Decoding Healthcare Workers' Knowledge, Practice, and Attitude Toward Cough Etiquette: Is the Elbow Bump a Safe Greeting?

BACKGROUND

Post-COVID-19, cough etiquette and safe greeting practices, such as the elbow bump, have gained prominence in healthcare settings to reduce respiratory infection transmission. However, evidence on healthcare workers' knowledge, practice, and attitudes toward these measures remains limited.

AIM: This study aimed to assess the knowledge, practice, and attitudes of healthcare workers regarding cough etiquette techniques and the safety of elbow bump greetings and to examine the influence of demographic factors on these parameters.

METHODS

A cross-sectional study was conducted among 216 healthcare workers using a structured, validated, self-administered online questionnaire over five months (May-October 2025). The questionnaire assessed demographics, knowledge (8 items), practice (7 items), and attitude (16 items) toward cough etiquette. Data were analyzed using descriptive statistics, Pearson correlation, and inferential tests to explore associations between variables.

RESULTS

Slightly more than half of the participants demonstrated high knowledge (50.9%), while only 24.1% exhibited good practice, and 40.7% showed a positive attitude. Knowledge showed a weak positive correlation with practice (r = 0.129, p = 0.05), and practice was moderately correlated with attitude (r = 0.402, p < 0.001). Age, occupation, department, education, experience, and training were significantly associated with KAP scores, with Infection Control Unit staff and experienced nurses achieving higher scores.

CONCLUSION

Although healthcare workers possessed moderate to high knowledge, practical adherence and positive attitudes toward cough etiquette and elbow bump greetings were suboptimal. Practical, hands-on, and department-specific interventions are necessary to bridge the knowledge-practice gap and enhance adherence to infection control measures.