Want to Stay Healthy? Cough in Your Elbow

Over the past 20 or so years, researchers have confirmed that viruses can remain viable for several hours once they land on a surface like a doorknob or chair. A sneeze or cough may send viral material or bacteria out into the air, but gravity quickly sends it to the ground. Germs on the hands can be easily transferred to other surfaces, and are then passed on to other people when their hands touch those surfaces.

"I think people still don't understand how important hands are," says Rubens, referring to the transmission of germs.

Along with government agencies, there are also freelance proselytizers of elbow coughing, elbow sneezing and other germ-fighting techniques.

Dr. William Sawyer, a family practice physician in Cincinnati, has created "Henry the Hand," a sort of good-hygiene crusader. Henry, in the form of a cartoon or costumed character, has met more than 150,000 health-care providers and more than 110,000 students around the country, by Sawyer's count.

Hand hygiene has the potential to change the world, Sawyer proclaims. "It's the latest breakthrough in biotech and it didn't cost anything."

Sawyer advocates the "four principles" of hand awareness. Two of them are familiar to nearly everyone -- wash your hands before eating, and don't put your fingers in your eyes, nose or mouth. But the other two tell kids to sneeze and cough into their elbows, instead of their hands.

"It absolutely has a huge impact," Sawyer says. He notes that "Henry the Hand" materials have been ordered and downloaded by health care professionals in Europe, Africa and India, among other places.

"I wouldn't say we'd have no flu," Sawyer says, "But it would certainly be decreased dramatically."

Elbow Room, From Oregon to Georgia

Grade schools in Oregon, public health officials in Georgia and nursery schools in Tennessee now teach kids to cough and sneeze in their elbows. The Lake County, Ill., Health Department recommends elbow coughing to help prevent the spread of whooping cough, or pertussis. The Montgomery County Health Department in Maryland endorses it; so does the Colorado Children's Immunization Coalition.

Cindy Ertle, a public health nurse in Benton County, Ore., says officials there have been recommending elbow coughing for at least three years, as part of an effort to teach "respiratory etiquette" -- wash your hands, don't share drinks and so on.

"It's just darling to see them in the cafeteria or wherever they're at -- when they cough or sneeze up comes their elbow," she says.