ArticleInternational journal of emergency medicine2025
A pilot study of coughing into the shirt to disrupt respiratory pathogen transmission.
Article in International journal of emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Decoding Healthcare Workers' Knowledge, Practice, and Attitude Toward Cough Etiquette: Is the Elbow Bump a Safe Greeting?Journal of multidisciplinary healthcare · 2026Article
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundScientific evidence is lacking for the respiratory etiquette maneuver of coughing into the elbow. This pilot study introduces and evaluates a novel maneuver " coughing into the shirt" comparing effectiveness of containing respiratory plumes to existing respiratory etiquette strategies.
methodsIn this open-bench, observational respiratory etiquette pilot study, five healthcare workers performed four respiratory etiquette maneuvers including: unobstructed, into the elbow, into a mask, and into the shirt. Observational data for the cough maximal plume area, an area calculation, were collected using slow-motion video recording. The various respiratory plume areas of the participants were compared to the unobstructed maneuver, assessing the percent reduction of the maximal plume area.
resultsAll respiratory etiquette maneuvers significantly reduced the maximal plume area as compared to the unobstructed condition (F(3,12) = 18.56, P < 0.005). Comparing the maximal plume area of the unobstructed maneuver to the "into the shirt" maneuver, we found a 95.4% decrease for the "into the shirt" respiratory etiquette maneuver (P < 0.005). There was no statistically significant difference when comparing the obstructive maneuvers to each other. Additionally, the maximal plume area from the "into the shirt" maneuver was 35.75% less than the "into the elbow" maneuver (P = 0.15). Comparing the maximal plume area of the "into the shirt" maneuver to the "into the mask" maneuver, results were inconclusive, with an average difference of 2.24% (P = 0.66).
conclusionsCoughing into the shirt may offer superior containment of the respiratory plume than coughing into the elbow. Larger studies are warranted to validate these findings and guide future public health recommendations. STUDY
designOpen bench, observational, cough etiquette pilot study comparing the into the shirt respiratory etiquette maneuver to other respiratory etiquette maneuvers.
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Registered trials
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