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ORIGINAL ARTICLE
Year : 2022  |  Volume : 20  |  Issue : 3  |  Page : 149-153

Microbial contamination on mobile phones of health-care workers at a tertiary care hospital of Northern India


Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

Date of Submission20-Feb-2022
Date of Decision05-Apr-2022
Date of Acceptance04-May-2022
Date of Web Publication01-Aug-2022

Correspondence Address:
Dr. Iqra Majid
Department of Microbiology, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmi.cmi_22_22

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  Abstract 


Background: The use of mobile phones (MPs) in hospital halls, laboratories, intensive care units, and operating rooms is a common practice. There are no proper guidelines for the disinfection of MPs that meet hospital standards. This study investigated the bacterial contamination on MPs of health-care workers employed in tertiary healthcare Sher-i-Kashmir Institute of Medical Sciences (SKIMS) Srinagar, Jammu and Kashmir.” Materials and Methods: One-hundred and fifty-five health-care workers (57 doctors, 50 nurses, 35 technical staff, and 21 other employees) were included in a cross-sectional study performed from January 2018 to June 2018 at the SKIMS, Srinagar, Jammu and Kashmir. Social demographic characteristics (such as gender and occupation) and cell phone-related questions were gathered through a self-administered questionnaire (e.g., frequency of MP disinfection and use of the MP at work). Sample collection and processing were done correctly to avoid any bias. Results: Majority (79%) were working in different wards of the institute, followed by (51%) working in different laboratories and (8%) working in intensive care settings. The majority of the participants (42%) said they used their phone less than ten times per day; 33% said they used it 10–20 times/day. In terms of disinfection, 107 (69%) of the participants cleaned their MP occasionally, 31 (20%) never cleansed their phone, and just 17 (11%) regularly disinfected their phone. Out of 155 MPs sampled, 125 (80.6%) showed microbial growth, and 30 (19.4%) were free of microbial growth. Out of the total 125 positive samples, 51 (40.8%) were Gram-positive bacilli (which was considered as airborne contamination), 36 (28.8%) were Gram-positive cocci (GPC), 25 (20%) Gram-negative bacilli, 11 (8.8%) were mixed growth, and 2 (1.6%) were yeasts. Out of 36 GPC, Staphylococcus aureus was predominant, i.e., 15 (41.6%), followed by Enterococcus spp. 12 (33.3%), Coagulase-negative Staphylococci spp. 7 (19.4%), and Streptococci spp. 2 (5.5%). Conclusion: Almost all MPs were contaminated, with more than half of them harboring pathogenic microorganisms. It could pose a significant risk to both health-care personnel and patients in the form of nosocomial infections.

Keywords: Bacterial contamination, health-care workers, healthcare-associated infections, mobile phones


How to cite this article:
Dar SH, Bashir G, Nisar Q, Majid I, Khandi MA. Microbial contamination on mobile phones of health-care workers at a tertiary care hospital of Northern India. Curr Med Issues 2022;20:149-53

How to cite this URL:
Dar SH, Bashir G, Nisar Q, Majid I, Khandi MA. Microbial contamination on mobile phones of health-care workers at a tertiary care hospital of Northern India. Curr Med Issues [serial online] 2022 [cited 2022 Dec 6];20:149-53. Available from: https://www.cmijournal.org/text.asp?2022/20/3/149/352970




  Introduction Top


Mobile phones (“MP's”) have become one of the essential items of both professional and social life.[1],[2] A MP, often known as a cellular phone, is a portable electronic device that allows long-distance communication.[3] MPs have evolved from rare, expensive technology used mainly by the corporate elite to widespread, low-cost personal goods in less than two decades. MPs increasingly exceed landline telephones in many nations since many adults and children own personal MPs.[4] Both health-care workers (HCWs) and patients use MP[5],[6] with over 98% of HCWs owning one and 84.5% bringing one to work every day.[7] Their appeal stems from their ease of use, inexpensive cost, user-friendliness, and ability to be taken anywhere. With all of the advantages of MPs, it is easy to ignore the potential health risks they may cause to their users.[6]

