Healthcare Workers Often Care for Patients While Experiencing Respiratory Illness Symptoms

Samantha DiGrande

According to a study published earlier this week, nearly 95% of healthcare workers risk potentially transmitting respiratory viruses to both patients and coworkers by attending work even when they show symptoms.

Healthcare workers are at an occupational risk of developing respiratory infection, and they they can also spread these infections to other employees and patients. In order to avoid such transmissions, the CDC recommends that healthcare workers with a fever and respiratory symptoms “consider temporary reassignment or exclusion from work for 7 days from symptom onset or until the resolution of symptoms.” However, working while displaying symptoms of an acute respiratory viral illness is quite common, as 92% of healthcare workers reported working while symptomatic.

“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. 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,” said Brenda Coleman, PhD, clinical scientist in the Infectious Disease Epidemiology Research Unit at Mount Sinai Hospital, in a statement.

Researchers conducted a 4-season prospective cohort study of influenza and other respiratory illnesses in 9 Canadian hospitals. The investigators asked healthcare workers in acute care hospitals who worked more than 20 hours per week to complete daily online illness diaries whenever they identified symptoms. These diaries contained information about symptoms, possible exposure, work attendance, reason for absence, and medical consultations.

In total, 10,156 illness diaries were completed by more than 2700 healthcare workers, although the diaries of participants who were not scheduled to work were excluded, which left 5281 remaining diaries for analysis.

Upon examining the diaries, 69% of participants said that they had worked during an illness because the symptoms were mild and felt well enough to work, 11% said they had things to do at work, 8% reported that they felt obligated to work, and 3% said they could not afford to stay home.

Furthermore, half of the study responders reported episodes of acute respiratory viral illness during each flu season, with 95% of those also reporting working 1 or more days during the illness, even though 79% said that they had the ability to take paid sick leave.

According to Coleman, these findings suggest the need to educate healthcare workers about the risk of transmission associated with respiratory viral infection, to clarify what symptoms require exclusion from work, and to develop and implement policies for working while symptomatic.

Jiang L, McGeer A, McNeil S, et al. Which healthcare workers work with acute respiratory illness? Evidence from Canadian acute-care hospitals during 4 influenza seasons: 2010-2011 to 2013-2014 [published online June 18, 2019]. Infect Control Hosp Epidemiol. doi: 10.1017/ice.2019.141
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