Rethinking the System: Atul Gawande's HMS commencement address

JR Hildebrand and his pit crew

"A structure that prioritizes the independence of all those specialists will have enormous difficulty achieving great care...We don’t have to look far for evidence. Two million patients pick up infections in American hospitals, most because someone didn’t follow basic antiseptic precautions."

You can read the full speech in the New Yorker (here)

Is a graduation handshake a risk factor for bacterial pathogens?

University of Maryland dean, Dr. E. Albert Reece,
shakes hands during a graduation

In all likelihood, many of us have just suffered through enjoyed sitting through a recent preschool, high school, college or medical school graduation. The astute readers of this blog probably noticed the alcohol hand rub dispensers on stage for use by the graduates prior to shaking their dean's hand. You also noticed how few graduates actually used the dispensers.  Maybe they were nervous or rushed or were already wearing gloves to go with their graduation gowns...cool contact precautions.

So, should a dean worry about catching bad bugs from their students?  According to a new study published in the Journal of School Nursing, there is very little risk of acquiring a bacterial pathogen during a brief hand shake. In the study, cultures were collected from school officials' hands before and immediately following graduation. From a sample of 5,209 hands, Staphylococcus aureus was separately detected on one pregraduation right hand, one postgraduation right hand (different strain), and one postgraduation left hand, while nonpathogenic bacteria were found on 93% of the hands. They estimate the acquisition risk as 0.019 pathogens acquired per handshake. Of course, the study didn't test for viral transmission, which to me is a bigger worry.

Bishai D et al. Journal of School Nursing, May 11, 2011

New York Times LA Times May 23, 2011 (Dr. Reece from U. Maryland School of Medicine is quoted in this article)