The CDC has finalized new infection control guidelines for healthcare workers, putting the onus on hospital administration to provide employee health resources to prevent recurrent problems like presenteeism.1

“An occupational health service can’t do that effectively without backup from the top of the organization. They need that support; otherwise, it is not going to work,” says David Kuhar, MD, who spearheaded the guideline development as the CDC’s liaison with its Healthcare Infection Control Practices Advisory Committee (HICPAC).

The longstanding problem of presenteeism was recently documented in a study that showed that healthcare staff in nine hospitals worked an average of two days with upper respiratory symptoms during flu seasons.2

“Whether because of individual work ethic, local culture (e.g., unwillingness to disappoint colleagues), or financial pressures such as a lack of paid sick leave or policies that combine sick leave and vacation days, presenteeism puts others at risk,” the CDC guidelines stated.

Discourage Presenteeism

Developing policies that discourage presenteeism can be challenging, partly because of inadequate backup staff, contractual workers, and physicians with clinical privileges who are not technically employees of the facility.

“Presenteeism is a big issue and one that needs to be adequately addressed,” Kuhar says. “This guideline itself does not provide very granular recommendations on specific strategies on how you might deal with presenteeism. The best strategies may vary widely based on the healthcare setting, and this guideline is aimed at all [settings]. It’s at a very high level, but we do talk about of some of the specific issues.”

A recurrent problem is healthcare systems that combine sick days and vacation leave in a single pool of total days off.

“People are not going to want to use their vacation time to be sick, so that is not something that discourages people from coming to work when they could be contagious to others,” he says. “Having dedicated sick leave they can use might help remedy that.”

The published guideline will be followed by other sections, with this first document outlining the infrastructure and routine practices for occupational health services to protect workers from infections.

“The second part of the guideline is going to come out in several sections that are going to address the epidemiology and control of selected infections that can be transmitted among healthcare personnel and patients,” Kuhar says. “It will address the infection prevention issues that are relevant to healthcare personnel and will often focus on post-exposure prophylaxis and work restrictions.”

The guidelines, which are the first from the CDC on this issue in 21 years, include a section on facility leadership.

“That is something that is new with this update, as opposed to the 1998 recommendations,” he says. “There are recommendations aimed at healthcare administration. They are focused on ensuring that [employee health programs] have resources and leadership commitment so they can succeed.

The administrative leadership recommendations by the CDC include:

• Develop a culture of safety, including occupational infection prevention and control;

• Review organizational policies related to occupational infectious risks, exposures, and illnesses;

• Assign one or more people with appropriate training to lead occupational infection prevention and control services;

• Provide resources to implement occupational infection prevention and control;

• Oversee, and include occupational health services leaders in, performance measurement and continuous quality improvement activities for occupational infection prevention.

Intent to Empower

With support and resources, employee health programs should be better able to protect workers from occupational infections.

“That was the intent,” Kuhar says. “The other part of this was to empower those who may be leading occupational services to have a dialogue with senior leaders and make sure that they have that support when needed.”

The CDC recommendations for occupational health services leaders and staff include:

• Notify all healthcare personnel and relevant departments about infection prevention policies and procedures;

• Collaborate with colleagues to achieve compliance with infection control policies;

• Create infectious disease emergency and outbreak management plans;

• Create written policies and procedures that adhere to federal, state, and local requirements for infection prevention;

• Address factors such as risk reduction among healthcare personnel, medical evaluations, education and training, immunization programs, potentially infectious exposures and illnesses, and personnel health records.


  1. Kuhar D, Carrico R, Cox K, et al. Infection Control in healthcare personnel: Infrastructure and routine practices for occupational infection prevention and control services. October 2019. Available at: Accessed Oct. 28, 2019.
  2. Jiang L, McGeer A, McNeil S, et al. Which healthcare workers work with acute respiratory illness? Evidence from Canadian acute-care hospitals during 4 influenza seasons: 2010-2011 to 2013-2014. Infect Control Hosp Epidemiol 2019;40:889-896.