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BRIEF RESEARCH ARTICLE
Year : 2019  |  Volume : 63  |  Issue : 2  |  Page : 147-150  

Microorganisms isolated from mobile phones and hands of health-care workers in a tertiary care hospital of Ahmedabad, Gujarat, India


1 Professor and Head, Department of Microbiology, Smt. N.H.L. Municipal Medical College, Ahmedabad, Gujarat, India
2 Assistant Professor, Department of Microbiology, Smt. N.H.L. Municipal Medical College, Ahmedabad, Gujarat, India
3 Third Year Resident, Department of Microbiology, Smt. N.H.L. Municipal Medical College, Ahmedabad, Gujarat, India

Date of Web Publication18-Jun-2019

Correspondence Address:
Nasiruddin Moinuddin Shaikh
Department of Microbiology, Smt. N.H.L. Municipal Medical College, Ahmedabad, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.IJPH_179_18

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   Abstract 


The mobile phones have become an inevitable part of life for communication everywhere. Hospital-acquired infections are causing increased morbidity and mortality of hospitalized patients. After getting approval from the institutional review board, a total of 300 samples from mobile phones and dominant hands of resident doctors, nurses, and support staff working in neonatal intensive care unit, pediatric intensive care unit, intensive care unit, and emergency ward were tested according to standard guidelines for culture. Of 300 samples tested, 144 (96%) mobile phones and 145 (96.66%) dominant hands showed contamination with one or more types of microorganisms. Monomicrobial organisms were recovered from 247 samples and polymicrobial organisms were isolated from 42 samples. Mobile phones and hands of helath care workers serve as a potential reservoir for hospital acquired infections as multi-drug resistant pathogenic bacteria as well as normal flora of skin were recovered.

Keywords: Health-care worker, hospital-acquired infections, mobile phone


How to cite this article:
Shah PD, Shaikh NM, Dholaria KV. Microorganisms isolated from mobile phones and hands of health-care workers in a tertiary care hospital of Ahmedabad, Gujarat, India. Indian J Public Health 2019;63:147-50

How to cite this URL:
Shah PD, Shaikh NM, Dholaria KV. Microorganisms isolated from mobile phones and hands of health-care workers in a tertiary care hospital of Ahmedabad, Gujarat, India. Indian J Public Health [serial online] 2019 [cited 2019 Nov 12];63:147-50. Available from: http://www.ijph.in/text.asp?2019/63/2/147/260597



The mobile phone has become an inevitable part of life for transmission and communication everywhere even in health-care facilities. The mobile phones among health-care workers (HCWs) act as a source of infections to patient while handling them. It facilitates the spread of microbes from one patient to another in different areas of hospital wards.[1],[2] Healthcare-associated infections spread through hands of HCWs, inanimate hospital objects, patient care equipment and instruments, and hospital environment. These infections are increasing day by day and are causing increased morbidity and mortality of hospitalized patients and also a significant financial burden.[3] The aim of the present study is to identify the presence of microorganisms on hands and mobile phones of HCWs.

After getting ethical approval from the institutional review board, the study was carried out at a tertiary care hospital of Gujarat state, India, from May 1, 2017, to June 30, 2017. A total of 300 samples from mobile phones and dominant hands of resident doctors (Group A), nurses (Group B), support staff (Group C; sweepers and helpers) working in neonatal intensive care unit (NICU), pediatric intensive care unit (PICU), intensive care unit (ICU), and emergency ward (EW) were included in the study. Each group comprising 50 personnel provided 100 samples. Prior informed consent was taken from all participants.

Latex gloves were worn before collecting samples. Sterile swab moistened with normal saline was used to collect samples from hands and mobile phones of health care workers. Front and reverse side of mobile phones were sampled. The dominant hand including the palm, webs, and fingers of HCWs were sampled. Both swabs were inoculated on nutrient agar, MacConkey agar, and blood agar and then incubated at 35°C ± 2°C for 18–24 h aerobically. The microorganisms isolated were identified as per the standard laboratory guidelines.

Cefoxitin disk (30 μg) was used to detect methicillin-resistant Staphylococcus aureus (MRSA) by Kirby–Bauer disk diffusion method, and the results were interpreted as per the Clinical and Laboratory Standards Institute guidelines.[4]

A total of 150 mobile phones and 150 dominant hands of HCWs were tested. Of these, 144 (96%) mobile phones and 145 (96.66%) dominant hands showed contamination with one or more types of microorganisms.

Of 144 mobile phones, the highest contamination rate was noted in resident doctors (32.66%) followed by support staff (32%) and nursing staff (31.33%). Of 145 contaminated dominant hands, the highest contamination rate was observed in support staff (32.66%) and resident doctors (32.66%) followed by nursing staff (31.33%).

