Should healthcare workers stop shaking hands and fist bump instead

Some well-intentioned researchers from West Virginia University published a small study claiming that substituting a fist bump for a handshake might reduce the transmission of bacteria.

Since many illnesses can be transmitted by contaminated hands, the idea is plausible, but its a good example of the media misinterpreting a study and misleading naïve readers..

They measured the surface area of open hands and fists in 10 subjects. Not surprisingly surface area of an open hand was significantly greater than that of the fist—30.206 vs. 7.867 sq. in. respectively, p < 0.00001.

They also measured the contact time of handshakes and fist bumps. The handshake took 2.7 times longer than that of the fist bump (0.75 vs 0.28 seconds). [No statistical analysis provided]

Then two (yes, just two) healthcare workers walked around the hospital touching various objects and shook the hands of 20 coworkers. The palm of one hand was then cultured by putting it in a plate of agar for 5 seconds. The experiment was repeated with a fist bump substituting for the handshake. Then the closed fist was cultured in the same way..

The result was that "Total colonization of the palmar surface of the hand was four times greater than that of the fist after incubation for 72 h (187.5 vs 42.5 colony forming units)." [Again, no statistical analysis provided and not surprising since the palmar area was four times the area of the fist]

Photos of both the palm culture and the fist culture were shown. The bacteria grew in patterns resembling an outstretched hand and a fist.

Regarding the amount of bacteria, way down near the end of the discussion section of the brief paper is this "The study is limited by our small sample size and it could not assess statistical significance."

So we have a study of a whopping two subjects that shows no significant difference for bacterial growth or contact time of the handshake vs. the fist. Also, I wonder how many times a day hospital workers shake hands with each other? In my experience, my guess would be zero.

Did these facts deter the media? Not one bit. Take a look at these unrestrained headlines.

LA Times "Handshakes are germ bombs - embrace the fist bump!"
The Atlantic "The Fist Bump Manifesto"
MedCity News "Want to spread fewer germs in hospitals? Ditch the handshake, go for a fist bump"
CBC News "Doctors encourage fist bump over handshake to prevent illness"
National Geographic "Why Germs Prefer Handshakes to Fist Bumps"
FierceHealthcare "Want to cut HAIs [Hospital Acquired Infections]? Try a fist bump"

This is just one of many examples of the media sensationalizing the findings of a paper far beyond what it is due. The idea is interesting and might be worth studying further with a few more subjects and then trying to prove that more infections were actually transmitted by the handshake than the fist.

A more recent study showed that fist bumps transmit fewer bacteria than handshakes or high fives.

Other than confusing many patients, it would cause no harm to offer them a fist as long as the reason was stated. However, taking this to its logical conclusion, maybe even a fist bump, which involves contact and potential bacterial transmission, is not the answer.

Here are some alternatives:

Prayer hands
Genuflection
Upraised palm
Bow/curtsey
Salute
Right hand to heart (your own heart)
Rubbing noses (even smaller surface area)
Or better still, this:

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Ultrasound selfies How surveys can mislead

Do you believe that traditional hospitals will be obsolete in the future? A recent survey found that 57% of those polled believed that would happen.

The survey, sponsored by the Intel Corporation, involved 12,000 subjects from the United States and seven other countries around the world.

Here are some other revelations from that survey:

• 84% said they would be willing to share their personal health information to advance and lower costs in the health care system.
• 70% said they were receptive to using toilet sensors, prescription bottle sensors, and swallowed health monitors.
• 53% said they would trust a test they personally administered as much or more than if that same test was performed by a doctor
• 30% of people would trust themselves to perform their own ultrasound. 

That made me laugh. Ultrasonography is one of the most operator-dependent tests in use today. It is not easy to perform, nor is it easy to interpret.
I then began to wonder about the credibility of this survey. Before I retired, I practiced in a typical small town in the northeastern United States. Some patients googled me, and a few searched the Internet for information about their illnesses. But for the most part, it was a technologically unsophisticated population.

I just cant envision most of my patients wanting to share their personal health information, use toilet sensors, or trust tests they did at home. Do their own ultrasounds? Not likely. Many of them did not even know what medications they were on.

After rereading the article about the survey, it occurred to me that the sample may have been flawed.

This sentence stood out. "[The] Intel Health Innovation Barometer was conducted online by Penn Schoen Berland in Brazil, China, France, India, Indonesia, Italy, Japan and the United States." The key word is "online."

This reminded me of a famous survey conducted by a magazine called The Literary Digest, which polled 10 million people and had a response of 2.4 million just before the 1936 presidential election. The magazine had correctly called the previous four presidential winners.

The names of the 10 million people queried were drawn from lists of the magazines subscribers, owners of automobiles, and those with telephones. The survey predicted a crushing defeat for President Franklin D. Roosevelt at the hands of the Republican nominee, Alf Landon.

Of course, the opposite occurred. Roosevelt won all but 8 electoral vote, a huge landslide. What went wrong? Unlike the prior years, 1936 was the middle of the Great Depression, and this time those who had enough money to subscribe to The Literary Digest, own cars, and have telephones were not a representative sample of those who voted.

Do you think maybe the 12,000 people polled online might not be a representative sample of the general population of the world?

Im not expecting patients to do their own ultrasounds anytime soon. I think hospitals will be around for a while too.

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