Nursing

Respiratory hygiene/cough etiquette in health care settings

Nurse Leader Weekly, December 18, 2003

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Respiratory hygiene/cough etiquette in health care settings

To prevent the transmission of all respiratory infections (including influenza) in health care settings, you should implement the following infection control measures at the first point of contact with a potentially infected person. Incorporate them into infection control practices as one component of standard precautions.

Visual alerts
Post visual alerts (in appropriate languages) at the entrance to outpatient facilities (e.g., emergency departments, physician offices, outpatient clinics). These signs should instruct patients and persons who accompany them (e.g., family, friends) to inform health care personnel of symptoms of a respiratory infection when patients first register for care and to practice respiratory hygiene/cough etiquette.

Respiratory hygiene/cough etiquette
The following measures to contain respiratory secretions are recommended for all individuals with signs and symptoms of a respiratory infection:

  • Cover the nose/mouth when coughing or sneezing
  • Use tissues to contain respiratory secretions and dispose of them in the nearest waste receptacle after use
  • Perform hand hygiene (e.g., hand washing with non-antimicrobial soap and water, alcohol-based hand rub, or antiseptic hand wash) after having contact with respiratory secretions and contaminated objects/materials

    • Health care facilities should ensure the availability of materials for adhering to respiratory hygiene/cough etiquette in waiting areas for patients and visitors.

  • Provide tissues and no-touch receptacles for used tissue disposal.
  • Provide conveniently located dispensers of alcohol-based hand rub; where sinks are available, ensure that supplies for hand washing (i.e., soap, disposable towels) are consistently available.

    • Masking and separation of persons with respiratory symptoms
    During periods of increased respiratory infection activity in the community (e.g., when there is increased absenteeism in schools and work settings and increased medical office visits by persons complaining of respiratory illness), offer masks to persons who are coughing. Either procedure masks (i.e., with ear loops) or surgical masks (i.e., with ties) may be used to contain respiratory secretions (respirators such as N-95 or above are not necessary for this purpose). When space and chair availability permit, encourage coughing persons to sit at least three feet away from others in common waiting areas. Some facilities may find it logistically easier to institute this recommendation year-round.

    Droplet precautions
    Advise health care personnel to observe droplet precautions (i.e., wearing a surgical or procedure mask for close contact), in addition to standard precautions, when examining a patient with symptoms of a respiratory infection, particularly if fever is present. These precautions should be maintained until it is determined that the cause of symptoms is not an infectious agent that requires droplet precautions www.cdc.gov/ncidod/hip/ISOLAT/Isolat.htm

    NOTE: These recommendations are based on the Draft Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC), CDC.

    For more information, visit www.cdc.gov/flu, or CDC's Division of Healthcare Quality Promotion at www.cdc.gov/ncidod/hip, or call the National Immunization Hotline at (800) 232-2522 (English), (800) 232-0233 (español), or (800) 243-7889 (TTY).



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