The Nib

It occurred to us that bumping each other’s elbow by two people could be a terrific way of minimizing both contamination and transmission between people. Although bumping elbows is not a new concept our idea was to give the act of bumping elbows a new name, a new beginning and new notoriety. What would be the most efficient way to promote this approach? Our thought was to give the elbow bump a new name: a name that was short, quick and fun.

Initially we thought of NIBTM as being an acronym for “Non-Infectious Bump”. It was a short word, easily remembered, and brought an immediate smile to patients’ faces.

After simultaneously bumping a patient’s elbow with my own elbow and reciting “Do the NIBTM”, the first several patients looked at me with an inquisitive pause, as if to say “what does this mean?” After a quick explanation of the word’s meaning, smiles came to their faces and the NIBTM would be repeated several times. Parents started asking their children to bring the NIBTMto school and teach their friends. Patients whose occupation is teaching were going back to school the next day and teaching whole classrooms full of eager students to “do the NIBTM”.

Thus the NIBTMwas readily accepted by my patients as part of the ritual of greeting the doctor. Elbows would bump upon entering the room and it became everyday commonplace for me, the doctor, and the patients to recite the words: “Do the NIBTM” during the elbow bump! We have been doing this each day with each patient for several years.

As we began to formalize the NIBTM as an approach to prevent disease across much larger populations, we started to review scientific studies. Clearly hand washing and hand decontamination with alcohol has become the gold standard for safe touching.

As regards elbow bumping there is no study which examined disease transmission by elbow bumping versus hand washing as a direct comparison. However, a review of the Center for Disease Control website and other literature revealed that medical clothing, such as doctors’ white jackets and ties, can indeed transmit virus and bacterial to patients. In addition, elbow skin containing virus or bacteria on its surface can be transmitted to another person’s elbow skin as a normal course of everyday life. In theory, even though elbow-bumping people are not shaking hands, some contamination between elbows is still possible.

Thus we now consider NIBTM to be an acronym for “Not- so Infectious Bump” (as compared to hand contamination and pathogen transmission). There is little doubt that elbows carry less pathogens as compared to unwashed hands.

Methods of Doing the NIB: “Right to Right, Left to Left”

We are suggesting that people who are right-handed use their right elbow to touch the right-sided elbow of the other greeted person. People who are left handed should use their left elbow to touch the left-sided elbow of the other person. You can remember this most easily by the following shortened version of the concept:” right to right, left to left”.

When you adhere to the right to right, left to left guideline, the heads of the two people will be slightly turned away from each other. We think this is important to minimize the chance of droplet spread from the mouth of one person to another. Thus when “doing the NIBTM” we stress the importance of NOT looking directly at the other person’s face.

In the setting of respiratory diseases you may recall that disease can be spread by 1) direct contact of a contaminated hand with the mucous membranes of the eye, nose or throat, or 2) by droplets that are exhaled by one person and inhaled by another person or deposited on the other person’s mucous membranes. Science has taught us that droplets can travel 3 to 6 feet from one person to another.

During the process of shaking hands most people look directly into the face of the other person. Given that holding another person’s hand will require each person to be located just a foot or two from the other person, disease spread by droplet is likely when shaking hands.

By turning our heads slightly away from each other during the course of doing the NIBTM, we are hoping to minimize droplet spread of disease, yet still be close enough to each other to have physical contact with our elbows.

Fun With the Nib

Our trademark, like all trademarks, is a noun: “do the NIBTM”. The word NIBTMdescribes an action which involves bumping elbows as a greeting. The use of a noun is a requirement of the US Patent and Trademark Office to obtain a trademark. Indeed we have applied for a trademark using NIBTM as a noun.

However, you can expand this grammar restriction by making the NIBTM a verb in colloquial language. For example you could say to a friend: “let’s NIB with each other” or “let’s NIB it”! Given that our central theme “do the NIBTM” is a sentence that describes an action, it is easy to consider NIBTM as a verb as well as a noun.

“Do the NIBTM” sounds to many people like you are describing a dance. You may recall dance names of prior times using phrases like: “do the hokeypokey”. Thus when people are in the mood it can be fun to expand on the NIBTM interaction to create a short dance. Children warm up to this quickly.

One such dance we call the “double cross NIBTM”. This consists of “right to right elbow touch, left to left elbow touch, then repeat the sequence. We see great smiles and giggles with children when doing the double cross NIBTM.

Alternatives to Elbow Bumping

The NIBTM can also be interpreted as a shortened version of the phrase: “ non-infectious bow”. In this case elbows will not touch each other: no contact between persons occurs. The only downside of this approach is that two people greeting each other will directly facing each other’s face. If they stand less than 6 feet from each other, droplets containing virus or bacteria may spread from one person to the other.

Indeed many countries in east Asia are characterized by bowing as a non-contact form of greeting. Bowing is common in Japan, Thailand, India, Nepal, Myanmar and other countries.