One interesting way of avoiding the transmission of pathogens is in changing the amount or the style of hand-to-hand contact – most simply by stopping shaking hands. Researchers at Aberystwyth University trialled alternative greetings and settled on the fist bump so beloved of sportsmen and women.

In the experiment, a greeter immersed a sterile gloved hand into a container of germs. Once the glove was dry, the greeter exchanged a handshake, fist bump, or high five with a sterile gloved recipient. Exchanges randomly varied in duration and intensity of contact. After the exchange, the receiving gloves were immersed in a solution to count the number of bacteria transferred during contact. Nearly twice as many bacteria were transferred during a handshake compared to the high five, and significantly fewer bacteria were transferred during a fist bump than a high five. In all three forms of greeting, a longer duration of contact and stronger grips were further associated with increased bacterial transmission.

Author David Whitworth, PhD said: “Adoption of the fist bump as a greeting could substantially reduce the transmission of infectious diseases between individuals. “It is unlikely that a no-contact greeting could supplant the handshake; however, for the sake of improving public health we encourage further adoption of the fist bump as a simple, free, and more hygienic alternative to the handshake.” Similar research in Scotland demonstrated that the six-step hand-hygiene technique recommended by the World Health Organization is superior to a three-step method suggested by the U.S. Centers for Disease Control and Prevention in reducing bacteria on healthcare workers’ hands. During the randomized controlled trial overseen by Jacqui Reilly, PhD, professor of infection prevention and control at Glasgow Caledonian University in Scotland in an urban, acute-care teaching hospital, researchers observed 42 physicians and 78 nurses completing hand-washing using an alcohol-based hand rub after delivering patient care.

The six-step technique was determined to be microbiologically more effective for reducing the median bacterial count (3.28 to 2.58) compared to the three-step method (3.08 to 2.88). However, using the six-step method required 25% more time to complete (42.50 seconds vs. 35 seconds).  Jacqui, lead author of the study, said: “One of the interesting incidental findings was that compliance with the six-step technique was lacking. Only 65% of providers completed the entire hand hygiene process despite participants having instructions on the technique in front of them and having their technique observed. This warrants further investigation for this particular technique and how compliance rates can be improved.” The researchers recommend authors of international guidance should consider this evidence when making official recommendations on best practices in hand hygiene.  Their work was published through a partnership between the Society for Healthcare Epidemiology of America and Cambridge University Press.