, safety measures, safety climate, road safety behaviors, knowledge of safety practices, and socio-demographic characteristics. Surveyors were trained to administer the survey using systematic sampling among taxicab drivers waiting for fares at two international airports and a downtown location in a large metropolitan city in the Southwest U.S. Preliminary analysis found 2 organization-related variables and 2 socio-demographic variables associated with 3 fatigue-related outcomes among a population of taxicab drivers. This analysis provides important insight for designing interventions and targeting research translation efforts for a worker population who drives for a living and has been the focus of very few research studies. Presenters received comments by conference goers that taxicab drivers were a population that was underrepresented in transportation safety research. 

The NIOSH Total Worker Health® Program and Opportunities for Promoting Health Sleep and Reducing Risks for Fatigue
Sara L. Tamers, PhD, MPH; Office for Total Worker Health, NIOSH
CDR Heidi Hudson, MPH; Office for Total Worker Health, NIOSH
Jeannie Nigam, MS, PhD Candidate; Division of Applied Research and Technology, NIOSH

Sleep has long been viewed as an individual behavior or choice. However, sleep quality is affected by a variety of complex and intersecting influences and pressures (societal, work, family, individual health conditions, etc.). Employers, for instance, influence employee health behaviors through the organization of work, which can significantly impact not only employees’ on-the-job experiences, but also their off-the-job risks such as their ability to get quality sleep. In June 2011, NIOSH launched the Total Worker Health® (TWH) Program as an evolution of the NIOSH Steps to a Healthier U.S. Workforce and the NIOSH WorkLife Initiatives which later became the Office for TWH in 2014. The TWH Program supports the development and adoption of ground-breaking research and best practices of approaches that emphasize the opportunities to sustain and improve worker safety and health through a primary focus on the workplace. Due to its vast effects on employee safety and health, fatigue and sleep quality are critical health risks in need of additional research attention and one that would especially benefit from a TWH approach, given the intersection between work design and worker behaviors that influence risk for fatigue.

Safeguarding the Health, Safety and Resilience of Emergency Responders
Richard W. Klomp, MOB, MS, LPC, BCPC, Centers for Disease Control and Prevention

The US Centers for Disease Control and Prevention routinely sends its highly-trained staff to dangerous and inhospitable domestic and international environments to respond to public health emergencies. To protect their health, a unique, 3-day training focused on key resiliency principles focusing on sleep, fatigue, and Disaster Site Safety basics was developed. Over 350 individuals have completed the training since its inception. Post-training assessment shows an increase in the perceived self-efficacy of those who have fully participating in the training event.

Post Conference Impressions from NIOSH Attendees

Following the conference, we asked for input from some of the NIOSH attendees. We received positive feedback from a number of attendees while collecting lessons learned. Cammie Chaumont Menendez reports, “The conference covered topics that related to my field of study and to my everyday life. The success of the conference speaks  to the fact that fatigue is such a basic human problem that affects us all in so many aspects of our lives, including doing our jobs safely.”

“One of my impressions from the conference is the continued innovations and work to objectively identify fatigue,” remarked Dawn Castillo. “This includes technology to detect fatigue such as devices that track eye-gaze, blinking and head movement; real-time video streams; and algorithms using vehicle data. There is also continued interest in identifying biomarkers that could provide real-time assessments in the field.  Continued advancement of this work will enhance future research and provide additional opportunities for countermeasures.”

Claire Caruso noticed a persistent theme: “The majority of the speakers presented interventions to promote alertness and reduce fatigue: fatigue risk management systems; development and testing of devices and bio mathematical models to detect fatigue; training for workers and employers; countermeasures to reduce fatigue; improving the design of work schedules; efforts by national organizations and some industries.” She also noted that Mark Rosekind, the former Administrator of the National Highway Traffic Safety Administration and internationally recognized expert, said decades ago that these conferences focused on examining the risks associated with working while fatigued, and now the focus has advanced to interventions to reduce the risks which are now much better recognized. Risks include career ending injuries, fatalities, and industrial disasters as well as the development of many types of chronic illnesses.

It is impressive to see the growth in this area as evidenced by the wide variety of sectors and researchers represented at this conference. Increased attention to this critical workplace health and safety hazard is warranted as it potentially endangers every worker and everyone around the tired worker at work, at home, on the roads, and anywhere else.

Resources

NIOSH has a vast body of research on work schedules, sleep and fatigue and a number of online training resources and guides for workers and managers. Fatigue is one of the focal areas of NIOSH’s new Health Work Design Cross-Sector Program, as we enter the third decade of the National Occupational Research Agenda (NORA). See the website Work Schedules: Shift Work and Long Hours for more information or check out other blog posts, including Shift Work and Sleep.

The 11^th International Conference on Managing Fatigue is in the planning stages; the date and location will be announced in the future. In the meantime, conference organizers will soon post this year’s PowerPoint presentations on the conference website for presenters who gave permission.

Sarah Mitchell, MPH, is an ORISE fellow in the NIOSH Office for Total Worker Health. ^®