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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 6  |  Issue : 3  |  Page : 83-89

A study of microbial flora of mobile phones used by health-care professionals in a tertiary care hospital in North India


Department of Microbiology, N.C. Medical College and Hospital, Panipat, Haryana, India

Date of Web Publication4-Mar-2019

Correspondence Address:
Dr. Gurjeet Singh
Assistant Professor, Department of Microbiology, N.C. Medical College and Hospital, Israna, Panipat - 132 107, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpsic.jpsic_19_18

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  Abstract 


Context: Mobile phones give all the advantages to its users but it also acted as a house for harbour the bacteria and causing health hazard that should not be over looked. Aim of study was study the prevalence of bacterial and fungal pathogens on mobile phones and their identification.
Aims: 1. To study the prevalence of bacterial and fungal pathogens on mobile phones. 2. Identification of bacterial and fungal pathogens to species level.
Settings and Design: The study was conducted in the Department of Microbiology, N. C. Medical College and Hospital, Israna, Panipat.
Methods and Material: A total of 100 mobile phones were randomly sampled with sterile moistened swabs from doctors, nurses, laboratory technicians and attendants working in the hospital on the days of sampling.
Statistical Analysis Used: Statistical analysis was done using SPSS 20.0 v. Descriptive analysis was done to estimate the percentage of microorganisms and Chi Square test was done to assess the difference in proportions. Level of significance was taken at p<0.05
Results: Total 100 mobile phones of health care professional were swabbed to check microbial flora harboured on mobile phones. Out of 100 mobile phones 79 (79%) were found with contaminated with microbial flora.
Conclusions: Mobile phones may act as carrier for cross contamination among patients and healthcare personnel. Simple cleaning with isopropyl alcohol reduced the microbial load of the cellular phones. Hence it is recommended that medical colleges should develop strict guidelines concerning cell phone use and hygiene.

Keywords: Bacteria and fungi, health care professional, infection, mobile phones, transmission


How to cite this article:
Singh G, Singh R. A study of microbial flora of mobile phones used by health-care professionals in a tertiary care hospital in North India. J Patient Saf Infect Control 2018;6:83-9

How to cite this URL:
Singh G, Singh R. A study of microbial flora of mobile phones used by health-care professionals in a tertiary care hospital in North India. J Patient Saf Infect Control [serial online] 2018 [cited 2019 Jun 18];6:83-9. Available from: http://www.jpsiconline.com/text.asp?2018/6/3/83/253384




  Introduction Top


Mobile phone is being widely used as one of the indispensable accessories, and its usage has increased dramatically worldwide. Despite the potential benefits of mobile in facilitating communications, this device has been considered as one of the most important factors that threaten human health, for example, transmitting microbial germs from one person to another.[1],[2],[3]

Mobile phone or cell phone or cellular phone is an essential accessory in the professional and social lifestyle of the modern world. Previously used telephone only for voice call but in mobile phones can do many additional services such as text messaging, access to the internet, multimedia messaging service and many more other things.[4] A report from Telecom Regulatory Authority of India (2009–2010) showed that the number of mobile phone users in India stood at 584.32 million.[5] Moreover, easy access and affordability of mobile phones leading to a dramatic increase in the use of cell phones. India becomes the second largest mobile phone user in the world which accounted for over 10% of the world's online population in 2011.[5]

Mobile phones give all the advantages to its users, but it also acted as a house for harbour the bacteria and causing health hazard that should not be overlooked.[1]

Studies reported from different parts of India showed that bacterial pathogens isolated from contaminated cell phones.[1],[6] However, some studies reported that Methicillin-resistant Staphylococcus aureus (MRSA) isolated from mobile phones. However, most of the health-care professionals are not aware of the fact.[7],[8] The present study was undertaken to study the prevalence of bacterial and fungal pathogens on mobile phones of health-care professional and identification of bacterial and fungal pathogens to species level. This study will further be used to build awareness about the health risks not only to the patients in the hospital but also to the loved ones at home.


  Subjects and Methods Top


Methodology

  1. The collection of microbiological samples from mobile phones was performed by the technique of rolling a sterile swab moistened in sterile peptone water on the target site
  2. The samples were appropriately labeled and then transported to the laboratory for microbial analysis.


Type of study

This was a prospective study.

Procedure

The collected swabs were cultured on blood agar and MacConkey's agar. The agar plates were incubated at 37°C for 24 h. Gram staining was used to examine the morphology and staining reaction of the organisms. The isolated colonies were identified by using standard techniques[9] Methicillin resistance in Staphylococcus species was tested with the help of Cefoxitin disc (Hi-Media Ltd., Mumbai, India) on Mueller Hinton agar as per Central Laboratory Standard Institutional guidelines.[10]

Study site

The study was conducted in the Department of Microbiology, N. C. Medical College and Hospital, Panipat, Haryana, India.

