What happens when a hospital NICU goes handshake-free?

In an attempt to quell the spread of germs, two UCLA Medical Centers instituted so-called handshake-free zones in their neonatal intensive care units and published findings on the effects of the change in the American Journal of Infection Control.

Prior research has shown handshakes are a major source of germ transfer — per one 2014 study in the American Journal of Infection Control, handshakes transfer nearly twice as much bacteria than a high-five, for instance.

"We are trying to do everything except for the most obvious and easiest thing to do, in my opinion, which is to stop shaking hands," Mark Sklansky, MD, one of the authors of the most recent study, told NPR.

Researchers from UCLA tested the feasibility of establishing handshake-free zones by implementing them in the NICU at Ronald Reagan UCLA Medical Center and UCLA Santa Monica Hospital.

They hung signs around the unit explaining the new policy, printed educational materials for staff and patients and encouraged other forms of greetings, like nods, smiles or fist bumps. Additionally, they surveyed clinicians and patients before and after the zone was implemented to gauge reactions and if the number of handshakes actually dropped.

The survey revealed patients' families preferred a greeting involving eye contact, a smile, being addressed by name and being asked about their well-being over a greeting involving a handshake.

However, even after the zones were implemented, about a third of clinicians on the units still did not support the handshake-free zones. One commented, "If I have done my job, the risk of spreading germs is minimal … hand-washing is key, not the handshake." Others believed not shaking hands wouldn't have an impact on infection rates, and failing to shake a parent's hand may come off as rude.

Most of the clinicians who supported a no handshake policy were medical school students and nurses, while male physicians were more resistant to the change.

Even though not all clinicians supported the handshake-free zone experiment, the number of handshakes in the two NICUs did decrease as a result of the experiment.

While this study identified groups that may show resistance to going handshake-free and noted compliance with the handshake-free zone, it did not examine if infections went down as a result of the program. However, Dr. Sklansky "hopes to answer that question in a future study," according to NPR.

Editor's note: This story was updated May 31 to add the last paragraph.

More articles on hand hygiene:
Poor hand hygiene, other safety errors identified at NJ clinic where 40 were infected
10 latest healthcare hand hygiene findings
Study: Mixed media education effectively improves standard precaution compliance among nurses

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