In the hospital, keep those hands (and germs) to yourself

June 4, 2017

Dr. Mark Sklansky, a self-described germaphobe, can’t stop thinking about how quickly those little microbes can spread.

“If I am at a computer terminal or using a phone or opening a door, I know my hands are now contaminated, and I need to be careful and I need to wash my hands,” said Sklansky, professor of pediatrics at the David Geffen School of Medicine at UCLA.

Not all health workers are so careful, despite strict hand-washing policies in virtually all medical facilities. A 2010 study published in the journal Infection Control & Hospital Epidemiology showed that only about 40 percent of doctors and other health care providers complied with hand hygiene rules in hospitals.

Sklansky decided to test a new method at UCLA for limiting the spread of germs and reducing the transmission of disease: a handshake-free zone.

“We are trying to do everything to minimize hospital-acquired infection except for the most obvious and easiest thing to do in my opinion, which is to stop shaking hands,” he said.

Infections can be serious

Hospital-acquired infections are a serious and potentially life-threatening problem in hospitals, and the unwashed hands of health care workers are often to blame. On any given day, 1 in 25 patients across the U.S. suffers from at least one infection acquired while they are in the hospital, according to the federal Centers for Disease Control and Prevention.

Sklansky first proposed the concept of handshake-free zones in a 2014 editorial published in the Journal of the American Medical Association. His proposal launched a debate about the possible risks of the time-honored greeting.

In 2015, Sklansky decided to try out the idea with a six-month experiment. He picked a place where patients are especially vulnerable — the neonatal intensive care unit. Infections among infants can cause them pain, prolong their stay in NICU, require more medications and even put them at risk of dying.

The anti-handshake experiment took place at two of UCLA’s NICUs, in Westwood and Santa Monica. Starting in 2015, Sklansky and his colleagues explained to the staff and families the purpose of handshake-free zones and posted signs designating the new zones. The signs feature two hands gripping each other inside a circle with a blue line through it, and the words: “To help reduce the spread of germs, our NICU is now a handshake-free zone. Please find other ways to greet each other.”

They didn’t ban handshakes outright. They suggested other options: a fist bump. A smile. A bow. A wave. A non-contact Namaste gesture.

“We aren’t like a military operation,” Sklansky said. “We are just trying to limit the use of handshakes.”

Zones help prevent spread

This spring, Sklansky and his colleagues published the findings of a survey on their handshake-free zone experiment in the American Journal of Infection Control. They found that establishing such zones is possible, can reduce the frequency of handshakes and that most health care workers supported the idea. They didn’t measure whether avoiding handshakes actually reduced the rate of infections, but Sklansky said he hopes to answer that question in a future study.

Though the formal experiment is now over, the signs in the NICUs are still in place and doctors and nurses still discourage handshakes.

As part of the UCLA survey, Sklansky and his colleagues asked staff and parents what they thought of the new handshake-free zones.

The majority of health care workers supported the idea — especially medical school students and nurses. Male doctors were the most resistant to giving up the handshake, partly because they weren’t convinced it was necessary to prevent infections.

Families, however, were universally supportive of the handshake-free zone, Sklansky found.

On one recent day in the NICU, Brittney Scott stood beside the crib of her 2-week-old son, Samuel, as he slept. He had ended up there with intestinal problems.

Scott said she’d never heard of a handshake-free zone and had instinctively offered her hand to a doctor when she first arrived. She said she was “a little taken aback at first” when the doctor declined to take her hand. “But once you really understand the meaning behind it, it’s great.”

Scott knows Samuel is at risk of infection, so avoiding germs is critical. She said she now prefers a smile to a handshake.

“A smile goes a long way in here,” she said. “There’s a lot of ups and downs … being a parent to a NICU baby.”