A suggestion to reduce rates of hospital-acquired infections by replacing handshakes with fist bumps and other gestures is meeting mixed reviews among clinicians.
It may be time for hospitals, doctors and nurses—and all healthcare settings where infections spread—to ban the handshake, starting with high risk areas. So suggests evidence reviewed by pediatrician Mark Sklansky, MD, and colleagues at Mattel Children's Hospital at UCLA.
"Shaking peoples' hands in hospital settings where we know there's a lot of vulnerable patients and a concentrated amount of pathogenic organisms just doesn't make sense," he says. "We know that hand-related transmission of disease is a big part of hospital-acquired infections, and we know the handshake is part of that."
In a recent issue of JAMA, Sklansky and colleagues suggest replacing the handshake with the Yoga-like Namaste gesture (placing palms together in front of the face or chest and tilting the head forward), a reverent bow, a hand wave, or even a fist bump.
In an interview last week, Sklansky said UCLA will try a pilot handshake-free zone soon, perhaps starting in the neonatal intensive care unit, where babies are especially vulnerable to infection, or another high risk area of the hospital.
But he's already encountered some resistance.
"What I found in our NICU is that when there are residents rounding, you come in and they shake your hand. If you don't, people misinterpret it as a lack of respect. People need to realize we're not trying to do away with trust, or interfere with the physician/nurse patient relationship," Sklansky says.
Since the JAMA article was released online in mid-May, the idea has drawn a range of reactions from providers on Twitter and some healthcare blogs.
Some gave it high fives, others thumbs down.
Virginia Commonwealth University Medical Center epidemiologist Michael Edmond, MD, wrote in his blog:
"I suspect that many will scoff at this recommendation, but I think we need to be open-minded and critically look at all potential mechanisms of transmission in the healthcare setting. I find it very interesting how high tech solutions to infection transmission seem to be all the rage, even when they're ridiculously expensive and marginally effective, while very simple potential strategies are quickly dismissed."
But healthcare ethicist Art Caplan has a different view.
"Now, the handshake ban might make sense if it were not for the fact that the constant touching of microbe-laden things by providers and patients is likely to go on and, handshake or not, they are still likely to fist bump, shoulder pat, rub noses or whatever else they think shows love, care and concern for one another.
"Healthcare has gotten very sterile and impersonal as more technology appears, less time is set aside for talking and more health providers find themselves chained to their computers or handheld medical devices. While not every culture values a handshake, many do, and putting the kibosh on grip and grinning just adds to the perception that caring and curing are heading down different highways."
Tweets ran hot and cold as well.
@mmmillet, a New York City bioethicist and lawyer, tweeted: "TAKE my hand and i will infect u"
@Chris_Bonafide, a pediatrician, and hospital medicine researcher, tweeted: "Thought this was a joke."
@rsgonner, a Milwaukee physician, tweeted: "We are idiots." Asked what he meant, he replied: "Lack of handWASHING is the problem. Not handSHAKING is a simplistic bandaid. IMHO."
Sklansky wants healthcare providers to think of the healthcare handshake in the context of how society regarded cigarette smoking some 50 or 60 years ago, when policy leaders tried to figure out how to ban tobacco use on hospital grounds.
In 1954, more than half of the doctors in the state of Massachusetts smoked. Evidence that smoking causes heart and lung disease drove down smoking levels. Today, only 18% of Americans smoke tobacco.
What's missing from any movement to ban the handshake is evidence that particular types of infectious organisms are more likely to be spread from grasping hand-to-hand contact, Sklansky acknowledges.
Does he refuse to shake hands? Sklansky says that he does, especially "when I'm coming off of a cold. I say, 'I'd rather not shake your hand because I don't want to give you an infection.' There's an element of social awkwardness at the time."
But Sklansky admits his effort to ban the handshake will not be a slam dunk. "Unfortunately, people are taking what we're suggesting very personally."