Wednesday, September 25, 2019
Society for Healthcare Epidemiology of America
Contact: Beth Casteel | | 202-868-4007
Author Contact: Donna Leusner | | 609-984-7160

Health Care Employees Work While Ill Despite Company Policies 
Surveillance of a Long-Term Care Facility Suggests Sick Leave Policies Need Revamping

NEW YORK (September 25, 2019) — Nearly 90 percent of staff members who had an acute respiratory illness during five months of intense surveillance at a long-term care facility went to work when they were ill, despite the facility’s policies against working while sick, according to a study published today in Infection Control & Hospital Epidemiology, the journal for the Society for Healthcare Epidemiology of America.

“Changes in sick leave and work exclusion policies to minimize the pressure on staff to come to work while sick would protect patients and other healthcare personnel,” said Hilary M. Babcock, MD, MPH, Professor of Medicine in the Infectious Diseases division at Washington University School of Medicine in St Louis and Medical Director for the Infection Prevention and Epidemiology Consortium of BJC HealthCare. “Respiratory infections at this facility were more common in staff than in patients and staff frequently worked while ill.”

Researchers conducted active surveillance from December 2015 through April 2016 for respiratory viral infections among residents and health care providers at a 120-bed long-term care facility. Staff and patients in the study were monitored through the period for acute respiratory infection symptoms, and nasal and throat swabs were taken whenever symptoms were reported and at the end of the study period, when participants were asked again about symptoms during the period.

Of the 76 staff members and 105 patients in the study, 18 staff members and four patients reported acute respiratory illnesses, while 16 staff members, or 89 percent of those who reported an illness, said they worked when they were sick despite the facility’s policy against working while ill. Researchers found fewer infections than anticipated, which they attribute to high vaccination rates at the facility, good infection control practices; and a mild respiratory virus season.

These findings highlight the need for facilities to strengthen their communication and enforcement of work restriction policies and ensure they are feasible for all staff members, the authors said. The study also demonstrates that active acute respiratory illness surveillance can be implemented among both patients and staff in an adult long-term care facility.

“This was a small study conducted at one long term care facility during one, rather mild, respiratory virus season.  This facility housed a mix of nursing home residents and shorter-stay post-hospital patients.  They also have a mandatory flu vaccination policy for staff, leading to a highly vaccinated staff population.  The findings may therefore not be generalizable to facilities with a different patient/resident mix or to facilities with lower staff flu vaccination rates” said Babcock.

Larger surveillance studies examining respiratory infections in both staff and patients at other long-term care facilities are needed to examine patterns of respiratory infection in facilities with other patient mixes and lower staff flu vaccination rates. As this study did not show direct transmission of respiratory viruses between patients and staff, larger studies are also needed to further investigate the relationship between respiratory infections among staff and patients.


Caroline O’Neil, Lindsay Kim, Mila Prill, H. Keipp Talbot, Brett Whitaker, Senthilkumar K Sakthivel, Yange Zhang, Jing Zhang, Suxiang Tong, Nimalie Stone, Shikha Garg, Susan Gerber, and Hilary M. Babcock. “Respiratory Viral Surveillance of Staff and Patients at an Adult Long-Term Care Facility.” Web (September 25, 2019)

About ICHE
Published through a partnership between the Society for Healthcare Epidemiology of America and Cambridge University Press, Infection Control & Hospital Epidemiology provides original, peer reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 41st out of 89 Infectious Diseases Journals in the latest Web of Knowledge Journal Citation Reports from Thomson Reuters.

The Society for Healthcare Epidemiology of America (SHEA) is a professional society representing more than 2,000 physicians and other healthcare professionals around the world who possess expertise and passion for healthcare epidemiology, infection prevention, and antimicrobial stewardship. The society’s work improves public health by establishing infection-prevention measures and supporting antibiotic stewardship among healthcare providers, hospitals, and health systems. This is accomplished by leading research studies, translating research into clinical practice, developing evidence-based policies, optimizing antibiotic stewardship, and advancing the field of healthcare epidemiology. SHEA and its members strive to improve patient outcomes and create a safer, healthier future for all. Visit SHEA online at, and @SHEA_Epi.

About Cambridge University Press
Cambridge University Press is part of the University of Cambridge. It furthers the University’s mission by disseminating knowledge in the pursuit of education, learning and research at the highest international levels of excellence. Its extensive peer-reviewed publishing lists comprise 45,000 titles covering academic research, professional development, over 400 research journals, school-level education, English language teaching and bible publishing. Playing a leading role in today’s international marketplace, Cambridge University Press has over 50 offices around the globe, and it distributes its products to nearly every country in the world. For further information about Cambridge University Press, visit