Asking HCWs to report symptoms when absent from work with a suspected contagious illness may be feasible as a means of surveillance for EIDs in some settings. However, more fundamental issues need to be addressed for the further development of this concept. These include standardising a culture of safe healthcare with education and compliance in infection control, tackling staffing pressures, homogenising absence recording, reviewing sick pay entitlements and improving the understanding of nosocomial outbreaks. Pilot studies will need to be tailored to specific countries and hospitals to investigate how these initial concepts may be adapted.