Is It Safer Not To Shake On It?

Science 2014-08-08

The practice of handshaking has been around since the times of Ancient Greece; it was originally thought of as a gesture of peace, offering your open hand to show that you were not concealing a weapon. Its purpose has since evolved, now it’s habitually used as a respectful greeting in both social and professional environments.


Recently the necessity of this gesture has been brought into question, particularly in regards to the healthcare environment. Studies have shown that due to the prolonged skin-to-skin contact, handshakes greatly heighten the risk of passing communicable diseases, most notably during flu pandemics and in the spread of superbugs.  These findings have even prompted a call for a ban on the handshake in hospitals. After all, is there any need for a doctor to greet a patient with an open hand to prove that they’re not holding a weapon?


If this ban were to be put into place an alternative greeting would need to be proposed to avoid doctors appearing disengaged or disinterested. In many cultures direct contact is not necessary to greet someone respectfully, for example the Namaste greeting performed in South Asian countries, or bowing in Japan.


However, would this make it more difficult for doctors to reassure their patients and instil them with confidence? A team at UCLA have suggested a possible compromise proposing that doctors reduce the risk by lowering the surface area and duration of direct contact. They have suggested using the ‘fist bump’.


This popular social greeting is not yet widespread professionally but has become more commonplace in recent years, with even Barack Obama opting for the fist bump on many occasions.


pilot study published in the Journal of Hospital Infection supports the case for the fist bump, showing that bacteria on the contacted skin was 4 times lower than after a handshake. There is now also an online ‘Stop the Handshake’ movement encouraging followers to wear their signature badge reading ‘no offence, it just makes sense’ as a polite way of declining a handshake.


The controversy may have made it a popular issue online, but infection control experts have suggested that the results of such a ban may not be as impactful as it first appears. The ban doesn’t go far towards preventing the large amount of bacteria transfer from hospital surfaces and door handles. The obvious solution seems to be encouraging healthy hand hygiene but this is notoriously difficult among doctors, patients and visitors.


study published in the Journal of the American Medical Association found that there is currently only a 40% compliance rate to hand hygiene programs among doctors, with a similarly low level among patients and visitors too. So, although in theory this is the simplest solution it has proven difficult to achieve.


It seems more appropriate to look into a solution that does not require day-to-day compliance or human intervention. For example, replacing the current surfaces in hospitals with copper-alloy surfaces could be highly effective, as copper has shown to have an anti-microbial effect.


When in contact, the copper places bacteria in a deficit of electrical charge, leading to its death. Scientists have suggested that copper-alloy surfaces could kill 99.9% of bacteria in a matter of hours. A study published in the Journal of Infection Control and Hospital Epidemiology found that putting a copper-alloy surface onto 6 regularly touched objects in ICU rooms lowered the risk of hospital-acquired infections by more than 50% at all the sites in the trial.


Switching to copper-alloy surfaces would be costly, however hospital-acquired infections add 19 days on average to a patient’s time in hospital. So this appears to be a cost-effective idea in the long-term, and therefore, perhaps a more realistic campaign to get behind.