Healthcare-associated infections (HAI) increase day by day, causing a significant morbidity and mortality rate.[8] These infections spread through many ways, including in the hands of HCWs.[8] The use of MPs in hospital halls, laboratories, intensive care units (ICU), and operating rooms is a common practice by HCWs during working hours.[1] During every phone call, the MP comes into close contact with strongly contaminated human body areas from hands to hands. Hands to other areas such as mouth, nose, and ears; MPs act as a perfect habitat for microbes to breed, especially in high temperatures (25°C–35°C) and humid conditions.[9] HCWs' MPs may serve as reservoirs of microorganisms that could be easily transmitted from the MPs to the HCWs' hands and therefore facilitate the transmission of microbes from one patient to another in different hospital wards.[10] If MPs are used inattentively in surgical wards or ICU, they may be a source of infection to patients while handling them.[11] All the research has led to a serious question: How to use MPs sensibly, get their benefits, and minimize their risks?

MPs are more problematic compared to other stationary objects (fomites) in that they facilitate inter wards (and possibly inter-facility) transmission and are exceedingly difficult to rid of pathogens.[6] Besides, there are no proper guidelines for the disinfection of MPs that meet hospital standards.[9] There are few reports on the role of MPs in the spread of nosocomial infections[1],[12] and even fewer in tropical settings.[13]

As documented in several studies, coagulase-negative Staphylococci (CoNS) are the most frequent bacteria isolated from the surfaces of MPs.[9],[14],[15] Some pathogenic organisms have been reported, including methicillin-susceptible Staphylococcus aureus, Escherichia coli, Corynebacterium spp. Enterococcus faecalis, Clostridium perfringens, Klebsiella spp., Enterobacter spp., Pseudomonas spp., Aeromonas spp., Acinetobacter spp., and Stenotrophomonas maltophilia have also been reported.[16],[17] and maybe potential threats to infection control practices, increasing the rate of HAIs.[18] The results varied by wards, hospitals, and regions where the studies were performed. Despite this knowledge, there is a scarcity of advice provided to either HCWs or inpatients on using or decontaminating MPs in hospitals.[14] However, there has been no such data or research conducted at the Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Soura, which is one of the premier institutes of national repute located in Srinagar, Jammu and Kashmir, even though similar studies have been conducted elsewhere. There is a need, as also, to identify how MPs are contaminated in Kashmiri contexts because contamination rates vary regionally as well as within various institutions or groups. In addition, MPs are freely used in hospitals, and the majority of HCWs do not frequently clean their MPs.[19] This study investigated the bacterial contamination on MPs of HCWs employed in tertiary healthcare SKIMS Srinagar, Jammu and Kashmir.”


  Materials and Methods Top


Study design, site and population

One-hundred and fifty-five health-care workers (57 doctors, 50 nurses, 35 technical staff, and 21 other employees) were included in a cross-sectional study performed from January 2018 to June 2018 at the SKIMS Srinagar, Jammu and Kashmir. SKIMS, Srinagar is one of the biggest and leading tertiary care teaching hospital in Jammu and Kashmir's capital city, Srinagar. Patients from all around Jammu and Kashmir benefit from the hospital's specialist treatment. It is pertinent to mention here that the institution did not have a preexisting protocol for disinfection of MPs as a hospital policy before the study. In this study, both male and female volunteers were included from neonatal and adult ICU, pediatric operating rooms, and general hospitals (admission and medical and surgical units).

Sample size

Based on a study conducted in a tertiary care health facility in Delhi, we assumed the prevalence of colonization on mobile phones to be 60% and took a precision of 15%.[20] Using the formula 4pq/d2, where P is expected prevalence, q is a complement of p, and d precision. Furthermore, nonresponse rate of 20% a sample size of 142 were estimated for this study. It was rounded off to 145. Later, we got 155 participants and included all in the final analysis.

