Keep Those Germs to Yourself: Hospitals Try Handshake-Free Zones

UCLA experiment draws mixed reviews

Dr. Mark Sklansky, a professor of pediatrics at the David Geffen School of Medicine at UCLA, has tested a new method for limiting the spread of bacteria and reducing the transmission of disease: handshake-free zones. Sklansky first proposed the concept in a 2014 editorial published in the Journal of the American Medical Association. His proposal launched a debate about the possible risks of the time-honored greeting.

“We are trying to do everything to minimize hospital-acquired infection except for the most obvious and easiest thing to do, in my opinion, which is to stop shaking hands,” Sklansky told Kaiser Health News.

In 2015, he decided to try out the idea with a six-month experiment. He picked a place where patients are especially vulnerable—the neonatal intensive care unit (NICU). Infections among infants can cause them pain, prolong their stay in the NICU, require more medications, and even put them at risk of dying.

The anti-handshake experiment took place at two of UCLA’s NICUs––in Westwood and Santa Monica. Starting in 2015, Sklansky and his colleagues explained to the staff and families the purpose of handshake-free zones and posted signs designating the new zones. The signs featured two hands gripping each other inside a circle with a blue line through it, and the words: “To help reduce the spread of germs, our NICU is now a handshake-free zone. Please find other ways to greet each other.”

They didn’t ban handshakes outright. They suggested other options: A fist bump. A smile. A bow. A wave.

Sklansky and his colleagues recently published the findings of a survey on their handshake-free zone experiment in the American Journal of Infection Control. They found that establishing such zones is possible; that it can reduce the frequency of handshakes; and that most health care workers supported the idea. They didn’t measure whether avoiding handshakes actually reduced the rate of infections, but Sklansky said he hopes to answer that question in a future study.

Although the formal experiment is now over, the signs in the NICUs are still in place, and doctors and nurses still discourage handshakes.

Avoiding handshakes is an effective way to reduce the spread of germs, said Maureen Shawn Kennedy, editor-in-chief of the American Journal of Nursing. Health care providers do wash their hands frequently, she said, but often they don’t do it for long enough or use the right technique. And bacteria live on computers, phones, medical charts, and uniforms throughout hospitals, she noted.

Some infectious-disease specialists believe, however, that health care workers don’t need to stop shaking hands. They just need to scrub better.

In a 2015 editorial in the Texas Heart Institute Journal, Dr. Herbert Fred, a Houston physician, wrote that “the problem isn’t the handshake: it’s the hand-shaker.” Doctors need to ensure that their hands are clean before touching patients, he wrote.

Sklansky agreed that hospitals need to improve compliance with hand hygiene, and he said handshake-free zones aren’t designed to replace hand-washing but to complement it. “I actually think handshake-free zones will bring attention to the hands as vectors for disease and help improve compliance with hand hygiene,” he said.

As part of the UCLA survey, Sklansky and his colleagues asked staff and parents what they thought of the new handshake-free zones.

The majority of health care workers supported the idea—especially medical school students and nurses. Male doctors were the most resistant to giving up the handshake, partly because they weren’t convinced it was necessary to prevent infections.

Families, however, were universally supportive of the handshake-free zone, Sklansky said.

Source: Kaiser Health News; May 30, 2017.