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Summer Project Training
Study of bacterial contamination of
mobile phones of healthcare workers
Submitted in partial fullfilement of the requirement for
B.tech. Biotechnologysemester V
AMITY INSTITUTE OF BIOTECHNOLOGY
AMITY UNIVERSITY RAJASTHAN JAIPUR
2010
Supervised by: Submitted by:Dr Smita Sood Ravi PareekMicrobiologistFortis,Jaipur
DECLARATION
I hereby declare that the project report entitled “Study of
bacterial contamination of mobile phones of healthcare workers”
is a record of the work compiled by me under the supervision and
guidance of Dr. Smita Sood, Microbiologist, Super Religare
Laboratories Ltd., Fortis Escorts Hospital, Jaipur as a part of my 45
days summer training.
Ravi Pareek
(B.TECH-BIOTECHNOLOGY)
(AUR0821094)
ACKNOWLEDGEMENT
First of all with due regard to my respective god with whose
kindness and blessing we could be able to accomplish the task of
training.
Dr. Deepa Dave (Director- Lab Operations- North and East
Super Religare Laboratories Ltd.), for her kind permission to
allow me to undergo my major project at SRL Lab, Fortis Escorts
Hospital, Jaipur.
I am overwhelmed with rejoice to take this opportunity to evince
my profound sense of reverence and gratitude to my esteemed
supervisor respective Dr. Smita Sood, Microbiologist for giving
her regular advice and excellent suggestion which have helped us
for completing the study. Her regular assistance and guidance
really helped me to bring formidable task in successful manner.
Sincere thanks to Dr. Priya Goyal (Sr. Consultant, Pathology
and Lab
incharge ), Dr. Madhawi Sharma (Pathologist) and Dr.
Neeraj Krishna Goyal (Pathologist) for their cooperation.
I also acknowledge with gratitude the help of all the scientific
officers in Microbiology section Mr. Navin Sharma, Mrs. Ambika
Nair, Mr. Rishabh Rajput and Mr. Narendra Sharma.
I express heartiest and sincere thanks to Super Religare
Laboratories Ltd., Fortis Escorts Hospital, Jaipur for providing all
necessary facilities without which I could not have completed my
study.
Ravi Pareek
(B.Tech- Biotechnology)
ABOUT THE INSTITUTE
Fortis Escorts Hospital, Jaipur (FEHJ) is brought to the
people of Rajasthan by India’s fastest growing healthcare
group-FORTIS. The Fortis group comprises the network of
62 hospitals across India and abroad. It includes the
Escorts Heart Institute and Research Center, Delhi, India’s
internationally renowned cardiac hospital.
In delivering healthcare, the organization is inspired by its
founder’s vision to create a world class integrated
healthcare delivery system in India, entailing the finest
medical skills combined with compassionate care. With
Fortis Escorts Hospital, the arrival of world class medical
care in Jaipur is a reality. Medical excellence is redefined
not first for patients in pink city, but patients across all
Rajasthan.
FEHJ is a multi specialty hospital with Cardiac Sciences,
Neurosciences, Renal sciences and gastrointestinal
diseases as super-specialties backed by a range of multi-
specialties. A faculty of highly experienced physicians
and surgeons who provide treatment across the wide
range of specialties is available. With its superior service;
Fortis Escorts Hospital has the ability to provide the best
possible treatments enhanced by ethos of compassionate
care.
ContentsContents
Topic
Page No.
1. Introduction 1-3
2. Aims and objectives 4
3. Review of Literature 5-
17
4. Material and Methods 18
5. Results
19-31
6. Discussion
32-36
7. Conclusion
37
8. References
38-41
INTRODUCTIONINTRODUCTION
Today India has 287 million mobile phone users and this
accounts for 85% of all the telecommunication users.
(10)Mobile phones have become one of the most
indispensable accessories of professional and social life.
Being expensive and conveniently small in size they are
used by doctors and other healthcare workers (HCWs) in a
hospital for immediate communication during emergencies,
in rounds and even in operation theatres and intensive care
units.(3)However they are seldom cleaned and are often
touched during or after examination of patients and
handling of specimens without proper hand washing .(9)
Mobile phones may serve as the perfect substrate of
microorganisms, especially in high temperatures and humid
conditions. Extensive use of mobile phones by HCWs may
serve as a vehicle for the spread of nosocomial pathogens
and also the associated nosocomial transmission of
pathogens. Further, sharing of cell phones between HCWs
and non HCWs may directly facilitate the spread of
potentially pathogenic bacteria to the community.
