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Fist Bumps Instead of Handshakes? | Guest Blog

Numerous headlines tout that substituting a fist bump for a handshake reduces transmission of infection. But is this just one of many examples of the media sensationalizing the findings of a paper far beyond what it is due?

Some well-intentioned researchers from West Virginia University published a small study claiming that substituting a fist bump for a handshake might reduce the transmission of bacteria. Since many illnesses can be transmitted by contaminated hands, the idea is plausible, but it’s a good example of the media misinterpreting a study and misleading naïve readers.

They measured the surface area of open hands and fists in 10 subjects. Not surprisingly, surface area of an open hand was significantly greater than that of the fist—30.206 sq in vs. 7.867 sq in, respectively (P < 0.00001). They also measured the contact time of handshakes and fist bumps. The handshake took 2.7 times longer than that of the fist bump (0.75 sec vs 0.28 sec). No statistical analysis was provided.

Then two (yes, just two) healthcare workers walked around the hospital touching various objects and shook the hands of 20 coworkers. The palm of one hand was then cultured by putting it in a plate of agar for 5 seconds. The experiment was repeated with a fist bump substituting for the handshake. Then the closed fist was cultured in the same way.

The result was that “total colonization of the palmar surface of the hand was four times greater than that of the fist after incubation for 72 h (187.5 vs 42.5 colony forming units).” Again, there was no statistical analysis and no surprise since the palmar area was four times the area of the fist. Photos of both the palm culture and the fist culture were shown. The bacteria grew in patterns resembling an outstretched hand and a fist.

Regarding the amount of bacteria, way down near the end of the discussion section of the brief paper is this: “The study is limited by our small sample size and it could not assess statistical significance.”

So, we have a study of a whopping two subjects that shows no significant difference for bacterial growth or contact time of the handshake versus the fist bump. Also, I wonder how many times a day hospital workers shake hands with each other? My guess would be zero.

Did these facts deter the media? Not one bit. Take a look at these unrestrained headlines.

  • LA Times: “Handshakes are germ bombs – embrace the fist bump!”
  • The Atlantic: “The Fist Bump Manifesto”
  • MedCity News: “Want to spread fewer germs in hospitals? Ditch the handshake, go for a fist bump”
  • CBC News: “Doctors encourage ‘fist bump’ over handshake to prevent illness”
  • National Geographic: “Why Germs Prefer Handshakes to Fist Bumps”
  • FierceHealthcare: “Want to cut HAIs [Hospital Acquired Infections]? Try a fist bump”


This is just one of many examples of the media sensationalizing the findings of a paper far beyond what it is due. The idea is interesting and might be worth studying further with a few more subjects and then trying to prove that more infections were actually transmitted by the handshake than the fist bump.

To be fair, other than confusing or possibly scaring many patients, it would cause no harm to offer them a fist bump.

But if I were the authors, I wouldn’t book my tickets to Stockholm to receive the Nobel Prize yet, and if I were working for a media outlet, I’d take a Xanax.

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last three years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 1400 page views per day, and he has over 8100 followers on Twitter.

  • VV says:

    Considering the old Tulane study which measured how frequently Infectious Disease specialists at a meeting washed their hands after using the restroom ( @17% of men, I believe; women slightly higher percentage…) : I don’t want to touch ANYBODY away from the scrub sink! Eeeeewwww!!!

    • SkepticalScalpel says:

      Was that really a study? I’d love to see the reference or a link to it.

      • Saif says:

        Study or not, it is not uncommon to see someone exit a stall or urinal, maybe take a look in the mirror and walk out the door. (I’m speaking in general terms) And, for those who wash, how many then grab the door knob without a cover and contaminate their hand again. Bottom line, don’t share a bag of chips.

        • SkepticalScalpel says:

          I agree many do not wash their hands after using the restroom. But I must point out that the practice of not using a paper towel to open the restroom door is unheard of outside of medicine. Yet to my knowledge, there have been no epidemics traced to grabbing a door handle with bare hands.

