Respiratory hygiene, cough etiquette and physical distancing

Transmission of infections that are spread by droplet and airborne modes, such as influenza and acute respiratory illness/viruses, can be minimised with respiratory hygiene, cough etiquette practices and physical distancing (or social distancing). 

Respiratory hygiene and cough etiquette are part of standard precautions and involve covering sneezes and coughs to prevent infected persons from dispersing respiratory secretions into the air. Hand hygiene must be performed after coughing, sneezing, using tissues or after contact with respiratory secretions or objects contaminated by these secretions.

Physical distancing refers to the practice of maintaining distance, usually one to two metres between yourself and others to prevent the transmission of infection.

Links to Action 1.22 Safe environment

• How does your healthcare service support the workforce to practise respiratory hygiene, cough etiquette and physical distancing?
• How does the environment in your healthcare service promote physical distancing between people moving around the service?
• How does your healthcare service promote key messages regarding respiratory hygiene, cough etiquette and physical distancing to consumers in a way that is easily understood?

Support the workforce and consumers to practise respiratory hygiene, cough etiquette and physical distancing by:

• providing the resources and environment to achieve respiratory hygiene, cough etiquette and physical distancing
• promoting key messages regarding respiratory hygiene and cough etiquette in the healthcare service 
• reviewing and adjusting the environment to maximise distance between people, for example, separating seating and furniture
• promoting good indoor air quality and effective ventilation to help reduce circulating infectious particles in the air.

The type and comprehensiveness of evidence used is dependent on the context of each healthcare service. The content and complexity of the policies and processes will likely depend on the size of the healthcare service, but could include:

• Processes or resources that are available to the workforce regarding respiratory hygiene, cough etiquette and physical distancing
• Observation of promotional material such as posters in the healthcare service, for example, in waiting rooms or treatment rooms, audiovisual material or brochures 
• Observation of resources made available to the workforce, patients and consumers, for example, such as face masks, tissues and waste receptacles
• Completion of training that supports the workforce to practise respiratory hygiene, cough etiquette and physical distancing and how to perform these actions correctly 
• Examples of documentation where respiratory hygiene, cough etiquette and physical distancing has been discussed with patients or their carer
• The design of the healthcare service provides for sufficient space to maximise physical distancing where possible.

Commission resources

• Addendum NSQHS Standards Accreditation Workbook 2021 Infection Prevention and Control Standard – provides users with updated information on reflective questions and examples of evidence for the 2021 Preventing and Controlling Infections Standard within the NSQHS Standards. Principles and strategies are broadly applicable.
• Infection prevention and control resources for consumers – fact sheets for consumers and carers about infection prevention and control, and common and emerging healthcare-associated infections.
• Break The Chain of Infection Poster – illustrates the chain of transmission of infection, in the context of COVID-19, and highlights measures that can be implemented to interrupt the spread of infection.
• Hand hygiene and infection prevention and control eLearning modules – a suite of eLearning modules on hand hygiene and infection prevention and control.
• COVID-19 Resources – for Australian health service organisations, healthcare professionals and consumers.

Other resources

• Australian Government Department of Health: Coronavirus (COVID-19) information and resources – information about the coronavirus (COVID-19) pandemic, how to protect yourself and your family, where and when you can get vaccinated, and the current situation in Australia. 
• National Health and Medical Research Council in collaboration with the Commission: Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019) – developed to specifically support improved infection prevention and control in acute health settings and provides a risk management framework to ensure that the basic principles of infection prevention and control can be applied to a wide range of healthcare settings.