Shift worker health and safety

The ongoing demand for round-the-clock services fuels many industries.

Enter shift work, which is a way of life for nearly 15 million Americans, data from the Bureau of Labor Statistics shows. The prevalence of shift work has spurred multiple studies on its potential adverse effects on employee health and safety.

Among the studies is 2017 research from Chinese and Dutch scientists that found permanent night shift workers are 29 percent more likely to become overweight or obese than workers on rotating shifts. In January, another group of Chinese researchers concluded that women who have been long-term shift workers may be 19 percent more likely to develop breast, skin and gastrointestinal cancer.

Studies also link shift work to fatigue. A recent series of reports from the National Safety Council attributes 13 percent of workplace injuries to fatigue.

So the risks are well-documented, but are they well-known? And what about the remedies?

“It’s a complicated story, and I think it’s really important to recognize these risks, and we need to understand them and we need to treat them,” said Hans Van Dongen, Washington State University professor and director of the school’s Sleep and Performance Research Center. “But at the same time, I want to say that just because you’re a shift worker, you’re not necessarily doomed just because of that.”

Wary of weariness

For employees who work rotating or night shifts, remaining alert can be especially challenging when the body’s circadian clock is compromised – that is, the body is active when it believes it should be resting.

According to a 2016 study from the Salk Institute for Biological Studies, shift work can disrupt circadian clocks, decreasing a person’s sleep quality, mood, metabolism and cardiovascular health while boosting the risk for some diseases.

A lack of awareness may be compounding the problem. Additional NSC findings show that 74 percent of employers underestimate the prevalence of workplace fatigue, while 73 percent don’t communicate with workers about it.

Mike Wells is director of environmental health and safety for North America at Ardagh Group, a metal beverage packaging company headquartered in Dublin. “Our clear objective is to have zero safety incidents, with each member of our team returning home safe to their family and friends every day,” Wells said. “An example of one of the issues we face in keeping our people safe is fatigue. We can have lapses of attention, especially when we’ve put in multiple, repetitive hours on equipment. We train our people to be aware of what our bodies are telling us and to take a break, refresh, stay alert at all times.”

Numerous guidelines and resources exist to help combat on-the-job fatigue. The National Sleep Foundation suggests that shift workers try these measures:

• Take a walk before shifts start – ideally in daylight, which is a natural stimulant.
• Drink caffeinated beverages such as coffee and soda during the first half of the shift, but avoid them for several hours before sleeping.
• Take short breaks to move around when possible.

NIOSH directs shift work employers to:

• Set at least 10 consecutive hours of protected off-duty time each day. This is intended to help workers sleep seven to eight hours each day.
• Provide brief breaks every one to two hours during demanding work, and allow for longer meal breaks.
• Acknowledge that five eight-hour shifts or four 10-hour shifts typically are tolerable. If 12-hour days are required, include more frequent breaks or trend toward “lighter” tasks, such as desk work.
• Educate employees on the nature of shift work and resources available.

At Ardagh, “fatigue is addressed in our consistent messaging on staying alert,” Wells said. “And it’s not just individual safety. A pillar of our efforts is watching out for our teammates. If we notice someone close to us having fatigue or performance issues, our people call it out and get the teammate the help they need to remain safe and focused.”

He said summer months often present additional challenges for workers, including covering shifts for vacationing co-workers and, for employees with school-age children, resting during off-duty hours amid a busier home environment.

Still, Wells finds that engineering controls and employee programs are effective in keeping employees safe and productive. Ardagh employees maintain the same 12-hour shifts for extended durations and toggle between different tasks while working – minimizing the risk of fatigue driven by repetition. The organization’s new “Map Your Moves” initiative directs workers to use active, procedural thinking when completing tasks both familiar and new.

“The focus remains keeping our people comfortable, alert, and watching out for individual and team safety every day,” Wells said.

Managing fatigue ‘in real time’

In September 2017, NSC introduced its Fatigue Cost Calculator, a free online tool intended to help employers gauge how much fatigue is affecting their bottom line while providing strategies to help mitigate the problem. Emily Whitcomb, senior program manager of the fatigue initiative at NSC, said officials from several shift work-reliant industries – including construction, transportation, utilities and manufacturing – have offered positive feedback about the resource.

