Nosocomial Hazards of Doctor`s Mobile Phones in Hospitals
A microbiological analysis of 75 doctor`s mobile phones was carried out
in Amravati city. A total of 90 bacterial pathogens were isolated, Staphylococcus
aureus 18 (20%) was prominent followed by Micrococcus luteus 16
(18%), Pseudomonas aeruginosa 14 (15%), Proteus mirabilis
10 (11%), Escherichia coli 10 (11%), Klebsiella pneumoniae
9 (10%), Enterobacter aerogenes 8 (9%) and Salmonella typhi
5 (5%). The male doctor`s mobile phones were more (69%) contaminated as
compared to female doctor`s phones (31%). The study demonstrates that
mobile phone in a clinical setting become contaminated by contact with
healthcare workers` hands (HCWs`) and acts as potential source to spread
infection is an important argument in any debate, in which the relaxation
of restrictions on its use is being considered.
Despite the advances in modern medicine, nosocomial infection still poses
a risk of increased morbidity and mortality to patients and the hands
of healthcare personnel may play an important role in the transmission
of Hospital-Acquired Infections (HAIs) (Landman et al., 2002; De
Gheldre et al., 2001). However, the etiological agent of HAI varies
from hospital to hospital and in different geographical regions (Struelens
et al., 2004). These days, mobile phones utilization has increased
in healthcare system and its acceptance by healthcare personnel. Few studies
have been reported from India (Khivsara et al., 2006; Tambekar
and Dahikar, 2006), Israel and Spain (Meltzer, 2003), that mobile phone
may also involved in the transmission of infections in the healthcare
systems (Borer et al., 2005; Brady et al., 2006; Brandy,
2006; Dubik, 2006) and threatening infection due to potential pathogens
could be acquired from doctor`s mobile phones in hospitals, which cause
great concern to everyone (Derbyshire and Burgess, 2006; Bhattacharya,
Moreover, the increased use of mobile phones is seen against a background
rise in nosocomial infection rates. The sources of contamination of mobile
phones include hands of healthcare personnel, inanimate objects (bed,
instruments, furniture etc.) and pathogenic air flora of the hospitals
(Rafferty and Pancoast, 1984). Hospital acquired or mobile phone transmitted
infections are therefore a constant thereat to the lives of already seriously
ill patients as well as healthy individuals visiting the hospital (Muhall,
1997; Myerson and Mitchell, 2003). The present study was undertaken to
investigate potential of doctor`s mobile phone to carry bacteria known
to cause nosocomial infection and to develop awareness in doctors, patients,
visitors and other healthcare workers for proper handling of mobile phone.
Due to relative lack of research into the doctor`s mobile phone pathogen
transmission tends to conduct role of doctor`s mobile phones in infection
transmission in hospital settings in Amravati city, India.
MATERIALS AND METHODS
Sample collection: A total of 75 mobile phone swab samples of
different speciality doctors (surgeons and non-surgeons) were collected
in Amravati city and analyzed for presence of bacterial pathogens on it
(Table 1). The doctor`s mobile phone swab samples were
collected in sterile vials by using sterilized cotton bud dipped in saline
water (0.85%). Before taking swab samples, both hands were thoroughly
washed with soap and disinfected with alcohol. The sterilized cotton bud
was rotated onto the overall surface area of the mobile phone by keeping
the mobile phone in two fingers. The cotton bud swab after swabbing the
mobile phone was again kept in the respective sterile vials.
||Speciality wise doctor`s mobile phone analyzed from
Amravati city hospitals
Isolation and identification of pathogens: The study was carried
out over a period of four months from July to October 2006, during which
random sampling of mobile phones (n = 75) was done. These collected samples
were immediately transported to the microbiology laboratory and inoculated
onto MacConkey agar plates, Cetrimide Agar and Mannitol Salt agar plates
(Hi-Media Laboratories, Mumbai). These plates were incubated at 37°
C for 24-48 h. Plates were observed for growth and a Gram smear was performed
from different types of colonies. Gram reaction, colony morphology, pigment
formation, florescence, catalase, coagulase, urease and oxidase tests
were performed and allocated to appropriate genera to the isolates. The
cultural characteristics including lactose fermentation by enterobacteriaceae
on MacConkey agar, pyocynin formation of Pseudomonas sp. on cetrimide
agar and golden yellow colored colonies of Staphylococcus aureus
on mannitol salt agar were noted. Further identification to species level
was carried out on the basis of various specialized tests. Methicillin
resistant Staphylococcus aureus (MRSA) isolates were confirmed
on Columbia plus 2% NaCl agar (Hi-media) with a methicillin 5 mg disc
A total of 75 doctor`s mobile phone swab samples were analyzed for the
presence of bacterial pathogens, (48 swabs from male and 27 from female
doctors` mobile phone), 71 showed growth of 8 various genera of 90 bacterial
pathogens. The Staphylococcus aureus 18 (20%) was the dominant
pathogen followed by Micrococcus luteus 16 (18%), Pseudomonas
aeruginosa 14 (15%), Proteus mirabilis 10 (11%), Escherichia
coli 10 (11%), Klebsiella pneumoniae 9 (10%), Enterobacter
aerogenes 8 (9%) and Salmonella typhi 5 (5%) Among the
Staphylococcus aureus, 15 (83%) were MRSA (Table 2).
