With COVID-19 spreading at unprecedented rates, Dutch Prime Minister Mark Rutte has advocated against shaking hands as a simple way to eliminate one transmission path. A very sensible policy, but as he proved seconds later, not always easy to remember to do. So, how do you change infection control processes, and how do you ensure they are followed?
- Awareness
The first step is ensuring all relevant persons are aware of the problem and the risks of the present system. In the case of COVID-19, the most severe cases cause pneumonia, acute respiratory syndrome, kidney failure and even death. (WHO 2020). The main risk is through human contact: COVID-19 is spread through respiratory (and possibly fecal-oral) pathways. Handshakes have been proven to be an unhygienic greeting that can spread dangerous levels of bacteria (Mela 2014). Sensitising the public about such risks encourages people to adopt social distancing as part of their efforts to protect themselves and their families from infection.
- Designing simple policies
Yes, not shaking hands is easy to do but hard to remember. Ingrained habits are hard to shake. In the case of handshaking, introducing a safe alternative is a good way to help people transition to a different process. The ‘Wuhan handshake’ (touching feet instead of hands) is becoming a popular alternative to the traditional handshake. Alternatives should be designed with scientific research to support the change. Current handshake replacements work on a similar logic – if you cut out a stage for transmission, you can cut out a risk for infection. Simple.
- Ease
Processes are best followed when they are easy, and preferably easier than the existing system. Take bedpan management, for example. Switching to single use is effective and popular with users as it is much easier than other alternatives. How do we transfer this logic to social distancing? Firstly, encouraging practices such as working from home will reduce the number of people seeing each other face-to-face so there will be less opportunity to have direct contact. Similarly, cutting public transport services can restrict the spread of potential carriers. Eliminating opportunities for contact will reduce disease spread.
- Auditing
Auditing is necessary to ensure that measures are both effective and followed. If they’re not effective, should they be scrapped or changed? If they’re not followed, why not? How do people carrying out these measures think they could be made more effective?
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Designing effective infection control practices is an essential part of improving safety in both healthcare facilities and public health. These steps should highlight the considerations to be made when drafting policy. For more information, get in contact with us at This email address is being protected from spambots. You need JavaScript enabled to view it..
Further reading
Mela, Sara, and David E Whitworth. “The Fist Bump: A More Hygienic Alternative to the Handshake.” AJIC: American Journal of Infection Control 42, no. 8 (August 2014): 916–917.
“Coronavirus: Dutch PM tells nation not to shake hands – then does” BBC News, March 10, 2020. https://www.bbc.com/news/av/world-europe-51820520/coronavirus-dutch-pm-tells-nation-not-to-shake-hands-then-does.
“Coronavirus” WHO, accessed March 13, 2020. https://www.who.int/health-topics/coronavirus.
“Handshakes are potential harbingers of covid-19,” The Economist, March 6, 2020. https://www.economist.com/graphic-detail/2020/03/06/handshakes-are-potential-harbingers-of-covid-19.
