Recently a very interesting article appeared in The American Journal of Infection Control.

The authors observed that the traditional handshake was contributing significantly as a way to transmit bacterial infections, at least in the hospital setting.

Authors Sara Mela and David Whitworth titled their article “The Fist Bump a More Hygienic Alternative to the Handshake.”

In this study participants wore sterile gloves and dipped their hands in a nonpathogenic strain of E. coli bacteria. Then they made hand contact with a partner and the transferred bacteria were then counted on the recipient’s gloved hand.

Viruses were not tested in order to prevent disease but it was assumed that the results would be similar.

What they found was that the fist bump was 20 times more hygienic than the handshake and 10 times cleaner than the high five hand slap.

The traditional handshake transferred 124 million colonies of E. coli. It was assumed that the handshake transferred more bacteria due to the larger contact area, hand pressure and longer exposure time.

They conclude their article by saying, “for the sake of improving health, we encourage the fist bump as a simple, free and more hygienic alternative to the handshake.”

A strong handshake in other studies as measured on a dynamometer transferred twice as many germs as did a moderate handshake.

It has been assumed that the handshake originated as a peaceful gesture to show that you did not hold a weapon in your hand.

Artifacts from ancient Greece depict the open hand as a gesture of trust and honesty. The first recorded handshake appears on ancient monuments in Babylon and Greece dating back to 500 B.C.

It seems, however, that bacteria could be a silent, invisible and unintentional weapon related to a peaceful greeting.

There was also an editorial in recent July 25 issue of the Journal of the American Medical Association recommending banning the handshake at least in the health care setting.

Others have called the handshake a “fitly disease spreading tradition.”

During the 2009 H1N1 flu epidemic a Canadian medical school recommended the fist bump as a replacement, at least in the hospital setting.

You can even buy a lapel pen if you are so inclined. The cost is $9.95, just visit

Some politicians seem to prefer the two handed hand hug as a greeting. Perhaps they feel that it appears warmer and more trustworthy. But at least one politician, Myron Lowery, the mayor of Memphis greeted the Dalai Lama in 2009 with a fist bump as he also said “Hello, Dalai.”

In summary, the fist bump is probably healthier than the “archaic custom” of the handshake, therefore knuckle down and do the bump.

David Keisler is a gastroenterologist and internist in Aiken.