To Reduce Infections, Try Fist Bumps Instead of Handshakes

Handshaking is widely practiced as a polite, professional way for healthcare professionals to greet their patients. Unfortunately, as a new study confirms, a handshake is also a great way to spread infections (Mela & Whitworth. Am J Inf Con. 2014; 42: 916-7).

It is no secret that hand-to-hand contact is a fast track to illness. But researchers at Aberystwyth University in the United Kingdom wanted to determine just how unhygienic handshakes are, specifically when compared to other types of physical greeting.

They evaluated the amount of bacterial transmission via handshakes as well as two other forms of direct physical contact, high-fives and fist bumps.

Perhaps not surprisingly, they reported that nearly twice as many bacteria were transferred during a typical handshake than during a high-five.

fistbumpFist bumps emerged not only as the hippest, but also as the most hygienic salutation of the three, consistently conveying the fewest germs between hands.

Smaller Contact Area

The researchers found that several key factors contribute to the transfer of bacteria through hand contact. First is the size of the contact area during a physical exchange. Handshakes create a relatively large contact area across the palms and fingers; fist bumps are confined to the much smaller surface of the knuckles only.

Also important are the greetings duration and strength. Because handshakes generally last longer than fist bumps and high-fives, the study controlled for contact time by prolonging each greeting for a total of three seconds.

Investigators determined that the amount of bacteria transferred did not increase significantly during the extended three-second high-five; however, lengthening the fist bump did correlate with increased bacterial transfer. While contact area is a critical factor, prolonged contact time and grip strength also influence bacterial transmission rates by affecting the intimacy of association between hands.

Despite the risks of direct hand contact, many healthcare practitioners believe that greeting through touch fosters an important sense of connection with their patients. Some argue that even in light of this new study, the compassionate practice of handshaking should continue -provided it is also balanced by rigorous hand-washing.

Handshake Bans

Some public health advocates have proposed the elimination of physical greetings altogether from healthcare settings. Some hospitals and medical facilities have established policies banning handshakes from their premises, though theyve been limited by variable compliance and efficacy (Sklansky et al. JAMA. 2014; 311(24): 2477-2478).

The authors of the fist bump study believe its unrealistic to expect that no-touch greetings will completely replace old-fashioned hand-to-hand contact. Instead, they suggest that, for the sake of improving public health, clinicians might adopt the fist bump as a simple, free, and more hygienic alternative to the handshake.

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