|Year : 2014 | Volume
| Issue : 4 | Page : 435-438
Study of the role of mobile phones in the transmission of Hospital acquired infections
Kalpana M Angadi1, Rabindranath Misra1, Urvashi Gupta2, Savita Jadhav1, Moumita Sardar1
1 Department of Microbiology, Padmashree Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
2 2nd M.B.B.S Student, Padmashree Dr. D.Y. Patil Medical College, Hospital and Research Centre, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
|Date of Web Publication||25-Jun-2014|
Kalpana M Angadi
Department of Microbiology, Pad. Dr. D.Y. Patil Medical College, Pimpri, Pune - 18, Maharashtra
Source of Support: STS ICMR project., Conflict of Interest: None
Nosocomial infections are an important cause of morbidity and mortality. The inanimate objects like mobile phones in the immediate environment of the patients can act as a source of infection. Infectious agents from patients can be transferred on to the hands of the health care workers and in the absence of adequate hand hygiene practices can be transferred on to the mobile phones during their use and this can serve as a vehicle for the transmission of nosocomial pathogens from one patient to another. Aim: To evaluate the role of mobile phones in the transmission of pathogens by health care workers in health care centres. Materials and Methods: Mobile phones and hands were tested for micro-organisms before and after application of a disinfectant. A total of 60 mobile phones were tested for micro organisms, 30 from the health care workers (study group) and 30 from relatives of patients attending Out Patient Department (control group). Swabs taken from their hands were also cultured. Results: Hands of all the health care workers and 27 mobile phones showed microorganisms on them. Only Staphylococcus aureus was isolated. The hands and mobile phones of 11 health care workers were contaminated with Methicillin sensitive Staphylococcus aureus (MSSA). Methicillin resistant Staphylococcus aureus (MRSA) was isolated from the hands of 24 (80%) and mobile phones of 16 (53.3%) health care workers. Ethyl alcohol was found to be 100% effective in disinfecting hands and mobile phones. Conclusions: To prevent the potential spread of infections through mobile phones, strict infection control practices, hand hygiene, and routine decontamination of mobile phones with alcohol should be advocated to prevent the spread of infection in the hospital settings.
Keywords: Hospital acquired infections, Methicillin resistant Staphylococcus aureus, Methicillin sensitive Staphylococcus aureus
|How to cite this article:|
Angadi KM, Misra R, Gupta U, Jadhav S, Sardar M. Study of the role of mobile phones in the transmission of Hospital acquired infections. Med J DY Patil Univ 2014;7:435-8
|How to cite this URL:|
Angadi KM, Misra R, Gupta U, Jadhav S, Sardar M. Study of the role of mobile phones in the transmission of Hospital acquired infections. Med J DY Patil Univ [serial online] 2014 [cited 2020 Feb 22];7:435-8. Available from: http://www.mjdrdypu.org/text.asp?2014/7/4/435/135256
| Introduction|| |
Nosocomial infections have become an increasing cause of concern because of the presence of large number of patients with decreased immunity, exposure to broad spectrum antibiotics, surgical manipulations, and exposure to some of the multidrug resistant strains in the hospital. The sources of infection can be endogenous or exogenous. Exogenous sources which can serve as reservoir of infection are patients, Health care workers (HCW's), inanimate objects like computer keyboards, faucet handles, stethoscopes, wrist watches, mobile phones, and other items present in the immediate vicinity of the patient. Bures et al. has reported that computer key boards and faucet handles as a source of infection in the intensive care units.  Keyboards harboring Acinetobacter baumanii as a source of infection in burn units was reported by Neely et al.  Gunashekara et al. have reported the use of mobile phones by HCW's in the operation theatres and contamination of their mobile phones and wrist watches with organisms known to cause Hospital acquired infections (HAI).  Multidrug resistant Acinetobacter spp. was isolated from significant number of mobile phones of health care workers by Abraham Borer et al. 
