Pharmacy OneSource Blog

Clinical Corner: Hand Hygiene, Social Greetings, and Popular Culture: Handshakes out, Fist bumps in?

Hand hygiene continues to play a critical role in protecting patients from the threats of infection. It is one of the most important ways to prevent the spread of germs both inside a healthcare facility and outside in homes, schools, and the community.

A commonplace greeting in my cultures, the handshake, has the potential to directly transmit germs between individuals. Alternative greetings continue to be explored to minimize the risks involved. In a recent AJIC study, Whitworth and Mela performed trials to determine if alternative greetings, such as the fist bump and high-five, would transmit fewer germs than the traditional handshake.

A greeting donor immersed a sterile-gloved hand into a container of germs and proceeded to exchange a series of greetings with a sterile-gloved recipient. Exchanges randomly varied in duration and intensity of contact. The handshake resulted in a transfer of nearly twice the bacteria (mean 1.24 x 108 CFU) of a high-five, whereas the fist bump consistently experienced the lowest transmission.1

Furthermore, they identified a direct correlation between surface area of contact, strength of grip, and duration of contact to the amount of bacteria transferred. These studies open the door for additional dialogue around the use of limited or non-contact greetings such as the head nod, wave, bow, and fist bump.

Implementing these non-contact greetings, however, would prompt a culture change. Social and professional contexts place great value in the handshake and its quality.2,3 Healthcare professionals are often encouraged to engage in handshakes with patients to establish rapport and meet their expectations.1

Handshakes are unlikely to vanish anytime soon, but making a conscious effort to reduce or eliminate unnecessary hand contact may help further protect the health and safety of patients. No-contact greetings seem ideal, but wide acceptance could prove challenging. The fist bump or other so-called dap greetings seem to be a compelling alternative for consideration. These studies will continue to enable more productive dialogue around this issue and may contribute to policies that further promote hand hygiene and patient safety.

Which form of greeting makes the most sense for the healthcare community?


Blog-MattWeissenbach.jpgAbout Matt Weissenbach, MPH, CPH, CIC
Matt Weissenbach is currently the Director of Clinical Operations for Sentri7. As a trained epidemiologist, Matt has significant experience within the healthcare informatics arena centered on leveraging automation to advance the fields of epidemiology and infection prevention. He has also been extensively involved in international public health, specifically infectious disease epidemiology and vector-borne diseases endemic to Southeast Asia. Matt is a member of the Association for Professionals in Infection Control and Epidemiology (APIC) at the national and local (NC) levels as well as a member of the Society for Healthcare Epidemiology of America (SHEA).

Matt received his Master of Public Health degree in Global Health Practice from the University of South Florida and is board certified in Public Health and Infection Control.



1 S Mela, DE Whitworth. The fist bump: A more hygienic alternative to the handshake. Am J Infect Control 2014;42:916-7.

2 Chaplin WF, Phillips JB, Brown JD, Clanton NR, Stein JL. Handshaking, gender, personality, and first impressions. J Pers Soc Psychol 2000;79(1):110.

3 Dolcos S, Sung K, Argo JJ, Flor-Henry S, Dolcos F. The power of a handshake: neural correlates of evaluative judgments in observed social interactions. J Cogn Neurosci 2012;24(12):2292-305.

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