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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Nigerian twitter reacts to NNPC workers protest of unbundling of the oil corporation

Some Nigerians on twitter have reacted to NNPC workers protest of the recent unbundling of the oil corporation into 7 units. Some feel it is a welcome development as it will help address the alleged corruption in the oil corporation. Continue to see their tweets...

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Can Google Glass make you a better surgeon

Advocates of Google Glass in surgery are apparently desperate to find some use for the device.

An article headlined "Google Glass makes doctors better surgeons, Stanford study shows" concluded that the study offered "compelling preliminary evidence that the head-mounted display can be used in a clinical setting to enhance situational awareness and patient safety."

Using an app capable of displaying vital signs on Google Glass in real time, 7 surgical residents recognized critical desaturation in simulated patients having procedures under conscious sedation 8.8 seconds faster than a control group of 7 residents relying on standard monitors. Glass-wearing residents also became aware of hypotension 10.5 seconds before the control group.

Not mentioned in the article but present in a linked abstract of the paper not yet submitted for peer review was this pearl—neither difference was statistically significant.

This evidence is not that convincing. Even if the difference had been statistically significant, it is surely not clinically important.

How seeing vital signs on Google Glass is better than relying on the simple alarms that are built in to every monitor is not clear. Either way, you must stop the operation and look up to see the vital signs.

In a brief video accompanying the article, a surgeon can be seen rather clumsily activating and resetting the app on his Google Glass. The time required to perform these maneuvers apparently was not discussed.

The article, probably written directly from a press release, took a comedic turn with this sentence, "One test demanded that the resident perform a bronchoscopy, in which the surgeon makes an incision in the patient’s throat to access a blocked airway." But bronchoscopy does not involve making an incision in the throat or anywhere else.

If you would like to hear a different side of the Google Glass story, check out this video review from GeekBeatTV entitled "Google Glass is the worst product of all time." You can forward to the 3:45 mark to get past the woes of wearing prescription glasses with Google Glass and hear about the poor battery life, the balky commands, the system crashes, and more.

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