Major Article
Working with symptoms of a respiratory infection: Staff who care for high-risk individuals

https://doi.org/10.1016/j.ajic.2006.12.005Get rights and content

Background

While many health care workers (HCWs) who have respiratory infections take sick leave, others work following illness onset. Little is known about attendance practices of HCWs caring for persons with spinal cord injuries (SCI), a group at high risk for respiratory complications.

Methods

Cross-sectional survey of HCWs. Logistic regression identified factors associated with having a respiratory infection and examined if awareness of facility level institutional control measures and/or individual level factors influenced working while symptomatic.

Results

Response rate was 53% (n = 820). Respiratory infections were reported by 36%; of those, 86% attended work while symptomatic. HCWs aged 50 and above were less likely (odds ratio [OR] 0.58, P = 0.003) and those with a chronic condition were more likely (OR 2.24, P < 0.000) to have had a respiratory infection. HCWs who indicated that their facility institutes droplet precautions (OR 0.42, P = 0.034), restricts staff movement between wards, (OR 0.26, P = 0.002), and restricts contact between patients (OR 0.32, P = 0.009) were significantly less likely to work while symptomatic.

Conclusions

It is alarming that 86% of HCWs attended work while symptomatic, given the consequences that respiratory infection can have on persons with SCI. HCW awareness of outbreak control measures within their facilities appeared to influence their attendance decisions, suggesting the importance of policy placement and information dissemination.

Section snippets

Study design

A cross-sectional survey and an anonymous business reply envelope was distributed to HCWs at VA Spinal Cord Injury (SCI) Centers during the spring of 2003. Follow-up surveys were mailed 4 weeks later with a note that requested only one response per participant. The study was approved by the Institutional Review Boards at the Edward Hines Jr., VA and the VA Puget Sound/University of Washington.

Setting

HCWs in this study provided care and services to individuals with SCI&D at 23 nationwide VA SCI

Results

The overall response rate for the survey was 53% (n = 820). Respondents included practitioners (13%), nurses (57%), and therapists/psychosocial workers (30%). Of those who were surveyed, 67% of the practitioners, 43% of nurses, and 74% of therapists/psychosocial workers responded to the survey. Sixty-seven people were excluded because they did not report whether they experienced a respiratory infection during the influenza season; the final sample was 753.

Table 1 shows demographic and work

HCWs with a respiratory infection

Ritchie et al20 found that respiratory illness was the number one cause of sickness absence in a cohort of HCWs (although the authors used a broader definition of HCWs than the current study, over half of their study cohort were nurses, similar to the current study). Over one third of HCWs (36%) caring for individuals with SCI&D reported experiencing symptoms of a respiratory infection during the influenza season (November 2002–March 2003). In a non-SCI population, Weingarten et al21 reported

Conclusion

Overall, the issue of respiratory illness and consequent attendance practices among HCWs is challenging to “solve.” On one hand, appropriately staying home from work while ill, may lead to patient safety concerns due to staff shortages; on the other hand, working while symptomatic may result in passing infectious agents to other staff and to patients and/or compromised work behaviors (e.g., slower reaction times, reduced alertness), which also have implications for patient safety. Further

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    This material is based upon work supported by the Office of Research and Development, Health Services Research, and Development Service of the Department of Veterans Affairs.

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    Copyright © 2007 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.