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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

Fist bumping in health care — looking cool could save a patient's life

Fist BumpIn another endorsement of the quixotic quest to ban hand shakes in health care, researchers in the United Kingdom have found that a "fist bump" greeting transmits less bacteria than the standard shake and the "high five" — which is so 1970s in any case.

If we may digress a bit and go down the rabbit hole of alternative hand shakes, the fist bump may have roots to boxers tapping gloves before a fight, motorcycle gangs in the 1940s who found it hard to shake hands astride their bikes, and Hall of Fame baseball player Stan "the man" Musial. The high five is thought to have evolved out the "low five" skin slap practiced by African American musicians in the Jazz Age.

In any case, in light of clear evidence that pathogens can spread from person to person via the time-honored hand shake, there has been discussion in the infection control community of finding another way to convey trust and respect while proving to your fellow primates that you have no weapon in your hand.

Now we have a study published in the August issue of the American Journal of Infection Control -- the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC) -- that concludes that bumped fists may save lives.

Researchers at Aberystwyth University in the United Kingdoms performed trials to determine if alternative greetings would transmit fewer germs than the traditional handshake. In this experiment, a greeter immersed a sterile-gloved hand into a container of germs. Once the glove was dry, the greeter exchanged a handshake, fist bump, or high-five with a sterile-gloved recipient. Exchanges randomly varied in duration and intensity of contact. After the exchange, the receiving gloves were immersed in a solution to count the number bacteria transferred during contact. Nearly twice as many bacteria were transferred during a handshake compared to the high-five, and significantly fewer bacteria were transferred during a fist bump than a high-five. In all three forms of greeting, a longer duration of contact and a 'stronger grip (we all know that guy) were associated with increased bacterial transmission.

““It is unlikely that a no-contact greeting could supplant the handshake; however, for the sake of improving public health we encourage further adoption of the fist bump as a simple, free, and more hygienic alternative to the handshake," says David Whitworth, PhD, one of the authors of the paper.

A key pathogen that may be driving this idea is Clostridium difficile, a spore former that is difficult to remove from the hands even when washing with soap and water. This resilient bug now comes in a variant, highly virulent strain that the CDC sometimes describes as "deadly diarrhea." That's good enough reason for me to endorse fist bumps at the bed side.