Overview of Respiratory Hygiene and Cough Etiquette

Respiratory hygiene and cough etiquette are essential infection prevention practices aimed at minimizing the transmission of respiratory infections, particularly those spread through droplets or aerosols. These practices are important in both healthcare settings and community environments, as respiratory pathogens are among the most common causes of infection. Proper respiratory hygiene and cough etiquette can significantly reduce the spread of diseases like influenza, tuberculosis, COVID-19, and other contagious respiratory infections.

Key Principles of Respiratory Hygiene and Cough Etiquette

Respiratory hygiene refers to practices that aim to prevent the spread of respiratory infections through coughing, sneezing, or speaking. Cough etiquette, a component of respiratory hygiene, focuses on specific actions that individuals should take to reduce the risk of infecting others when they cough or sneeze.

The following key principles guide these practices:

1. Covering the Mouth and Nose

• Covering when coughing or sneezing:
  • It is essential to cover your mouth and nose with a tissue or the inside of your elbow (when a tissue is unavailable) to block the spread of respiratory droplets.
  • Avoid using your hands to cover your mouth or nose, as this can lead to contamination and transmission to surfaces or other people.
  Key Points to Remember:
  • Always carry tissues and dispose of them immediately after use.
  • If you use your elbow, ensure that the inner part of the elbow is directed inward, away from other people.

2. Proper Disposal of Tissues

• Tissue Disposal:
  • After coughing or sneezing into a tissue, immediately dispose of the tissue in a lined trash bin.
  • Do not leave used tissues lying around, as they can serve as a source of infection for others.
  Key Points to Remember:
  • Use a hands-free trash bin, if possible, to avoid touching contaminated surfaces.
  • Wash hands thoroughly after disposing of tissues.

3. Hand Hygiene After Coughing or Sneezing

• Washing Hands:
  • Immediately wash hands with soap and water for at least 20 seconds after coughing or sneezing, especially if your hands have been in contact with respiratory droplets.
  • If soap and water are not available, use an alcohol-based hand sanitizer (containing at least 60% alcohol).
  Key Points to Remember:
  • Hand hygiene is the most effective way to prevent the spread of infections.
  • Clean all parts of the hand, including between fingers and under nails, when washing.

4. Use of Masks

• When to Wear a Mask:
  • Masks should be worn by individuals who have symptoms of a respiratory infection (such as coughing, sneezing, or a runny nose) to prevent the spread of droplets to others.
  • This is particularly important in healthcare settings, crowded places, or when interacting with vulnerable populations.
  Key Points to Remember:
  • Masks should cover both the nose and mouth completely and fit snugly around the face.
  • Surgical masks are appropriate for blocking large droplets, while N95 respirators are used in situations where aerosolized particles might be present.

5. Physical Distancing

• Maintaining Distance:
  • If possible, maintain at least a 1-2 meter distance from others when you have respiratory symptoms to avoid transmission of infectious droplets.
  • This is particularly important in healthcare settings where patients may be vulnerable to infections.

6. Stay Home When Sick

• Avoiding Work or School:
  • Individuals exhibiting symptoms of respiratory illness, such as coughing, sneezing, or fever, should stay home to avoid spreading the illness to others.
  • In healthcare settings, healthcare workers who are symptomatic should refrain from working and follow protocols for reporting illness.

Respiratory Hygiene and Cough Etiquette in Healthcare Settings

In healthcare settings, it is particularly important to ensure that patients, healthcare workers, and visitors follow proper respiratory hygiene and cough etiquette to minimize the risk of spreading infectious agents, including those that can cause serious infections like tuberculosis or COVID-19. Healthcare institutions often take additional steps, such as:

• Designating areas for patients with respiratory symptoms: Some hospitals have separate waiting areas for patients with symptoms like coughing, sneezing, or fever, reducing the risk of exposure to other patients.
• Education and Training: Healthcare workers are routinely educated on the importance of respiratory hygiene and cough etiquette to protect both patients and staff from potential infections.
• Signage and Reminders: Visual reminders (posters and handouts) are placed throughout healthcare facilities, encouraging patients and visitors to follow these practices.

Role of Visitors in Respiratory Hygiene

Visitors to healthcare facilities should also adhere to respiratory hygiene and cough etiquette to prevent the spread of infection. This includes:

• Wearing masks if they exhibit any symptoms of respiratory illness.
• Hand hygiene: Visitors should sanitize their hands before and after visiting a patient, especially if they have been coughing or sneezing.
• Following staff instructions: Healthcare workers should inform visitors about where to sit or wait if they exhibit respiratory symptoms, ensuring they follow proper precautions.

Key Takeaways for Effective Respiratory Hygiene and Cough Etiquette

• Always cover your mouth and nose when coughing or sneezing using a tissue or elbow.
• Wash your hands thoroughly after coughing or sneezing or dispose of used tissues properly.
• Wear a mask when you have symptoms of respiratory illness or when caring for patients who do.
• Maintain physical distancing whenever possible to reduce the spread of respiratory droplets.
• Stay home when sick to prevent transmitting infections to others.

Quiz: Respiratory Hygiene and Cough Etiquette

1. What is the primary reason for covering your mouth and nose when coughing or sneezing? a. To avoid irritating others
   b. To prevent respiratory droplets from spreading to others
   c. To keep your clothes clean
   d. To reduce coughing frequency

2. Which of the following is the best action after coughing or sneezing into a tissue? a. Place the tissue in your pocket
   b. Throw the tissue into a trash bin immediately
   c. Reuse the tissue after shaking it out
   d. Keep the tissue in your hand for later disposal

3. When should a person wear a mask? a. Only when they feel sick
   b. Only during healthcare procedures
   c. When experiencing respiratory symptoms like coughing or sneezing
   d. Only when directed by a doctor

4. How far should you maintain physical distance from others if you have respiratory symptoms? a. At least 0.5 meters
   b. At least 1-2 meters
   c. Less than 1 meter
   d. No physical distance is required

Practical Exercise: Cough Etiquette Role Play

Objective: To demonstrate proper cough etiquette in a real-world context.

Instructions:

1. Pair up with a colleague or practice partner. One person will simulate symptoms (coughing, sneezing), and the other will practice responding appropriately by:
   • Offering tissues
   • Encouraging the sick person to wear a mask
   • Ensuring proper hand hygiene after coughing/sneezing
2. Discuss what worked well during the exercise and identify areas for improvement.

Online Resources for Further Learning

1. World Health Organization (WHO) – Respiratory Hygiene Guidelines
   https://www.who.int/infection-prevention/cough-etiq

2. Centers for Disease Control and Prevention (CDC) – Cough Etiquette
   https://www.cdc.gov/flu/protect/covercough.htm

3. Public Health Agency of Canada – Respiratory Hygiene
   https://www.canada.ca/en/public-health/services/respiratory-hygiene.html