كتاب
Cough Etiquette and Respiratory Hygiene Practices
- Recommendations
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Recommendations |
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Educate healthcare personnel on the importance of source control measures to contain respiratory secretions to prevent droplet and fomite transmission of respiratory pathogens, especially during seasonal outbreaks of viral respiratory tract infections (e.g., influenza, RSV, adenovirus, parainfluenza virus) in communities (Strong recommendation, Moderate grade evidence) |
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Implement the following measures to contain respiratory secretions in patients and accompanying individuals who have signs and symptoms of a respiratory infection, beginning at the point of initial encounter in a healthcare setting (e.g., triage, reception and waiting areas in emergency departments, outpatient clinics and physician offices): 1. Post signs at entrances and in strategic places (e.g., elevators, cafeterias) within ambulatory and inpatient settings with instructions to patients and other persons with symptoms of a respiratory infection to cover their mouths/noses when coughing or sneezing, use and dispose of tissues, and perform hand hygiene after hands have been in contact with respiratory secretions. (Good practice statement) |
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2. Provide tissues and no-touch receptacles (e.g., foot-pedal-operated lid or open, plastic-lined wastebasket) for disposal of tissues (Good practice statement) |
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3. Provide resources and instructions for performing hand hygiene in or near waiting areas in ambulatory and inpatient settings; provide conveniently-located dispensers of alcohol-based hand rubs and, where sinks are available, supplies for handwashing (Strong recommendation, Moderate grade evidence) |
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During periods of increased prevalence of respiratory infections in the community, offer masks to coughing patients and other symptomatic persons (e.g., persons who accompany ill patients) upon entry into the facility or medical office and encourage them to maintain special separation, ideally a distance of at least 3 feet, from others in common waiting areas (Strong recommendation, Moderate grade evidence) |
➡️Remarks
The elements of Respiratory Hygiene/Cough Etiquette include:
1. Education of healthcare facility staff, patients, and visitors that anyone with signs and symptoms of a respiratory infection, regardless of the cause, should follow or be instructed to follow respiratory hygiene and cough etiquette as follows:
● Cover the nose/mouth with disposable single-use tissues when coughing, sneezing, wiping and blowing noses. (Annex 1. Cover your Cough, CDC)
● Use tissues to contain respiratory secretions.
● Dispose of tissues in the nearest waste receptacle or bin after use.
● If no tissues are available, cough or sneeze into the inner elbow rather than the hand (Annex 2. Cough manner).
● Practice hand hygiene after contact with respiratory secretions and contaminated objects/materials.
● Keep contaminated hands away from the mucous membranes of the mouth, eyes and nose.
● In healthcare facilities, patients with symptoms of respiratory infections should sit as far away from others as possible. If available, healthcare facilities may place these patients in a separate area while waiting for care.
● Healthcare workers should also assist patients (e.g. elderly, children) who need assistance with containment of respiratory secretions. Those who are immobile will need a receptacle (e.g. plastic bag) readily at hand for the immediate disposal of used tissues and will need to be offered hand hygiene facilities.
2. Posted signs, in language(s) appropriate to the population served, with instructions to patients and accompanying family members or friends.
3. Source control measures (e.g., covering the mouth/nose with a tissue when coughing and prompt disposal of used tissues, using surgical masks on the coughing person when tolerated and appropriate)
4. Hand hygiene after contact with respiratory secretions.
5. Spatial separation, ideally equal or more than 3 feet (1 meter) of persons with respiratory infections in common waiting areas when possible.
Covering sneezes and coughs and placing masks on coughing patients are proven means of source containment that prevent infected persons from dispersing respiratory secretions into the air. These measures should be effective in decreasing the risk of transmission of pathogens contained in large respiratory droplets (e.g., influenza virus, adenovirus, B. pertussis and Mycoplasma pneumoniae).
Hands can become contaminated through contact with respiratory secretions when coughing or sneezing. Contaminated hands can lead to the cross-transmission of infectious agents in non-outbreak situations. The patient and visitors should also be aware of their role in minimizing risks by being instructed on how to perform hand hygiene after coughing or contact with respiratory secretions.
Healthcare personnel are advised to observe Droplet Precautions (i.e., wear a mask) and hand hygiene when examining and caring for patients with signs and symptoms of a respiratory infection.
Healthcare personnel who have a respiratory infection are advised to avoid direct patient contact, especially with high-risk patients. If this is not possible, then a mask should be worn while providing patient care.
1.2 Indicators for Monitoring
Cough etiquette is assessed among elements of standard precautions during audit. Presence of posters, hand sanitizers, tissues, masks and waste bins are an indicator of proper implementation.
1.3 Plan to Update this National Clinical Guideline
This guideline will be reviewed and updated when new
evidence emerges that is likely to influence the recommendations.