The total number of bacterial isolates recovered from 144 mobile phones of HCWs was 161. Recovered isolates were coagulase-negative Staphylococcus (CoNS) (85; 52.79%), followed by Bacillus species (22; 13.66%), methicillin-sensitive S. aureus (MSSA) (14; 8.69%), Klebsiella pneumoniae (10; 6.21%), Acinetobacter baumannii (10; 6.21%), MRSA (9; 5.59%), and Corynebacterium species (5; 3.10%).

The total number of bacterial isolates recovered from dominant hands of HCWs was 172. Recovered isolates were CoNS (87; 50.58%), followed by Bacillus spp. (25; 14.53%), MSSA (17; 9.88%), K. pneumoniae (12; 6.97%), Enterococcus sp. (10; 5.81%), A. baumannii (8; 4.65%), and MRSA (4; 2.32%).

A total of nine MRSA were recovered from mobile phones of four nurses, four support staff and one resident doctor. Among the total of four MRSA isolates from dominant hands, two was from support staff followed by one each from resident doctor and nursing staff.

The mobile phones of resident doctors showed that 7 out of 18 isolates of A. baumannii and 5 out of 22 isolates of K. pneumoniae were recovered from the dominant hands of resident doctors. One each of Pseudomonas spp. and  Escherichia More Details coli was isolated from the dominant hands of nursing staff in EW.

The bacterial isolates were recovered predominantly from the dominant hands of support staff (60; 34.88%), followed by nursing staff (56; 32.56%) and resident doctors (56; 32.56%). Of a total of 300 samples, single bacterial type was recovered from 247 samples and more than one bacterial types were isolated from 42 samples in HCWs.

Of a total of 49 resident doctors, 24 showed the same type of bacterial isolates in mobile phones and dominant hands. Of a total 47 nursing staff and 48 support staff, 27 and 26 showed the same type of bacterial isolates in mobile phones and dominant hands, respectively. The most common bacteria were CoNS, followed by Bacillus, Acinetobacter spp., K. pneumoniae, MSSA, and others [Table 1].
Table 1: Types of microorganisms isolated from mobile phones and dominant hands of health-care workers

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In ICU, microorganisms recovered were CoNS (49.49%), followed by Acinetobacter spp. (13.13%) and K. pneumoniae (8.08%). In EW, microorganisms recovered were CoNS (53.90%), followed by K. pneumonia (7.09%), Enterococcus sp. (5.67%), and Acinetobacter spp. (4.25%). In NICU, microorganisms recovered were CoNS (62.22%), followed by K. pneumonia (2.22%). In PICU, microorganisms recovered were CoNS (39.58%), followed by Acinetobacter spp. (6.25%), K. pneumonia (6.25%), and Enterococcus sp. (6.25%) [Table 2].
Table 2: Distribution of microorganisms from different locations of health-care facility

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In ICU and PICU, mobile phones and dominant hands of resident doctors, nursing staff, and support staff were fully contaminated. In EW, mobile phones and dominant hands of resident doctors and support staff were fully contaminated. In NICU, mobile phones of resident doctors were fully contaminated.

Health care wokrers of ICUs are expected to pay special attention to hand hygiene before and after using mobile phones. Multidrug-resistant microorganism causing hospital-acquired infection is a growing concern in many health-care institutions. The burden of nosocomial infection rises and poses a greater risk of increased mortality and morbidity among the patients.[5] The use of mobile phones is highly prevalent among the HCWs to communicate concerning hospital affairs daily with positive impact.[3] Hands, mobile phones, and other inanimate objects proved for transmission of microorganism.[6] Unlike fixed phones, mobile phones are used in close area to the patients and are more significant to hospital-acquired infections. Constant handling and heat generated by the mobile phones create a prime environment for the growth of microorganisms that are normally found on the skin and are called as “technological Petri plate for thousands of worms.”[7]

In the present study, the mobile phones and dominant hands of HCWs showed high contamination rate by bacteria. This correlates with the results of studies by Elkholy and Ewees from Egypt (96.5%).[1] Among the three groups, the highest contamination rate was detected in mobile phones of resident doctors (32.66%) and dominant hands of resident doctors (32.66%) and support staff (32.66%). The highest contamination rate in resident doctors could be due to patient overload, improper disinfection usage, inappropriate hand hygiene practice, as well as no local policy restricting use of mobile phones in clinically sensitive areas. High contamination rate in the hands of support staff could be unawareness toward the nosocomial infection control policy, sensitization, and lack of education in implementation of it.

