If a doctor, dentist or nurse reaches out to shake your hand, should you: (a) reciprocate and extend your hand, (b) shake at least once or twice but don’t pump or hold hands for more than five seconds, (c) make eye contact and smile while shaking or (d) recoil in horror, shove your hands deep into any available pocket and report the perpetrator to the nearest infection control specialist?
If you answered ‘d,’ then high five me. You understand the sorry state of hand hygiene in American health care and the toll it takes in spreading disease.
An editorial in the Journal of the American Medical Association suggests banning the handshake from health care settings. Instead, the authors recommend “infection-conscious alternatives,” such as the hand wave, bow or hands-together Namaste.
Health care workers get all manner of germs on their hands. And despite the proliferation of liquid hand sanitizer bottles over every wall, hallway, kitchen and bathroom, people do not wash their hands. Rates for hand washing for doctors, nurses and volunteers hover around 40 percent.
Before you ask how can that be, know that patients and visitors, who touch everything and their friends and families in waiting rooms, cafeterias, patient rooms and bathrooms, do no better. Moreover, if you don't spend more than a few microseconds washing, you don't get your hands clean enough to kill germs.
The solution? Well, we could send third graders who have been through health classes into our finest health care institutions to demonstrate good hand-washing technique and urge on the doctors, dentists, technicians and nurses to be vigilant.
The authors of the new study, however, say it is time to surrender. Hand washing is not happening and ain’t gonna happen. They want to teach doctors, dentists and nurses not to accept the offer to shake and to post signs saying hospitals and clinics are “handshake free zones.”
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.
Health care 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.
So what to do about controlling infections that kill and sicken many in our hospitals? OK, fist bump rather than handshake if you can since the former is better than the latter at preventing disease. “Thumbs up” has a place too.
But everyone still needs to be washing their mitts — you, your fellow visitors, the doctors, the administrators, the cable TV installer, the dental assistant, etc. If they don’t, remind them. If you don’t, don’t get mad if someone reminds you. The handshake is only a problem in health care if the hands that shake have not recently been thoroughly washed.