Clinical Practice Guideline for an Infection Control/Exposure Control Program in the Oral Healthcare Setting
Respiratory Hygiene/Cough Etiquette

Background

These recommendations evolved from observations during the SARS epidemic that failure to implement basic source control measure with patients, visitors, and healthcare personnel with signs and symptoms of respiratory tract infection may have contributed to SARS coronavirus (SARS-CoV) transmission.

1. Applies to any person with signs of illness when entering the oral healthcare facility, i.e., cough, congestion, rhinorrhea, or increased production of respiratory secretions.
   1. The absence of fever does not always exclude a respiratory infection.
2. Elements of Respiratory Hygiene/Cough Etiquette
   1. Education of oral healthcare workers (OHCWs), patients, and visitors.
   2. Posted signs, in language(s) appropriate to the population served, with instructions to patients and accompanying family members and friends.
   3. Source control measures
      1. Covering the mouth/nose with a tissue when coughing and prompt disposal of used tissues.
      2. Using a surgical mask on the coughing person when tolerated.
      3. Hand hygiene after contact with respiratory secretions.
      4. Spatial separation, ideally greater than3 feet, of persons with respiratory infections in common waiting areas.
   4. OHCPs observe Droplet Precautions
      1. Wear a mask and perform appropriate hand hygiene when examining and caring for patients with signs and symptoms of a respiratory infection.