Wednesday, September 10, 2014

Handshakes, handholding, and other dangerous methods of transmitting bacteria

by: Alex Smith @AlexSmithMD

In a recent study in the American Journal of Infection Control, researchers coated a gloved hand in e. coli.  One person with the e coli glove then they shook hands, high-fived, and fist bumped another person with a sterile glove.  Transfer of e coli to the sterile glove was measured.


  • Highest transfer of bacteria: Handshake
  • Lowest transfer of bacteria: Fist bump (high five was in the middle)
  • Difference: Fist bump less than 10% of bacteria transmitted compared to the handshake
  • Explanation: handshakes have the greatest surface area in contact, for a longer time

This has been a practice changing finding for me.  Rarely are articles practice changing.  After reading these findings, I admit, I have shaken hands less.

I have not yet tried to fist bump my patients.  "Hey, I'm your palliative care doctor, punch it in there!  Knuckles!"

I use hand sanitizer before and after each visit, and also wash with soap and water after every third or so encounter.  But I used to shake hands with pretty much every patient, on every single visit, at both the beginning and end of each visit.  And with each family member.  I now generally only shake hands at the initial visit.

Isn't this sad, in a way?  I was happy when ties where found to carry the most germs of any piece of a doctor's outfit.  I hated ties anyway.  But the fist bump beating the handshake?

Has it come to this?

Have we really taken the touch of out medicine to the extent that it will soon be verboten to shake hands?  If shaking hands spreads germs, then a hug is definitely out of the question.  If infectious disease transmission is the only considered factor, then we should just stand in the doorway.  Or communicate with our patients via snapchat.

In geriatrics and palliative care, we probably prize the virtue of caring above all other virtues. We care for our patients by making strong connections with them.

Part of that connection, for many of us, is developed through non-verbal communication, including handshakes, handholding, hugging, and other dangerous methods of transmitting bacteria.

How do you weight these values against this new information about bacteria, amidst a backdrop of increasingly deadly healthcare-related infections?  Even with the terrific success of hand sanitizer initiatives, hands are still a major source of transmission (see this tomb for details).  It's not just about protecting the patient in front of you, but other patients who may have less resilience against bacteria.

Will this information change what you do?

I'm just providing the perspective.

It's in your hands now.

Thanks to longtime GeriPal reader Aunt Sue for the idea for this post.  And for pointing me to this blog, that contains a link to this funny video primer about how to fist bump.


cerebral e said...

I always feel a little rude washing my hands on the way out of the room immediately after touching a patient but fortunately my hospital now has signs in all the patient rooms telling them to tell their doctors/nurses to do this!

A bigger barrier to the humanity of touch is the long-sleeve plastic gown and gloves we need to wear if the patient is colonised with bugs like VRE, ESBL, MRSA (MRSA not being endemic in my state). Worse is when you have to use droplet precautions and wear a face mask. Communication is difficult when the other person can't see your mouth.

Margaret Fleming said...

Touch is imperative for many patients. People who have been in relationships, live or lived with loving families, and those who have been lonely - their is magic in touch. Why do you think babies fail to thrive in "warehouse" orphanages? If you have to wash your hands after taking my hand, go right ahead. Even my spine surgeon took my hand after an unpleasant announcement from my roommate came in on the phone.

Ruth Hill said...

We're getting too sterile conscious. Wash your hands judiciously and continue to shake hands with patients. There is so little touching of the sick it is becoming pathetic. We also neglect to give hugs to our elderly. I always hug my senior patients and watch the gleaming smile on their faces when I kiss them on the forehead or cheek.