Data and Sample collection

Social demographic characteristics (such as gender and occupation) and cell phone-related questions were gathered through a self-administered questionnaire (e.g., frequency of MP disinfection and use of the MP at work). Sample collection and processing were done correctly to avoid any bias. The swab collector wore sterile latex gloves (per sample), and a clean cotton swab moistened with normal saline was swabbed over the screen, touch pad, mouthpiece, hot keys, and sides and back of the MPs (including the mobile cover if available) to take the sample from the mobiles of HCWs. The swab collector cleaned both hands with an alcohol-based hand sanitizer before and after wearing gloves to prevent cross-contamination. A unique identification number was assigned to each sample before being brought to the laboratory and inoculated in tryptic soy broth (TSB). It was then cleaned using alcohol-based wipes and returned to the user.

Bacterial isolation and identification from mobile phones

The TSB medium was incubated aerobically at 35°C–37°C for 24 h before inoculating MacConkey, chocolate, and blood agar. The plates were inspected for growth and colony shape following an 18–24-h incubation at 35°C–37°C. Gram stain was used to distinguish Gram-negative and Gram-positive bacteria in pure isolated colonies. The Gram-positive cocci (GPC) were tested for catalase, and those who tested positive for catalase were next tested for coagulase test. This was done to distinguish S. aureus from CoNS. Simmons' citrate test, triple sugar iron agar, indole tests, lysine iron agar, and oxidase test were used to identify Gram-negative isolates. The latter was used to distinguish oxidase-positive Gram-negative bacteria (Pseudomonas spp. and Vibrio spp.) from oxidase-negative Enterobacterales.

Testing for antimicrobial susceptibility

The antimicrobial susceptibility of the isolates was evaluated using the Kirby–Bauer disc diffusion technique on Mueller–Hinton agar by the Clinical and Laboratory Standards Institute (CLSI) 2019 recommendations.[21] Pure colonies of the organisms to be examined (one to two colonies) were put in a sterile tube containing 2 ml of normal saline and gently stirred until a homogenous solution was produced. To standardize the turbidity of the bacterial suspension, 0.5 McFarland standards were used. A sterile cotton swab was dipped into the solution and inoculated on the Mueller–Hinton agar surface (Oxoid, Basingstoke, UK). After leaving the Mueller–Hinton plates at room temperature for 3–5 min to air dry, antimicrobial discs were put on the surface of the agar with sterile forceps. The leaves were gently inverted and incubated at 35°C–37°C for 18–24 h. Quality control was carried out using the CLSI reference strains E. coli ATCC 25922 and S. aureus ATCC 25923.[18] After 18–24 h, the diameter of the zone of inhibition for each antibiotic disc examined was measured with a metric ruler. The acquired measurements were compared to the standard tables in the CLSI recommendations.[21]

Data analysis

The data were entered into Excel 2016 (Microsoft Corp., Redmond, WA, USA) and analyzed with Python 3.7 for Mac, Python Package Index. Descriptive statistics were used to analyze baseline demographic data, MP contamination, and isolated organisms and then reported as frequencies and percentages in tables and graphs. To investigate the relationships between MP contamination and other factors such as occupation, age group, gender, MP disinfection, and work area, the Chi-squared test of independence was used. In addition, the Mann–Whitney U-test was used to assess the most frequent kinds of bacteria identified during the research.


  Results Top


Age distribution of study participants

One-hundred and fifty-five health-care workers (57 doctors, 50 nurses, 35 technical staff, and 21 other employees) were included in a cross-sectional study.

Distribution of work area of the study participants

The majority (79%) were working in different wards of the institute, followed by (51%) working in other laboratories and (8%) working in intensive care settings.

Disinfection and mobile phone usage by the study participants

The majority of the participants (42%) said they used their phone less than ten times per day; 33% said they used it 10–20 times per day; 18% said they used it more than 20 times per day, and just 7% said they did not use their phone at work. In terms of disinfection, 107 (69%) of the participants cleaned their MP occasionally, 31 (20%) never cleansed their phone, and just 17 (11%) regularly disinfected their phone. When asked how they disinfected their phones and what cleaning solution they use to disinfect their MPs. They stated that they normally follow the mobile company's cleaning guidelines and use a solution containing at least 70% alcohol. Wipes containing 70% alcohol may be a better option than sprays for reducing the chance of harming the phone as solutions may pool on the phone, causing interior damage.