The study population

A total of 100 mobile phones were randomly sampled from doctors, nurses, laboratory technicians and attendants working in the hospital on the days of sampling.

The sample size (n) was calculated by taking prevalence (P) of bacterial contamination of mobile phones used by health-care workers 72%, in a previous study by Datta et al.[11] in North India with the margin of error (E) of 10%. Zα/2 is normal deviate for two-tailed test alternative hypothesis.



So for statistical calculation 100 samples were taken.

Inclusion criteria

  1. Mobile phones with touch screen and keypad both were included
  2. Mobile phones of doctors, nurses, laboratory technicians and attendants were included.


Exclusion criteria

  1. Sliding mobile phones were excluded from the study
  2. Any person who had participated in the study once was excluded from repeat enrolment so that each person submitted his or her cell phone only once.


Statistical analysis

Statistical analysis was done using Chi-square test. Descriptive analysis was done to estimate the percentage of microorganisms, and Chi-square test was done to assess the difference in proportions. The level of statistical significance was considered as P < 0.05.


  Results Top


In the present study, we had taken a total of five groups of 30 participants in each group i.e., 30 doctors (Clinicians = 18, Microbiologist = 7 and Pathologist = 5), 30 nurses, 30 laboratory technicians (Pathology = 15, Microbiology = 7 and Biochemistry = 5) and 30 attendants [Table 1].
Table 1: List of study groups

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Of 100 mobile phones sampled, 79 (79%) were found contaminated with varied numbers of bacteria and fungi [Table 2].
Table 2: Prevalence of microbial flora on mobile phones of health-care professional

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Mobile phones of laboratory technicians were 25/25 (100%) contaminated, followed by nurses 24/25 (96%), attendants 22/25 (88%) and doctors 18/25 (72%), in which mobile phones of microbiologists showed 100% microbial contamination. Differences in the rate of contamination in different groups of health professionals were statistically significant, P ≤ 0.005 [Table 3].
Table 3: Distribution of contaminated mobile phones among different categories of health-care professionals

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About 50.56% of mobile phones had single bacterial contamination while 30.34% of mobile phones were contaminated with 2 or more types of bacteria. About 8.99% of mobile phones were contaminated with only fungi while 10.11% of mobile phones were contaminated with both bacteria and fungi [Table 4].
Table 4: Different microbial contaminant isolates from mobile phones of health-care professionals

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Totally 136 bacteria were isolated, comprising of 12 species. Of which 105/136 (77.21%) were Gram-positive organism and 31/136 (22.79%) were Gram negative. The most commonly isolated organism was S. aureus (36.03%), followed by Bacillus species (19.85%), Micrococcus species (14.71%), Acinetobacter species (5.88%), Diphtheroid and Pseudomonas species (4.41%) each, Klebsiella species and Citrobacter species (2.94%) each,  Escherichia More Details coli (3.68%), Enterobacter species and Streptococcus species (2.21%) each, Enterococcus species (0.74%) [Table 5]. 61.03% (83/136) mobiles sampled, presented with bacteria that are established nosocomial pathogens such as S. aureus, Enterococci, Pseudomonas, Acinetobacter, Enterobacter, Citrobacter, E. coli and Klebsiella species.
Table 5: Identification of bacterial isolates

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MRSA was recovered 16 out of 49 i.e., 32.65%, which could be a cause of concern [Table 6].
Table 6: Prevalence of methicillin-resistant Staphylococcus aureus from mobile phones of health care workers

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Fungal isolates from mobile phones were maximum Aspergillus species 9 (52.94%), Candida species 67 (35.29%), Penicillium species and Mucor 1 (5.88%) each. Doctors mobile phones were contaminated with Aspergillus species i.e., 2 (66.67%), followed by Candida species 1 (33.33%). Nurses mobile phones were contaminated with Aspergillus species 3 (60%), followed by Candida species 2 (40%). Laboratory technician mobile phones were contaminated with Aspergillus species 3 (60%), followed by Candida species 2 (40%) and Mucor 1 (20%). Attendants mobile phones were contaminated with Aspergillus species 2 (50%), followed by Candida species and Penicillium species 1 (25%) each [Table 7].
Table 7: Identification of fungal isolates from mobile phones of health-care professionals