“These four industries often require 24/7 operations, putting their workforce at a higher risk of fatigue,” Whitcomb said. “Safety is a priority for these industries, and tired employees are more likely to make mistakes. Safety management systems that address fatigue risk is a best practice to reducing near misses, safety-critical incidents, injuries and fatalities.”

An example of such a system exists in the aviation industry. FedEx, a national cargo delivery company, has more than 230 sleep rooms adjacent to the operations center at its Memphis, TN, headquarters. These facilities provide pilots the opportunity to rest between their late or overnight inbound and outbound flights, offering private quarters and an automated wake-up call program.

Pilots napping can enhance safety for about 65 percent of trips that depart at night, organizational findings show.

Van Dongen praises the advantages of strategic napping, saying that any sleep achieved when the body is at or near its window of circadian low is crucial to helping it become refreshed. However, he notes that some shift work industries have been slow to embrace strategic napping because of concerns over cost effectiveness or lost productivity.

Daniel Patterson, an assistant professor of emergency medicine at the University of Pittsburgh, said that although some emergency medical service providers prohibit on-duty employee napping, he and fellow researchers believe they have found an emerging solution – regardless of policy.

A research team at Pitt has created an experimental mobile tool for studies involving out-of-hospital emergency medical technicians and paramedics, as well as flight nurses and flight paramedics. The device aims for immediate intervention, sending text messages to EMS workers at various intervals and prompting them to respond with their present fatigue level on a scale of zero to five.

Should a worker respond with a “four” or “five,” a specific text from a bank of messages will be returned, instructing the worker to address his or her fatigue through measures such as exercising, conversing with a work partner, consuming caffeinated beverages or napping, when allowed.

“It’s like an automated back-and-forth dialogue,” Patterson said. “We’ve shown in two trials – one of them has already been published, the other is currently under review at a journal – that trying to intervene in real time actually has a positive impact on certain types of shifts.”

Patterson said he and his colleagues have observed positive results in 12-hour shifts more frequently than shifts of longer duration.

Another pilot program is in progress at The Dow Chemical Co., which is developing wearable technology that would track vital signs, eye movement and head positioning for night shift workers who operate motor vehicles or heavy equipment.

“Obviously, when we have people monitoring critical processes, we want them to be at a high state of alertness,” said Dave Ott, who leads the Total Worker Health team at the Midland, MI-based company. “For us, being able to gather data wirelessly from multiple people and study patterns and trends is really going to be critical.”

Moving forward

The need for shift work isn’t going away, experts note. That’s why Van Dongen stresses the importance of collaboration among employers, employees, industry stakeholders and scientists to help address continued concerns about fatigue and long-term health risks among shift workers.

“The things those people want to accomplish aren’t so much different, right?” Van Dongen said. “Everybody would love to see a shift work setting be productive. That’s good for the employer. But it’s also good for the employee, because it means more income and more job security and all those things. At the same time, everybody would love to see that the employees are safe, because if the employees are not safe and they are then, therefore, absent from work … that reduces productivity.

“And so all these things are intertwined, but people look at it from different angles. … (But) when everybody recognizes and decides that they all want to accomplish the same thing, then all of a sudden that leads to really cool moments of creativity.”

Research into shift worker health endures in the meantime. Van Dongen recently co-authored a study that found individual digestive organs contain separate biological clocks that may influence the metabolism of night shift workers and help explain the link between shift work and adverse health issues such as obesity and diabetes.

Van Dongen said that further studies and innovations such as those at FedEx and Pitt can be vital to achieving additional success in enhancing shift worker safety and health.

“I’ve seen settings that have really been transformed in this process this way,” Van Dongen said. “And so I’m very hopeful in that regard and very positive that when there’s people that are pushing for change and they do it in a concerted and collaborative manner, it’s quite possible to make shift workplaces safer and healthier while keeping the economy running and doing the right things.”