  • 99bonk says:

    How about elbow bumps instead?

  • Steve Bornfeld says:

    What medical study (no matter how good or bad) hasn’t been mangled in the popular press?
    How’s this one : On a health-related forum, I asked a physician what was his choice for dry, cracking fingers (exacerbated by washing of course–probably by contact with cold and ice melt as well).
    His answer was that he didn’t wash his hands between every two patients–he used hand sanitizer, and washed only after every 5 or 10 patients. (“Oh yes,” he said; it was supported by clinical research!)
    I threw up a little in my mouth. My fingers are still cracking.

  • John R. Agnew, M.D. says:

    Considering all the bad–worse–awful news of late, maybe we could cut them a little slack for something hopeful.

  • There is a third alternative which no one has mentioned. I believe it started in Ancient Rome although it is not clear. You take your hand and grasp the forearm of the other person. The other person does likewise. Thus, no matter how infectious your hand is, you are only contaminating the forearm and therefore unlikely to transmit anything. This works well for everyone. If you are a surgeon you will be scrubing your forearms before surgery anyway. I welcome any feedback. Thanks

    • SkepticalScalpel says:

      How about we salute like they do in the army? A salute has the advantage of no touch at all.

  • Morton I. Goldstein M.D. says:

    Strongly agree with the Salute as a greeting or exchange whenever a handshake would have been conventional. In practice it would become very well received. I have no interest in giving or receiving a fist or elbow bump.

    • SkepticalScalpel says:

      I think we are on to something. The salute trumps the handshake and the fist bump because no touching is involved. Should be a standard military salute or the palm forward one favored by the Brits?

      • KAC RN says:

        I am a big fan of keeping my hands in my pockets. Present company excluded, I am sure, but surgeons are high enough on their own pedestals without being graced with a salute. LOL

        • SkepticalScalpel says:

          I’m not so sure. The more I think about it, the better I like the idea of a salute.

          • KAC RN says:

            You drive a hard bargain, but I am feeling generous. It’s Friday, after all. A salute it is. But don’t let this get around or everyone will be expecting one!
            How’s the shoulder? I’m 3 months out and up up 144 degrees and 20 pounds on the weights. I can sleep a few hours on it, but not all night. So close!

          • SkepticalScalpel says:

            I always return a salute. My shoulder is fine. Thanks for asking. It’s about 95% of normal range of motion. I’m back playing tennis way ahead of schedule. Keep up with your PT. You’ll be good as new.

  • Vince says:

    Perhaps the saying ” physician heal thyself ” since you have provided no link to the actual study I assume it was a medical professional that conducted the study and since it was published again I assume another group of professionals found it worthy of publication. In a time when c diff infections caused largely by practices in the medical profession…it is interesting you choose to ‘chastise the media.

    • SkepticalScalpel says:

      Vince, if you click on the word “study” in the first sentence of the post, you will find that it contains a link to the abstract of the original paper. I could not provide you with a link to the full text as it is not available online to non-subscribers to the journal. I do not know what you mean by “since it was published again.” It has not been published again to my knowledge. I wasn’t just chastising the media, I was pointing out that the study contained only 2 subjects and no proof that more bacteria are transmitted by a handshake. There is no connection between the study and the transmission of C. diff or any other disease.

  • Vince says:

    First off thanks for pointing out the link I missed it the first time.As for my comment about published again since this study was published in the Journal of Hospital Infection a peer reviewed publication that would be the published again reference I alluded to. Most of the time a study may be printed as an abstract and presented for Journal publication many do not make but lets not quibble over details. The important point is that since the title is “Reducing pathogen transmission in a hospital setting. Handshake verses fist bump: a pilot study” and the CDC as I recall recently published guidelines urging hospitals to become cleaned to combat a rapidly growing problem with c-diff infection largely transmitted in a hospital setting. Here it really dose not seem to be much of a stretch to believe that the less area that contacts a possible infected surface the less chance of infection. Considering the amount of truly bad science picked up and amplified by the media…this seems a relatively innocent choice to rail against.

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