The potential of cell phones to serve as vectors to
nosocomial infection has been studied before. (4,12,15)
Recent studies have demonstrated that 9-25% of mobile
communication devices are contaminated with
pathogenic bacteria.(5)Most commonly found bacterial
isolate were Coagulase Negative Staphylococci as a part
of normal skin flora. Other potentially pathogenic bacteria
found were Methicillin sensitive Staphylococcus aureus
(MSSA), coliforms, Methicillin resistant staphylococcus
aureus (MRSA), Corynebacterium species, Enterococcus
faecalis ,Clostridium perfringens ,Klebseilla spp.,
Enterobacter spp., Pseudomonas spp., Aeromonas spp. ,
Acinetobacter and Stenotrophomonas maltophilia.(6,9)The
sources of contamination of mobile phones include hands
of the healthcare workers , inanimate objects(bed,
instruments ,furniture etc.) and pathogenic air flora of the
hospital.(13)
Since there is no data on the risk of contamination of
personal mobile phones in HCWs in this part of the
country (i.e. the state of Rajasthan), this study was
undertaken to determine whether the mobile phones of
HCWs are contaminated since they are used in an
environment that harbours nosocomial agents.
Aims andAims and
ObjectivesObjectives
To investigate microbial colonization of mobile phones
used by healthcare workers.
Review ofReview of
LiteratureLiterature
Khivsara A , Sushma TV , Dahashree B , Brady RR , Soto
RG , Bhattacharya K. (2006)
The ability of mobile phones of healthcare workers to serve as a
reservoir of bacteria known to cause nosocomial infection was
reported by Khivsara et al.. They reported high levels (40%) of
contamination in these phones by Staphylococcus aureus and its
methicillin-resistant (sic) relative (MRSA) at a hospital in
Mangalore.
Karabay O , Koçoglu E , Tahtaci M. (2007)
An investigation was conducted to determine the bacterial
contamination of the mobile phones of the healthcare personnel
(HP) employed in a teaching hospital in Turkey . Samples were
collected from the mobile phones of 122 HP, of whom 39 were
physicians, 50 nurses, 22 residents, and 11 interns. Growth was
observed in 111 out of 122 samples evaluated; however, bacteria
that might be associated with hospital infection were isolated in
only ten (9.0%) samples, four of which were Escherichia coli, two
Enterococcus feacalis (Vancomycin sensitive),two Pseudomonas
aeruginosa, one Pseudomonas fluorescensis, and one Klebsiella
pneumoniae. Neither MRSA nor vancomycin-resistant Enterococci
were isolated from mobile phones in this study. This study reveals
that mobile phones of HP may get contaminated by bacteria
(such as Escherichia coli, Pseudomonas aeruginosa and Klebsiella
pneumoniae), which cause hospital infections, and may serve as a
vehicle for the spread of nosocomial pathogens.
Tambekar DH , Gulhane PB , Dahikar SG and Dudane MN.
(2008)
A microbiological analysis of 75 doctor’s mobile phones was
carried out in Amravati city . A total of 90 bacterial pathogens
were isolated , Staphyllococcus aureus 18 (20%) was prominent
followed by Micrococcus luteus 16(18%) , Pseudomonas
areuginosa 14 (15%) , Proteus mirabalis 10(11%) , Esherichia coli
10 (11%) , Klebsiella pneumoniae 9(10%) , Enterobacter aerogens
8(9%) and Salmonella typhi 5(5%) . The male doctor’s mobile
phones were more contaminated as compared to the female
doctor’s phones (31%) . The study demonstrated that mobile
phones in a clinical setting become contaminated by contact with
healthcare workers’ hands (HCW’s) 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
Jayalakshmi J , Appalaraju B , Usha S. (2008)
A total of 84 cellphones belonging to doctors at the PSG hospitals
and about 60 cellphones belonging to doctors working in the pre
and para clinical departments of PSG Institute of Medical Sciences
and Research, Coimbatore, were screened for bacterial isolates.
Sterile swabs moistened with trypticase soy broth were used to
swab the front, back and the sides of the cellphones and were
subjected to culture and sensitivity. Except for the 12 new
cellphones, all the others (91.6%) were found to be contaminated
76 (90.4%) owned by clinical doctors and 56(93.3%) owned by
non clinical doctors. Single bacterial type was recovered in 49
cellphones. Two and more than two bacterial types were isolated
from 67 and 16 cellphones respectively. The contaminating
pathogens were coagulase negative staphylococcus (108) Bacillus
spp (46), Staphylococcus aureus (33) and others amounting to
229 bacterial isolates .
