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January 31, 2014
Your employees need to be at work, not sick at home

Here’s how to keep them protected and productive

Employees in the United States miss more than half a billion days of work each year, which costs their employers more than $40 billion. According to the Employer Assistance and Resource Network, illness-related absenteeism would exceed 15 percent of business losses if it were listed on a profit and loss statement.

Is absence part of the cost of doing business? Or can you control the factors that keep your employees home and threaten your productivity? We believe you can. In this Compliance Report, you’ll find research and best practices that show you how.

Innocent or culpable?

Absence affects business operations in diverse ways. There are the direct costs, such as lost time, reduced productivity, and the expense of providing and training replacement workers. Then there are the indirect costs, including reduced morale and presenteeism, which refers to the productivity losses caused by sick employees coming to work when they should be home.

One way to understand absenteeism is by dividing it into two categories. Innocent absenteeism is related to legitimate medial or personal reasons. Culpable absence has no genuine cause and is within an employee’s control. However you define it, being off the job is a costly proposition for employers.

Donald Bucklin, MD, is regional medical director for U.S. HealthWorks, one of the largest occupational health providers in the country, with more than 200 clinics. Asked about the primary causes of absence, Bucklin says the top reason is “legitimate illness,” especially in winter when flu and other infectious diseases run rampant. The problem is autoinoculation, or infecting oneself.

Bucklin explains: “That means, for example, that somebody has their hand on the escalator handrail, then they rub their nose with that hand. Or they touch their cell phone and then scratch their eyes.”

One of the most effective ways to prevent illness is to never touch one face’s without first washing the hands or cleaning them with alcohol-based hand sanitizer. Bucklin spends his days around sick people and rarely becomes ill, which he attributes to good habits like the “wash first” policy.

“In terms of preventing illness, I also recommend the flu shot,” says Bucklin. The average flu-related work absence is 10 days, and 30,000 people die each year from the disease. Bucklin believes shoring up the immune system with nutritious food and adequate sleep can help stave off infection. “We’re all surrounded by germs and we manage to fight off 99.9 percent of them. The stronger our immune systems, the better chance we have.”

The second major cause of absence is injuries, those that occur at work and at home. Whatever the cause of an injury, Bucklin advises employees to get back on the job quickly. “There are tons of studies that show people get better faster working light duty than they do staying home,” he adds.

Another top contributor to absence is child care. With so many single parents in the workforce, a mom or dad with a sick child has few options other than staying home. It becomes more complicated when the working parent gets infected and has to lose even more time.

Another absence category is what Bucklin calls “voluntary absence due to special things going on in people’s lives.” An example is an employee who calls in sick on a Friday because his girlfriend is coming into town. Bucklin says it’s hard for employers to fight this type of thing. Requiring an employee to get a doctor’s note to prove illness may backfire because it can cost the employer $50 for that visit. Some employers do not distinguish between types of leave, instead offering a set number of days, which can be used for any purpose.

Focus: A cleaner workplace

The escalator handrail and the cell phone are just two of the countless repositories of germs workers encounter every day on the job. Germ expert Charles Gerba, PhD, is a professor of environmental microbiology at the University of Arizona in Tucson. He says we’re touching more germy surfaces than ever. That’s because we go to bigger office buildings, travel in bigger airplanes, and work out in bigger gyms.

Offices are a breeding ground for bacteria, mold, and viruses. Gerba says phones are the worst because they are rarely cleaned or disinfected. Cleaning crews tend to ignore other objects on the desktop because they are considered employees’ personal space. The problem is that germs easily migrate from the phone to the keyboard, mouse, photocopier, etc.

Then there’s the bathroom. Gerba and his colleagues conducted research in several cities. They camped out in office bathrooms to see what goes on there, including at the sink. In one city, they found that two-thirds of people washed after using the facilities. Only about half of those used soap and, among those, just half washed for the recommended 15 to 20 seconds.

Gerba says many workplace viruses aren’t serious enough to keep people home. Instead, they come to work sick and, to some degree, infectious. Like Bucklin, Gerba urges the use of disinfecting wipes around the office and workstation, as well as alcohol-based hand sanitizers.

He advises employers to train workers to think proactively about infection control. That means assuming that everyone is potentially infectious, that the environment is germ-laden, that workers are not using the best personal hygiene practices, and that the maintenance crew is not doing its job. That puts the individual in charge of washing, wiping, and overall vigilance.

