Friday, August 22, 2014

Should healthcare workers stop shaking hands and "fist bump" instead?

Some well-intentioned researchers from West Virginia University published a small study claiming that substituting a fist bump for a handshake might reduce the transmission of bacteria.

Since many illnesses can be transmitted by contaminated hands, the idea is plausible, but it's a good example of the media misinterpreting a study and misleading naïve readers..

They measured the surface area of open hands and fists in 10 subjects. Not surprisingly surface area of an open hand was significantly greater than that of the fist—30.206 vs. 7.867 sq. in. respectively, p < 0.00001.

They also measured the contact time of handshakes and fist bumps. The handshake took 2.7 times longer than that of the fist bump (0.75 vs 0.28 seconds). [No statistical analysis provided]

Then two (yes, just two) healthcare workers walked around the hospital touching various objects and shook the hands of 20 coworkers. The palm of one hand was then cultured by putting it in a plate of agar for 5 seconds. The experiment was repeated with a fist bump substituting for the handshake. Then the closed fist was cultured in the same way..

The result was that "Total colonization of the palmar surface of the hand was four times greater than that of the fist after incubation for 72 h (187.5 vs 42.5 colony forming units)." [Again, no statistical analysis provided and not surprising since the palmar area was four times the area of the fist]

Photos of both the palm culture and the fist culture were shown. The bacteria grew in patterns resembling an outstretched hand and a fist.

Regarding the amount of bacteria, way down near the end of the discussion section of the brief paper is this "The study is limited by our small sample size and it could not assess statistical significance."

So we have a study of a whopping two subjects that shows no significant difference for bacterial growth or contact time of the handshake vs. the fist. Also, I wonder how many times a day hospital workers shake hands with each other? In my experience, my guess would be zero.

Did these facts deter the media? Not one bit. Take a look at these unrestrained headlines.

LA Times "Handshakes are germ bombs - embrace the fist bump!"
The Atlantic "The Fist Bump Manifesto"
MedCity News "Want to spread fewer germs in hospitals? Ditch the handshake, go for a fist bump"
CBC News "Doctors encourage 'fist bump' over handshake to prevent illness"
National Geographic "Why Germs Prefer Handshakes to Fist Bumps"
FierceHealthcare "Want to cut HAIs [Hospital Acquired Infections]? Try a fist bump"

This is just one of many examples of the media sensationalizing the findings of a paper far beyond what it is due. The idea is interesting and might be worth studying further with a few more subjects and then trying to prove that more infections were actually transmitted by the handshake than the fist.

A more recent study showed that fist bumps transmit fewer bacteria than handshakes or high fives.

Other than confusing many patients, it would cause no harm to offer them a fist as long as the reason was stated. However, taking this to its logical conclusion, maybe even a fist bump, which involves contact and potential bacterial transmission, is not the answer.

Here are some alternatives:

Prayer hands
Upraised palm
Right hand to heart (your own heart)
Rubbing noses (even smaller surface area)
Or better still, this:


Anonymous said...

I have one regular patient who insists on bumping elbows instead of a fist bump to avoid catching any germs. He's a strange one.

Anonymous said...

How about we just hello and get on with it please? Oy vey.

Skeptical Scalpel said...

Lib, how could I forget bumping elbows? That reminds me--I also forgot the chest bump.

Anon, hello might work.

artiger said...

The military salutes; is that the answer?

Actually, bowing or genuflection sounds ok to me.

Anonymous said...

Let's abolish hugging, kissing, sex, and all forms of human touch, because germs might get spread. Let's all become hermits. Even better, we could all jump into autoclaves and get sterilized.

Skeptical Scalpel said...

We could all wear space suits too.

Carolyn Thomas said...

Or you could just remember to wash your hands between patients . . .

Lily Dixon said...

This is beyond hilarious - the media blows everything out of proportion. Imagine going to visit your doctor and they bump your fist on the way out (not that I even shake hands with my doctor when I visit, or with any of my patients while I'm at work). The important thing to remember is just washing hands before & after any patient contact!

Anonymous said...

Just wave as you pass.


Skeptical Scalpel said...

Carolyn, I agree that hand washing is a good idea. We should all do it frequently. It's not always possible before every single patient encounter. See

Lily, thanks for finding it funny. That was my intention.

Anon, a wave is another option as is are a nod or a wink.

RuggerMD said...

If I don't shake hands with my patients or colleagues, how will I ever recolonize my hands back to normal bacterial homeostasis which protects my skin from fungal and other infections after scrubbing for an operation and eradicating them?

Skeptical Scalpel said...

Rugger, skin flora on the hands are not truly eradicated by scrubbing. Colony counts are lowered quite significantly, but the flora start to increase during the case. They hide in pores and hair follicles.

Anonymous said...

A wink? A nod? You know some lawsuit greedy person will say that's harrassment.

Skeptical Scalpel said...

You are correct. Forget about a wink and a nod.

David Penington said...

Hilarious. I think I'd take an Oriental bow from my doctor as a sign of welcome and respect. That will do.

Skeptical Scalpel said...

It will take some getting used to.

Terrance McDaniel said...

Interesting blog and I really like your work and must appreciate for your work for the handshake disease.

Spread Love Not Germs

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