Ulger F , Esen S , Dilek A , Yanik K , Gunaydin M and
Leblebicioglu H (2009)
The objective of their study was to determine the contamination
rate of the healthcare workers' (HCWs') mobile phones in
operating room and ICU. 200 HCWs were screened; samples from
200 mobile phones were cultured. In total, 94.5% of phones
demonstrated evidence of bacterial contamination with different
types of bacteria. The gram negative strains were isolated from
mobile phones of 31.3% and the ceftazidime resistant strains
from the hands were 39.5%. S. aureus strains isolated from
mobile phones of 52% and those strains isolated from hands of
37.7% were methicillin resistant. Distributions of the isolated
microorganisms from mobile phones were similar to hands
isolates. Some mobile phones were contaminated with
nosocomial important pathogens. The results showed that HCWs'
hands and their mobile phones were contaminated with various
types of microorganisms.
Chawla K , Mukhopadhayay C , Gurung B , Bhate P , Bairy
I (2009)
This study compared the nature of the growth of potentially
pathogenic bacterial flora on cell phones in hospital and
community. 75% cell phones from both the categories grew at
least one potentially pathogenic organism. Cell phones from
HCWs grew significantly more potential pathogens like MRSA
(20%), Acinetobacter species (5%), Pseudomonas species (2.5%)
as compared to the non HCWs. 97.5% HCWs use their cell phone
in the hospital, 57.5% never cleaned their cell phone and 20%
admitted that they did not wash their hands before or after
attending patients, although majority (77.5%) knows that cell
phones can have harmful colonization and act as vector for
nosocomial infections.
Arora U , Devi P , Chadha A , Malhotra S (2009)
Cellphones can harbour various potential pathogens and become
an exogenous source of nosocomial infections. A total of 160
cellphones belonging to doctors and paramedical staff working in
various departments at Govt. Medical College and hospital,
Amritsar were screened for bacterial isolates. Sterile swabs
moistened with nutrient broth were used to swab the front, back
and the sides of the cellphones and were subjected to culture and
sensitivity. The same procedure was repeated after
decontamination with 70% iso propyl alcohol.Out of total 160
cellphones growth was obtained in 65(40.62%) cellphones.
31(19.37%) from clinical workers and 34(21.25%) from non
clinical workers. Coagulase negative staphylococcus was the most
commonly isolated organism.The efficacy of decontamination with
70% isopropyl alcohol was found to be 98% as only 5 cellphones
showed growth after decontamination.It was found that around
40% of the cellphones of health care workers were contaminated
and thus acted as a potential source of nosocomial infections.
Simple measures like decontamination with 70% isopropyl alcohol
was found to be 98% effective.
Akinyemi K O , Atapu A D , Adetona O O and Coker A O
(2009)Their study determined the potential role of mobile phones
in the dissemination of diseases. 400 swab samples from mobile
phones were collected and divided into groups categorized by the
owners of the phones as follows: Group A was comprised of 100
food vendors; Group B, 104 lecturers/students; Group C, 106
public servants; and Group D, 90 health workers. Samples were
cultured and the resulting isolates were identified and subjected
to antimicrobial susceptibility tests by standard procedures. The
results revealed a high percentage (62.0%) of bacterial
contamination. Mobile phones in Group A had the highest rate of
contamination (92; 37%), followed by Group B (76; 30.6%), Group
C (42; 16.9%), and Group D (38; 15.3%). Coagulase negative
Staphylococcus (CNS) was the most prevalent bacterial agent
from mobile phones in Group A (50.1%) and least from phones in
Group D (26.3), followed by S. aureus. Other bacterial agents
identified were Enterococcus feacalis, Pseudomonas aeruginosa,
Escherichia coli, and Klebsiella spp. There was no statistical
significance difference (P < 0.05) in the occurrence of S. aureus,
the most frequently identified pathogenic bacterial agent isolated
from the mobile phones in the study groups. Fluoroquinolones
and third generation cephalosporin were found to be effective
against most isolates.
