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Cough and sneeze into elbows, not hands

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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