Focus: Avoiding flu and other illnesses


Incorporate these practices to reduce the spread of germs at your workplace this winter:

  • Train maintenance staff to make sure they are not using cleaning cloths or sponges in the restroom and then reusing them in other parts of the workplace. Consider disposable cleaning products.
  • Place hand sanitizer dispensers throughout the workplace, including the break room. One study found that this simple step reduced the spread of viruses by more than 90 percent. Choose sanitizers containing 65 percent to 70 percent alcohol.
  • Encourage employees not to share clothing, razors, towels, cups, or other personal items.
  • Cover broken skin immediately, as intact skin is an important barrier for pathogens.
  • Encourage employees to regularly wipe down their computer, phone, and desktop with disinfecting wipes.
  • If coworkers seem sick, keep a safe distance of at least 6 feet.

You’ve heard the reports about the flu this season, and they’re quite concerning. The Centers for Disease Control and Prevention (CDC) recommends a yearly flu vaccine for everyone six months and older as the first and most important step in protecting against flu viruses. Vaccination is especially important for healthcare workers and others who care for high-risk people.

Beyond getting the flu vaccine, there are a number of everyday preventive actions to stop the spread of germs. Make sure your employees know and follow them:

  • Try to avoid close contact with sick colleagues, customers, etc.
  • If you are sick with flu-like illness, stay home for at least 24 hours after the fever is gone without the use of fever-reducing medication. (Flu-like symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. Some people may also have nausea and diarrhea.)
  • Cover your nose and mouth with a tissue when you cough or sneeze, then throw the tissue in the trash.
  • Wash frequently and avoid touching the eyes, nose, and mouth.

If you do get the flu, talk with your doctor about getting antiviral drugs. These are prescription medicines that work best when they are started within 2 days of getting sick, but the CDC says they can still be helpful if started later.

Focus: Moving our bodies

We hear a lot about the benefits of healthy habits to stave off illness. Bucklin of U.S. HealthWorks confirms that it’s true. Nutritious food, rest, exercise, and minimizing caffeine and stress help keep the immune system strong and better able to ward off germs.

The benefits of exercise are well-known. Wellness Councils of America ( notes that current guidance has shifted from an emphasis on vigorous exercise like jogging to moderate amounts of moderate-intensity activity. Encourage employees to get a total of 30 minutes of moderate activity on most days of the week. Moderate is defined as the equivalent of a walking pace of a 15 to 20-minute mile.

For weight loss, the recommendation is 60 minutes of moderate activity at least 5 days per week. It’s important for all employees to complete a health assessment or obtain physician consent before beginning a physical activity program.

Consider these tactics to encourage physical activity at the workplace:

  • Logging physical activity helps employees recognize (and change) their patterns.
  • Goal setting gives people something concrete to work toward, helps measure progress, and provides a sense of accomplishment.
  • Social support adds encouragement and fun. It’s harder to say no if someone is expecting you to show up for a walk or a gym session.

Many workplaces, including small sites, have found a good return on an investment in workout facilities. Some offer reduced price memberships to local YMCAs and fitness clubs. Other ideas:

  • Provide flextime for exercising during the workday.
  • Set up walking clubs that meet before work, during lunch, or after hours.
  • Make stairs user friendly by providing music in the stairwell, slip guards, and good lighting.
  • Encourage small exercise “chunks,” such as a 10-minute walk break in the morning and in the afternoon.
  • Send a daily e-mail with a tip for increasing physical activity.
  • Create an incentive system that includes competition and prizes (water bottles, not pizza).

Focus: Food and sleep


Research presented at a conference in Great Britain earlier this month found that employers who support employee well-being outside the workplace reap the benefits during working hours.

Researchers questioned more than 1,200 people and found that those who are more engaged in their jobs are less likely to be absent. Respondents with high anxiety were more likely to report that they had been absent from work as a result of tiredness or boredom. People with low anxiety were more likely to describe themselves as healthy and happy and were more likely to receive promotions.

Concluded researcher Rob Bailey, “It is unrealistic for employers to expect employees to leave their emotions at home, especially employees who are not so emotionally stable. Workplace support is likely to help to improve people’s engagement with their jobs and to reduce staff turnover and absence.”