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  Discussion Top


The hospital environment plays a critical role in the transmission of microorganisms associated with healthcare-associated infections. Microorganisms can be transferred from patient to patient, patient to doctor, patient to visitors or from inanimate objects (such as stethoscopes, bronchoscopes, pagers, ballpoint pens, patient hospital charts, computer keyboards, mobile phones and fixed telephones) to hand and vice versa.[12],[13],[14],[15],[16],[17] In a study, it was discovered that average cell phone is dirtier than either a toilet seat or the bottom of your shoe.[6] A study showed that 40% of mobile phones of 266 medical staff and students were culture positive.[18]

According to the recent recommendations of the United Kingdom National Health Service, regular cleaning of phones and hand hygiene have been introduced as main factors for the prevention of spreading mobile-related pathogens in hospital environments.[19] According to the observation by Morioka et al. while all the nurses were aware of hand washing with water or alcohol after regular work, 33.6% of the nurses were not conscious of hand washing with water or alcohol after using a mobile phone. Therefore, because hand washing with water or alcohol prevents the contamination of mobile phones, nurses should take standard precautions after using mobile phones.[20]

The possible transmissions of nosocomial pathogens by electronic devices were previously reported.[21],[22]

Hospital-acquired infection caused by multidrug-resistant organisms is a growing problem in many health care institutions.[23],[24],[25] Hands, instruments, mobile phones or other inanimate hospital objects used by HCWs may serve as vectors for the nosocomial transmission of microorganisms.[14],[26],[27],[28]

Although the hospital environment and patients could be considered as a source of infection and play a significant role impacting public health, health-care workers such as physicians, nurses and other members of health-care system may additionally play a role as a source for transmission of infections. This transmission to patients may occur through routine habits such as using personal belongings during work shifts.[26],[27]

Unlike fixed phones, mobile phones are often used in these areas close to the patients, and these patients are more vulnerable to hospital-acquired infections.[29],[30]

In this study, we have taken five groups i.e., doctors, nurses, laboratory technicians, attendant and sweepers. From each group, we have collected 30 samples.

In our study, we had taken total five groups which consists of 30 participants in each group i.e., 30 doctors (Clinicians = 18, Microbiologist = 7 and Pathologist = 5), 30 nurses, 30 laboratory technicians (Pathology = 15, Microbiology = 7 and Biochemistry = 5) and 30 attendants [Table 1].

Out of 100 mobile phones sampled, 79 (79%) were found contaminated with varied numbers of bacteria and fungi [Table 2]. La Fauci et al. from Italy, reported bacterial contamination on mobile phones 76.6% which is similar to our study.[31] Another study conducted by Datta et al. from Chandigarh, India, they reported bacterial contamination on mobile phones used by health care workers 72%.[11] Morioka et al. from Japan, reported a similar prevalence of mobile phones i.e., 79.1%.[20] Omani et al. from Riyadh, reported high prevalence on mobile phones i.e., 98.5%.[32] However, Tagoe et al. from Ghana reported 100% prevalence,[33] Sedighi et al. From Iran reported 99.2% prevalence,[34] Gashaw et al. from Ethiopia reported 98% prevalence[35] and Tekerekoǧlu et al. from Turkey reported 98% prevalence.[36] Elmanama et al. from Gaza, also reported similar prevalence i.e., 71.6%.[37] Parhizgari et al. from Iran, reported 90% bacterial prevalence on mobile phones.[38] Kumar et al. from Saudi Arabia, reported 83.9% of mobile phones were found to be contaminated with bacteria.[39] Lakshmi and Lakshmi from Telangana, India reported 91.8% prevalence.[40] Bhat et al. from Karnataka, India, reported 99% bacterial contamination on mobile phones.[1] Tambe and Pai from Navi Mumbai, India reported that 82.5% of mobile phones of health-care personnel were found to be contaminated.[41]

Mobile phones of laboratory technicians were 25/25 (100%) contaminated, followed by nurses 24/25 (96%), attendants 22/25 (88%) and doctors 18/25 (72%). Differences in rate of contamination in different groups of health professionals were statistically significant, P ≤ 0.005 [Table 3]. 50.56% mobile phones had single bacterial contamination while 30.34% of mobile phones were contaminated with 2 or more types of bacteria. About 8.99% of mobile phones were contaminated with only fungi while 10.11% mobile phones were contaminated with both bacteria and fungi [Table 4].

