Results of a study1 using active surveillance for acute respiratory infection (ARI) over a five-month period revealed that 89% of sick staff in a long-term care facility still reported to work. The facility established policies against such presenteeism, but they may need to be revised to minimize the pressure on staff not to miss work, the authors noted.

“This finding suggests that facilities should consider strengthening communication and enforcement of work restriction policies and should ensure that they are feasible,” the authors concluded.

The investigators conducted active surveillance over a five-month period, taking nasal and throat swabs whenever symptoms were reported by staff members and residents at a long-term care facility. Overall, 76 healthcare workers were enrolled, including 21 nurses. In addition, 105 patients/residents were enrolled. The findings include 13 patients and 24 healthcare personnel (HCP) who reported respiratory symptoms during the period. Overall, 18 healthcare workers met the study definition for ARI.

“None of the patients with ARIs reported contact with a sick visitor during the previous five days,” the authors reported. “However, 44% of HCP with ARIs reported a sick household member prior to illness. Of the 18 HCP with an ARI, five (28%) reported having taken sick days and 16 (89%) reported working while ill, including four HCP who had also used sick days.”

Self-reporting symptoms was a limitation of the study, with the authors conceding that healthcare workers “may have been particularly reluctant to report respiratory symptoms if they had come to work while ill.”

In contrast to many long-term settings, the facility created a mandatory flu immunization program for workers. One worker had influenza but the most commonly identified pathogen was rhinovirus. Many had infections of unknown etiology. No patients had influenza. The study did not show direct transmission of respiratory viruses between patients and staff, but the level of presenteeism presented that risk.


  1. O’Neil C, Kim L, Prill M, et al. Respiratory viral surveillance of staff and patients at an adult long-term care facility. Infect Control Hosp Epidemiol 2019:1-4.