Mobile phones have become an essential commodity used for communication and has become an important accessory of human life. Its use in the hospital by health care workers can lead to infectious agents being transferred from on patient to another and thus serve as a vehicle in the transmission of nosocomial pathogens especially in critical areas like Intensive care units, Burns units or Operation theatres in the setting of low compliance to hand hygiene practices. Organisms from the patients are transferred onto the hands of the HCW's while attending on the patients and if the phones are used while attending the patients the organisms are transferred on to the mobile phones. When phones are used again while attending another patient these organisms can be transferred and cause cross infection. The organisms if pathogenic can be detrimental to the health of the patient especially those in critical care units, burns wards etc. and if the organism transferred happen to be a drug resistant strain; the situation becomes even more grave as it becomes difficult to treat because of the limited drug options available. Hence, this study was undertaken to assess the role of mobile phones in the transmission of hospital acquired infections.
Aim of the Study
To study the role of mobile phones in the transmission of hospital acquired infections.
| Materials and Methods|| |
Place of Study
The study was conducted at a Medical college in Pune over a period of 3 months from May 2012 to July 2012. The study was approved by Medical college ethics committee.
The study was conducted over a sample size of 30 mobile phones of health care workers (HCW) which formed the study group and 30 mobile phones from relatives of patients attending Out patient department which served as the control group. Informed consent was taken from the participants.
Using all aseptic precautions, pre- and post-disinfection swabs from mobile phones and hands of health care workers and relatives of patients attending Out patient department were collected, and sent to the laboratory. 70% ethyl alcohol was used to disinfect hands and the mobile phones. In the laboratory, the swabs were transferred to test tubes containing 1 ml sterile saline and 0.1 ml of this was cultured on Blood agar and Mac Conkey's agar. Identification of the isolates was carried out according to the Standard microbiological procedures.  Oxacillin testing was done for detection of Methicillin resistant Staphylococcus aureus (MRSA) and the result was interpreted according to CLSI guidelines.  The total colony counts were noted and the bacterial load in 1 ml was calculated.
Descriptive statistics was applied.
| Results|| |
Swabs taken from the mobiles and hands of HCW (Study group) and relatives of patients attending various OPD (Control group) were tested for the presence of bacteria before and after application of disinfectant.
In the study group, swabs were taken randomly from mobiles and hands of 24 doctors (2 from Surgery ICU, 3 from Gynaecology ward, 2 from Orthopaedics ward, 2 from Medicine ICU, 8 from Medical ward, 8 from Surgery ward, and 2 from Anaesthesia Department) and 6 Nurses (1 from Surgery ICU, 2 from Surgery ward and 3 from Medicine ward) working in the hospital.
Hands of all the HCW's (100%) and 27 (90%) mobile phones showed microorganisms on them. Only Staphylococcus aureus (S. aureus) was isolated, no Gram negative bacilli were grown. Methicillin sensitive Staphylococcus aureus (MSSA) was isolated from the hands and mobile phones of 11 (36.6%) HCW's. MRSA was isolated from the hands of 24 (80%) and mobile phones of 16 (53.3%) HCW's. The number of colonies in 1 ml saline from hands ranged between 100-1000 in 27 cases. The colonies in 1 ml saline from mobiles were 100-1000 in 9 cases and less than 100 in 19 cases [Table 1]. Quantitative analysis was done to know the effect of cleaning the hands and mobiles with disinfectants and to know whether there was a significant reduction in colony counts after the application of disinfectant.
|Table 1: Pre-disinfection details from the mobile phones and the hands of the health care workers|
Click here to view
In the study group, the swabs cultured from the hands showed 50-700 colonies of MRSA and 50-800 colonies of MSSA in 1 ml saline. The swabs cultured from mobile phone showed 40-500 colonies of MRSA and 30-200 colonies of MSSA from 1 ml saline [Table 2]. The mobile phones had the same organism as that found on the hand. Hands which had higher counts also had high counts on their mobile phones.
|Table 2: No of colonies from swabs from hands and mobile phones before disinfectants|
Click here to view
Pre-Disinfection Results in the Control Group (i.e., Relatives of Patients Attending OPD)
Hands of 20 (66.6%) and mobile phones of 10 (33.3%) in the control group were contaminated with micro-organisms. Only Staphylococcus spp. were isolated. Coagulase negative Staphylococci was the predominant pathogen and was isolated from the hands of 20 (66.6%) and mobile phones of 10 (33.3%). MSSA was isolated from hands of 4 (13.3%) and mobile phones of 2 (6.6%) subjects. MRSA was isolated from the hand of only 1 (3.3%) subject and none from the mobile phones. The total number of colonies in 1 ml saline were less than 10 2 from the hands and less than 10 1 from mobiles [Table 3].
