Sneeze & Cough Etiquette

There are many reasons why someone might sneeze or cough, and it is a perfectly natural mechanism in the body^.3,4,11 We sneeze or cough to remove germs, dust, pollen or other foreign objects from our airways.¹¹ Sneezing or coughing however, also means any germ-containing saliva droplets are rapidly expelled from our mouths and into the air around us.^2,11 For respiratory airway viruses, like those this give us a cold or flu, sneezing and coughing allows them to easily spread from person-to-person.^2,5,11 Sometimes it’s difficult to avoid a sneeze or cough, as they can come on suddenly. But by practising sneeze and cough etiquette, we can somewhat limit the spread of germs.²

Whether at home, in the community or at work, there are some do’s and don’ts when it comes to proper sneeze and cough etiquette.^2,6,7 The next section will look at how to sneeze properly, how to cover a cough or sneeze or the proper way to cough. We’ll also touch on the importance of tossing dirty tissues, hand washing and isolating oneself when sick.^2,6

Sneeze & Cough into a Tissue or Your Elbow

It’s important to cover a cough or sneeze using a tissue or if the cough or sneeze comes without warning, then into your elbow.⁶ This is important for two reasons; by covering a cough or sneeze with a tissue, this can catch droplets which means others around us are less likely to pick up germs.^6,11 It also means our hands may have less germs on them until they can be washed thoroughly.^6,11

If a tissue isn’t available, then it’s better to sneeze or cough into your elbow rather than your hands.⁶ Why is this important? Contaminated hands can transfer germs to other surfaces, and some germs can survive for hours to days on certain surfaces.¹ These can then be picked up by unsuspecting people who may touch the same surface.² They can then become infected once they transfer the germs from their hands to their face.^2,6 So sneeze or cough into your elbow, as this means less chance of placing any germs onto your hands and it’s also another way to practice sneeze and cough etiquette.⁶

Toss Dirty Tissues

Once a tissue has been used for a sneeze or cough, it is very important not to keep it but to throw it away where others are unlikely to touch it.⁷ As mentioned earlier, some germs are hardy and can survive up to several days on surfaces.1 So keeping or reusing a used tissue that has already been used to cover a cough or sneeze could mean germs will eventually get onto your hands.^1,7 Also having used tissues lying around after a sneeze or cough, means others may pick up germs and get sick.⁷ Remember that tissues are meant to be used then thrown, so throwing them away straight away is how we can also practice good sneeze and cough etiquette.⁷

Wash Hands

Even if you sneeze or cough into a tissue or your elbow, another way to practice good sneeze and cough etiquette is hand washing . 6,7 Contaminated hands are a common way to pass germs around,, and as we now know, these can lurk around on surfaces for up to several days.^1,2

Thoroughly washing hands by using soap, scrubbing for enough time, and rinsing are all important for general hygiene and for following sneeze or cough etiquette.^2,8 Soap is especially important as the surfactants it has help lift soil and oils from skin whilst lathering and scrubbing hands creates friction and movement.^2,8 Various germs can also be present on all surfaces of the hand, especially under the nails.⁸ So after a sneeze or cough, whether into a tissue or an elbow, the entire hand should be scrubbed.^2,8 It is recommended that both hands be scrubbed for at least 20 seconds and a good timer can be humming happy birthday twice to make sure enough time has passed .8 Hands should be rinsed well under clean running water, and then dried using a clean towel if available or air drying.⁸

Alcohol based sanitisers have been shown to be effective against germs if used according to the instructions on the label.^2,9 When out-and-about, hand sanitisers can be an effective way to follow sneeze and cough etiquette.^2,9 However, they may not be as effective if hands are grossly dirty or have chemicals on them.^2,9 It’s important to use enough sanitiser to effectively cover hands, but sanitisers shouldn’t replace proper hand washing with soap and water - both have their place.^2,9

Keep Distance from Others

Social distancing is another example of using sneeze and cough etiquette, especially if someone is sick.^2,10 Social distancing involves moving away from others before a cough or sneeze, to help prevent the spread of any germs to others.¹⁰ When someone is unwell, and has a regular cough or sneeze, then isolation means they should also be away from others during recovery.¹⁰ Having the option of sleeping in a separate room, or using separate facilities, can also help limit spread too.¹⁰