A new survey highlights why hospitals are not only a great place to get well, they're a great place to get sick.
In a survey conducted at the Children's Hospital of Philadelphia, 83 percent of doctors and other health practitioners reported going to work despite being sick. They reported working at the hospital with active symptoms including diarrhea, fever or respiratory symptoms.
The doctors cited reasons such as not wanting to disappoint colleagues or patients, staffing concerns or fear of being ostracized. Many said it was more of a hassle to arrange for someone to cover for them, rather than just work through their illness. Others said they worried about the continuity of care provided to their patients if they called in sick.
Doctors may also have a financial motive. Many hospitals use productivity measures that tie physician pay and bonuses to the number of patients they see or procedures they perform. That may encourage many to work while sick to avoid lower pay.
When working around people who are ill or have compromised immune systems, these simple precautions can help prevent the spread of germs.
Stay home: The most obvious advice is that when you're sick, you should stay home - regardless of where you work. Employers could help by creating a list of symptoms that should keep people at home.
Flu shots: Though there's little scientific data to prove that patients benefit when health care workers get flu shots, most hospitals require them.
Wear a mask: Anyone who is coughing from a respiratory illness could wear a surgical-type mask when around people in hospitals.
Wash your hands: The Centers for Disease Control and Prevention reports that washing your hands with soap is one of the single most effective things you can do to stop the spread of all kinds of germs. It reduces the number of people who get diarrhea by 31 percent and reduces respiratory illnesses (such as colds) by 21 percent.
Hand sanitizer: If soap and water are not available, hand sanitizer with at least 60 percent alcohol can be used to kill or reduce the growth of many germs.
Be proactive: If you're a patient or have a friend or family member in the hospital, ask anyone coming into the room to wash their hands and to clean any medical equipment they use on the patient.
Sources: Dr. Jeffrey Starke; Centers for Disease Control and Prevention
Past surveys have found similar results among nurses and other health care support staff, but it's unclear how big a problem this is in health care facilities overall. Infection control in hospitals has typically focused on patients who pick up germs from one another. Much less attention has been paid to doctors and nurses as the potential sources of infection.
"Any one of us would advise other people, 'Don't work when you're sick, especially when you're around people who are vulnerable to getting illnesses,' " said Dr. Jeffrey Starke, an infection-control expert with Baylor College of Medicine. "A lot of that happens within health institutions, and I think we probably have not paid adequate attention to it."
Starke, who co-authored an editorial on the survey results, said hospitals may have policies saying doctors shouldn't come in sick, but few have reasonable measures in place that allow doctors to stay home.
"Physicians are pretty tough. It takes a lot for us not to come to work," he said.
Texas Children's Hospital in Houston has a formal policy that covers all of its workers, says Dr. Judith Campbell, the hospital's medical director for infection control and prevention.
"Generally speaking, our policy says if you're ill and you think you have a contagious disease, you shouldn't come to work," she said.
The hospital lists certain conditions or symptoms, such as having fever or chills, for which health practitioners are actively discouraged from coming in.
"I think the bigger solution is really about culture," Campbell said. "Our culture is more and more to really encourage us to have these conversations with each other if someone does appear ill, rather than allowing someone to remain at work."
Starke once was responsible for infection control at Texas Children's and said it took a lot of convincing before some sick doctors would go home.
"I know that's well meaning, but there are ramifications," he said.
The trouble is those ramifications can be hard to prove. It would be difficult, if not impossible, for hospitals to determine who infected whom, and there would be no way of knowing when patients were infected if they developed symptoms after they were discharged. And infections might have different impacts on different types of patients. Passing a respiratory illness to an otherwise healthy patient with a broken leg, for example, does not carry nearly as much risk as infecting a patient with a compromised immune system, who could be unable to fight off the disease.
Most hospitals require workers to get annual flu shots to limit the spread of disease to vulnerable patients. That has been controversial, as many employees have resisted mandatory vaccination. And there is little data to suggest that vaccination will reduce infection rates for patients.
"Sometimes it boils down to common sense," Starke said. "Here's the irony: In many hospitals, including children's hospitals, the visitors are screened for illness and if they are judged to be ill, they often are not allowed to visit. But health care workers are not screened for illness."
Starke suggested hospitals take steps to reduce the number of health workers coming in sick, starting by making a list of symptoms that should keep people at home.
"That's not so straightforward," he said. "If you have a simple cold, by the time you're symptomatic, you're probably on the downswing of our infection."
They could eliminate punitive sick-day policies, such as those that require sick employees to use vacation days first.
Hospitals could also provide workers with flu days - time off that could be used when a worker has the flu - in addition to their regular vacation or sick days. One recent analysis found that offering employees two flu days a year reduced the impact of workplace flu infections by 40 percent.
If workers do come in sick, they should at least avoid working around patients whose immune systems might be compromised, such as those undergoing transplants, and take extra care to wash hands or wear a mask.
Starke also suggests that patients and their families be vigilant.
"To be honest with you, if I have a vulnerable child in the hospital, and a person came into a room who was obviously ill, I would politely ask them to please leave and get one of your colleagues to come in," he said. "Because I don't want to expose my child to it."