Does the Fist Bump Transfer Less Methicillin-Resistant Staphylococcus aureus Than a Handshake?

Abstract

Background: Contaminated hands are the most important source for transmission of pathogens in healthcare settings. It has been proposed that replacing the handshake with alternative greetings such as the fist bump might reduce the risk for pathogen transmission. Methods: In a cohort of 50 patients with methicillin-resistant Staphylococcus aureus (MRSA) colonization, we compared the frequency of transfer of MRSA by handshake versus fist bump versus cruise tap (ie, a modified fist bump involving knuckle-to-knuckle contact with a single finger). MRSA-colonized patients performed each greeting with research personnel wearing sterile gloves, and cultures were obtained to determine the number of colonies transferred. Transfer by handshake was also assessed after MRSA-colonized patients used alcohol-based hand sanitizer. Quantitative cultures were obtained to compare the burden of MRSA on the palm versus dorsum of the hands of the MRSA carriers. Results: As shown in Fig. 1, there was a significant reduction in the frequency of MRSA transfer for the cruise tap compared to the handshake, but not for the fist bump. Use of alcohol-based hand sanitizer by MRSA carriers also significantly reduced the risk for transfer of MRSA. There was no significant difference in the burden of MRSA on the dorsum versus the palm of the hands (mean +SE colonies recovered, 32.7+12.3 vs 27.3+12.7; P > .05). Conclusions: The fist-bump greeting did not transfer less MRSA than a handshake. However, transfer was significantly reduced by a cruise-tap greeting or by handshake after the use of hand sanitizer. Modified greetings and patient hand hygiene are potential strategies to reduce transmission of healthcare-associated pathogens.

Funding: None

Disclosures: None