Skip to main content

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.

Results:

  • 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.





Comments

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.
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.

Popular posts from this blog

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Length of Stay in Nursing Homes at the End of Life

One out of every four of us will die while residing in a nursing home. For most of us, that stay in a nursing home will be brief, although this may depend upon social and demographic variables like our gender, net worth, and marital status. These are the conclusions of an important new study published in JAGS by Kelly and colleagues (many of whom are geripal contributors, including Alex Smith and Ken Covinsky).

The study authors used data from the Health and Retirement Study (HRS) to describe the lengths of stay of older adults who resided in nursing homes at the end of life. What they found was that out of the 8,433 study participants who died between 1992 and 2006, 27.3% of resided in a nursing home prior to their death. Most of these patients (70%) actually died in the nursing home without being transferred to another setting like a hospital.

 The length of stay data were striking:

the median length of stay in a nursing home before death was 5 months the average length of stay was l…

Palliative Care in Nursing Homes: Discussion of a Multinational Trial with Lieve Van den Block

Nursing homes are a tough place to do palliative care.  There is extremely high staff turnover, physicians are often not present except for the occasional monthly visit, many residents die with untreated symptoms usually after multiple hospitalizations and burdensome life-prolonging treatments, and specialty palliative care - well that is nowhere to be found in most nursing homes outside of hospice.  So what can we do to improve the palliative care outlook in nursing homes?

On todays podcast we talk with Lieve Van den Block about her recent palliative care intervention that was published in JAMA IM this week.  Lieve led a multicomponent intervention to integrate basic nonspecialist palliative care in in 78 nursing homes located in 7 different European countries.  Just take a moment to grasp the size of this study - 7 counties, 78 nursing homes.  I struggle with just trying to improve palliative care in one site!

We discuss with Lieve the results of the study, her take on why they got…