Disclosures: Donskey reports receiving research grants from Clorox, PDI and Pfizer. All other authors report no relevant financial disclosures.
October 23, 2021
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Fist and elbow bump greetings frequently result in transfer of MRSA

Disclosures: Donskey reports receiving research grants from Clorox, PDI and Pfizer. All other authors report no relevant financial disclosures.
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Fist bump and elbow bump greetings both resulted in the frequent transfer of MRSA from colonized patients, although significantly more MRSA colonies were recovered from fists vs. elbows, according to a study.

Curtis J. Donskey

“During the pandemic, there has been a major shift from the handshake to alternative greetings like the fist bump and elbow bump. However, we previously reported that both fist bump and handshake greetings frequently transfer MRSA and benign viruses that are surrogates of SARS-CoV-2,” Curtis J. Donskey, MD, professor of medicine at Case Western University and staff infectious disease physician at the Louis Stokes Cleveland VA Medical Center, told Healio.

Alhmidi H, et al. Infect Control Hosp Epidemiol. 2021;doi:10.1017/ice.2021.435.
Alhmidi H, et al. Infect Control Hosp Epidemiol. 2021;doi:10.1017/ice.2021.435.

“We conducted this study to test whether the elbow bump might a safer greeting than the fist bump,” Donskey said. “We studied MRSA-colonized patients because they often have MRSA contamination on their skin and clothing.”

Donskey and colleagues conducted a cohort study of 40 patients in isolation for MRSA colonization who had positive anterior nares screening results within 1 month of enrollment. According to the study, each person greeted a research staff member once using their right fist or elbow and left fist or elbow. All recipients wore a sterile glove on the hand that received the fist bump or a 10-by-10-cm section of cotton cloth cut from hospital scrubs over their elbow, which were imprinted directly on plates containing cefoxitin for assessment.

Among the 40 MRSA-colonized patients, 32 participants had anterior nares cultures, 18 (56.3%) of whom tested positive for MRSA.

Donskey and colleagues reported that MRSA was recovered more frequently from the fist vs. elbow of MRSA-colonized patients (16 of 40, or 40%, vs. nine of 40, or 22.5%; P = .02), but there was no significant difference in the frequency of MRSA transfer for the fist bump vs. the elbow bump (10 of 40, or 25%, vs. six of 40, or 15%; P = .13). They said significantly more MRSA colonies were recovered from fists vs. elbows and more MRSA colonies were transferred by fists vs. elbows (P < .01).

“All greetings that involve hand-to-hand contact are a public health hazard. The elbow bump may be preferable to handshake and fist bump, but it also poses a risk for pathogen transfer,” Donskey said. “Noncontact greetings should be encouraged to reduce the risk for transmission of health care-associated pathogens and respiratory viruses.”