Eating healthy food keeps weight down and can help prevent absence-inducing conditions like heart disease, diabetes, and high blood pressure. To stay well and productive, employees need a balanced diet that includes carbohydrates, fiber, protein, and healthy fats.

It’s tempting to imagine that your workers will choose a turkey sandwich on whole grain bread with some fruit for lunch. But old habits die hard, and many people find it hard to give up their cheeseburgers and fries. Try these tips to promote good worksite nutrition.

  • A healthy breakfast really does make a difference. Host an occasional all-staff breakfast to kick off a new safety and health initiative or celebrate a milestone. Good breakfast choices include whole grain bagels, plain yogurt and fresh fruit, oatmeal, fruit smoothies, and veggie omelets.
  • Discourage soda drinking by providing low-calorie and no-sugar-added beverages at meetings. Always have a bowl of fresh fruit available. If possible, hold walking meetings.
  • Work with the people who run your company cafeteria to promote healthy options. Encourage employees to submit favorite healthy recipes and offer a prize for those that are adopted. Some employers discount smarter choices like the salad bar. Ask the chef to remake some unhealthy favorites to cut out extra fat and calories (think grilled fish tacos vs. fried fish and chips).
  • If you don’t have an in-house cafeteria, identify nearby healthy lunch places and post their menus. Ask those restaurants to consider offering your employees a discount.
  • Work with local vendors to host a weekly on-site farmers’ market in season.
  • Ask your vending machine supplier to substitute water, fruit, pretzels, and nuts for candy, chips, and soda.

Like food, sleep is an essential component of good health. Sleep disorders are blamed for everything from obesity and emotional problems to alcohol and drug abuse. Poor sleep may cause cravings, affect our ability to know when we feel full, and lead to blood pressure spikes in people with hypertension.

Sleep puts us in a more cheerful and agreeable state of mind and helps restore depleted reserves of energy. That makes it easier to head out for a walk or to the gym, which can contribute to a strong heart, good bones, and a healthy weight.

Most adults require 7 to 8 hours of sleep, yet more than a third say they sleep less than that. The CDC cites an increase in the percentage of American civilian workers reporting six or fewer hours of sleep per day. Almost 40% of those who participated in a study admitted falling asleep unintentionally at least once in the previous month.

The implications are especially significant for workers who operate machinery, guide airplanes to safe landings, and drive, as drowsy driving is an acknowledged safety risk.

Make good “sleep hygiene” the subject of an upcoming safety meeting. Share the following tips with employees:

  • Stay away from stimulants like caffeine and alcohol close to bedtime.
  • Enjoy relaxing exercise like yoga before bed, but choose morning or late afternoon for strenuous workouts.
  • Avoid heavy snacking before bedtime.
  • Create a relaxing bedtime routine that includes activities like reading or listening to music.
  • Reserve your bed for sleeping; keep the TV and computer in another room.
  • Keep the room comfortable—not too bright and not too hot or cold.

Focus: Absence reduction 101

Emory University in Atlanta has launched a major culture-change initiative across its campus, hospitals, and other facilities. Healthy Emory spans health, safety, and wellness.

According to Director of Health Management Michael Staufacker, Healthy Emory offers a coordinated approach. The program includes offerings for students, employees, and spouses/partners. Some of these offerings include employee assistance programs, health coaching, group challenges, health education, a flu vaccination program, and popular walking programs.

Asked about the chief causes of absenteeism at Emory, Staufacker points to chronic health conditions (like diabetes, asthma, and heart disease), as well as musculoskeletal and lower back issues.

He notes that many strategies to help control these illnesses also have a positive impact on employees’ overall health. Examples are eating well, getting more movement into the day, managing stress, and getting enough good-quality sleep. “All these have an influence on employees regardless of chronic conditions, and they are all things that are generally within an individual’s control,” he says.

Emory has taken steps to ensure the success of its initiative, including conducting a survey to understand employees’ challenges and needs. Another important step was to establish a widely representative Healthy Emory steering committee. The university has also worked to make sure its program is easy to participate in. Says Staufacker, “We’re trying to make this part and parcel of our organization by weaving health, wellness, and safety into the fabric of Emory.”

Program leaders are taking the long view, acknowledging that increasing health and decreasing absenteeism and related costs is a marathon, not a sprint. “We’re setting expectations with leaders and throughout the organization that it will take time to improve the health and well-being of our employees. We also recognize the importance of research and evaluation to measure our efforts,” Staufacker notes.

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