Gunasekara T D C P , Kudavidanage B P , Peelawattage M
K, Meedin F , Guruge L D, Nanayakkara G , Nanayakkara
M. , Fernando S S N. (2009)
Personal items such as mobile phones are commonly used by
doctors working in the operation theatre. The hands and personal
use items of anaesthetic doctors working in the operation theatre
may serve as vectors for transmission of nosocomial pathogens
among surgical patients. Their aim was to determine the hand
contamination among anaesthetists working in the operation
theatre and contamination of mobile phones of anaesthetic
doctors. Forty five anaesthetic doctors working in the operation
theatres at Colombo South Teaching Hospital and Ratnapura
General Hospital were enrolled in the study. Swabs from keypads
of mobile phones were taken using moist sterile swabs and plated
on Mac Conkey and Blood agar plates. The bacteria isolated were
identified by biochemical tests. Hand washing was performed by
60% (n=27/45) doctors entering the theatre. 95% (n=43/45)
brought their mobile phone to the theatre and 78.5% used it at
least once during the theatre session . Bacterial growth was
detected 70% mobile phone swabs. Staphylococci were
predominantly cultured from all three specimens tested. MRSA
was isolated from 15% mobile phones . Methicillin sensitive
Staphylococcus aureus (MSSA) was isolated from 46.5% swabs
mobile phones . 30% mobile phone swabs did not show bacterial
growth. Personal use items of doctors such as mobile phones
show a high percentage of bacterial contamination. Hand washing
compliance was moderate among the study population. Thus
personal use items and hands may act as an important source of
nosocomial pathogens in the Sri Lankan operation theatre
settings.
Sepehri G , Talebizadeh N, Mirzazadeh A , Mir-shekari TR
and Sepehri E (2009)
The contamination rates of Health Care Worker's (HCW) mobile
phones and resistance to commonly used antimicrobials were
evaluated in three teaching hospitals in Kerman, Iran. They
examined 150 randomly selected HCWs in three teaching
hospitals in Kerman, Iran, 2007. For each HCW a sterile swab
moistened with sterile water was rotated over the surface of both
sides of his/her phone . The swab is cultured by the routine
methodology in use at laboratory. Plates were incubated
aerobically at 37°C for 48 h. All samples were examined for the
antimicrobial activity for commonly used antimicrobials using disc
diffusion method. A total of 48 (32.0%, CI95 24.6-40.1%) mobile
phones had bacterial contamination and Staphylococcus
epidermidis was the most commonly cultured organisms from all
sites. The resistance rates to commonly used antimicrobials in
isolated bacteria from phones and dominant hand varied from
6.7% for cephalothin to 25% for amoxicillin, respectively. In
conclusion, the results indicated that the rate of bacterial
contamination of the HCW's phone is just below 50%,
accompanying with a resistance rate to the common used
antibiotics in one fourth of all the cases. Therefore, mobile phones
could be an important source of nosocomial infections and the
spread of bacterial resistance bacteria in medical healthcare
settings.
Datta P , Rani H , Chander J , Gupta V (2009)
In this study they investigated the rate of bacterial contamination
of mobile phones of HCWs employed in a tertiary healthcare
teaching hospital, located in Chandigarh, India. They compared
this contamination rate with that of a control group (n=50)
Attendants of patients in OPDs, not working in any healthcare
setting, formed the control group. Random sampling of 200
HCWs, from December 2007 to February 2008,, was carried out.
Various areas of the hospital included were OPDs, wards, ICUs,
CCU, burn wards and laboratories. A sterile swab moistened with
sterile demineralised water was rotated on the sides and over the
keypad of mobile phone. The swabs were immediately inoculated
and streaked onto five per cent sheep blood agar and eosin
methylene blue agar . Plates were incubated aerobically at 37˚C
for 24 hours. Isolated organisms was processed according to
colony morphology and gram stain. Bacteria were identified
according to standard protocol (Mackie and McCartney). Tests for
identification of gram positive cocci included catalase, Oxidative/
Fermentative test, anaerobic mannitol fermentation and
coagulase production. Oxacillin sensitivity of Staphylococcus
aureus was carried out by using oxacilin disk diffusion test. In
total, 200 HCWs, 97 doctors, 55 nurses, 42 laboratory technicians
and 6 safai karamcharis were included. Bacteriological analysis
revealed that of the 200 MPs sampled, 144 (72%) were
contaminated with bacteria. Among 144 bacterial isolates from
mobile phones, the following number and type of bacteria were
isolated: 26 methicillin resistant Staphylococcus aureus (MRSA),
46 methicillin sensitive Staphylococcus aureus (MSSA), 19
coagulase negative Staphylococcus (CONS), 4 Micrococcus spp., 2
viridans Streptococci and 47 aerobic spore bearers. Hence,
72(36%) of the mobile phones were contaminated with bacteria
which are well known to be associated with hospital associated
infections i.e. Staphylococcus aureus. MRSA was present on 18%
mobile phones of HCWs in their health care settings.
