Handshakes must be banned or minimised

The cholera outbreak that has resulted in several deaths and the hospitalisation of more than 100 people, including two Cabinet secretaries, poses a national challenge.

Some of the deaths were associated with an upper-class event in Nairobi where an outdoor catering company provided the meals and public health officials suspect that the food was contaminated.

Measures taken by public health officials to contain further spread of the disease, include the cancellation of medical certificates issued to food handlers.

Two hotels were closed and the Ministry of Health directed that all food handlers be re-tested within 21 days and new public health compliance documents issued.

In addition to also doing an environmental sanitation audit, the strategy should include changing people’s behaviour and specifically common practices such as the handshake, which can help spread diseases.

DISEASES

Infectious diseases such as cholera are transmitted mainly through contaminated food and water, but they can also be passed on through contaminated hands.

Studies have shown that handshakes are very unhygienic and researchers have recommended banning the practice in hospitals.

Handshaking is part of many cultures and is used as a form of greeting or farewell.

In business circles, it is used as a sign of respect or indication that an agreement has been made.

However, in medicine, and especially in surgery, the hand is known to harbour many micro-organisms that cause diseases.

Health care workers pick up disease-causing bugs during direct contact with patients, contaminated surfaces, fabrics and objects in health facilities.

INFECTIONS

The micro-organisms multiply on the skin and may be easily transferred from one person to another, spreading respiratory and skin infections, worm infestations, hepatitis, Ebola and diarrhoeal diseases such as cholera.

Studies have shown that washing hands with soap can reduce acute respiratory infections by 23 per cent and prevent diarrhoea-related deaths, especially among children below five.

Kenya needs to tap messages from global hand washing campaigns to emphasise the role of each person in preventing cholera spread.

Cholera, which affects both children and adults, is caused by an infection of the intestines with the bacterium Vibrio cholerae.

Cholera outbreaks are more common where water supply, sanitation, food safety, and hygiene are inadequate.

The greatest risk occurs in densely populated areas, especially those with unsafe drinking water.

EBOLA

Cholera spread can be reduced by modifying behaviour, especially handshakes. During the Ebola outbreak in West Africa in 2014 people stopped shaking hands and used the “Ebola elbow shake”.

The Ghana Medical Association and health authorities in Uganda are also warned people to avoid handshakes.

If people stopped handshakes and washed hands with soap and running water, the transmission of germs would be minimised.

A campaign can promote positive behaviour change with alternatives such as fist and elbow bumps, a nod, bow, pat on the head or wave.

The handshake is, however, an integral part of many cultures, health campaigns discouraging it are likely to meet resistance.

This can be overcome by the involvement of community champions, opinion-shapers or health workers in communicating the message.

Sustained infection prevention and control strategies should be encouraged to reduce transmission of infectious diseases.

 Dr Wanjeri is a lecturer in the Department of Surgery of the University of Nairobi. [email protected]