There’s a common rule that hospital staff who suffer from diarrhoea and vomiting are expected to stay off work for 48 hours symptom-free. It’s in case they’re still infectious when the D&V’s finished. Such a policy only exists in this sector, where potentially vulnerable patients are being cared for.
Staff can obviously be susceptible to hospital-acquired infection. Paradoxically, trusts are clamping down on sick leave. More than three episodes in a year, even of only one day each, can lead to further action being taken. Staff may be tempted to skimp on what they view as unnecessary absence and return to work prematurely, or not go off at all.
Some doctors have chronic non-infective digestive or psychological conditions and routinely have gastrointestinal upsets. They may not be able to tell if their symptoms are normal for them or caused by infection. If they are known to be affected and the 48-hour rule rigidly followed, they could end up never being at work.
Hospital-acquired D&V can also be a problem for those who live in, particularly in close proximity to the wards. Some resident doctors rely on the hospital canteen for sustenance, which is out of bounds if they’re ill. They may even be restricted from emerging to buy food if they have to pass clinical areas to leave the site. If they share accommodation with staff who are well and going about their work as normal, they risk contaminating them.
In reality, the 48-hour rule is not imposed universally. This is often because doctors do not reveal the extent of their afflictions, or anyone that they tell is not aware of the guidelines. Many doctors soldier on despite being ill, perhaps more ill than their patients. There has traditionally been a culture in the medical profession of not going off sick and burdening colleagues with extra duties. Anxiety surrounding this may be exacerbated if sickness targets are robustly enforced.
However, blatant lying is not advisable and you could still fall foul of the procedures anyway. You should also make sure that all your leave is recorded officially, even if you feel it is not fair. So long as you play by the book, you can argue the merits afterwards.
Some trusts take a pragmatic view. They acknowledge that if a certain virus is known to be doing the rounds and several people are off sick, then it could be construed as an industrial illness i.e. acquired as a result of your work. This could mean it need not be counted as sick leave. However, that is a matter of discretion. It may be something that cannot be hidden from a future employer who asks. If a member of staff takes several episodes of sick leave, supposedly because of hospital-acquired D&V, then occupational heath may want a stool sample to be submitted.
If staff are honest and trusts flexible, then this can go some way towards circumventing these problems. Trusts need to be stricter on applying this rule when it matters, yet allowing for non-infective causes of D&V. A more comprehensive occupational health history on appointment could identify specific digestive conditions, however mild.
At the same time, trusts should not penalise employees who are forced off sick when they would have felt well enough to turn up to work in any other sector. Such leave should not automatically be revealed to future employers, and certainly not if a junior happens to be going for a job in a different sector. There should be no guilt trips about going off sick if necessary. Stool analysis should be more rigorously and frequently carried out, no matter how distasteful. This will determine true causes of symptoms, even in retrospect, so that a pragmatic view can be taken on the nature and amount of sick leave.
And, finally, guidance needs to be issued for resident staff.
Tags: HAI
