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May 28, 2014

Shake Your Germy Hand? Let Me Think About That

Image courtesy of (Ambro) / FreeDigitalPhotos.net

Your dad may have taught you it’s a manly thing to have a firm one.

You may have a softer version for your aunt or grandmother.

But, did you ever consider, despite handshaking’s long history and worldwide practice, that it might not be healthy?

Sure, many who suffer from obsessive compulsive disorder (OCD) abhor the practice. Consider celebrities like Howie Mandel and Howard Stern – they believe the plague lurks in the palms of would-be fans and greeters. They’d rather gargle bleach than shake a hand of a stranger.

But, there are some in the health care field who believe it’s time to ban the practice outright.

That’s right, there are doctors and respected associations of health-care professionals who espouse a ban on handshaking in some settings.

Let’s first consider the history of handshaking, at least recent history.

Image courtesy of (Ambro) / FreeDigitalPhotos.net

Image courtesy of (Ambro) / FreeDigitalPhotos.net

One of the more popular beliefs is the one involving medieval strangers shaking hands to ensure no weapons would be drawn. More recently, historians note that it was Thomas Jefferson who ended the practice of bowing to guests in the White House, preferring a handshake instead to separate any notions of monarchy from the American presidency.

While Jefferson’s intent was certainly admirable, many presidents since have regretted this change in etiquette, including President Hoover, who was reportedly never really good at handshaking. After shaking hands with thousands of people at the annual White House reception, his arm was so fatigued he couldn’t write for days.
Secret orders, fraternities, and sororities and even religions have long use handshake rituals to recognize members, exclude outsiders, and even to supposedly reveal the identity of demons and angels.

But, is it really bad for you?

An Illinois man recently tested positive for MERS – Middle Eastern Respiratory Syndrome – a deadly respiratory illness that is plaguing parts of the world, particularly as the name of the virus refers, the Middle East. It’s similar to the SARS virus that hit Toronto, Canada, some years back and killed more than 20 people, many of them in the health-care field.

But, the Illinois man, who landed in intensive care and is recovering in hospital, didn’t visit the Middle East. He was at a business meeting in Illinois where he — wait for it — shook hands with associates.

“This is the first MERS infection acquired in the U.S.,” said ABC News’ chief health and medical editor, Dr. Richard Besser. “There are a couple possibilities: one is that it was transmitted by handshake; the other is that their face-to-face meeting, which lasted 40 minutes, was enough for the virus to be transmitted. At this point, there’s no way of knowing which it was.”

Image courtesy of (Ambro) / FreeDigitalPhotos.net

Image courtesy of (Ambro) / FreeDigitalPhotos.net

In the field of health care, there’s a growing ‘better safe than sorry’ movement.”

The Journal of the American Medical Association recently suggested that healthcare workers should do away with the handshake in dealings with patients.

“[T]he hands of health-care workers often serve as vectors for transmission of organisms and disease. Health care workers’ hands become contaminated with pathogens from their patients, and, despite efforts to limit the spread of disease, cross-contamination of health care workers’ hands commonly occurs through routine patient and environmental contact… hand-related transmission of organisms in the health care setting can contribute to the burden of antimicrobial resistance,” the JAMA wrote on May 15.

According to JAMA, it’s wise to consider banning handshaking at least in the medical field. Doc meet patient, patient, meet doc. Fist bump. That’s the recommendation.

In typical journalese, the practice is dissected and suggestions posited.

“Particularly in the current era of health care reform, innovative, practical, and fiscally prudent approaches toward the prevention of disease will assume increasingly important roles. Regulations to restrict the handshake from the health care setting, in conjunction with more robust hand hygiene programs, may help limit the spread of disease and thus could potentially decrease the clinical and economic burden associated with hospital-acquired infections and antimicrobial resistance. Effective development and implementation of such a handshake ban will likely require further study to confirm and describe the link between handshakes and the transmission of pathogens and disease; the promotion of an alternative, health-conscious gesture to substitute for the handshake; and widespread media and educational programs.

