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Experts offer advice for keeping germs at bay during cold-and-flu season

Mary Selecky, head of Washington’s Department of Health, was one of seven children. She learned early to cover her coughs and sneezes with her hands, so she wouldn’t spread germs to her siblings.

A decade ago, she had to unlearn this habit.

Her teacher? A preschooler.

“He said, ‘No, no, no, here’s how you do it.’ And here’s this 4-year-old coughing into the little crook of his arm,” Selecky says.

“Swine-flu etiquette” sounds like a bad punch line to a worse joke, but etiquette helps determine society’s habits. Healthy habits may lessen swine flu illness and even save lives, if the pandemic materializes.

But figuring out the proper etiquette, and changing old habits, can be tricky. For instance, should you confront a grocery store clerk who forks over your change after sneezing into her hands?

Several experts weighed in on this cold-and-flu season’s etiquette concerns.

Sleeve vs. hands

Experts recommend coughing or sneezing into your sleeve, because germs get trapped in material and dry there, rendering them harmless.

Nickname for the move? The Dracula Sleeve.

Second best is sneezing or coughing into Kleenex held in the hands. Hankies are a distant third.

Sneezing into bare hands – the method most baby boomers learned as children – can be even worse than sneezing into the air.

“Respiratory droplets are an issue, but we spread germs by touch,” Selecky points out.

Women seem to have more difficulty adapting to sleeve-coughing, the experts agree. It’s awkward. And some fear it will stain their clothes.

Carol Lindburg, 64, of Newport, Wash., refuses to do it. She’s a lifelong Kleenex-in-the-hand sneezer and intends to remain one.

“I’m not sure it is any healthier than using a Kleenex, because once you open your arm, the germs are back in the universe,” Lindburg says.

Cynthia Taggart began her public information and education work at Panhandle Health District in 2006. She was a veteran Kleenex-in-the-hand person until introduced to the sound science behind sleeve-sneezing.

It took her about three months to kick the Kleenex habit. Now, the Dracula Sleeve is a natural reflex.

“We were brought up to sneeze into our hands,” Taggart, 54, acknowledges. “But some people sneeze into their hands and don’t think to wash them.”

Confronting the careless cougher

Mike Coston, a retired paramedic who lives near Tampa, Fla., started a blog, the Avian Flu Diary, when that virus threatened in 2005. He now posts articles and scientific research on swine flu.

His blog has grown so popular that this week, Coston – along with mainstream journalists – will be part of a media panel at a national swine flu conference at the University of Minnesota.

Coston believes in direct confrontation with people whose coughing and sneezing seem a health threat.

“Every encounter is a teachable moment,” he said in a recent interview.

On his blog,, he recounted this incident at his local grocery store:

“While paying for my goods, the cashier began counting out money. She then coughed into her free hand – and barely skipping a beat – continued counting out my change.

“I started to say something but was interrupted as this lady sneezed (loudly and wetly) into her free hand, wiped her hand on her pants leg and then blithely resumed counting my change.

“I said, ‘Excuse me, you just sneezed into your hands and now you are counting out my change.’ The cashier immediately said, ‘I did not!’

“She indignantly grabbed a plastic container of hand wipes, gave her hands a five-second wipe down, glowered at me, then took fresh bills from the cash register (probably contaminated) and handed them to me.”

Coston complained to the manager, because he believes managers should be held responsible for teaching their employees proper cold-flu etiquette.

Roxanne Vandermause, an assistant professor at Washington State University’s College of Nursing, supervises nursing students who are out in the community doing germ-busting education.

Vandermause suggests giving the careless cougher an on-the-scene demonstration of the sleeve cough. Or offering a Kleenex in a gentle voice.

“We can share information kindly,” she says.

Pass the peace, not the germs

In Episcopal Church services, people “pass the peace.” In Catholic Church services, Mass-goers exchange the “kiss of peace.”

Both rituals are usually done by friendly handshakes, and it’s nearly impossible to refuse those hands outstretched in peace.

The etiquette strategies for this translate to any public situation where it might appear rude not to shake hands.

Lindburg, the Kleenex-sneezer from Newport, has allergies. In church recently, the woman next to her wouldn’t shake her hand, intimidated by her minor coughs and sneezes. Lindburg felt hurt.

So what to do?

From Coston, the flu blogger: “Carry sanitizer. The minute you are done, squirt your hands and rub them together.”

Even in church you can do it discreetly, he says. Carry a small sanitizer; some attach to key chains. Disguise what you’re doing by hiding your hands under a prayer book.

From Vandermause, the nurse: “There are many other ways to convey greetings – a nod, a smile, a light touch on the shoulder.”

Proactive etiquette

When Lindburg’s allergies prompted a sneezing attack at the grocery store recently, an entire aisle of shoppers froze.

She said loudly: “I have allergies. I don’t have a cold or flu.”

“There was a collective sigh of relief at WinCo,” she says.

And Selecky, the state Health Department head, told this story:

“I stayed overnight in another city recently. I was at the front end of a cold. As I was checking into the hotel there, I suggested to the person across the counter that they may want to use alcohol wipes after they handled anything I touched.

“We should treat people with the same respect we’d want to be treated.”

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