Fist Bumps Instead of Handshakes?

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...
Critical Considerations for Blood Culture

Critical Considerations for Blood Culture

Sepsis and septic shock are leading causes of morbidity and mortality in the United States and represent an increasing problem for patients, providers, and healthcare systems. Studies indicate that these conditions contribute to more than 20,000 deaths per day worldwide. Despite the emergence of newer microbiology technologies, blood cultures continue to be indispensable tests for the microbiology laboratory. Positive blood cultures are often a critical step in diagnosing sepsis and are required for downstream identification and susceptibility testing. Significant advances have been made in automated blood culture systems, including the addition of enriched growth media, enhancements in automated agitation systems, and improved growth algorithms. Despite the progress, obtaining blood cultures before initiating anti-infective therapy and ensuring appropriate fill volumes of 20 mL to 40 mL of blood per venipuncture remain key factors in the successful detection of adult bacteremia. In some healthcare settings, anaerobic bacteremia has reemerged as a significant clinical problem, most likely due to more patients presenting to these institutions with complex underlying diseases. Reaching Clinical Goals Initiation of prompt, appropriate antimicrobial therapy in patients at risk for sepsis is a critical clinical goal, but doing so before culture collection may delay or prevent pathogen recovery. To address this issue, blood culture manufacturers have incorporated blood-broth ratios and/or proprietary antimicrobial removal systems into media to minimize the impact of antimicrobials and facilitate pathogen detection. For example, the BACTEC Plus (Becton Dickinson) and BacT/Alert (bioMérieux) are two frequently used aerobic blood culture media that incorporate the use of proprietary antimicrobial removal systems. The BACTEC medium uses proprietary resin beads, whereas the BacT/Alert medium uses Ecosorb (a blend of...