Major Article| Volume 47, ISSUE 8, P895-901, August 2019

Understanding drivers of influenza-like illness presenteeism within training programs: A survey of trainees and their program directors

Published:March 18, 2019DOI:


      • Influenza-like illness (ILI) presenteeism puts patients and health care workers at risk.
      • In this study, 54% of trainees and 26% of program leaders cited ILI presenteeism.
      • Only 9% of program leaders accurately estimated trainee ILI presenteeism prevalence.
      • Accountability to colleagues is the primary reason cited for ILI presenteeism.
      • Cultural change should augment safety and prevention practices in training programs.


      Working with influenza-like illness (ILI) is pervasive throughout health care. We assessed knowledge, attitudes, and practices regarding ILI presenteeism of both postgraduate trainees and program leaders.


      This survey study was conducted at the Montefiore Medical Center, Albert Einstein College of Medicine, a large academic center in the Bronx, New York. Internal medicine and subspecialty house staff and program directors completed an anonymous electronic survey between April 23 and June 15, 2018.


      A total of 197 of 400 (49%) house staff and 23 of 39 (59%) program leaders participated; 107 (54%) trainees and 6 (26%) program leaders self-reported ILI presenteeism in the past 12 months. More than 90% of trainees and program leaders reported that ILI presenteeism places others at risk. Only 9% of program leaders accurately estimated trainee ILI presenteeism prevalence. Both cited “not wanting to burden colleagues” as the top reason for ILI presenteeism. Twenty-six (24%) trainees practiced ILI presenteeism on critical care units. The majority reported that they would provide patient care with upper respiratory symptoms without fever. Most trainees incorrectly answered influenza knowledge questions.


      ILI presenteeism prevalence is high within training programs at our medical center. Program leaders can model best practices, enforce nonpunitive sick-leave policies, and ensure infection prevention competencies are met annually.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Widera E
        • Chang A
        • Chen HL
        Presenteeism: a public health hazard.
        J Gen Intern Med. 2010; 25: 1244-1247
        • Al Nuhait M
        • Al Harbi K
        • Al Jarboa A
        • Bustami R
        • Alharbi S
        • Masud N
        • et al.
        Sickness presenteeism among health care providers in an academic tertiary care center in Riyadh.
        J Infect Public Health. 2017; 10: 711-715
        • Brborović H
        • Brborović O
        Patient safety culture shapes presenteeism and absenteeism: a cross-sectional study among Croatian healthcare workers.
        Arh Hig Rada Toksikol. 2017; 68: 185-189
        • Chiu S
        • Black CL
        • Yue X
        • Greby SM
        • Laney AS
        • Campbell AP
        • et al.
        Working with influenza-like illness: presenteeism among US health care personnel during the 2014-2015 influenza season.
        Am J Infect Control. 2017; 45: 1254-1258
        • Johansen V
        • Aronsson G
        • Marklund S
        Positive and negative reasons for sickness presenteeism in Norway and Sweden: a cross-sectional survey.
        BMJ Open. 2014; 4e004123
        • Chow EJ
        • Mermel LA
        More than a cold: hospital-acquired respiratory viral infections, sick leave policy, and a need for culture change.
        Infect Control Hosp Epidemiol. 2018; 39: 861-862
        • Chow EJ
        • Mermel LA
        Hospital-acquired respiratory viral infections: incidence, morbidity, and mortality in pediatric and adult patients.
        Open Forum Infect Dis. 2017; 4: ofx006
      1. Centers for Disease Control and Prevention. Overview of influenza surveillance in the United States. Available from: Published 2017. Updated October 13, 2017. Accessed July 20, 2018.

      2. American Association for Public Opinion Research. 2016. Standard definitions: final dispositions of case codes and outcome rates for surveys. 9th edition. AAPOR.

        • Szymczak JE
        • Smathers S
        • Hoegg C
        • Klieger S
        • Coffin SE
        • Sammons JS
        Reasons why physicians and advanced practice clinicians work while sick: a mixed-methods analysis.
        JAMA Pediatr. 2015; 169: 815-821
        • Turnberg W
        • Daniell W
        • Duchin J
        Influenza vaccination and sick leave practices and perceptions reported by health care workers in ambulatory care settings.
        Am J Infect Control. 2010; 38: 486-488
        • Rosvold EO
        • Bjertness E
        Physicians who do not take sick leave: hazardous heroes?.
        Scand J Public Health. 2001; 29: 71-75
        • Jena AB
        • Baldwin DC
        • Daugherty SR
        • Meltzer DO
        • Arora VM
        Presenteeism among resident physicians.
        JAMA. 2010; 304: 1166-1168
        • Jena AB
        • Meltzer DO
        • Press VG
        • Arora VM
        Why physicians work when sick.
        Arch Intern Med. 2012; 172: 1107-1108
        • Mitchell KJ
        • Vayalumkal JV
        Sickness presenteeism: the prevalence of coming to work while ill among paediatric resident physicians in Canada.
        Paediatr Child Health. 2017; 22: 84-88
        • Mossad SB
        • Deshpande A
        • Schramm S
        • Liu X
        • Rothberg MB
        Working despite having influenza-like illness: results of an anonymous survey of healthcare providers who care for transplant recipients.
        Infect Control Hosp Epidemiol. 2017; 38: 966-969
        • LaVela S
        • Goldstein B
        • Smith B
        • Weaver FM
        Working with symptoms of a respiratory infection: staff who care for high-risk individuals.
        Am J Infect Control. 2007; 35: 448-454
        • Cunningham CT
        • Quan H
        • Hemmelgarn B
        • Noseworthy T
        • Beck CA
        • Dixon E
        • et al.
        Exploring physician specialist response rates to web-based surveys.
        BMC Med Res Methodol. 2015; 15: 32
        • Ridgway JP
        • Bartlett AH
        • Garcia-Houchins S
        • Cariño S
        • Enriquez A
        • Marrs R
        • et al.
        Influenza among afebrile and vaccinated healthcare workers.
        Clin Infect Dis. 2015; 60: 1591-1595
        • Cleve WE
        • Cochran K
        • Ramsey KM
        • Silvernail JL
        Sick employee online log (SEOL) system to monitor employee illnesses at a multi-hospital system.
        Am J Infect Control. 2016; 44: 22
        • Nori P
        • Madaline T
        • Munjal I
        • Bhar S
        • Guo Y
        • Seo SK
        • et al.
        Developing interactive antimicrobial stewardship and infection prevention curricula for diverse learners: a tailored approach.
        Open Forum Infect Dis. 2017; 4: ofx117