Respiratory Hygiene/Cough Etiquette

Respiratory hygiene/cough etiquette evolved from observations made during the 2003 outbreak of coronavirus (CoV)-associated severe acute respiratory syndrome (SARS).1 Investigators concluded that transmission of the virus resulted from a failure to implement source-control measures when patients, visitors, and HCP with undiagnosed respiratory tract infections entered healthcare facilities.1 The new standard requires prompt implementation of source-control measures at the first point of encounter within all healthcare settings (Box A).1

Box A. Respiratory Hygiene/Cough Etiquette.1
  • All patients and visitors with respiratory tract infections should:
    • Turn head away from others and cover mouth and nose during coughing and sneezing.
    • Use tissue paper to contain respiratory secretions and discard it promptly into a no-touch receptacle.
    • Perform hand hygiene after contact with respiratory secretions with soap and water or an alcohol-based hand rub.
    • Wear (when tolerated) a surgical mask when coughing to decrease contamination of the surrounding environment.
    • Observe a spatial separation, ideally greater than 3 feet, in common waiting areas.
  • Healthcare personnel with respiratory tract infections should:
    • Avoid direct patient contact, especially with high-risk patients.
    • Observe contact and droplet precautions, i.e., must wear a gown, gloves (perform appropriate hand hygiene), and a surgical mask for all patient interactions.

Respiratory hygiene/cough etiquette is effective in decreasing the transmission of pathogens disseminated in droplets. Source-control measures apply to any person entering a healthcare facility with signs of illness, i.e., coughing, congestion, rhinorrhea, or production of respiratory secretions.1 In addition, the new standard requires educating HCP, patients, and visitors and the posting of signs with instructions about respiratory hygiene/cough etiquette (Figure 1).

Figure 1. Respiratory Hygiene/Cough Etiquette Poster.
CDC cover your cough
Cover your Cough.