Prevention of Potential Infection Transmission: No Coat, No Tie, No Handshake, Please!

Do you greet your patients when you enter the examination room in your office or their room in the hospital? “Of course I do,” most physicians reply. And, do you shake hands? If your answer is yes, should you? Perhaps a fist bump would be a more hygienic alternative.

Mela and Whitworth (Am J Infect Control. 2014;42:916-917) demonstrated that “dap greetings” such as the high five and the fist bump dramatically reduced the transfer of bacteria during greeting exchange compared with the traditional handshake. Transmission of bacteria during the handshake was influenced not only by the large contact area but also the duration of the activity and the strength of the grip. Specifically, they observed the following about bacterial transfer: (1) it positively correlated with the area of contact made during the greeting, (2) it increased for greetings lasting longer than 3 seconds (handshakes and prolonged fist bumps), and (3) it was greater following handshakes with a strong grip as compared to those with a moderate-strength grip.

What’s the issue?

The potential spread of infection by physicians to their patients is an issue of concern. The transmission of health care–associated microorganisms by fomites in the hospital environment may contribute to this problem. Indeed, contaminated apparel of health care personnel may result in cross-transmission of bacteria.

A physician’s attire is influenced by culture and tradition. Many medical schools still conduct “white coat ceremonies” for their students to acknowledge the beginning of clinical training. However, physicians’ white coats may increase nosocomial infection transmission. It was shown that 91.3% of swabs taken from the cuffs and pocket mouths of white coats worn by physicians at an acute care hospital had bacterial contamination (World Health Popul. 2010;11:44-54).

Another potential vector for the transmission of infections by physicians is the necktie. Bacteria often colonize the neckties of health care workers; therefore, they can become a source of nosocomial infections in hospitalized individuals. Perhaps physicians, while providing patient care in a clinical setting, should not only hang up their white coats but also abandon their neckties in an effort to keep their patients safe.

Now, in addition to the physician’s attire, it has been shown that the physical interaction during the initial moments of the physician-patient encounter also may have the potential to transmit infectious organisms directly between 2 individuals. Indeed, an increased risk for infection transmission may be associated with the greeting type (particularly, the handshake), the greeting longevity (often >3 seconds), and the greeting contact force (eg, a strong grip). Therefore, following the salutation with patients, perhaps physicians should consider a fist bump instead of a handshake.

We want to know your views! Tell us what you think.

Suggested Readings

• Abuannadi M, O’Keefe JH, Brewer J. Neckties for physicians: yes? no? maybe? Mo Med. 2010;107:366-367.
• Bearman G, Bryant K, Leekha S, et al. Healthcare personnel attire in non-operating-room settings. Infect Control Hosp Epidemiol. 2014;35:107-121.
• Bi G, Wilson AB. Deadly ties and the rise of multi-drug resistant infections: a case for a new health care practitioner hygienic dress code. Independent Democratic Conference. https://www.yumpu.com/en/document/view/24854102/deadly-ties-and-the-rise-of-multi-drug-resistant-infections-a-case-. Published May 2011. Accessed March 12, 2015.