Post disinfection results in the study and the control group
There was no growth of organisms from swabs taken from the hands and mobiles after the application of disinfectant.
| Discussion|| |
Mobile phones have become an essential commodity in man's day-to-day life. In India, mobile phones account for more than 88% of all telecom users. It is carried by the doctors during visits to the hospital and is extensively used within the hospital premises including areas like Operation theatres and Intensive care units. If proper infection control practices especially hand hygiene are not followed these device can serve as a reservoir of infection.
In our study, 90% of the mobile phones and hands of all (100%) the health care workers were contaminated with organisms known to cause hospital acquired infections. Other studies across the globe have reported contamination of the mobile phones. Ramesh et al. have reported 45% contamination rate of mobile phones used by medical staff at Queen Elizabeth hospital, Barbados.  A contamination rate of 94.5% was reported by Fatima Ulger et al. in a study in Turkey.  In a Sri Lankan study, Gunasehkara has reported a contamination rate of 70% of mobile phones of anesthetists working in the operation theatres.  Other studies in India have reported the presence of organisms in 72 and 95% of the mobile phones by Datta et al.  and Tambekar et al.  , respectively.
In our study, mobile phones harbored Staphylococcus spp., Staphylococcus aureus being the only species isolated, no Gram negative bacteria or fungi were isolated, and 53.3% isolates of S. aureus from the mobiles were resistant to methicillin.
In other studies, though Staphylococcal spp were the predominant species, Gram negative bacteria like E. coli, Klebsiella spp., Pseudomonas spp, Acinetobacter which also can cause hospital acquired infections were also isolated from the mobile phones. ,,,
The rate of isolation of MRSA from mobile phones was 53.3% in our study. Drug resistant strains were also isolated from mobile phones in other studies as well. The MRSA isolation rates were as high as 83% in Tambekar et al. study  and lower isolation rates other than our study was seen with other studies 40% in Bhat et al., 18% in Datta et al., 2.7% in Jaylaxmi et al. ,, Fatima Ulger et al. has reported isolation of not only MRSA in 37.7% of cases but also isolation of multidrug resistant Gram negative bacilli. 
Staphylococcus aureus is carried by healthy people on the skin and nose. It can cause mild to serious infections if it enters the body through cuts, wounds etc. It is a pathogen known to cause hospital acquired infections. If the infection happens to occur by a multidrug resistant strain like methicillin resistant Staphylococcus aureus, the infection becomes difficult to treat because of the limited drug options available as MRSA is resistant to β lactam group of drugs like Penicillin and Cephalosporin group of drugs. Vancomycin which is given for the treatment of infection with MRSA needs to be given parenterally and can be toxic. Hence, to prevent such infections, infection control measures like screening of all the health care workers for MRSA carrier state should be carried out and those found to be positive should be decolonized with Mupirocin. Patients should be screened before admission for MRSA carrier state. If patients are positive for MRSA they should be isolated and barrier precautions are to be followed. To prevent the emergence of drug resistant forms, indiscriminate use of higher antibiotics needs to be stopped and antibiotic policy to be strictly followed.
In the control group, contamination rates of hands and mobile phones were 66.6% and 33.3%, respectively. Coagulase negative Staphylococcus was the predominant isolate, the rate of isolation of MSSA was 13.3% from hands and 6.6% from mobile phones. MRSA was isolated in a single swab from hand (3.3%) and this could be acquired from visit to the wards in the hospital.
Decontamination of mobile phones can be done with alcoholic disinfectants and in our study we noted that ethyl alcohol was 100% effective. Effectiveness of alcohols (Ethyl or Isopropyl) in cleaning mobile phones was found to be 80-100% in other studies Maryam et al.  Jaylakshmi et al.  and Usha Arora et al. 
| Conclusions|| |
Mobiles can act as fomites in the transmission of hospital acquired infections. However, further studies have to be carried out to know the genetic relatedness between the organisms isolated from the hands and from the mobiles which offer conclusive proof of their role in the spread of hospital acquired infections.