Mariappan S , Jagannathan K , Srikanth P , Rajaram E ,
Sudharsanam S , Lakshmanan A , Sivamurugan U (2010)
A study was conducted to determine whether mobile phones of
healthcare workers (HCWs) harbour micro-organisms. Swabs
collected from mobile phones were inoculated in solid and liquid
media, and incubated aerobically. Growthwas identified as per
standard microbiological procedures. Antibiotic susceptibility was
determined for Staphylococcus aureus . A questionnaire was used
for data collection on awareness of mobile phone use. Of 51
HCWs mobile phones sampled, only 5 (6 % ) showed no growth.
Pathogens isolated from HCW samples included S. aureus
[meticillin-sensitive S. aureus (4), meticillin-resistant S. aureus
(2)], Escherichia coli (1), Klebsiella pneumoniae (1) and
Pseudomonas aeruginosa (1). Coagulase-negative Staphylococci
(43) were also isolated. Polymicrobial growth was detected in 71
% of HCW and . Only 12 % of HCWs used disinfectants to wipe
their mobile phones.
Material andMaterial and
MethodsMethods
Surface samples were taken from mobile phones of 150
healthcare workers in June-July 2010.Each mobile phone was
sampled only once during the study period. Sterile swabs
moistened with sterile broth were rotated over the surfaces of the
mobile phone (holding sides, back side and keypad) and
collected. Sampled swabs were streaked over Sheep blood agar
and Mac Conkey agar plates and inoculated in Nutrient broth (Hi
Media, Ltd., Mumbai) for characterization of aerobic bacteria; no
anaerobic /fungal cultures were done. Plates were incubated
aerobically at 37degree C for 24-48 hours. Gram positive and
gram negative bacteria were identified by gram’s staining and
were processed further for identification and susceptibility testing
by MicroScan- autoscan 4.
The protocol was approved by the institutional review committee
and samples were taken from those participants who volunteered
and verbally consented for giving samples without prior
intimation.
Picture1: Gram’s stained smear showing f Gram positive cocci in
pairs and clusters (under oil immersion).
Picture 2 : Gram’s stained smear showing Gram negative bacilli
(under oil immersion)
Picture 3: Sheep blood agar plate with growth of Gram positive
cocci
Picture 4 : MacConky Agar Plate showing growth of Lactose
fermenting Gram negative bacteria (LFGNB)
Picture 5 : MacConky Agar Plate showing growth of Non-Lactose
fermanting Gram negative bacteria (NLFGNB)
Picture 6: Catalase test.
(Test positive: indicated by bubbling or effervescence production,
Test negative-absence of bubbling after addition of catalase
reagent (3% H2O2))
Picture 7 : Tube Coagulase Test:
(Test positive-yellow coagulum formation given by
Staphylococcus aureus,Test Negative-no coagulum formation as
given by Coagulase negative staphylococci)
Picture 8: MicroScan autoscan 4 (automated organism
identification and sensitivity testing machine)
Picture 9: Positive Breakpoint combo panel type 20
(Antibiotic Testing Panel for Gram Positive Cocci.)
Picture10: Negative Breakpoint combo panel type 34
(Antibiotic Testing Panel for Gram Negative Bacteria.)
RESULTSRESULTS
A total of 150 samples were collected from mobile phones of
various categories of health care staff.
Table: 1. Demonstrates the distribution of the swabs collected
from the mobile phones various category of healthcare staff. Of
the total 150 swabs, 87(58%) of the swabs were collected from
mobile phones of nurses followed by 50(33.33%) from doctors. 49
(98%) swabs collected from mobiles of doctors and 76 (87.35%)
swabs from the nurse’s mobile phones were positive for bacterial
growth.
Table:1. Distribution of swabs from mobile phones of different
categories of healthcare workers
Category
of HCW
Number of Swabs
Collected
% of
Swabs
No. of swabs with
bacterial growth
% of bacterial
growth
Doctor 50
33.33
% 49 98%
Nurse 87 58% 76 87.35%
Technician 6 4% 6 100%
Others 7 4.66% 6 85.71%
Total 150 100% 137 100%
Graph: 1a.Distribution of swabs from mobile phones of various
HCWs
33%
58%
4%
5%
Doctor Nurse Technician Others
Graph:1b.Distribution of mobile swabs with bacterial growth in
various categories of healthcare workers
Doctor Nurse Technician Others0
10
20
30
40
50
60
70
80
90
Number of Swabs CollectedNo. of swabs with bacterial growth
Table:2. shows the distribution of swabs collected from male and
female healthcare worker’s mobile phones. A total of 101 swabs
were collected from male and 49 from female HCWs cell phones.
