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Bump The Handshake For Hand Hygiene

Jason Tetro
January 21, 2014

FistbumpIn the context of human exchange, nothing is as versatile as the handshake. Dating back to the 5th Century BC, the practice has become one of the most common customs to meet and greet as well as demonstrate congeniality. 


In more modern times, shaking hands has gained several other meanings including “Good game,” “Thank You,” and even the unfortunate “This date is most definitely not ending in a kiss.”


But handshaking does have a darker side microbiologically speaking.  The CDC is frequently quoted as claiming that up to 80% of infection spread can be spread through hands.  The allegation makes sense as many bacteria and viruses are known to survive on human skin for several minutes if not hours.  



There is another option available to help prevent the spread of infection and still show amiability to another.  The method is simple:  take the hand, clench it tightly – making sure the thumb is kept outside – and then stretch out the arm offering the exposed metacarpels for contact with another performing the same protocol.  Over the decades, this move has been called a number of different terms including the closed-fisted high five, fist-jabbing and even the rather confusing, dap.  But for the majority of people, this is known quite simply as the fist bump. 


The history of the fist bump is unclear and few can agree on its evolution.  But almost everyone can agree on how it became popular.  Back in 2008, then Senator Barack Obama had mathematically won the nomination of the Democratic Party for President and was about to give a victory speech in St. Paul.  Before he stepped up to the podium, he took a moment to greet his wife, Michelle; a tradition in American politics.  But, rather than a hug or a kiss, he chose the fist bump to acknowledge his first lady.  


It was a moment that sparked millions to mimic the action and call for the adoption of National Fist Bump Day. But while this act had a strong public following, in the context of hand hygiene, there was little indication this change would be beneficial.  That would have to wait until September, 2009 in the midst of a flu pandemic and meeting between the Dalai Lama and the Mayor of Memphis. 



While the matching of the metacarpels may not have been customary, according to the Mayor’s own account of the encounter it was a way to show likability as well as a means to help avoid the flu.  Once again, national attention was given to the bump but this time, infection control professionals were listening and as a result, asked a very important question.


Should health care professionals eschew the shake and switch to the bump?       


The answer came last September in a paper published by a team from the West Virginia University School of Medicine. The study was simple in nature and the results were minimal in comparison to most published papers but the outcome was robust.  What the group found was that in comparison to a fist bump, the handshake increased sharing of skin surface area, took longer to perform and ultimately led to a 400% increase in bacteria transferred.  There was little doubt which of the two gestures was safer and worth recommending.


Though the data appears to be conclusive as to the future of cordiality, some may find the practice somewhat foreign and difficult to perform.  Thankfully, there are a plethora of how-to’s offering advice on technique and etiquette.   With some training and practice, everyone can achieve the perfect fist bump and look good doing it. 



There is one other advantage to championing this rather subtle act.  In order to keep the hand hygiene revolution moving forward, there has to be a link to popular culture; it cannot be avoided.  The fist bump could potentially offer yet another step in gaining not only a greater audience but also, and most importantly, a larger number of champions and adopters. 


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