Time to Get Serious About ‘Handshake-Free’ Health Care?

By Shawn Kennedy, AJN editor-in-chief

Tombstone handshake, from Mel B, via Flickr.

Tombstone handshake, from Mel B, via Flickr.

Last month in JAMA, Mark Sklansky and colleagues wrote a Viewpoint column, “Banning the Handshake From the Health Care Setting.” The article explored the idea and its feasibility, while acknowledging the importance of such rituals as handshakes in human interaction. In the end, the authors argued that it’s an idea we might need to start taking more seriously.

Is this an antisocial idea? That’s debatable, but it would certainly be a good step towards reducing transmission of infections—and one that’s probably long overdue.

It’s well known that pathogens are easily transmissible from health care workers’ hands, even if they practice hand hygiene in between seeing patients. But as the authors remind us, heath care workers are notoriously bad at doing so—they cite research showing that “compliance of health care personnel with hand hygiene programs averages 40%.”

And it’s no better in ambulatory care settings—an original research article we published in March 2013 that measured hand hygiene compliance by health care workers in an ambulatory care clinic found that, even after a campaign to improve adherence, compliance (as measured by direct observation) had only improved to between 32% and 51% at one-month follow-up. The introduction of alcohol-based hand sanitizers helped, but they aren’t effective against all pathogens, including C. difficile and some noroviruses

Bacteria have been shown to live on many surfaces—computer keyboards, telephones, uniforms, and even paper (see our December 2011 research article, “Survival of Bacterial Pathogens on Paper and Bacterial Retrieval from Paper to Hands”). If a conscientious nurse charted on a paper chart or entered a patient’s vital signs into the electronic record after providing care but before washing hands, bacteria could be transmitted to whoever next picked up the chart or used the keyboard. Then that person might shake hands with a family member or colleague, and so on, and so on . . .

We’ve addressed the issue of hand hygiene many times: in original research pieces as above, in articles reviewing implementation strategies (see this one from 2008), news reports (soap and water vs. hand sanitizers), an editorial examining the issue—and as far back as  an article from August 1932, “Pray, Let Us Wash Our Hands,” in which the author asks,

“What are we going to do about it? For something ought to be done and done quickly for the safety of all concerned: the patient, the student, and the community. It has long been an established fact that one of the most dangerous agents in the transfer of bacteria is the human hand with its five fingers.”

I think the “no handshake” policy would be a reasonable addition to current steps to reduce the spread of bacteria. The authors offer a statement that could be posted throughout health care settings:

“Handshake-free zone: to protect your health and the health of those around you, please refrain from shaking hands while on these premises.”

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Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. […] not only acquiring them from patients but from contaminated surfaces as well. The editors at the American Journal of Nursing write […]

  2. Peggy June 2, 2014 at 7:37 pm

    I just got back from China and spent time in hospitals talking to nurses. I did a LOT of handshaking (and washing my hands) as it is a cultural expectation. I am very keen to reduce infections in any way possible but think this may be a tough thing to change.
    Looking forward to other comments. I do agree with Jackie, when it comes to patients, we cannot forget touch as a mode of healing.

  3. Jackie Perryman June 2, 2014 at 12:30 pm

    Are we so removed from the patient that we can’t touch a patient anymore? As a nurse, I believe patients sometimes need human touch.

Comments are moderated before approval, but always welcome.

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