90.09% of swabs from mobile phones of males and 93.87% of
swabs from mobile phones of females were found to harbour
bacteria on them.
Table:2. Distribution of the swabs collected from male and
female healthcare worker’s mobile phones
Sex
Number of swabs
collected
Number of swabs
with bacterial
growth
Number of
swabs which
are sterile
Male 101 91(90.09%) 10
Female 49 46(93.87%) 3
Graph: 2. Distribution of the swabs collected from male and
female healthcare worker’s mobile phones
Male; 101
Female; 49
Table:3. shows the distribution of the samples collected from
mobile phones of HCWs in different units of the hospital. Of the
150 swabs, 38% of the swabs were collected from mobile phones
of HCWs in the OT complex followed by 16.66 % from HCWs
posted in SICU-2 and Wards.
Locati
on Category of health care worker
Doctor Nurse Technician Other Total(%)
MICU 4 12 1 2
19(12.66%)
SICU
0 23 1 1
25(16.66%)
NICU 1 7 0 1 9(6%)
OT
28 24 3 2
57(38%)
Wards
2 21 1 1
25(16.66%)
OPD
15 0 0 0
15(10%)
Total 50 87 6 7 150
*MICU : Medical Intensive Care Unit
*SICU : Surgical Intensive Care Unit
*NICU : Neonatal Intensive Care Unit
*OT : Operation Theatre
Graph:3. Location wise distribution of mobile phone swabs
13%
17%
6%38%
17%10%
MICU SICU NICU OT wards OPD
Table:4.shows location wise distribution of bacterial growth in
mobile phone swabs.100% of the swabs from OPD and 92%
swabs from wards and 91.22% swabs from OT complex were
positive for bacterial growth.
Table:4. Location wise distribution of mobile phones swabs with
bacterial growth
Area Number of swabsNo. of swabs with bacterial growth
MICU 19 17(89.47%)
SICU 25 22(88%)
NICU 9 8(88.88%)
OT 57 52(91.22%)
Wards 25 23(92%)
OPD 15 15(100%)
Total 150 137
Graph:4. Location wise distribution of mobile phones swabs with
bacterial growth
MICU SICU NICU OT Wards OPD Total0
20
40
60
80
100
120
140
160
Number of swabsNo. of swabs with bacterial growth
Table:5. Depicts the growth status of the swabs following their
processing in Microbiology lab. Mono-bacterial (of single bacteria)
growth was observed in 77% of the swabs and polybacterial
(more than one bacterium) in 14% swabs, 9% of the swabs were
sterile.
Table:5. Growth status of swabs from mobile phones of HCWs
S.no. Status
No. of
isolates(%)
1 No growth (sterile) 13(8.66%)
2 Single bacteria grown (mono-bacterial) 116(77.33%)
3
More than one bacterium
grown(polybacterial) 21(14%)
Total swabs 150
Graph:5. Growth status of swabs from mobile phones of HCWs
9%
77%
14%
no growth(sterile) single bacteria grown(monobacterial)more than one bacteria grwn(polybacterial)
Table:6. Shows the frequency distribution of bacterial isolates
obtained from processing of swabs collected from mobile phones.
Of the 150 swabs, 82% of swabs demonstrated growth of Bacillus
species (aerobic spore bearing gram positive bacilli).5.33% swabs
grew Gram negative bacteria and 14% grew gram positive cocci.
Table: 6. Frequency distribution of bacteria grown from swabs of
mobile phones
S.No. Organism no. isolated % isolation
1 Bacillus species(ASBGPB) 129 82%
2 Methicillin resistant CONS 16 10.00%
3 Methicillin sensitive CONS 5 3.00%
4 Lactose fermenting GNB 3 2%
a Klebseilla pneumoniae 1
b Enterobacter cloacae 2
5 Non Fermenter GNB 5 3%
a Pseudomonas stutzeri 3
b Acinetobacter lwoffii 1
c Acinetobacter baumannii 1
Total isolates 158 100%
*ASBGPB- Aerobic Spore Bearing Gram Positive Bacilli
*CONS- Coagulase Negative Staphylococcus
*GNB- Gram negative bacteria
Graph: 6. Showing frequency distribution of bacteria grown from
swabs of mobile phones
82%
10%3%
2%3%
Bacillus Species Methicillin resistant CONSMethicillin Sensitive CONS Lactose fermenting GNBNon Lacose fermenting GNB
Table : 7. Shows the antibiotic sensitivity of gram positive cocci
isolated from mobile phones. 100% sensitivity was observed for
Linezolid, Vancomycin and Cotrimoxazole. Oxacillin (methicillin)
resistance was seen in 5 %isolates.
