Respiratory Hygiene/Cough Etiquette in Healthcare Setting

To prevent the transmission of all respiratory infections in healthcare settings, including influenza, the following infection control measures should be implemented at the first point of contact with a potentially infected person. They should be incorporated into infection control practices as components of Standard Precautions.

1. Visual Alerts
Post visual alerts, in appropriate languages, at the facility's entrance (e.g., emergency departments, physician offices, outpatient clinics) instructing all persons who enter to inform healthcare personnel of symptoms of a respiratory infection and to practice Respiratory Hygiene/Cough Etiquette. Visual alerts should:

2. Respiratory Hygiene/Cough Etiquette Reminders/Supplies

3. 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.

4. Droplet Precautions
Advise healthcare 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.

5. Restrictions for ill Visitors and Health-care Personnel

If there is no, or only sporadic, influenza activity occurring in the surrounding community:

If widespread influenza activity is in the surrounding community: