Handshakes are a staple at graduation, germs or no germs

Before the Johns Hopkins University president gives 1,300 graduating students their congratulatory handshake on Thursday, volunteers will give them a cautionary dollop of hand sanitizer.

"What can I say? We're a health-conscious university," said Dennis O'Shea, spokesman for Hopkins.

Since the influenza epidemic of 2009, gel disinfectant has been spreading around schools like strep on throats. Yet there's little scientific evidence that harmful bacteria are passed through a casual squeeze of the hands during commencement. One of the first studies to put the handshake under the microscope comes from Hopkins School of Public Health, and it shows little danger from dangerous pathogens.

And other, more general research may make deans, presidents and principals question why they ever bother to wash.

Another Hopkins researcher recently found that the automatic faucets common in public bathrooms are harboring excess bacteria such as Legionella. A study led by an Ohio researcher found refillable soap dispensers so prone to contamination that users' hands may be more bacteria-laden than before they were washed. And a University of Virginia study last year found that alcohol-based sanitizers aren't very effective in preventing colds or flu.

Still, the hand-shaking Hopkins researcher is not anti-hygiene. Dr. David Bishai is a professor in the School of Public Health, after all.

Watching graduation after graduation, he said, the scary pathogens stuck to the dean's hands "was all I could think about." For his study, more than a dozen deans agreed to be swabbed before and after their 2008 ceremonies — though some had to be disqualified for sneaking sanitizer every 10 or 20 students.Turns out that palms, unless extra moist from stress, just aren't good receptors for pathogens.

Bishai insists that hand-washing is still a good idea. There's still bad stuff out there, such as antibiotic-resistant Staphylococcus aureus, or MRSA. But his study, published in the June issue of Journal of School Nursing, found only one dangerous bacterial pathogen per every 5,209 on someone's hand.

"I thought I'd get a big grant from Purell to study more graduations," he said. "But no. The level of bacteria at graduations is probably smaller than you thought it was. So chill out: A graduate's hand is probably not the dirtiest thing you are going to touch on graduation day."

The reward also far outweighs the risk, said Dr. E. Albert Reece, vice president for medical affairs at the University of Maryland and dean of the School of Medicine.

"Graduation is a very important event for us and for the students, and shaking hands is not only an important symbol but it has far-reaching implications for the spirit of the day," he said. "A bit of extra hand-washing after is small price to pay for being part of the wonderful festivity."

In a nonhospital setting, among the scrubbed and dressed graduates, he said, there is little chance of obtaining dangerous bacteria. And in the spring, Reece said, there usually is little risk of a virus such as influenza, which the Hopkins study didn't test for.

He said hospital workers likely have far more dangerous pathogens on their hands and still need to wash regularly. Ditto for anyone using the bathroom and serving food. Extra steps also are definitely warranted during flu season — a former Maryland health secretary began bumping elbows instead of shaking during the H1N1 flu epidemic.

Reece also recommends hand-washing before a post-graduation meal. The risk is low, not zero, he noted. And pathogens make you sick when they enter your body through your mouth or nose. He keeps sanitizer in his dressing room. (For the sanitizer to be effective, a good dose, well-rubbed, is necessary.)

Officially, no one in Maryland wants to quash tradition, said Alvina Chu, chief of the division of outbreak investigation at the Maryland Department of Health and Mental Hygiene. But if someone is sick or is immune-compromised in some way, they ought to consider keeping their hands to themselves.

"It should be socially acceptable not to shake hands," she added.

It's not clear how much hygiene advice and sanitizer is being dispensed at graduations this year, since many schools say they don't have a specific policy. But the germ-killing gel still seems abundant. The University of Maryland, Baltimore County, for example, which made shaking optional at graduation during the flu epidemic, according to news reports, now says only that sanitizer is available.

The University of Maryland, College Park didn't take any specific steps for graduation last week but added sanitizer dispensers in campus buildings in 2009.

O'Shea, the Hopkins spokesman, says that despite the new data from one of the university's own researchers, the sanitizer will likely stay in place at Thursday's graduation.

He added, "We are a research university, committed to evidence-based best practices, so we might take another look later on. On the other hand, a little hand sanitizer never hurt anybody."

Source: By Meredith Cohn, The Baltimore Sun