Table:7. Antibiotic sensitivity of Gram positive cocci isolated
from mobile phones
S.No Name of drug %sensitive
1 Amoxyclav 15.80%
2 Azithromycin 10.50%
3 Cefepime 26.30%
4 Cefotaxime 26.30%
5 Ceftriaxone 26.30%
6 Ciprofloxacin 84.20%
7 Clindamycin 26.30%
8 Erythromycin 89.50%
9 Gentamycin 21%
10 Imipenem 21%
11 Levofloxacin 84.20%
12 Linezolid 100%
13 Ofloxacin 26.30%
14 Oxacillin 26.30%
15 Rifampicin 95%
16 Tetracycline 95%
17 Cotrimoxazole 100%
18 Vancomycin 100%
Graph:7. Antibiotic sensitivity of Gram positive cocci isolated
from mobile phones
Amoxycla
v
Azithro
mycin
Cefepim
e
Cefotax
ime
Ceftria
xone
Ciprofloxa
cin
Clindam
ycin
Erythro
mycin
Gentam
ycin
Imipen
em
Levofloxa
cin
Linezo
lid
Ofloxacin
Oxacill
in
Rifampicin
Tetra
cyclin
e
Cotrimoxa
zole
Vanco
mycin
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
%S
Table: 8 depicts the antibiotic sensitivity of gram negative
bacteria isolated from mobile phones. These isolates were
sensitive to almost all the drugs tested except Aztreonam
(50%Sensitive) and Ceftriaxone (87.50% sensitive)
Table:8. Antibiotic sensitivity of gram negative bacteria isolated
from mobile phones
S.No. Name of drug %Sensitivity(S)
1 Amikacin 100%
2 Aztreonam 50%
3 Cefazolin 12.50%
4 Cefepime 100%
5 Cefotaxime 100%
6 Ceftazidime 100%
7 Ceftriaxone 87.50%
8 Ciprofloxacin 100%
9 Gentamicin 100%
10 Imipenem 100%
11 Levofloxacin 100%
12 Meropenem 100%
13 Piperacillin/Tazobactam 100%
14 Tetracycline 100%
15 Ticarcillin Clavulanic acid 100%
16 Tobramycin 100%
17 Cotrimoxazole 100%
Graph: 8. Antibiotic sensitivity of gram negative bacteria isolated
from mobile phones
Amikacin
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DiscussionDiscussion
Innovation in mobile communication technology has provided
novel approaches to the delivery of healthcare and improvements
in the speed and quality of routine medical communication.
Bacterial contamination of mobile communication devices could
be an important issue affecting the implementation of effective
infection control measures and might have an impact on efforts to
reduce cross contamination.(4)
Our study documents the presence of high level of bacterial
contamination (91.33%) on mobile phones of HCWs. Similar to our
findings Chawla et al (2009) also reported 92.5% bacterial
contamination in HCWs mobile phones at Manipal, Karnataka.
(6)Another study of bacterial contamination of mobile phones of 75
doctors from Amravati City, India revealed 95% of mobile phones
to demonstrate evidence of bacterial contamination. (16) Srikanth
et al (2010) conducted a study at Sri Ram Medical College and
Research Institute, Porur, Chennai found 94% of mobile phones to
be contaminated with bacteria. (15) Hands may contaminate mobile
phones at the time of use specially when it is hot and humid and
hands are sweaty. Comparatively poor hand hygiene practices
followed by HCWs in India might be a contributory factor for this.
World wide a varying prevalence of bacterial colonization of
mobile phones in healthcare workers has been reported.
