{"id":8391,"date":"2017-05-29T16:17:54","date_gmt":"2017-05-29T20:17:54","guid":{"rendered":"http:\/\/blogs.nejm.org\/hiv-id-observations\/?p=8391"},"modified":"2017-06-05T15:19:00","modified_gmt":"2017-06-05T19:19:00","slug":"healthcare-providers-shouldnt-come-work-sick-heres","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/healthcare-providers-shouldnt-come-work-sick-heres\/2017\/05\/29\/","title":{"rendered":"Healthcare Providers Shouldn’t Come to Work While Sick, but They Do \u2014 Here’s Why"},"content":{"rendered":"

Let’s start with two\u00a0questions:<\/p>\n

    \n
  1. Have you ever seen a doctor, nurse, PA, pharmacist or other person directly involved in\u00a0patient care wearing a surgical mask because they have a respiratory tract infection?<\/li>\n
  2. Has this mask-wearing person ever been you?<\/li>\n<\/ol>\n

    Bold prediction:\u00a0Virtually every reader who works in a hospital or large office practice answered “Yes” to #1. Some of you might even have said “Yes” to #2.<\/p>\n

    Clearly healthcare providers do go to work while sick, and the mask-wearing is our way of saying, “I care.”<\/p>\n

    But if we really cared, shouldn’t we\u00a0just stay home?<\/p>\n

    Of course we\u00a0should stay home. But we don’t. Here’s a recent paper<\/a>\u00a0on the topic highlighted by Mike Edmond on his excellent blog<\/a>, using the nifty “visual abstract” method to present\u00a0the results:<\/p>\n

    \"\"<\/a><\/p>\n

    Remember, surveys aren’t exactly perfect in eliciting whether people are doing some ill-advised behavior. People lie, even in anonymous polls. I know, shocking.<\/p>\n

    So consider the above estimates of this “presenteeism” a minimum<\/em>. Yikes. That’s a lot of sniffling, coughing, and potentially mask-wearing healthcare providers out there.<\/p>\n

    So let’s examine the top 5 reasons why people got to work with an influenza-like illness in a bit more detail; I’ll play the part of the person choosing each\u00a0response:<\/p>\n

      \n
    1. Could still perform duties.<\/strong> Hey, does having a cold preclude me\u00a0from typing and clicking boxes? That’s mostly what I get paid to do\u00a0these days, right?<\/li>\n
    2. Professional obligation to co-workers.<\/strong>\u00a0Who else will do my work? And how can I ask for coverage for what might be “just a cold”?<\/li>\n
    3. Didn’t feel bad enough to miss work.\u00a0<\/strong>I told you I could type.<\/li>\n
    4. Didn’t feel contagious. <\/strong>If I work while having a cold, I promise to double-down on the hand hygiene — you can call me “Dr. Purell” — and (though it’s embarrassing) to wear a mask. And no one really<\/em> knows how long a cold is contagious.\u00a0Symptoms can easily last 1-2 weeks, should I be out the entire time? Impossible.<\/li>\n
    5. Professional obligation to patients.<\/strong>\u00a0My patients will be mad<\/em> if I don’t show up. They\u00a0would prefer to see a sniffly, red-eyed, coughing me than a covering clinician, or to wait a week until I’ve recovered.\u00a0And obviously no one can provide the brilliant, compassionate, and efficient care that I do.<\/li>\n<\/ol>\n

      Jokes\u00a0aside, presenteeism gives\u00a0infection control practitioners a major challenge. It’s even more intractable when you factor in the most common reason cited by healthcare providers at long-term care facilities, which is the\u00a0inability to afford lost pay.<\/p>\n

      One practical\u00a0problem we could work on is\u00a0directly related to reason #4, “Didn’t feel contagious.”<\/p>\n

      While it’s intuitively obvious that a healthcare worker with pulmonary tuberculosis, active salmonellosis, or highly symptomatic influenza shouldn’t be working,\u00a0what about milder illnesses that can, in certain hosts, be life-threatening? Thinking about you, RSV, adenovirus, and parainfluenza virus.<\/p>\n

      Perhaps it’s time we all got a multiplex PCR machine for home use. It would look great in the\u00a0living room.<\/p>\n

       <\/p>\n

      \"Register<\/a><\/p>\n

      Save<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

      Let’s start with two\u00a0questions: Have you ever seen a doctor, nurse, PA, pharmacist or other person directly involved in\u00a0patient care wearing a surgical mask because they have a respiratory tract infection? Has this mask-wearing person ever been you? Bold prediction:\u00a0Virtually every reader who works in a hospital or large office practice answered “Yes” to #1. […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,5,8,9],"tags":[500],"class_list":["post-8391","post","type-post","status-publish","format-standard","hentry","category-health-care","category-infectious-diseases","category-patient-care","category-policy","tag-influenza"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8391","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=8391"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8391\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=8391"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=8391"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=8391"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}