Stay Home if You Are Sick

Two recent publications serve as yet another reminder that healthcare workers (HCWs) should avoid patient care duties when feeling ill.

Esbenshade and colleagues performed prospective biweekly surveillance to assess influenza and other respiratory virus shedding in a cohort of hospital-based HCWs between November 2009 and April 2010. During the 20-week study period, 1404 nasal swab specimens were collected from 159 physicians, nurses, and ancillary staff working in patient care areas. Multiplex respiratory virus polymerase chain reaction was also performed on 119 specimens from 83 ill HCWs and 200 specimens from 106 randomly selected asymptomatic HCWs.

Forty-two specimens were positive: 35 (29.4%) obtained from ill HCWs and 7 (3.5%) from asymptomatic HCWs. Human rhinovirus was the most commonly identified virus (n = 33), followed by coronavirus and parainfluenza virus (n = 4 each) and human metapneumovirus (n = 1). No influenza was detected, which was believed to be related to the atypical influenza season in 2009-2010 as well as the high level of vaccination among participants (74.2%).

Multivariate analysis demonstrated that viral shedding was strongly associated with report of any symptoms (odds ratio [OR],13.06; 95% confidence interval [CI], 5.45-31.28; P < .001) and less strongly associated with younger age (OR 0.96; 95% CI, 0.92-0.99; P = .23). In a postsurveillance survey, 46% of study participants reported working with an influenza-like illness.

The Centers for Disease Control and Prevention report on an outbreak of severe respiratory illness at a 12-bed assisted-living facility in Colorado in 2012. Two confirmed and 5 probable cases of infection caused by Streptococcus pneumoniae were identified in the investigation. Six of the patients (2 confirmed, 4 with probable pneumococcal disease) were residents of the assisted living facility, and 1 patient with probable pneumococcal disease was a staff member at the facility.

Five of the 6 residents required hospitalization, 2 developed invasive disease with bacteremia, and 3 died. The 2 isolates obtained were serogroup 3, with identical antimicrobial resistance patterns. Review of symptom onset and duration revealed that the staff member had the earliest onset of respiratory symptoms and continued to work while symptomatic, suggesting a possible source of the outbreak.

Both studies highlight the potential for transmission of respiratory pathogens to vulnerable patient populations by HCWs and the consequences that may be associated with presenteeism by employees when sick. HCWs often feel a duty to come to work at all costs because of staffing issues, and they may not understand that their actions can come at a higher cost to patients and colleagues. Infection control programs may need to engage administration to improve staff support and remove financial repercussions in an effort to convince HCWs to avoid patient care while ill.