Doing More Harm Than Good? Healthcare Workers Often Provide Care While Sick

Organizations should clarify what symptoms require exclusion from work and develop policies for working while symptomatic, says the study's lead author.

This article was published by HCPro's Patient Safety & Quality Healthcare on June 18, 2019.

Many healthcare workers may be putting patients at risk by continuing to work when they have symptoms of cold, flu, or other respiratory illnesses, according to a new study published in Infection Control & Hospital Epidemiology.

The study found that 95% of healthcare workers have worked while sick, most often because the symptoms were mild or began during their work shift.

"We found that physicians and people working in areas that required the most intensive contact with patients were less likely than other workers to stay home or to leave work if symptoms progressed after the start of the day," said Brenda Coleman, PhD, clinical scientist in the Infectious Disease Epidemiology Research Unit at Mount Sinai Hospital, Toronto, and lead author of the study, in a release. "Managers and senior staff need to both model and insist on workers staying home when symptomatic as it protects both patients and coworkers from infection."

The study, published in the journal for the Society for Healthcare Epidemiology of  America, found that 92% of healthcare workers report to work while symptomatic for an acute respiratory viral illness. Hospital-acquired respiratory viral infections cause significant illness and death, in addition to increased healthcare costs. The Centers for Disease Control and Prevention recommends that healthcare workers with fever and respiratory symptoms consider temporary reassignment or exclusion from work while they are symptomatic.

Researchers conducted a four-season prospective cohort study of influenza and other respiratory illnesses in nine Canadian hospitals in Toronto, Hamilton, and Halifax. Healthcare workers in hospitals who worked more than 20 hours per week filled out daily online illness diaries whenever they developed symptoms; these included information about symptoms, possible exposure, attendance at work, reason for work or absence, and medical consultations.

In all, 10,156 illness diaries were completed by 2,728 participants. Diaries of workers who were not scheduled to work were excluded, which left 5,281 diaries for analysis. Sixty-nine percent of participants said they worked during an illness because their symptoms were mild and they felt well enough to work, 11% said they had things to finish at work, 8% said they felt obligated to work, and 3% responded that they couldn’t afford to take the time off. Half of the participants said they had episodes of acute respiratory viral illness during influenza season, with 95% of those working one or more days of their illness. Of the study participants, 79% said they were entitled to paid sick leave.

Coleman said the study illustrates the need to educate healthcare workers, managers, workplace health/safety/infection control staff, and administrators about the transmission risk associated with respiratory viral infection. Organizations should also clarify what symptoms require exclusion from work and develop and roll out policies for working while symptomatic, she added.