Archive July 2017 XVIII, No. 7

Ideas That Work: Create a Handshake-Free Zone

no handshakes KEEP YOUR HANDS TO YOURSELF As part of its infection prevention efforts, UCLA Mattel Children's Hospital strongly discourages handshakes at its facility.

HAND HYGIENE Create a Handshake-Free Zone

handshake free zone sign SHAKING THINGS UP One of the many signs posted around UCLA Mattel Children's Hospital.

We've dramatically decreased handshaking in our facility without being militant about it. Instead, we've used education to get people to understand what's at stake and encouraged alternative gestures to greet each other — waves, nods, bowing, even fist bumps.

It hasn't been easy. Handshaking has been ingrained in our culture for centuries. But when we shake hands, we unwittingly convey bacteria and viruses to our partners. Our hands are vectors for disease. And the hands of physicians typically act as vehicles for many more bacteria, including antibiotic-resistant bugs, than the hands of the average person.

Research suggests that physician compliance with hand-hygiene policies is about 40%. I suspect it's actually lower, because there's a difference between washing your hands, and washing them effectively, which takes 15 to 20 seconds and proper technique. (Using a few drops of alcohol-based gel and rubbing your hands together for 5 seconds doesn't cut it.) Granted, when we're in the OR, we have intense hand-washing rituals. But in other settings, we become laissez-faire.

Patients may be at their most vulnerable on the operating table, but they're also very vulnerable before they reach the OR. Consider the patient in pre-op, lying there with an IV in his arm, while multiple caregivers — the anesthesia provider, the surgeon, a nurse — file in and out, each greeting him by extending a bare hand. And while this is going on, chances are the patient occasionally touches his face, mouth, nose and eyes. Now, with each touch, he increases the risk that the bacteria he just picked up will result in a post-op infection.

Seen in that light, shaking hands seems like a crazy and unnecessary ritual. The challenge is to reduce it without coming across as rude. By posting numerous signs in our facility and generating conversations among both patients and providers, we've accomplished that.

Will we decrease infections? We haven't demonstrated that yet, although we think we will. But knowing what we know, there's no reason for people to wait around for that study to be completed. Discouraging handshaking in your facility is a logical step you can take to help address the enormous challenges related to nosocomial infections.

Mark S. Sklansky, MD
UCLA Mattel Children's Hospital
Los Angeles, Calif.

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