During their education, healthcare providers are taught about disease transmission and infection control. The six links in the chain of infection — infectious agent, reservoir, portal of exit, mode of transmission, portal of entry and susceptible host — are a mainstay in infection prevention and well known by healthcare providers.

In an effort to contain infections, providers are required to wash their hands between patients, and personal protective equipment is required in carrying for especially contagious patients. However, this logic is completely counterproductive when the providers themselves are sick.

Providers will educate their patients on proper infection control principles, yet they will go from patient to patient coughing and sneezing on each patient and staff member they encounter. A recent article by JAMA Pediatrics has attempted to answer the question of why physicians and advanced practice clinicians continue to come to work sick.

The research was completed at a large children's hospital. Considering the vulnerable patient population, the thought would be that the providers would be especially sensitive to not placing their patients at jeopardy. The study revealed that 95.3 percent of the respondents believed working sick put their patients at jeopardy. Unfortunately, the study also found 83.1 percent of the surveyed population reported working sick at least once in the previous year.

The reasons noted for working sick were not wanting to let colleagues down (98.7 percent), staffing concerns (94.9 percent), not wanting to let the patients down (92.5 percent), fear of ostracism by colleagues (64.0 percent) and concerns of continuity of care (63.8 percent).

The study further identified three issues for this phenomenon: policies and logistic issues that do not support calling in sick, cultural norms that discourage absenteeism, and the ambiguity felt by the healthcare providers regarding what constituted being too sick for work.

This study sheds light again on the conflict between the evidence and the reality of providing care. The answers are not clear-cut, and most institution policies are contradictory when it comes to implementation.

For example, staff may be provided sick time, however, may be given a hard time when trying to use their time or even written up if used "too much." Some institutions actually will reward staff for not using their sick time, further giving them an incentive to come in sick.

Yet, if they come to work sick, the staff working with them are placed at risk, not to mention the vulnerable patients. Not only are others at risk for illness, but the productivity of the sick provider is also substantially sub-par, again contributing to substandard care.

Although one of the culture norms for healthcare providers is to work through the illness, they really are doing a disservice to their patients and colleagues. However, the culture will need to change and recognize that no one gets rewarded for working sick. In fact, the patients, who they are charged with serving, suffer greatly due to those decisions.

As we continue to attempt to provide evidence-based care, we need to take infection control seriously — starting with each one of us. Remember, we are called to do no harm.