To prevent the potential spread of infections through mobile phones, training of the health care personnel about strict infection control practices, hand hygiene, environmental disinfection and routine decontamination of mobile phones with alcohol should be advocated to prevent the spread of infection in the hospital settings.
| References|| |
|1.||Bures S, Fishbain JT, Uyehara CF, Parker JM, Berg BW. Computer keyboards and faucet handle as reservoirs of nosocomial pathogens in the intensive care unit. Am J Infect Control 2000;28:465-71. |
|2.||Neely AN, Maley MP, warden GD. Computer keyboards as reservoirs for Acinetobacter baumanii in a burn hospital. Clin Infect Dis 1999;29:1358-60. |
|3.||Gunasekara TD, Kudavidanage BP, Peelawattage MK, Meedin F, Guruge LD, Nanayakkara G, et al. Bacterial contamination of anaesthetist hands, Personal mobile phones and wrist watches used during Theatre sessions. Sri Lanka J Anaesthesiol 2009;17:11-15. |
|4.||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. |
|5.||Collee JG, Fraser AG, Marmion BP, Simmons A. editors. Mackie and McCartney Practical Medical Microbiology, 14 th ed. New York: Churchill Livingstone; 1996. |
|6.||Clinical laboratory Standards Institute. Performance Standard for antimicrobial susceptibility testing: Seventeenth Informational supplement M100-S17, Vol. 27 No 1. Clinical laboratory standards institute, Wayne, IA, USA; 2007. |
|7.||Ramesh J, Carter AO, Campell MH, Gibbons N, Powlett C, Moseley H Sr, et al. Use of mobile phones by medical staff at Queen Elizabeth hospital, Barbados: Evidence of both benefit and harm. J Hosp Infect 2008;70:160-5. |
|8.||Ulger F, Esen S, Dilek A, Yanik K, Gunaydin M, Leblebicioglu H. Are we aware how contaminated our mobile phones with nosocomial pathogens? Ann Clin Microbiol Antimicrob 2009;8:7. |
|9.||Datta P, Rani H, Chander J, Gupta V. Bacterial contamination of mobile phones of health care workers. Indian J Med Microbiol 2009;27:279-81. |
|10.||Tambekar DH, Gulhane PB, Dahikar SG, Dudhane MN. Nosocomial hazards of Doctors mobile phones in hospitals. J Med Sci 2008;8:73-6. |
|11.||Akinyemi KO, Atapu AD, Adetona OO, Coker OO. The potential role of mobile phones in the spread of bacterial infections. J Infect Dev Ctries 2009;3:628-32. |
|12.||Killic IH, Ozaslan M, Karagoz ID, Zer Y, Davutoglu V. The Microbial colonisation of mobile phone used by health care staff. Pak J Biol Sci 2009;12:882-4. |
|13.||Badr RI, Badr HI, Ali NM. Mobile phones and Nosocomial infections. Int J Infect Control 2012;8:2. |
|14.||Patil PD, Pawar SA. Nosocomial hazards of Doctors mobile phones. J Theor Exp Biol 2012;8:115-21. |
|15.||Bhat SS, Hegde SK, Salian S. Potential of mobile phones to serve as a reservoir in spread of nosocomial pathogens. Online J Health Allied Sci 2011;10:14. |
|16.||Jayalakshmi J, Appalaraju B, Usha S. Cellphones as reservoirs of nosocomial pathogens. J Assoc Physicians India 2008;56:388-9. |
|17.||Sichani MM, Karbaizadeh V. Bacterial contamination of health care workers mobile phones and the efficacy of surface decolonization techniques. Afr J Microbiol Res 2011;5:5415-8. |
|18.||Arora U, Devi P, Chaddha A, Malhotra S. Cellphones a modern stayhouse for bacterial pathogens. JK Science 2009;11:127-9 |
[Table 1], [Table 2], [Table 3]