Respiratory Hygiene/ Cough Etiquette

Guidelines for Practice Success | Managing Regulatory | Centers for Disease Control and Prevention

Respiratory hygiene is intended to build awareness of signs of illness that could indicate someone, either a patient or a member of the dental team, has a respiratory infection. The most commonly observed symptoms include coughing, congestion, runny nose, and/or increased production of respiratory secretions. Dentists and members of the team should know how to prevent the spread of respiratory pathogens anytime they have contact with someone who has obvious symptoms.

It’s a good idea for dental practices to have strategies in place to help reduce the spread of respiratory diseases. On any given day, chances are good that one of your patients, or a person accompanying the patient, might have some type of respiratory infection. You and your team are at risk for infection regardless of whether or not the infection has been diagnosed. Of course, infection can spread the other way too, so it’s possible that a team member could unknowingly transmit disease to patients and/or coworkers.

Respiratory hygiene/cough etiquette infection prevention measures can reduce the likelihood of respiratory pathogens spreading either by droplets or through airborne transmission. The measures target primarily patients, and those who travel with them to the practice, who might have undiagnosed transmissible respiratory infections. But these safety measures should apply to anyone, including dental healthcare workers, who has signs of a respiratory infection.

Dental healthcare personnel need to know how to prevent the spread of respiratory pathogens when they’re dealing with anyone who has symptoms. Information related to respiratory hygiene, sometimes referred to as cough etiquette, is available in Centers for Disease Control and Prevention’s (CDC) 2007 Guideline for Isolation Precautions. The basic steps for effective respiratory hygiene/cough etiquette, according to CDC Influenza (FLU) Respiratory Hygiene/Cough Etiquette in Healthcare Settings, are to:

  • Post visual alerts reminding people to
    • cover the mouth and nose with a tissue any time they cough or sneeze 
      • place used tissues in the nearest waste receptacle 
      • wash their hands
    • Wear masks if they have, or suspect they might have, a respiratory infection
  • Offer masks to anyone who is coughing and, if space permits, encourage those individuals to sit at least three feet away from others in common waiting areas.
    • This is especially important if there’s been an increase in respiratory infections in the community.
  • Recommend that staff wear surgical or procedure masks when coming in close contact while examining any patient with symptoms of a respiratory infection, especially if the person has a fever.

It’s also important to be aware of the steps to prevent the spread of influenza, a highly contagious viral infection of the respiratory passages that causes fever, severe aching, and coughing, and often occurs in epidemics. Detailed information is available on CDC’s webpage on Infection Control in Health Care Facilities. Also, keep in mind that some states may have their own aerosol transmissible disease standards, so it’s a good idea to confirm whether additional non-federal regulations might apply.