Distribution of bacteria isolated from mobile phones of health-care workers

Of 155 MPs sampled, 125 (80.6%) showed microbial growth, and 30 (19.4%) were free of microbial growth. Out of the total 125 positive samples, 51 (40.8%) were Gram-positive bacilli (which was considered as airborne contamination), 36 (28.8%) were GPC, 25 (20%) Gram-negative bacilli (GNB), 11 (8.8%) were mixed growth, and 2 (1.6%) were yeasts [Table 1].
Table 1: Distribution of bacteria isolated from mobile phones of health-care workers (n=125)

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Antibiotic susceptibility of significant microorganisms isolated from mobile phones

Out of 36 GPC, S. aureus was predominant, i.e., 15 (41.6%), followed by Enterococcus spp. 12 (33.3%), CoNS spp. 7 (19.4%) and Streptococci spp. 2 (5.5%). Among 25 isolates of GNB, E. coli was isolated from 13 (50%) samples, followed by Pseudomonas aeruginosa 6 (23%), Klebsiella pneumoniae 4 (15.3%), and Acinetobacter baumannii 3 (11.5%). Most of the isolated microorganisms were subjected to antimicrobial susceptibility testing (AST). It was found that many multidrug-resistant (MDR) strains were present on MPs. Out of 15 isolated S. aureus, 9 (60%) were Methicillin Resistant staphylococcus aureus (MRSA), out of 12 Enterococcus species, 6 (50%) were vancomycin-resistant. Among GNB, 5 (38.4%) E. coli out of 13 were extended spectrum beta-lactamase (ESBL) producers, 3 (75%) out of 4 isolates of K. pneumonia were ESBL producers. Five MDR species of P. aeruginosa out of 6 were found resistant to meropenem, ertapenem, doripenem, tigecycline, and ceftazidime [Figure 1].
Figure 1: Antibiotic susceptibility of significant microorganisms isolated from MPs. MPs: mobile phones. S. aureus: Staphylococcus aureus. E. coli: Escherichia coli. P. aeruginosa: Pseudomonas aeruginosa. K. pneumoniae: Klebsiella pneumoniae.

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Mobile phone contamination and associated factors

MP contamination did not have any associations with other factors (such as age group, designation of the participants, workplace, and mobile disinfection practices) as indicated in [Table 2].
Table 2: Relationship between mobile phone contamination and study variables

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  Discussion Top


MPs used during patient examinations without proper disinfection can transmit infection.[7] Many studies have been published in recent years that showed that MPs could play an essential role in spreading diseases. The hospital environment plays a critical role in the transmission of microorganisms. Based on the opinion of experts, MPs are more infected than toilets and the soles of shoes.[9],[15],[16] Our study on HCWs' MPs showed that 80.6% are contaminated.

In a study carried out by Singh et al., they saw 64% of mobile users in their institution never cleaned their phones,[17] in comparison to our study, where 31 (20%) of study participants never cleansed their phone. One of the reasons for such difference maybe not knows the side effects of mobile use within the health-care system. Datta et al. showed that 144 samples of 200 MPs were contaminated out of that 36% were infected by bacteria such as S. aureus, which is associated with nosocomial infection. Moreover, methicillin-resistant S. aureus was isolated from 18% of staff phones.[2] In comparison to our study, 155 MP samples were collected, and bacterial growth was observed in 125 (80.6%); the most cultured organisms were S. aureus, E. coli, E. faecalis CONS, and Pseudomonas. When the isolates were subjected to AST, it was found that among 9 (60%) S. aureus isolated were MRSA, 3 (75%) K. pneumoniae, and 5 (38.4%) of E. coli were ESBL producing found resistant to antibiotics such ceftazidime and ceftazidime clavulanate. Among Enterococci, six were vancomycin resistant (50%). In a similar study by Brady, <4.76% of isolated bacteria were GNB.[15] Karabay et al.[19] showed that 40% of MPs of health-care workers had been contaminated with Staphylococcus and methicillin-resistant Staphylococcus. In a research work by Akinyemi et al.,[18] 62% of MPs were contaminated with bacteria such as CoNS, followed by S. aureus. A study conducted by Mohammadi-Sichani.[22] showed that 25% of isolated microorganisms were S. aureus. Karabay et al.[19] evaluated 200 swabs of three parts (keyboard, microphone, and the handset) and showed that 39.6% of patients' MPs and 20.6% of staff's MPs were positive for pathogens. Ramesh et al.[23] reported that 46% of MPs of medical staff and students were culture positive and that 15% of them were GNB. Ulger et al. reported that 94.5% of MPs of health-care workers were contaminated with various bacteria, and Gram-negative bacteria were isolated from 31.3% of MPs.[6]

