This document discusses cough etiquette and respiratory hygiene to prevent the spread of respiratory infections in healthcare settings. It recommends that individuals with respiratory symptoms cover their mouth and nose when coughing or sneezing, and dispose of tissues properly. Healthcare facilities should promote these practices and make resources like masks and hand hygiene supplies available. Proper patient placement, respiratory protection for healthcare workers, and other infection control measures are needed to manage patients with infectious respiratory illnesses like tuberculosis.

2. What the Cough
Etiquette/ Respiratory
Hygiene?

3. COUGHING.

4. (From Policies and Procedures on infection control , May 2010)
Cough etiquette/respiratory hygiene is controlling
the spread of pathogens from infected patients
( source control) is key to avoid transmission to
unprotected contact.
For diseases transmitted through large droplets or
droplet nuclei, respiratory hygiene/ cough
etiquette should be applied by all individuals with
respiratory symptoms.
All individuals (HCWs, patient and visitors) with
signs and symptoms of a respiratory infection
should:

5. Cont…….
Cover their mouth and nose when
coughing/sneezing;
Use tissues, handkerchiefs, cloth mask or medical
masks if available, as sourcecontrol to contain
respiratory secretions and dispose of them into the
waste containers;
Use medical mask on a coughing/sneezing person
when tolerated and appropriate and perform hand
hygiene.

7. 1st TECHNIQUE OF COUGHING
& SNEEZING

8. 2nd TECHNIQUE OF COUGHING
& SNEEZING.

9. Cont…
Hospital should promote respiratory hygiene/
cough etiquette:
Promote the use of respiratory
hygiene/cough etiquette by all HCWs, patient
and family members with acute febrile
respiratory illness;
 Educate HCWs, patient, family members and
visitors on the importance of containing
respiratory aerosois and secretion to help prevent
the transmission of respiratory disease;

10. Cont…
Consider providing resources for hand hygiene
(e.g. dispensers of alcohol-base hand rubs, hand-washing
supplied) and respiratory hygiene (e.g.
tissues); areas of gatthering,such as waiting rooms,
should be prioritized.

11. WASH YOUR HAND

12. Cough
Etiquette/Respiratory
hygiene in Healthcare
Settings

13. (From CDC info 1 Aug. 2009)
DEFINATION
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 one
component of Standard Precautions.

14. Visual Alerts
At the entrance to outpatient facilities (e.g.,
Emergency Departments, Physician Offices,
outpatient clinics) instructing patients and
persons who accompany them (e.g., family,
friends) to inform healthcare personnel of
symptoms of a respiratory infection when
they first register for care and to practice
Respiratory Hygiene/Cough Etiquette.

15. Masking and Separation of Persons with Respiratory
Symptoms
During periods of increased respiratory infection
activity in the community, offer masks to persons
who are coughing.
Either procedure masks or surgical masks may be
used to contain respiratory secretions.
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.

16. We need to be prepared!!
HOW?

17. Patient Placement
1. Negative pressure room en-suite bath
2. Single room(nurse with door Closed) and
en-suite bath

18. 4 single patient room
Air condition with negative pressure
Attached bathroom and toilet.

19. Single Room/Cohort

20. Respiratory Protection(N95)
Wear respiratory protection(N95)
when entering the room of a patient
with known or suspected infectious
pulmonary tuberculosis.

21. Type of Mask
N95 respirator
Duckbill N95 respirator

22. Mask N95 – Fitting Test LAMPIRAN 2
Step 1 Step 2
Step 3 Step 4 Step 5

23. Glove and Hand Washing

24. Glove and Hand Washing
As per standard precautions
 When touching blood, body fluids
secretions, excretions, contaminated items ,
mucous membranes, non intact skin.

25. Face Shield/Eye Protection
As per standard precautions
For procedure /activities likely to generate
splashes/sprays of blood , body fluids ,
secretions and excretions.

26. Gown
As per standard precautions
For procedures/ activities likely to
generate splashes/sprays of blood ,
body fluids, secretions and excretions.

30. TB
Hierarchy of TB infection Control
Administrative controls (managerial)
Environmental control
Personel protective equipment (PPE)
Screening for HCW

31. Administrative controls (managerial)
The most important measures of TB infection
control is to prevent exposure and reduce
transmission to health care workers and patient.
1. Written TB Infection Control Plan.
2. Workplace Risk Assessment
3. Triage and screening of patients
4. Early diagnosis, prompt treatment and isolation
5. Training and education of health care workers
6. Patient education e.g. cough hygiene

32. Personel Protective Equipment (PPE)
The use of appropriate PPE is important and HCW
must be trained to use PPE correctly.
Screening for HCW
Health care workers should be screened for
Tuberculosis whenever they are symptomatic.
Chest radiograph and Tuberculin Skin Test are not
routinely recommended.

33. Inpatient Setting
 All patients with infectious or potentially infectious Tuberculosis should
be placed in(Airborne Infection Isolation /Negative Pressure) AII room if
possible. However, if AII room is not available, TB patients should be
cohorted from non tuberculosis patient, infectious from non infectious TB
patients.
 Isolation ward or area for TB patients should have maximum natural
ventilation, mechanical ventilation by local exaust ventilation and air
cleaning methods such as HEPA filter and/or Ultraviolet Germicidal
Irradiation (UVGI) whenever appropriate.
 All patients suspected or confirm TB should be educated about the
importance of cough etiquette (refer to std precaution) and wear surgical
or close the mouth/nose when sneezing or coughing.

34. Cont…
All health care workers handling infectious TB
patients should use PPE properly, ideally at least
N95 mask. HCW handling non infectious or
unconfirmed cases should use N95 whenever
possible.
Only minimum number of visitors should be
allowed to visit active TB patient in the Ward.
Protections for visitor are similar to medical staff.

35. Outpatient and Emergency
Department
Triage.
Triaging patient at the counter should be done to
identify high risk patients by history taking
(patient with history of cough for more than 2
weeks). Specific waiting area or room for patients
are recommended.
 Signage directing patients with chronic cough to
go to specific or identified counter. These patients
should be provided with surgical mask.
 Provide N95 respirator for HCW in-charge of
triaging.

36. Cont…
Educate patient with suspected or confirmed
infectious TB disease on strict respiratory hygiene
and cough etiquette.
 Sputum induction room should be made available
at OPD.
 Ideally patients should be seen in a designated
consultation room for TB equipped with
appropriate environmental control, good
ventilation with or without UV light. HCW should
be protected using N95.