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Cough and sneeze into elbows, not hands

NSW Health authorities should withdraw advertisements urging people to cover their coughs and sneezes with their hands and…

Sneezing into your hands is more likely to spread cold and flu germs around than prevent infection of others. NSW Strategic Communications

NSW Health authorities should withdraw advertisements urging people to cover their coughs and sneezes with their hands and instead tell people to use their inner elbow, according to a letter to the editor published in the Medical Journal of Australia today.

In his letter, University of Sydney Associate Professor of Surgery and Cancer Guy Eslick said covering a cough or a sneeze with the hands was more likely to spread cold and flu germs around than prevent infection of others. He used the example of a 2012 New South Wales Health poster (pictured above) that depicts a person sneezing into their hands.

Dr Guy Eslick said he was prompted to write the letter by warnings that this flu season will be particularly bad and by the need for public education.

“When living in Boston at the height of the H1N1 pandemic, at her childcare centre, my daughter was being taught to sneeze into her sleeve, not into her hands, and coming home showing me how it was done,” he said.

“When I got back to Sydney, I was on a bus and saw these posters showing a person coughing into their hands.

“I hope New South Wales Health will change the image on their posters to be more in line with CDC [US Center for Disease Control] recommendations.”

Minnesota ‘Cover Your Cough Poster’ depicting current best practice Minnesota Department of Health

The Minnesota Department of Health poster (left) is a good example, he said.

“I’m also hoping it might get discussion going within the community about optimal ways to stop flu spreading.”

A NSW Department of Health spokesperson said its annual flu campaign was aimed at reducing the spread and severity of the illness, and the posters were only designed to provide a reminder to people about the main messages.

“The cartoon icon of the person coughing was not meant to be an instruction of how to cough safely,” the spokesperson said.

The campaign is revised annually to include the most current flu advice from Australia and around the world, the spokesperson said. The 2013 campaign will recommend people cover coughs and sneezes with a tissue and then dispose of it, or if that’s not possible, to cough into their elbow.

Professor Lindsay Grayson, Director of Hand Hygiene Australia and Director of Infectious Diseases at Austin Health, said the letter raised a reasonable point.

“We know hands are a major transmitter of influenza,” Professor Grayson said

Posters should depict a number of key messages, he said, including coughing into your elbow; ensuring hands are washed often, with soap and water or alcohol hand rub; avoiding handkerchiefs and using tissues, where possible; and staying home from work if you’re sick.

“Don’t be a martyr; you’ll just spread it,” he said.

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9 Comments sorted by

  1. Patrick McPhee

    Analyst at large

    Always use a finger or hand knuckle when using ATMs, elevator buttons or train doors. I have been employing these techniques for several years and have not had the 'flu for ages.

    Tram hand-holds, shared computers and handling cash remains an issue. Above all, never shake hands with a doctor.


  2. ben harrison

    logged in via email

    Such a simple means to slow the spread of disease it's amazing to me I haven't seen more of it in cities, especially considering the amount of people travelling by public transport where thousands of hands touch the same railings, doors, handles, etc. Mine sites throughout Australia have carried this message (sneeze into the elbow) for many years.

    1. Christie Harris

      Director of Domestic Management at The Castle

      In reply to ben harrison

      At daycare, kinder and school my children have been taught (and constantly reminded) to cough and sneeze into their crooked elbow instead of hands. The first time I saw it I was stunned at how simple the message was, and that it hadn't occurred to me before.

      So the littlies are getting the idea - it's adults that need retraining!

      Instead of getting defensive about it, NSW Dept of Health could have SO easily taken the "hey good idea!" approach and actually changed the artwork.

  3. Jill Strong

    Literature teacher

    Should we start adopting face masks, as they do in parts of Asia?

  4. Jeff

    logged in via Twitter

    Check out the project being run by Prof Sandra Jones and her team at the University of Wollongong's Centre for Health Initiatives. It has been running for a couple of years on Campus around The cold and flu season. The message is exactly that - cough and sneeze into your elbow.

  5. Sandra Jones

    Professor and Director of the Centre for Health Initiatives at University of Wollongong

    And it works!
    We conducted multi-component intervention on the University of Wollongong campus to raise awareness of the importance of individual behaviour in the spread of colds and flu and encourage people to adopt three simple behaviours: wash your hands, cough and sneeze into your sleeve, and stay at home if you are sick.
    Our intervention clearly communicated the key messages to the target audience, with high unprompted recall, and even higher prompted recall. We were able to change attitudes and beliefs, as well as self-reported prevention behaviors. Key to the success of this intervention was the application of consumer insight to prompt the use of multiple strategies – addressing all of the 4Ps rather than a single-strategy communication campaign.