Healthcare Workers Often Work While Sick

Nicola M. Parry, DVM

June 21, 2019

Most healthcare workers (HCWs) with an acute respiratory illness (ARI) have worked while sick, putting their patients and coworkers at risk for infection, a recent study published online June 18 in Infection Control & Hospital Epidemiology has shown.

"[We] found that 50% of participants working in Canadian acute care hospitals reported 251 episodes of ARI during each influenza season, with 95% of those who reported an ARI working 1 or more days of their illness," write Lili Jiang, PhD, Sinai Health System, Toronto, Canada, and colleagues.

The investigators conducted a four-season prospective cohort study of influenza and other respiratory illnesses among HCWs across nine Canadian hospitals during the 2010–2011 to 2013–2014 influenza seasons.

They collected data from HCWs via daily online diaries whenever respondents developed symptoms suggestive of an ARI. In their diaries, HCWs provided information about their symptoms, possible exposures, work attendance, reason for work or absence, and medical consultations.

Overall, 2728 HCWs completed 10,156 illness diaries, with a mean of 3.7 diaries (95% confidence interval [CI], 3.7 - 3.8) per respondent. 

Over the four seasons of the study, 2728 participants reported 2222 ARI episodes, which corresponds to an incidence of 0.81 (95% CI, 0.80 - 0.83) ARI episodes per participant.

Half of all participants (50.4%) reported having experienced at least one ARI episode during each study season.

And, among 1036 who reported having ARI symptoms on a scheduled work day, 980 (94.6%) said they had worked on at least 1 day of their illness.

In their final analysis, investigators included 5281 diary days from only those HCWs who were scheduled to work. These participants worked an average of 1.93 days (95% CI, 1.91 - 1.95) with symptoms, with an average of 0.47 days (95% CI, 0.45 - 0.49) of absence, during an ARI.

In multivariable analysis, the researchers adjusted for hospital site, asthma in the past 12 months, chronic medical conditions, study season, multiple seasons' participations, manager's and colleagues' approach to ARI and [influenza-like illness], and influenza vaccination status. Compared with other HCWs, physicians were more likely to work while sick (adjusted relative risk [aRR], 1.11; 95% CI, 1.04 - 1.19), whereas nurses were less likely to do so (aRR, 0.88; 95% CI, 0.84 - 0.93).

Participants who worked in high-risk areas such as an emergency department or intensive care unit were more likely to work while sick (aRR, 1.15; 95% CI, 1.10 - 1.20) than were HCWs from other hospital areas.

HCWs were also less likely to work as the severity of their symptoms increased (aRR, 0.95 per 1-point increase; 95% CI, 0.94 - 0.95), and after the first day of illness (aRR, 0.87; 95% CI, 0.85 - 0.89).

Among participants who worked while symptomatic, most (69%) reported doing so because their symptoms were mild and they felt well enough to work; 11% said they had things to do at work, 8% felt obligated to work, and 3% said they could not afford to stay home.

These findings highlight the risk of infection transmission from sick HCWs to vulnerable patients and coworkers, say Jiang and colleagues.

Addressing this issue will require changing both sick leave policies and cultural norms, they add.

"Infection control and occupational health and safety teams need to (1) educate HCWs on the risk of transmission of viruses causing ARIs, (2) improve self-awareness of when the HCWs themselves are higher risk of transmitting to their vulnerable patients, and (3) develop and implement policies for working while symptomatic," the authors conclude.

Sophia Chiu, MD, MPH, from the National Institute for Occupational Safety and Health (NIOSH) at the Centers for Disease Control and Prevention in Cincinnati, Ohio, highlighted similar findings among clinicians in the United States.

Chiu told Medscape Medical News, "Our NIOSH survey found that more than 40% of health care personnel who had flu-like symptoms worked while they were sick. The most common reasons for healthcare personnel working while sick were that they were still able to perform their job duties and did not feel bad enough to miss work."

Because contagious employees risk infecting others when they turn up for work, Chiu emphasized that better understanding of the reasons for presenteeism (i.e., working while ill) can help health professionals inform interventions to reduce healthcare-associated influenza transmission.

"We recommend all healthcare facilities take steps to support and encourage their staff to stay home while they are sick," she concluded.

This study was supported by the Canadian Institutes of Health Research and the Ontario Workplace Safety and Insurance Board. The authors and Chiu have disclosed no relevant financial relationships.

Inf Control Hosp Epidemiol. Published online June 18, 2019. Abstract

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