In total, 95% of mobile phones demonstrated evidence of bacterial contamination,
4 (5%) (3 belongs to non-surgeon`s, 1 ayurvedic and 2 homoeopathic doctor,
1 belongs to cardiac surgeon) did not show any growth whereas 52 (70%)
showed growth of single bacterial pathogen, of which 40 belongs to non-surgeon`s
while 12 surgeons and 19 (25%) showed 2 pathogens each belongs to 12 non-surgeon
and 5 surgeon (Table 3).
Among different disciplines (pathy`s) doctor`s mobile phones, 98% allopathic,
86% ayurvedic, 82% homeopathic and 100% dentist`s phone were contaminated.
Out of 90 bacterial pathogens isolated, 69 (76%) were found on allopathic
doctor`s mobile. On comparison, 46 (96%) swabs from male and 25 (93%)
from female doctor`s mobile phones were found contaminated with pathogens.
Out of 90, 62 (72%) pathogens were found on male doctor`s phone while
25 (28%) on female doctors` mobile phone (Table 4).
|| Bacterial pathogens from doctors` mobile phone
||Analysis of doctor`s mobile phone swab for presence
of bacterial pathogens
The microbial contamination observed in doctors mobile phones were similar
with the reports of Brady et al. (2006), who reported high rate
of mobile phone contamination by pathogens known to cause nosocomial infection
(Table 2). A similar study at Soroka hospital in Israel
found that 12% of mobile phones belonging to doctors and nurses carried
drug-resistant bacteria that can be lethal to critically ill patients.
Hence, the use of mobile phones in patient-care areas has been banned
in that hospital (Meltzer, 2003).
The non-surgeons mobile phone were comparatively more contaminated with
bacterial pathogens, it may be due to not following the preventive measures
(like hand washing practices) strictly as that of the surgeon. The potential
of mobile phones of healthcare workers to serve as a reservoir of bacteria
known to cause nosocomial infection was reported by Khivsara et al.
(2006). They reported high levels (40%) of contamination in these
phones by Staphylococcus aureus and its MRSA at a hospital in Mangalore.
All types of isolated pathogens were found on allopathic doctor`s mobile
phone, it might be due to environments, except those maintained under
sterile conditions, harbors microorganisms that may be pathogenic (Rhame,
1998). In ayurvedic doctor`s, the female`s mobile phone were 100% contaminated
by pathogens while that of male 50%. The dentist`s (Male/ Female) mobile
phones were 100% contaminated, homeopathic male doctors mobile phones
were 100% and females phones were 66% contaminated by pathogens (Table
4). The different methods of handling and treatment of patients by
various pathy`s doctors, the bioburden of pathogens varies along with
different activities of patients like coughing, sneezing, loud talking
etc. expel the pathogens in the environment, which might get adhered onto
the doctors` mobile phone.
|| Comparison of pathogens obtained on male and female
doctors` mobile phones of different discipline
The male doctors` mobile phone were comparatively more contaminated than
female doctor`s phone with bacterial pathogens, it might be due to the
reason that female doctors often keep their phones in purses and use less
frequently during their duties. On the other hand, male doctor keeps their
mobile phones in their pockets and used frequently anywhere, any time
whenever it is needed and thus contaminated and played an important role
in transmission of pathogens.
Present results indicate that mobile phones may get contaminated through
the hands. Hence, these mobile phones when used carelessly in the ICU
or surgical wards may act as a source of infections to patients. Moreover,
these contaminated mobile phones and the hands of the healthcare professionals
may also pose a danger in the spread of infection to the community. These
findings clearly explain that, growth of organisms from mobile phone samples
of healthcare professionals (71 out of 75) could be due to relaxed hand
washing practice after patient examination. Surely, the best measure for
avoidance of HAI is effective training and implementation of strict hand-hygiene
measures, thus avoiding mobile phone contamination in the first place.
CONCLUSION AND RECOMMENDATIONS
This study demonstrates that mobile phone in a clinical setting become
contaminated by contact with healthcare workers` hands (HCWs`). The potential
of mobile phones to spread infection is an important argument in any debate,
in which the relaxation of restrictions on use is being considered. However,
development of effective preventive strategies such as regular decontamination
of mobile phones with alcohol disinfectant wipes to reduce the bioburden
combined with emphasis on hand hygiene are necessary to prevent cross
infection in healthcare system. Nevertheless, further studies involving
more number of samples are needed to substantiate the role of mobile phones
in the transmission of infection to critically ill patients in the hospitals.
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