The handshake: It’s an important social convention that can convey a greeting, respect, sportsmanship, reconciliation, congratulations, or agreement on a transaction. It’s essential to making a strong first impression. It creates an instant opportunity to forge an interpersonal connection. And according to a recent JAMA article, it’s a vector for spreading pathogens in the healthcare setting.
The article, which was published in the June 25 issue, acknowledges the cultural context of a handshake within the provider-patient relationship – its ability to establish trust and communicate warmth. It then goes on to make the case that handshakes should be banned in healthcare, as part of infection control protocols, and replaced with another gesture, like the fist bump, elbow bump, hand wave, or bow.
It seems that this controversial suggestion is backed by science. On July 28, a study was published in the American Journal of Infection Control, offering evidence that a fist bump does indeed transfer about 90 percent less bacteria than a handshake.
The findings of the case study
The study involved subjects who wore gloves that were coated with a film of E. coli (a non-pathogenic strain was used) and were paired with subjects who wore sterile gloves. Each pair of study participants then shook hands with various grip strengths and length of duration; they also high-fived, and fist-bumped. The sterile gloves were examined to find out how much bacteria was transferred during each interaction. Fist-bumps were the clear winner, in terms of lowest risk of infection. Handshakes transfer more microbes because there is a larger area of contact on the hands. Longer, stronger gripped handshakes also spread more germs than quick, loose handshakes.
The JAMA authors would like to see handshakes banned in healthcare entirely, even suggesting that hospitals and outpatient facilities post signs reading “Handshake-free zone: to protect your health and the health of those around you, please refrain from shaking hands while on these premises.” They cite evidence demonstrating that even today, when hospital-acquired infections are a hot topic in healthcare, hand hygiene compliance rates hover right around 40 percent among providers – and are probably much lower among patients and visitors.
So what’s a nurse to do?
No one knows better than nurses how important human touch can be to health, wellness, and healing. Traditionally, however, nurses have been less likely than physicians to shake hands with patients – there is even an online CE course purporting that nurses should shake hands more often with patients and family members, as a way to become more visible and more credible in healthcare, and to establish high levels of trust.
Yet, as frontline caregivers, nurses may be the most likely clinicians to transfer microbes from their hands, not only acquiring them from patients but from contaminated surfaces as well. The editors at the American Journal of Nursing write that:
Bacteria have been shown to live on many surfaces—computer keyboards, telephones, uniforms, and even paper. If a conscientious nurse charted on a paper chart or entered a patient’s vital signs into the electronic record after providing care but before washing hands, bacteria could be transmitted to whoever next picked up the chart or used the keyboard. Then that person might shake hands with a family member or colleague, and so on, and so on.
Initially, patients and visitors might perceive a provider who declines to shake hands as cold, uncaring, or rude. But eventually shaking hands in a hospital might become as taboo as smoking a cigarette.
What do you think? Do you support a handshake ban or do you feel that a personal touch is essential to establishing a caring connection?