Workplaces need to change their culture because even in hospitals, too many health-care workers show up for work when sick, and risk spreading infections to their patients, a new study suggests.

The study published in Monday's online issue of JAMA Pediatrics suggests while 95 per cent of attending physicians, certified registered nurse practitioners, midwives and other health-care workers at Children's Hospital of Philadelphia who answered an anonymous survey said they believed working while sick puts patients at risk. Eighty-three per cent of these health-care workers admitted to going to work while not feeling well, at least once in the past year.

Reasons given by the 536 respondents were:

  • Not wanting to let colleagues down (98.7 per cent).
  • Staffing concerns (94.9 per cent).
  • Not wanting to let patients down (92.5 per cent).
  • Fear of being ostracized by colleagues (64 per cent).
  • Concerns about the continuity of care (63.8 per cent).

Newborns and people in hospital for transplants or cancer treatment, as well as individuals in nursing homes are especially vulnerable to infections, such as influenza, spreading in health-care settings.

Julia Szymczak of the Children's Hospital of Philadelphia and her co-authors found three main themes in the written comments part of the study:

  • Logistical challenges in finding and arranging someone to cover their jobs, and a lack of resources to accommodate sick leave. Participants described taking sick leave in clinical areas as "a nightmare" and "brutal."
  • A strong cultural norm in the hospital to report for work unless one is extremely ill, such as "physicians do not take days off," which is embedded in their identity. Some recounted stories of working or seeing others on the job while so ill they needed intravenous hydration.
  • Ambiguity about what symptoms constitute being too sick to work. Most agreed fever, diarrhea and vomiting are clear reasons to stay away from work mainly because they hinder performance.
SARS CANADA TOPIX

A Toronto General Hospital employee gets her temperature checked as part of SARS screenings in 2003. Hospitals still have a ways to go in encouraging health-care workers to stay home when sick, new research suggests. (J.P. Moczulski/Canadian Press)

"Creating a safer and more equitable system of sick leave for health-care workers requires a culture change in many institutions to decrease the stigma — internal and external — associated with [health-care worker] illness," pediatrician Jeffrey Starke of Baylor College of Medicine in Houston and Dr. Mary Anne Jackson from the infectious diseases division at Children's Mercy Hospital in Kansas City, Mo.  said in a journal editorial.

It isn't all about you

Dr. Michael Gardam is director of infection prevention and control at Toronto's University Health Network, where last year, a policy was passed to restrict workers from coming in sick. He has worked in Canada and the U.S., and suspects the findings of the U.S. study would be the same here.

"I'm going to come clean here. When I was a medical resident, I came to work deathly ill because you just didn't call in sick," Gardam recalled.

"I've had a clinic and I had no choice but to come in because patients were coming to see me from all over the place. What I would do is plunk myself in a room with a mask, with a bottle of alcohol gel and I would have my staff see them, review them with me and I would not be face to face with patients."

Gardam would like to see hospitals get to the point where if he were working on the transplant unit and had an obvious cold, and he called in sick, then the administration would celebrate his move to avoid putting vulnerable patients at risk. But he recognizes it'll likely take years to get there.

In his career, he has seen:

  • More than a decade ago, a casual worker came to work with SARS and spread the infection to several people in the emergency room.
  • A misguided but dedicated employee handed out food trays in between vomiting.
  • A family member with norovirus visited his/her mother who had just come out of surgery and vomited in the garbage can in the patient's room.

"This is a bigger societal issue," Gardam said. "It's getting you to realize that it isn't all about you."

A fever, chills and sweats are what Gardam watches for when deciding to send employees home.

Exert positive peer pressure

It's team-oriented, demanding jobs where people are more inclined to go to work when ill, or exhibit presenteeism, said Gary Johns, a management professor at the John Molson School of Business at Concordia University in Montreal.

"Bosses need to pay attention to both sides of the coin of presenteeism and absenteeism," Johns said.

While clear and realistic standards on staffing are needed, "our peers are a stronger constraint than any policy," Johns said.

In John's review of research into presenteeism, he has found employees were less likely to be inclined to feel pressure to attend work when sick whenever there's adequate staffing. Since the financial crisis of 2009, he expects a trend away from being absent from work because of sickness because employees feel insecure. 

The practice was also common in sectors where employees deal with people, such as teachers who feel obligated to their students and are exposed to germs in the classroom, he said.

The JAMA study was funded by the Epicenters for the Prevention of Healthcare-Association Infections from the U.S. Centers for Disease Control and Prevention.

With files from CBC's Amina Zafar and Kelly Crowe