Respiratory Hygiene and Cough Etiquette to Minimize Transmission of Influenza and Other Respiratory Tract Pathogens

In reception and common waiting areas of ambulatory medical facilities, the implementation of some or all components of respiratory hygiene and cough etiquette should be implemented for patients with suspected influenza or other respiratory tract pathogens. Influenza or another respiratory tract pathogen is suspected in patients with a new onset of cough or increased respiratory tract secretions, especially in the presence of a fever.
 1. Visual alerts for patients at the entrance to ambulatory facilities instructing patients and accompanying persons to inform staff of symptoms of a respiratory tract infection when they first register for care and to practice respiratory hygiene and cough etiquette.
 2. Respiratory hygiene and cough etiquette for patients and accompanying individuals with suspected respiratory virus infection
  • Cover the nose and mouth when coughing or sneezing. Cough or sneeze into the elbow rather than a hand.
  • Use tissues to contain respiratory tract secretions and dispose of them in the nearest waste receptacle after use.
  • Perform hand hygiene (ie, use of alcohol-based hand rub, hand washing with soap and water, or use of an antiseptic handwash) after having contact with respiratory tract secretions and contaminated objects and materials.
  • If tolerated and feasible, consider providing a size-appropriate mask for the patient to wear to prevent respiratory droplet dispersal while in common reception and waiting areas.
 3. Components of respiratory hygiene and cough etiquette for staff
  • Educate patients and accompanying people on the need for and components of respiratory hygiene and cough etiquette.
  • In reception area, have tissues and no-touch receptacles for used tissue disposal available.
  • If feasible, provide conveniently located dispensers of alcohol-based hand rub with instructions for use (or have a sink available with consistently available soap and disposable towels).
  • When space and chair availability permit, cluster chairs for a coughing patient and accompanying people at least 3 feet away from other patients.
  • Consider having masks available for distribution to symptomatic patients by staff.
  • In addition to hand hygiene before and after patient contact, health care personnel should consider wearing a mask when examining an ambulatory patient with suspected influenza.