Gunasekara et al (2009)(8) in their study of bacterial contamination
of mobile phones used during theatre sessions of anesthetists in
Sri Lanka found 70% of mobiles to be harboring bacteria. Sepheri
et al (2009)(14) in their study conducted in teaching hospitals of
Kerman, Iran reported 32% mobiles phones to have bacterial
contamination. Akinyemi KO et al (2009) (1) reported 15.3%of
mobile phones of healthcare workers in Nigeria. Study by Datta et
al (2009)7 conducted at Govt. Medical College Chandigarh
revealed that of the 200 Mobile phones sampled, 144 (72%) were
contaminated with bacteria. Another study conducted at
Government Medical College and Hospital, Amritsar reported
bacterial growth in 40.62% of cell phones with 19.37% from
clinical departments and 21.25% from non clinical departments. (2)
In our study 90.09% of swabs from mobile phones of males and
93.87% of swabs from mobile phones of females were found to
harbour bacteria on them. Tambekar et al (2008) in their study of
75 mobile phones of doctors reported that mobile phones of male
doctors were more contaminated than female doctors. (16)
Mono-bacterial (of single bacteria) growth was observed in 77% of
the swabs and polybacterial (more than one bacterium) in 14%
swabs, 9% of the swabs were sterile. However other studies from
India have reported polymicrobial growth in majority of swabs. (4, 9
,15)
In our study 82% of the bacteria were aerobic spore bearing gram
positive bacilli (ASBGPB) belonging to Bacillus species and these
are generally considered non- pathogenic and environmental
contaminants. Growth of pathogenic bacteria known to cause
healthcare associated infections was observed only in 29(19.33%)
swabs aerobic spore bearing gram positive. The pathogenic
bacteria were mainly Coagulase negative staphylococcus
(13.29%) with 10% methicillin resistant CONS and 5% methicillin
sensitive CONS .Other pathogenic bacteria were lactose
fermenting gram negative bacilli (2%) including Klebseilla
pneumoniae and Enterobacter cloacae and Non fermenter GNBs
(3%) such as Pseudomonas stutzeri and Acinetobacter lwoffii. No
Staphylococcus aureus was isolated in our study.
Similar to our findings Chawla et al (2009) have also reported
ASBGPB as the common bacteria isolated from mobile phones of
HCWs .(5)However, Arora et al(2009)(2) ,Jayalakshmi et al(2008)(9) ,
Srinath et al (2010) (15)have reported CONS as the most common
isolate from mobile phones of HCWs. The colonization of
nosocomially significant pathogens such as Pseudomonas,
Klebseilla, Enterobacter and Acinetobacter spp. on the mobiles of
HCWs in our study demonstrates a hitherto unsuspected and
inadvertent source of transmission to vulnerable patients.
While the range of pathogenic organisms isolated from mobile
phones is small, all are nosocomial and may represent transient
or resident flora from the hands of HCWs or surfaces touched by
HCWs. Since the sampling was done only once it is not possible to
conclude from the study whether the organism are transient or
resident .Simultaneous cultures from the hands of HCWs or
environmental surfaces were not carried out, this is the limitation
of this study . Also the purpose of the study was to determine the
presence of aerobic bacteria, so cultivation of anaerobic bacteria
and fungi was not done. In the present study efficacy of various
chemical disinfectants was not checked for cleaning of cell
phones. These types of studies should be done in future that can
help to reduce the transmission of pathogens from cell phones.
Previous studies and our findings do suggest that mobile phones
pose a risk, although small for transmission of nosocomial
pathogens. Should the use of mobile phones be restricted in
healthcare facilities? The benefits of mobile phones far outweigh
the risks. Mobile phones allow for easy accessibility of the
clinician so can help in providing timely patient care .The mobile
phone technology not only allows for rapid communication but
also enables storage of formulary data, clinical and diagnostic
protocols that can be made available to a busy clinician at his
fingertips. The lack of awareness regarding the possibility of
mobile phone contamination occurring in the grooves and keys
although the phone appears to be clean and shiny suggest the
need for an awareness campaign to ensure hygienic practices in
their handling. Given the benefits of mobile phone use in
healthcare facilities we advocate that infection control guidelines
include recommendations for periodic disinfection with
appropriate disinfectants to avoid mobile phone contamination.
We also advocate hand washing prior to and after usage to
prevent cross transmission of nosocomial pathogens .Also there is
an urgent need to disseminate knowledge among healthcare
workers regarding the possible contamination of mobile phones.
CONCLUSIONCONCLUSION
Bacteria were colonized on mobile phones frequently and mobile
phones may become reservoir of microorganism for nosocomial
infection.
Recommendations to reduce contamination risks include staff
education, strict hand hygiene measures, guidelines on device
cleaning and consideration of restrictions regarding use of mobile
phone technology in certain high risk areas for examples in OTs
and ICUs. Further work is required to evaluate the benefit of such
interventions on MCD contamination and to determine whether
link exists between contamination and subsequent patient
infection.
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