Wednesday, November 08, 2017

AJIC: HCWs Working With Influenza-Like Symptoms


A little over 8 years ago, in A Hospital Is No Place For A Sick Person, I wrote about the results of a poll taken among attendees at CIDRAP's H1N1 Summit in the fall of 2009, which suggested that the Health Care Industry lagged behind others in making it easy for employees to stay home if they are sick.
Of course, health care facilities will say they want sick employees to stay home . . . but often their HR policies run counter to that claim.
Sick leave for many HCWs often comes out of an accrued PTO (Paid Time Off) account which combines vacation, holiday, and sick time off.  Workers accrue hours based on shifts worked, and their seniority.
Employees who haven’t sufficient hours `banked’ (or part-time workers who aren’t usually enrolled in PTO plans), must take unpaid leave if they fall ill, while those that do have hours must `burn' potential vacation days. 
While the biggest challenge during a severe pandemic may be finding HCWs willing to work at all (see Study: Willingness of Physicians To Work During A Severe Pandemic and UK Poll: Will HCW’s Work In A Pandemic?) during regular cold and flu season, the evidence shows far too many reporting for work when they shouldn't.
Whether it is due to punitive or restrictive corporate policies, financial necessity, peer pressure, or an overactive work ethic . . .  Health Care Workers continually find themselves torn between doing the right thing and staying home when sick, and and caving into the myriad pressures and going in to work.
Presenteeism is a topic we've visited often (see CIDRAP: Working, And Working Sick In A Pandemic and EID Journal: Nosocomial Transmission Of 2009 H1N1), as we do once again today with the following report from the American Journal of Infection Control.

Working with influenza-like illness: Presenteeism among US health care personnel during the 2014-2015 influenza season

Sophia Chiu, MD, MPH'Correspondence information about the author MD, MPH Sophia ChiuEmail the author MD, MPH Sophia Chiu, Carla L. Black, PhD, Xin Yue, MPS, MS, Stacie M. Greby, DVM, MPH, A. Scott Laney, PhD, Angela P. Campbell, MD, MPH, Marie A. de Perio, MD PlumX Metrics
DOI: |


    •Over 40% of surveyed US health care personnel worked with self-reported ILI.
    •By occupation, pharmacists and physicians were most likely to work with ILI.
    •By work setting, hospital-based personnel were the most likely to work with ILI.
    •Interventions should target misconceptions on working while ill and paid sick leave.


Health care personnel (HCP) working while experiencing influenza-like illness (ILI) contribute to influenza transmission in health care settings. Studies focused on certain HCP occupations or work settings have demonstrated that some HCP often continue to work while ill.


Using a national nonprobability Internet panel survey of 1,914 HCP during the 2014-2015 influenza season, we calculated the frequency of working with self-reported ILI (ie, fever and cough or sore throat) and examined reasons for working with ILI by occupation and work setting.


Overall, 414 (21.6%) HCP reported ILI, and 183 (41.4%) reported working with ILI (median, 3 days; range, 0-30 days). Pharmacists (67.2%) and physicians (63.2%) had the highest frequency of working with ILI. By work setting, hospital-based HCP had the highest frequency of working with ILI (49.3%).
The most common reasons for working while ill included still being able to perform job duties and not feeling bad enough to miss work. Among HCP at long-term care facilities, the most common reason was inability to afford lost pay.


More than 40% of HCP with ILI work while ill. To reduce HCP-associated influenza transmission, potential interventions could target HCP misconceptions about working while ill and paid sick leave policies.
         (Continue . . .)

While a problem every flu season, with an expected `sub-optimal' H3N2 flu vaccine, and recent reports of unusually severe influenza in Australia and Hong Kong - particularly among elderly residents of nursing facilities -  the risks of nosocomial transmission from staff to patients (and to other staff members) this winter may be even greater.

Once again proving the old adage, that a hospital is really no place for a sick person.

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