Infections cause serious illnesses, often resulting in death. The Ebola epidemic is a well-publicized example, but it is a rare illness. More common infections include influenza, pneumonia, urinary infections, and bronchitis. How do we catch these illnesses? The source of these infections can be contact, as can happen in a hand shake, droplet infection from coughing as with influenza, or contamination by body fluids as with Ebola. Current recommendations to reduce infectious spread of disease, even for Ebola, include avoiding contact and using hand washing.
In clinical medical practices, physicians and nurses often give patients a welcoming and supportive atmosphere by shaking hands, sometimes hugging, and occasionally giving pats on the shoulder. These gestures enhance patient physician relationships. Or at least, they have in the past.
Recently, a new viewpoint has just been published. They make a strong argument for greetings at a distance, and totally banning the hand shake (and presumably the hug and pat also) from all health care settings. Another study has shown that doing a hand bump transmits fewer germs than shaking hands.
Interestingly, the common social custom of hand shake dates back to the Greeks who used the open palm to indicate trust. More scientifically, recent studies have shown that brain activity has more positive attitudes associated with hand shakes. Trust is today what we continue to seek between doctors and patients. But hand contact transmits diseases, and is the rationale for recommendations for required hand washing in patient care.
Do we doctors do it? Hospital worker compliance with hand washing averages only 40 percent. Some studies are as low as 35 percent! In my experience, my patient and visitor compliance is much lower than physician compliance.
So what have we done to reduce the risk of infection due to contact between patients and their health care workers? Alcohol based hand rubs (e.g. Purell and others) have become very common, including in my office. But such rubs have only limited activity against some germs, such as Clostridium difficile (a common condition causing severe diarrhea and fever), and Norovirus (produces diarrhea). But alcohol sanitizing hand rubs containing over 60 percent alcohol are generally effective against most common germs.
Here are Dr. Cary's tips for you to prevent infection in the health care setting.
• Make it your rule to always wash your hands or use an alcohol hand rub every time before and after entering a doctor's office or hospital or medical facility of any kind.
• Follow the official guidelines for hand washing, and use soap and running water, lather for 20 seconds, and dry with a clean towel.
• Use alcohol rubs or sanitizers if your hands have been clean and are not contaminated with dirt, soil or waste. If they are contaminated, use hand washing and dry towels after.
• Insist that your doctors, nurses, technicians, and aid workers wash their hands before touching you or your food to reduce risks of infection. For more information on talking with your doctors and nurses in the hospital, see my book Surviving American Medicine.
• If you want to shake hands, have a pat on the back or a hug from your physician, wash your hands after to be sure you remain healthy.
• Do not visit people who have infections. If you must visit, avoid touching as much as possible.
Social gestures are important to feel welcome, express trust, show gratitude, and conclude visits with a hopeful tone. Find the best way between you and your doctor to have these feelings (a bump, a wave, a Namaste, a bow or even a hand shake), but do not increase your risk of infection in the process. Put in place a better, safer habit not only for yourself, but also everyone in your family. Always be aware of others as a possible source of illness, and be cautious in how you interact with people.
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