If you’ve followed the "Talk Clean To Me" blog for a while, you’ll know that sharing others misfortunes for the sake of getting my point across is not something new. Take the #FF – Micro Blog’s Viral Misfortunes blog from November 2013 as an example, outlining a Norovirus outbreak within his family. This past week I had the “fortune” or “misfortune” to have lived through some sort of outbreak that spread through 5 of 6 people at my cottage. The line listing looks something like this:
Wednesday July 1/15, Male aged 6.5, vomiting
Saturday July 4/15, Female aged 44, vomiting
Sunday July 5/15, Male aged 45, pooping
Monday July 6/15, Female aged 43, pooping
Tuesday July 7/15, Male aged 10, vomiting
Wednesday July 8/15, Female aged 7 strutting around the cottage bragging that she was the only healthy one (picture to prove it)
As someone in the “know”, perhaps I should have called my friend and had her postpone her arrival...when I came down sick on Saturday. But she’s my best friend. I wanted to see her and spend some time with her and her kids....I was hoping that by disinfecting everything and washing my hands like crazy I could stem the outbreak, but I knew I was putting my friend and her kids at risk.....
So why then do doctors, clinicians and nurses routinely work when sick and put their patients at risk? Well, an editorial in JAMA Pediatrics focused on just that. For centuries, Primum Non Nocere (first do no harm) has been the guiding principle for healthcare workers which one would assume also means they should not spread infections by working while sick. As the editorial goes to describe, a survey of healthcare workers was conducted looking at the role of presenteeism and what the key reasons were for going to work while sick (and infectious).
The top reasons for working while sick included; concern over who would fill in for them, concern that their patients could not get by without them and a widespread belief that if they stayed home because of a cold or flu they would be perceived as being weak or unprofessional. Of the 280 healthcare workers who competed the survey 83% positively responded to working while sick at least once in the past year even though 95% stated that working while sick put their patients and colleagues at risk. That rationale for working while sick was the belief of an unspoken understanding that you should be on your deathbed if you are calling in sick. It was easier and less stressful coming into work than feeling they were letting their colleagues and patients down. When asked about what symptoms they would come to work with 55% would work or have worked with symptoms such as a cough, congestion or sore throat and 30% said they would work with diarrhea!
The co-authors in reviewing the reasons for showing up while sick cited that there were systemic, logistic and cultural factors involved which created a climate where staff felt they had to work when sick. With streamlining, budget cuts and the need to balance the books, hospitals have become a place where everyone is expected to work at peak capacity all the time and with a lean staff this means less redundancy and less flexibility to find a replacement to cover sick time. The result being a culture where those who know they should not work while sick and know that by working sick they are putting their patients at risk come into work anyways.
Changing a culture of a facility and changing the beliefs and norms of staff is no small feat. But in the day and age where hospitals are under scrutiny by the public for infection prevention rates....perhaps it’s time to invest in developing a culture where when sick staff know “we’ve got your back”. Stay home and get well because it’s better for all of us. The alternative of course could be that the staff member with diarrhea in fact has C. diff....because we just never know when or how the next outbreak is going to start!
To my friend....sorry that you lost a day of your vacation being sick!