“Nevertheless, the hands of health-care workers often serve as vectors for transmission of organisms and disease. Health care workers’ hands become contaminated with pathogens from their patients, and, despite efforts to limit the spread of disease, cross-contamination of health care workers’ hands commonly occurs through routine patient and environmental contact. The duration of survival of bacteria and viruses on the hands of health care workers varies by pathogen and environmental factors. Moreover, hand-related transmission of organisms in the health care setting can contribute to the burden of antimicrobial resistance.”

So, there you go. Pretty scary stuff and not entirely impractical in the health-care setting when one looks at it clinically — the hands of patients are sometimes crawling with pathogens. Health-care workers come in contact with all manner of bad-for-you germs and the like. Ergo, ban the handshake in a hospital or clinic setting.

Fair enough.

But, the discussion has recently taken on a life of its own. Television newscasters, looking for one of those oddity kinds of story, seized on it and extrapolated the suggestions of the health experts to suggest there was a move afoot to ban the practice, outright.

Image courtesy of (David Castillo Dominici) / FreeDigitalPhotos.net

Image courtesy of (David Castillo Dominici) / FreeDigitalPhotos.net

In a recent article in the Boston Globe, the notion of banning the practice was presented from a number of angles.
The Globe noted that economist Tyler Cowen recently attended a meeting in Manhattan during which Bill Gates briefed him and a small group of other guests on his latest philanthropic endeavors. Cowen was impressed, the Globe reported. But, he blogged later that Gates had been “smart enough, and health-savvy enough” to begin his presentation without first shaking everyone’s hand.

“He could spend his whole life shaking people’s hands, and basically be sick all the time,” Cowen said later, adding, “I shake hands with people, but I wish the whole custom didn’t exist. I’d rather bow or just pass business cards or something.”

Cowen, a professor at George Mason University, is not alone in worrying about the dangers of the handshake. He is part of a small but adamant group of people who believe that one of our most common customs—the symbol of “hello,” “goodbye,” and “let’s make a deal”— is also one of our most reckless. Other notables in the club include Donald Trump, who once called handshaking “one of the curses of American society,” and the high-profile technology investor Michael Arrington, who has written that he’d rather not “swap germs via the ancient but disgusting habit of shaking hands.”

Well, we’re not likely to see the custom die off completely in our lifetime, I’d suggest. But, it clearly has merit in some settings.

The Journal JAMA concluded it’s probably prudent to encourage a ban in health-care settings. After all, it’s not a costly preventative measure and merely involves an education program, one that is well established for hand-washing, for instance.

Banning the handshake from the health care environment may require further study to confirm and better describe the link between handshake-related transmission of pathogens and disease. Moreover, given the profound social role of the handshake, a suitable replacement gesture may need to be adopted and then promoted with widespread media and educational programs. Nevertheless, removing the handshake from the health care setting may ultimately become recognized as an important way to protect the health of patients and caregivers, rather than as a personal insult to whoever refuses another’s hand. Given the tremendous social and economic burden of hospital-acquired infections and antimicrobial resistance, and the variable success of current approaches to hand hygiene in the health care environment, it would be a mistake to dismiss, out of hand, such a promising, intuitive, and affordable ban.”

But, is it a practical solution in day-to-day life, in business and social settings? We’re not likely to see the fist or elbow bump any time soon at the end of a sporting match, such as rugby or a hockey or basketball playoff.

For some, it’s an overreaction. For others, such as doctors and nurses, it’s common sense. For the OCD afflicted among us, it’s already a no-brainer.

Let’s just decide to be careful with hand washing, whom we might greet with a handshake (do you really need to shake hands with that sweaty guy who just sneezed into his paw?) and shake on it.


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Chris Malette is a retired newspaper journalist with 35 years of experience as a reporter and city editor. Over his career, Malette covered municipal and federal politics, military, health and court beats. He has reported from Somalia, Bosnia, Haiti and covered relief efforts in Honduras in the wake of Hurricane Mitch in 1998. He now works for SPN News as an editorial columnist.

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