December 07, 2019
2 min read

Q&A: Reducing presenteeism among health care personnel

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Hilary Babcock, MD, MPH
Hilary M. Babcock

In March 2018, infectious disease physicians in the Emerging Infections Network received a survey asking about their institution’s experiences with and policies for working with an influenza-like illness, or ILI. The results of the survey revealed that more than one-third of respondents did not know whether their facility had sick leave policies, and those who did reported a variability in the dissemination, monitoring and enforcement of the policies, researchers said.

Presenteeism among health care personnel has been well documented. Healio spoke with Hilary M. Babcock, MD, MPH, president of the Society for Healthcare Epidemiology of America and professor of medicine at Washington University School of Medicine in St. Louis, about the challenges health care personnel (HCP) face when ill and ways to improve sick leave policies.

Babcock and colleagues said the results of their survey confirm that more research is needed to develop effective interventions. – by Marley Ghizzone

Q: What inspired the survey?

A: We recently completed a study of respiratory viral illnesses in long-term care facilities in which multiple HCP noted that they worked while ill for a variety of reasons. In addition, in my own experience and observations at my facility, HCP are reluctant to stay home when ill, some citing a desire to “be strong” or “not let down their colleagues” and others noting that there are often policies that end up encouraging working while ill, such as attendance bonuses and a combined pool of days off such that taking sick days can limit available vacation days.

Q: What did the survey find?

A: The survey confirmed that sick leave policies are variable and are also enforced variably in a range of medical facilities worked at by respondents to the survey. There is also variability in tracking illness among HCP and in identifying HCP working while ill. This variability makes it difficult to study what policies might be better at helping HCP appropriately stay home when ill.

Q: What sort of policies exist for HCP working with ILI , and what contributes to the lack of awareness of these policies? How are policies monitored and enforced?

A: Most facilities have policies that HCP with a febrile respiratory illness should stay home from work. However, communication of policies and enforcement of policies are not uniform.


Q: How dangerous is “presenteeism” to patients?

A: Ill HCP can potentially spread their infection to vulnerable patients. Patients may be at higher risk of complications if they acquire respiratory infections, especially patients with compromised immune systems, infants and the elderly.

Q: What should facilities be doing to reduce it?

A: Although there are few data (as noted earlier) on which to base recommendations, from a common sense perspective, facilities should ensure that HCP are aware of the policies around staying home from work while ill, as well as the rationales for the policy: protecting patients and coworkers. Ideally, sick leave policies should not be punitive, ie, HCP do not lose vacation days or attendance bonuses by not coming to work sick.


Babcock HM, et al. Infect Control Hosp Epidemiol. 2019;doi:10.1017/ice.2019.305.

Disclosure: Babcock reports no relevant financial disclosures.