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Fist Bump or Handshake: Which is Safer?

January 27, 2015

handshake_or_fistbump-730780-editedViewers of the game show Deal or No Deal probably remember host Howie Mandel's habit of bumping fists with contestants instead of shaking their hands. It was later revealed that Mandel preferred the fist bump because of an intense fear of germs, which was part of his obsessive-compulsive disorder. With hand hygiene compliance becoming such a critical issue in the healthcare arena, experts are considering whether Mandel was ahead of his time.


Physicians often shake hands with their patients upon entering treatment rooms, but those handshakes can pass dangerous bacteria from person to person if physicians aren't careful about their hand hygiene practices. But is the fist bump a better alternative to the handshake? A group of researchers from West Virginia University decided to find out.


As part of the study, volunteers shook hands with 20 hospital patients and then had their palms cultured. After washing their hands, they returned to the hospital to bump fists with 20 other patients, and their fists were then cultured. Researchers discovered that the volunteers' palms showed four times the amount of contamination found on their fists.


In a separate study, United Kingdom researchers compared germ transmission rates of handshakes, fist bumps and high fives. Of the three methods of greeting patients, the high five transmitted just half the germs of a handshake, while the fist bump was found to transmit the least amount of bacteria.


Experts are divided as to the conclusions of these studies. While some advocate using non-verbal methods of greeting, others insist the handshake should not be eliminated, particularly given the increasingly fast-paced nature of healthcare and the need for patients to connect with their physicians on a personal level.


Marianne Green, MD, FACP, associate dean for medical education and competency achievement at Northwestern University's Feinberg School of Medicine, co-wrote a 2007 study that found 78 percent of patients want to shake hands with their physicians. Dr. Green feels the focus should not be on finding alternative (and potentially negative) methods of greeting patients, but instead on making sure physicians are practicing better hand hygiene methods.


"I don't agree with not shaking hands," noted Dr. Green. "Simple things like shaking hands can bring … rapport back to the [patient] visit."


According to Michael B. Edmond, MD, FACP, chief quality officer at the University of Iowa Hospitals and Clinics, the bottom line is that physicians must be accountable for their hand cleanliness: "If everyone was compliant with hand hygiene protocols, [whether to shake hands] wouldn't even be an issue."


It is important for all patient care providers, including physicians, to remember that the World Health Organization's (WHO) Hand Hygiene Moments and Centers for Disease Control and Prevention (CDC) guidelines include cleaning hands before and after any patient contact, which clearly would include the act of shaking a patient's hand. So, Dr. Edmond's point is absolutely correct. If physicians always followed the WHO and CDC guidelines, they could worry less about infecting their patients.


Here are a few recommendations on how hospitals can ensure their healthcare teams are adhering to WHO proper hand hygiene guidelines and protecting patients:


  • Educate staff about proper hand hygiene.
  • Evaluate the best methods to obtain accurate data about staff hand hygiene compliance.
  • Provide real-time feedback to staff members so they can adjust their behaviors accordingly.


Learn more  about the history of the fist bump.


For more healthcare related articles on hand hygiene and infection prevention, subscribe to the DebMed Healthcare Blog.


Originally posted by DebMed on Jan 8, 2015 12:27:00 PM


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