Shift Work and Respiratory Infections in Health-Care Workers

Abstract

Recently, there has been interest in whether shift work may enhance susceptibility to infection. Our aim was to determine whether shift workers in the health-care field have a higher incidence, duration, and/or severity of influenza-like illness (ILI) and acute respiratory infection (ARI) than non–shift workers. From September 2016 to June 2017, 501 rotating and/or night-shift workers and 88 non–shift workers from the Klokwerk+ Study (the Netherlands, 2016–2017) registered the occurrence of ILI/ARI symptoms daily using a smartphone application. The incidence rate of ILI/ARI (defined as ≥2 symptoms on the same day/≥1 symptom on 2 consecutive days), the mean duration of each episode, and the incidence rate of severe episodes were compared between shift workers and non–shift workers using negative binomial regression and linear mixed-model analysis. In total, participants completed 110,347 diaries. Shift workers’ incidence rate of ILI/ARI was 1.20 (95% confidence interval (CI): 1.01, 1.43) times higher than that of non–shift workers, and for severe ILI/ARI episodes, shift workers’ incidence rate was 1.22 (95% CI: 1.01, 1.49) times higher. The mean duration of an ILI/ARI episode did not differ (ratio between means = 1.02, 95% CI: 0.87, 1.19). In conclusion, shift workers in health care had more ILI/ARI episodes and more severe ILI/ARI episodes than non–shift workers, but with a similar duration. Insight into underlying mechanisms connecting shift work and infection susceptibility will contribute to the design of preventive initiatives.

Sickness absenteeism, work performance, and healthcare use due to respiratory infections for shift and non-shift workers

“…Correspondingly, prior work found shift work to be associated with increased infection susceptibility (Cuesta et al 2016;Mohren et al 2002). A recent study of our group suggested that, compared to non-shift workers, shift workers in healthcare have a 20% higher incidence of respiratory infections, and a 22% higher incidence of severe respiratory infections (Loef et al 2019).…”

“…As reported, the results suggest that when a respiratory infection is present, shift workers are not more or longer absent than non-shift workers. Nevertheless, as shift workers were found to have a higher incidence rate of respiratory infection episodes (Loef et al 2019 , Table 1), a similar sickness absenteeism rate due to respiratory infections might suggest that shift workers are cumulatively (e.g., during an entire winter season) more often absent than non-shift workers. For example, if shift workers as well as non-shift workers are on average absent during approximately 15% of the ILI/ARI episodes (Table 2), but shift workers report 20% more ILI/ARI episodes per winter season (Loef et al 2019), than the total number of absenteeism spells will be higher in shift workers.…”

“…The start of an ILI/ ARI episode was defined as having ≥2 symptoms on the same day or ≥1 symptom on two consecutive days. If the participants did not report symptoms for two consecutive days, an episode ended (Loef et al 2019). After an episode ended, participants received additional questions in the app about their sickness absenteeism and work performance during the ILI/ARI episode, and whether a general practitioner (GP) and/or specialist was consulted and also whether medication was used due to the ILI/ARI episode.…”

“…Besides the individual burden, respiratory infections among workers may have consequences for employers and society as a whole, such as increased sickness absenteeism, reduced work performance, and increased healthcare use (Khawaja et al 2012). Multiple studies have reported that respiratory infections explain almost half of the sickness absenteeism in the workplace (Bramley et al 2002;Loef et al 2019). Furthermore, presenteeism, where employees are present at work but do not operate at a maximum capacity due to their illness/health problems, is a common phenomenon (Johns 2010;Kessler et al 2003;Mohren et al 2005).…”

Working Schedule, Sleep Quality, and Susceptibility to Coronavirus Disease 2019 in Healthcare Workers

“…Since circadian rhythm disruption may impair immune system function, some scholars sustained that it could enhance susceptibility to infection [5,6]. A recent prospective cohort study showed that shift workers in healthcare had 20% more acute respiratory infection and influenza-like illness than non-shift workers [7]. These infections also appeared to be more severe also.…”