MANY HEALTH CARE WORKERS CONTINUE TO WORK WITH INFLUENZA

Four in 10 healthcare personnel (HCP) worked despite suffering from influenza-like illness (ILI) during the 2014 to 2015 season, according to results of a study publishedin the American Journal of Infection Control.

Sophia Chiu MD, MPH, from the National Institute for Occupational Safety and Health at the Centers for Disease Control and Prevention in Cincinnati, Ohio, and colleagues collected data from 1914 HCP during the influenza season of 2014 to 2015, using an online survey. The survey defined ILI as fever and cough or sore throat, and collected information on health occupations and work settings.

Of the 1914 respondents, 414 (21.6%) reported ILI, and 183 (41.4%) of them worked for a median duration of 3 days while sick (range, 0 - 30 days) and missed work for a median duration of 2 days (range, 0 - 30 days). Of the 414 workers who reported ILI, 57.3% visited healthcare providers, who diagnosed influenza in 25.2% of them.

When analyzed by type of work setting, the researchers found that HCPs who work in a hospital were most likely to work while sick (49.3%), followed by those who work in an ambulatory care/physician office (45.7%) or in long-term care facilities (28.5%).

When analyzed by profession, the authors found that physicians (63.2%) and pharmacists (67.2%) were the groups most likely to report to work while sick. Other groups were less likely to work during respiratory illness, including assistants and aides (40.8%), nonclinical HCPs (40.4%), nurse practitioners/physician assistants (37.9%), and others (32.1%).

Age, number of years on the job, and job characteristics did not influence the likelihood of working while ill.

Respondents cited at least one of the following reasons for working while sick:

• "I could still perform my job duties."
• "I wasn't feeling bad enough to miss work."
• "I did not think I was contagious or could make other people sick."
• "I have a professional obligation to my coworkers."
• "It is difficult for me to find someone to cover for me."

Economics was another factor. For example, among respondents who work in long-term care facilities and who reported working while ill, 49.8% said they did so because they needed the pay.

Perhaps workers are not seeing the bigger picture and the danger of spreading infection, the researchers suggest. "Commonly cited reasons for working with ILI overall, such as perceptions of ability to perform job duties, not feeling bad enough to miss work, and sense of professional obligation, reflect misconceptions about working during ILI," they write.

They suggest that employers communicate the importance of infection control at the workplace. One institution, they write, requires a clinical exam and viral testing, with 7 days of "mandatory absence" for those testing positive for influenza. Instituting paid sick leave may also help convince workers to stay home when they risk spreading infection.

Also, the authors stress that healthcare providers who care for HCPs should reinforce the public health risk of infecting patients.

"The statistics are alarming. At least one earlier study has shown that patients who are exposed to a healthcare worker who is sick are five times more likely to get a healthcare-associated infection. We recommend all healthcare facilities take steps to support and encourage their staff to not work while they are sick," said Dr Chiu in a news release.

Limitations of the study include the nonrandom self-reporting sample relying on recall and incomplete information on vaccination rates, symptom onset, and severity. The study also did not include reasons cited by HCPs who did choose to stay home during ILI.

The researchers have disclosed no relevant financial relationships.

Am J Infect Control. 2017;45:1254-1258. Full text