CoNS were the most prevalent bacteria isolated from mobile phones (59.02%) and hands (60%), which correlates with the results (48%) of Srikanth et al.[2]

Isolation of MRSA was a concern as these are epidemiologically important drug-resistant pathogens. In this study, 9 (39.19%) MRSA were isolated from the mobile phones of HCWs and 4 (19.04%) MRSA out of a total 21 S. aureus in the contaminated hands of HCWs, which correlates with the findings of Badr et al. (31%).[8]

The established pathogens for nosocomial infection isolated are A. baumannii (6.94%), K. pneumoniae (6.94%), Citrobacter freundii (0.69%), and Enterococcus spp. (2.77%) from the mobile phones and A. baumannii (5.51%), K. pneumoniae (8.27%), Enterococcus spp. (6.89%), E. coli (0.68%), and Pseudomonas aeruginosa (0.68%) from the hands of HCWs.[9] A. baumannii is a well-known multidrug-resistant nosocomial pathogen isolated in this study. Our finding was supported by a study conducted in the ICU at Soroka University Medical Centre, Israel.[10]

Same bacteria were recovered from hands and mobile phones of health care workers. This suggests the hands of health care workers as source of contamination for mobile phones. The similar bacterial types were recovered in 53.47% mobile phones and hands of HCWs and 0.55% showed polymicrobial isolates. Our study shows that mobile phones get contaminated through hands and vice versa as bacterial flora detected in both are similar.

Mobile phones and hands of helath care workers serve as a potential reservoir for hospital acquired infections as multi-drug resistant pathogenic bacteria as well as normal flora of skin were recovered. The contaminated mobile phones and hands pose increased risk epidemiologically, and their use should be limited to emergency situation only with due care to reduce the risk of transmission of nosocomial pathogens as complete restriction may prove impracticable. The use of headset during hospital hours is a good alternative for using mobile phones. Strict infection control measures such as hand washing must be advocated.

The infection control practices and simple measures such as proper hand hygiene practice and regular decontamination and cleaning of mobile phones with alcohol containing disinfectant (70% isopropyl alcohol) may reduce the risk of hospital-acquired infection caused by these devices.

There is an urgent need to educate and stress awareness among the HCWs about the potential role of phones in the transmission of infectious agents in and outside hospital.

Infection control committee can step forward to make clear-cut guidelines regarding the use of phones in health-care setup. There is a need to produce mobile phones with protective material against bacterial contamination.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Elkholy MT, Ewees IE. Mobile (cellular) phone contamination with nosocomial pathogens in intensive care unit. Med J Cairo Univ 2010;2:1.  Back to cited text no. 1
    
2.
Srikanth P, Rajaram E, Sudharsanam S, Lakshmanan A, Umamaheshwari SS, Kalyani J. The mobile phone in tropical setting-emerging threat for infection control. Sri Ramachandra J Med 2009;2:18-2.  Back to cited text no. 2
    
3.
Ramesh J, Carter AO, Campbell MH, Gibbons N, Powlett C, Moseley H Sr., et al. Use of mobile phones by medical staff at Queen Elizabeth hospital, Barbados: Evidence for both benefit and harm. J Hosp Infect 2008;70:160-5.  Back to cited text no. 3
    
4.
Clinical and Laboratory Standard Institute. Performance Standards for Antimicrobial Susceptibility Testing. Vol. 1. Pennsylvania, USA: Clinical and Laboratory Standard Institute; 2007. p. M2-A9.  Back to cited text no. 4
    
5.
Brady RR, Wasson A, Stirling I, McAllister C, Damani NN. Is your phone bugged? The incidence of bacteria known to cause nosocomial infection on healthcare workers' mobile phones. J Hosp Infect 2006;62:123-5.  Back to cited text no. 5
    
6.
Brady RR, Fraser SF, Dunlop MG, Paterson-Brown S, Gibb AP. Bacterial contamination of mobile communication devices in the operative environment. J Hosp Infect 2007;66:397-8.  Back to cited text no. 6
    
7.
Tambe N, Pai C. A study of microbialflora and MRSA harboured by mobile phones of health care personnel. Int J Recent Trends Sci Technol 2012;4:14-8.  Back to cited text no. 7
    
8.
Badr RI, Badr HI, Nabil MA. Mobile phones and nosocomial infections. Int J Infect Control 2012;8:1-5.  Back to cited text no. 8
    
9.
Wendt C, Dietz B, Dietz E, Ruden H, Nallusamy R. Swabbing computers in search of nosocomial bacteria. Pediatr Infect Dis J 1998;17:533.  Back to cited text no. 9
    
10.
Borer A, Gilad J, Smolyakov R, Eskira S, Peled N, Porat N, et al. Cell phones and Acinetobacter transmission. Emerg Infect Dis 2005;11:1160-1.  Back to cited text no. 10
    



 
 
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  [Table 1], [Table 2]



 

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