Cold and flu season is here, and for many companies that means more workers calling in sick.

While higher absenteeism presents challenges, so can "presenteeism -- when employees come to work sick.

A survey last year by NSF International, a global independent health and safety organization, found that four in 10 American workers say they come to work sick because they have deadlines or would have too much work to make up when they return after a sick day.

"It's a lose-lose situation," says Ron Goetzel, senior scientist at Johns Hopkins Bloomberg School of Public Health in Baltimore and a vice president at Ann Arbor, Michigan-based Truven Health Analytics, a provider of health care data and consulting services.

If the illness is infectious, like a cold or the flu, coming to work sick can spread germs to others, which impacts their productivity, he says. If it's a chronic, noncontagious illness that's not being managed well, that will affect the worker's performance and productivity if left unaddressed, he says.

More than a decade ago, Goetzel was part of a team that researched the costs of presenteeism as it related to 10 health conditions, including hypertension and arthritis. They found that companies' productivity losses could be as high as 60 percent of the total cost of worker illness.

Prevention. One solution is to institute workplace health promotion programs that can help identify, address and prevent some of these illnesses, Goetzel says.

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To identify opportunities, have an outside firm do an assessment to see what wellness programs are most needed and desired by employees, such as smoking cessation or stress management.

Educate employees on wellness best practices, including washing hands regularly, especially during cold/flu season, taking vitamins to boost immunity and not coming to work if they feel the onset of sickness, suggests Lisa Yakas, a microbiologist with NSF International.

"By going to work sick, you're putting co-workers at risk," she says.

Legal considerations. Under Occupational Safety and Health Administration laws, employers generally have an obligation to maintain a safe working environment, explains John Diviney, a partner in the labor group at Rivkin Radler LLP in Uniondale.

In the case of the flu, for example, you may be able to ask the employee to go home and provide a doctor's note upon return, he notes. But with a chronic illness, you must tread carefully, Diviney says.

There are restrictions under federal and state disability discrimination statutes as to when you can "unilaterally inquire about medical conditions," Diviney says. Also, some illnesses may require an accommodation so the employee can perform essential job functions; you can't simply send them home, he notes.

Less pressure. It helps to create a culture where employees feel comfortable enough to stay home if sick, says Diane Pfadenhauer, an employment lawyer and president of Employment Practices Advisors, HR consultants in Northport.

Some organizations create an environment where employees have to work through an illness and not being in the office is seen as a sign of weakness, she notes. You must enable employees to take their sick days when needed, Pfadenhauer says.

'Bank' downside. Many firms over the years have switched from separating sick, personal and vacation days to a paid-time-off "bank" that lumps them all together, says Dawn Davidson Drantch, counsel at Alcott HR, a Farmingdale professional employer organization. But this spurs presenteeism, because employees are often reluctant to use days when they're sick, preferring to save time for vacation, she notes.