The Western social practice of handshaking has only grown more popular in recent decades with variations up high and down low now often accompanied by the ubiquitous “bro hug.” However, some doctors are pushing to “ban the handshake” in hospitals and doctor’s offices across the country to prevent the spread of communicable disease.

Physicians from the University of California, Los Angeles, argue in an editorial published Thursday in JAMA that handshaking thwarts the practice of handwashing to limit the spread of dangerous pathogens. Soon, health care workers and patients may see the following advisory: “Handshake-free zone: To protect your health and the health of those around you, please refrain from shaking hands while on the premises.”

Although research has long associated handwashing with decreases in bacterial colonization and hospital-acquired infections, only 40 percent of clinicians and other health care workers comply with such mandatory hygiene policies. Among patients and visitors, handwashing hygiene is even lower. And alcohol-based rubs, the most touted solution to hospital hygiene problems, remain ineffective against such dangerous pathogens as Clostridium difficile.

“The hands of health care workers often serve as vectors for transmission of organisms and disease,” wrote Drs. Mark Sklansky, Nikhil Nadkarni, and Lyn Ramirez-Avila. “Health care workers’ hands become contaminated with pathogens from their patients, and, despite efforts to limit the spread of disease, cross-contamination of health care workers’ hands commonly occur through routine patient and environmental contact.”

Common handwashing policies in health care settings reflect wisdom gleaned multiple studies showing the handshake as a vector of dangerous pathogens, with bacteria surviving longer on the hand in the presence of mucous.

“The handshake represents a deeply established social custom. In recent years, however, there has been increasing recognition of the importance of hands as vectors for infection, leading to formal recommendations and policies regarding hand hygiene in hospitals and other health care facilities,” the doctors wrote. “Such programs have been limited by variable compliance and efficacy. In an attempt to avoid contracting or spreading infection, many individuals have made their own efforts to avoid shaking hands in various settings but, in doing so, may face social, political, and even financial risks.”

However, the UCLA team has an even better solution for friends and colleagues greeting one another in health care settings: the fist bump.

 

Source: Sklansky M, Nadkarni N, Ramirez-Avila L. Banning the Handshake From the Health Care Setting. JAMA. 2014.