Working with symptoms of a respiratory infection: Staff who care for high-risk individuals

Background: While many health care workers (HCWs) who have respiratory infections take sick leave, others work following illness onset. Little is known about attendance practices of HCWs caring for persons with spinal cord injuries (SCI), a group at high risk for respiratory complications. Methods: Cross-sectional survey of HCWs. Logistic regression identified factors associated with having a respiratory infection and examined if awareness of facility level institutional control measures and/or individual level factors influenced working while symptomatic. Results: Response rate was 53% (n = 820). Respiratory infections were reported by 36%; of those, 86% attended work while symptomatic. HCWs aged 50 and above were less likely (odds ratio [OR] 0.58, P = 0.003) and those with a chronic condition were more likely (OR 2.24, P < 0.000) to have had a respiratory infection. HCWs who indicated that their facility institutes droplet precautions (OR 0.42, P = 0.034), restricts staff movement between wards, (OR 0.26, P = 0.002), and restricts contact between patients (OR 0.32, P = 0.009) were significantly less likely to work while symptomatic. Conclusions: It is alarming that 86% of HCWs attended work while symptomatic, given the consequences that respiratory infection can have on persons with SCI. HCW awareness of outbreak control measures within their facilities appeared to influence their attendance decisions, suggesting the importance of policy placement and information dissemination.