A modified “cover your cough” campaign prevents exposures of employees to pertussis at a childrenʹs hospital

n the 4th quarter of 2004, there was an increase in patients seeking medical care for pertussis symptoms at the Childrenʹs Hospital, Omaha, NE. The Hospital Epidemiology service noted a sharp rise in exposures of Childrenʹs Hospital employees to these patients, requiring employee testing, prophylactic antibiotic prescriptions, and relief from duty. Methods Initial efforts at employee education failed to prevent the exposures. An exposure-control plan was then initiated by placing “Cover Your Cough” posters (in English and Spanish) describing appropriate cough etiquette at entrances to the emergency room, outpatient clinics, and hospital lobby. In addition, personal protective equipment (PPE) including child- and adult-sized masks, hand sanitizers, and tissues were provided at these stations for patients and their attendants. Results Prior to the initiation of the above exposure control measures, there were 166 reports of employee exposure to patients and other employees with pertussis symptoms during a 4-week period. Of these, 140 were given prophylactic antibiotics, and 31 underwent diagnostic testing for pertussis and required paid time off from work. The cost of antibiotics and diagnostic testing was $17,407.00. After the introduction of the modified “Cover Your Cough” campaign, the number of employee exposures declined significantly to 37 in the next 4-week period. Notably, the number of patients tested for pertussis during the second 4-week period was 290 compared to 162 in the first 4-week period, indicating continuation of the epidemic. Conclusions Availability of PPE along with posters regarding cough etiquette at entry points of the hospital interrupted employee exposure to patients/personnel with pertussis symptoms significantly, when an employee educational initiative alone was unable to achieve this outcome.