Major Article
Presenteeism among health care workers with laboratory-confirmed influenza infection: A retrospective cohort study in Queensland, Australia

https://doi.org/10.1016/j.ajic.2019.07.024Get rights and content

Highlights

  • Some 14.1% of health care workers (HCWs) were attending work while ill with influenza.

  • Approximately one-quarter of medical doctors were working while ill with influenza.

  • Full-time HCWs had significantly shorter sick leave duration than part-time HCWs.

Background

A high prevalence of working while ill (presenteeism) has been documented among health care workers (HCWs). However, previous evidence is primarily based on nonspecific causes of sickness and self-reported data. Our study examined presenteeism among HCWs with laboratory-confirmed influenza.

Methods

The data pertaining to laboratory-confirmed influenza cases and history of sick leave among HCWs in Queensland, Australia, were collected from 2009-2015. The incidence and duration of sick leave around the time of disease confirmation were analyzed. The associations of factors, such as job category and employment status, on presenteeism were assessed with regression analyses.

Results

The overall sick leave incidence was 85.9% in the laboratory-confirmed periods, which translates that 14.1% of HCWs were working while ill with influenza. Among medical doctors, approximately one-quarter of them were attending work in the period. A shorter duration of leave was also observed among medical doctors and full-time employees compared with other HCWs and part-time employees.

Conclusions

Presenteeism among HCWs with influenza put both HCWs and patients at risk by increasing potential for transmission. Our findings emphasize the importance of an integrated approach including both HCW sick leave management and vaccination for strategic prevention and control of nosocomial influenza infection.

Section snippets

Background

Influenza is a highly contagious infectious disease that causes annual, seasonal epidemics in temperate climates.1 In health care settings, the influenza virus can spread rapidly among vulnerable patients, leading to serious complications and death.2 In response to this potential hazard, international guidelines, such as those from the Centers for Disease Control and Prevention in the United States, advise the appropriate management of ill health care workers (HCWs) as a core prevention

Data

Queensland Health (QH) is the arm of the Queensland government responsible for the delivery of publicly funded health care through hospitals and other institutions in Queensland, Australia. QH employs approximately 80,000 full-time equivalent staff9 and consists of various types of workers, including clinical professionals in public hospitals and administrative officers in the department.

Payroll, staff vaccination, and lab-confirmed influenza data among QH employees from 2009-2015 were

Results

From 2009-2015, there were 2,380 lab-confirmed influenza cases in 2,337 HCW records in the payroll database. Of these, 100 cases were removed as they were casual workers or had an undefined job category. There were 111 cases excluded because baseline and lab-confirmed periods were fewer than 4 weeks apart, meaning we did not have an adequate control period for these participants. A total of 228 cases were also excluded owing to changes in job categories or employment status within each year of

Discussion

In our study examining employees—medical doctors, nursing, HP, and nonclinical professionals—in a single, large, state-funded, health care organization, average sick leave incidence was 77%-86% in the lab-confirmed periods. This translates to 14%-23% of HCWs who were working while ill with influenza.

As only lab-confirmed cases were targeted in this study, our study population represented one proportion of the true influenza cases within HCW population. Our results in regard to the presenteeism

Conclusions

This study illustrates the diversity of ill presenteeism by job categories and employment status and the complexity of the potential underlying mechanisms. As drivers of presenteeism are intricate and multifactorial, strategies to change ill presenteeism behaviors among all HCWs will have to be manifold and systematically implemented at the institutional level. Health care organizations may need to review or reinforce their sick leave policies and warrant available resources for sick employees.

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      Citation Excerpt :

      While presenteeism has been reported across multiple HCW occupations [46–48], physicians are frequent culprits. A combination of cultural and logistical factors, such as perseverance in a competitive environment, fear of ostracism and job-loss due to appearing lazy or unproductive, a lack of practical relief-of-duty systems, and concerns over compromising patient care can all contribute to presenteeism [47,49–55]. Negative consequences of presenteeism include reduced work performance, compromised patient safety, and HCW burnout [46,56–58].

    View all citing articles on Scopus

    Funding/support: This project is funded by the Australian National Health and Medical Research Council for Centre of Research Excellence Grant GNT 1030103 (https://www.nhmrc.gov.au) and the Australian Centre for Health Service and Innovation for Stimulus Grant SG0020-000643 (http://www.aushsi.org.au).

    Conflicts of interest: None to report.

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