Another study by Sharma et al.[24] reported that 29.28% of the 181 medical students tested positive for S. aureus in their study. S. aureus was determined to be a healthy carrier in 37.38% of the hospital exposed group and 17.57% of the hospital unexposed group. Only one student (from the hospital-exposed group) tested positive for MRSA. Beta-lactamase production was identified in 90.57% of S. aureus strains, while slime layer production was observed in 73.58% of strains. Shibabaw et al.[25] in their study on 118 health care workers reported that 28.8% of the health-care professionals had S. aureus, 15 of which were methicillin-resistant. As a result, 12.7% of all HCWs were found to be MRSA carriers. Methicillin resistance was found in 44.1% (15/34) of all S. aureus isolates. MRSA carriage was especially prevalent among nurses (21.2%). Workers on surgical wards had the greatest proportion of MRSA carriers (57.1%). S. aureus was detected in 42.9% of 324 nasal samples in yet another study by Danelli et al.,[26] with MRSA accounting for 28.8%. Males and students were significantly more likely to be S. aureus carriers, but no characteristics were found to be associated with MRSA carriage. Vancomycin was effective against all isolates, with penicillin having the highest resistance rate (90.6%).

The difference in results may be because of several factors such as the number of patients visiting the hospital, the country's development, knowledge about the disinfection, and the research carried out about it. This study is the first study done in our institution; many of the participants were unaware of the role of MP's in the transmission of infection and how to disinfect it. HCW's are constantly exposed to various microorganisms hence the incidence of their MP's getting contaminated is higher. This requires infection control guidelines to be developed and implemented in the hospitals. Unfortunately, there are currently no clear guidelines for the use of mobile health-care workers. People use different ways to clean and sterilize their MPs as some disinfectants can damage the MP's. This study showed that MPs harbor significant microorganisms, even MDR, such MPs used at home by the family members of the HCW's may also infect them. Hence, MPs must be disinfected before leaving the hospital, and their use should be minimized even stopped in critical wards such as ICUs, where about 37.5% of growth was observed from our hospital.


  Conclusion Top


We came to the conclusion that MP contamination is nearly widespread among HCWs. More than half of these microorganisms have the potential to cause nosocomial infection in hospitalized patients. MP use during patient care/work hours should be prohibited for health-care providers who are actively involved in patient care, according to the institutional guidelines.

Recommendations

HCWs' MPs carry potentially pathogenic bacteria, making them a source of HAI in health-care settings. As a result, regulations regarding MP use are needed, especially in critical areas, to prevent the spreading of pathogens. A comprehensive ban on cell phones is unnecessary and impractical to implement properly. Cell phones should be turned off near critical care or life support equipment and used only in approved locations. Authorized health and social care employees, as well as external service personnel, must always follow local restrictions regulating the use of MPs.

Local standards should be developed in hospitals to reduce the use of interference with critical medical equipment. Because of the potential of cross contamination and infection to patients, MPs should not be used in critical care areas such as intensive treatment units and special care infant units.

Acknowledgment

Authors are highly thankful to the authorities of SKIMS for assisting with the study.

Ethical statement

As the study was done on inanimate objects, the institution has the policy to exempt such studies from obtaining the Ethical approval.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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