Barriers and facilitators to influenza-like illness absenteeism among healthcare workers in a tertiary-care healthcare system, 2017–2018 influenza season

Abstract

Objective: Influenza can be introduced and propagated in healthcare settings by healthcare workers (HCWs) working while ill with influenza. However, reasons driving this behavior are unclear. In this study, we examined barriers to and facilitators of absenteeism during the influenza season. Design: Cross-sectional mixed methods study. Setting: Ambulatory and inpatient settings in a large, tertiary-care healthcare system. Methods: An anonymous electronic survey was sent to HCWs between June 11 and July 13, 2018, asking participants to self-report influenza-like illness (ie, ILI symptoms of fever, chills, cough, or sore throat) during the 2017–2018 influenza season. We conducted a logistical regression analysis to identify factors associated with absenteeism. Results: Of 14,250 HCWs, 17% responded to the survey. Although 1,180 respondents (51%) reported symptoms of ILI, 575 (43%) did not stay home while ill. The most commonly perceived barriers to ILI absenteeism included being understaffed (odds ratio [OR], 1.78; P = .04), unable to find a replacement for work (OR, 2.26; P = .03), desiring not to use time off (OR, 2.25; P = .003), and paid by the hour or unable to afford being absent (OR, 2.05; P = .02). Common perceived facilitators of absenteeism included support from coworkers and management, clearer policy, better sick days availability, and lower perceived threat of disciplinary action. Conclusions: Reporting to work with ILI symptoms is common among HCWs. Most barriers and facilitators are related to systems. Addressing system factors, such as policies regarding sick days and sick leave and ensuring adequate backup staffing, is likely to facilitate absenteeism among ill HCWs.

Risk factors associated with respiratory infectious disease-related presenteeism: a rapid review

“…Eight studies measured the association between occupations and RID-related presenteeism [22,27,29,38,40,50,51,58]. Healthcare workers were more likely to report previously working with ILI than other workers including those in education in Kansas, U.S. [29].…”

“…Moreover, 96% of healthcare workers agreed that it is important for ill employees with confirmed influenza infection (positive test result) to stay at home [40].…”

“…Eight studies measured the association between occupations and RID-related presenteeism [24,29,31,40,42,52,53,60]. In a survey of employees from organisations represented at the Sedgwick County Pandemic Influenza Workgroup, Kansas, healthcare workers were more likely to report previously working with ILI than other workers, including those in education.…”

“…Eight studies reported "lack of cover" as one of the main reasons for presenteeism [19,26,28,41,44,49,51,61] and one reported an association in healthcare workers [42]. The percentage of participants who chose this as one of the main reasons ranged from 24% to 96%.…”

“…Jiang et al [40] reported that healthcare workers from nine Canadian hospitals, who did not receive paid sick leave, were significantly more likely to choose "can't afford to stay home" while symptomatic with an ARI. : Hoang Johnson et al [42] identified that access to paid sick leave increases adherence to absenteeism for ILI in healthcare workers at a midwestern academic institution in the U.S.…”