A total of 136 bacteria were isolated, comprising of 12 species. Of which, 105/136 (77.21%) were Gram-positive organism and 31/136 (22.79%) were Gram-negative. The most commonly isolated organism was S. aureus (36.03%), followed by Bacillus species (19.85%), Micrococcus species (14.71%), Acinetobacter species (5.88%), Diphtheroid and Pseudomonas species (4.41%) each, Klebsiella species and Citrobacter species (2.94%) each, E. coli (3.68%), Enterobacter species and Streptococcus species (2.21%) each, Enterococcus species (0.74%) [Table 5]. About 61.03% (83/136) mobiles sampled, presented with bacteria that are established nosocomial pathogens such as S. aureus, Enterococci, Pseudomonas, Acinetobacter, Enterobacter, Citrobacter, E. coli and Klebsiella species. Elmanama et al. from Gaza, also reported the most frequent isolate of S. aureus i.e., 27%.[37] Tambe and Pai from Navi Mumbai, India also reported that maximum isolation of S. aureus (54.16%), followed by Micrococci (20.83%), Diptheroids (7.5%), Enterococci (4.1%), Pseudomonas, Citrobacter, Bacillus (3.3% each), Acinetobacter, Enterobacter and Streptococcus viridans (1.6% each)[41] La Fauci et al.(2014) from Italy, also reported most frequent isolate of Staphylococci.[31]

MRSA was recovered 16 out of 49 i.e., 32.65%, which could be a cause of concern. MRSA reported maximum in mobile phones of laboratory technician 6 (37.5%), followed by nurse's mobile phones 5 (31.25%), attendant's mobile phones 3 (18.75%), doctor's mobile phones 2 (12.5%) [Table 6]. MRSA is increasingly spreading not only among the hospitalised patients but as recent studies show, it has some impact on serious community-acquired infections.[42],[43] Furthermore, these bacteria are often resistant to multiple commonly used antimicrobial agents, which can infect both healthy children and immune-compromised ones. It is indeed surprising to document the presence of MRSA in the mobile phones from health care personnel working in hospital environment including intensive care unit (ICU) because such environments are routinely screened and controlled by infection control teams and such organisms are extremely fatal in such units. Elmanama et al. from Gaza, also reported 28.3% MRSA.[37]

Fungal isolates from mobile phones were maximum Aspergillus species 9 (52.94%), Candida species 6 (35.29%), Penicillium species and Mucor 1 (5.88%) each. Doctors mobile phones were contaminated with Aspergillus species i.e., 2 (66.67%), followed by Candida species 1 (33.33%). Nurses mobile phones were contaminated with Aspergillus species 3 (60%), followed by Candida species 2 (40%). Laboratory technician mobile phones were contaminated with Aspergillus species 3 (60%), followed by Candida species 2 (40%) and Mucor 1 (20%). Attendants mobile phones were contaminated with Aspergillus species 2 (50%), followed by Candida species and Penicillium species 1 (25%) each [Table 7]. A similar study reported by Tambe and Pai from Navi Mumbai, India, fungi isolation on mobile phones was Candida 8 (6.66%), Aspergillus 6 (5%), Mucor 1 (0.8%) and Trichophyton 1 (0.8%).[41]

More than three-fourth of mobile phones belonging to health-care personnel harboured potential pathogens, including multidrug-resistant organism, for example, MRSA but health-care workers were quite unaware of the fact. Due to no proper information regarding suitable mobile disinfection methods that are both effective and at the same time do not damage the mobile phones, restricted use of mobile phones in the hospital is to be implemented. Moreover, hand washing before or after attending a call or seeing WhatsApp messages is to be recommended strictly. Mobile phones are now an extension of a person's lifestyle, accompanying them everywhere. We recommended that a simple measures such as hand washing, cleaning of mobile phones with 70% isopropyl alcohol, using hand-free mobile phone while working hours, well-controlled infection control plan and regular training of health-care personnel to reduce the rate healthcare-associated infection.

Recommendations

  • Emphasis should be given on strict guidelines regarding the use and disinfection of mobile phone for health-care professionals
  • Mobile phones should be regularly wiped with tissue paper moistened with 70% isopropyl alcohol to avoid harbouring of microbial flora
  • Hand washing should be practiced both before as well as after finishing the clinical procedure
  • Gloves should be worn and changed for each patient
  • Mobile phones use in between the clinical procedure should be avoided. If at all has to be used, then a thorough hand washing before and after use of mobile phone is necessary
  • Manufacturers should provide clear disinfection guidelines and emphasis more on the development of equipment such as antibacterial covers, ultraviolet chambers, decolonising mobile phone charger for the decontamination of cellular phones
  • Continuing medical education programmes should be organised to create awareness among health-care personnel regarding the role of mobile phones as a vector in transmission of nosocomial infections.


Acknowledgement

Authors would like to thank Mrs. Asha Rani and Mr. Arvind Sharma (Technician, Department of Microbiology, NC Medical College and Hospital, Panipat) for help during the preparation of culture media and collection of samples from mobile phones. Also want to thank Ms. Preeti (Tutor cum Biostatistician, Department of Community Medicine, NC Medical College and Hospital, Panipat) for help during the selection of samples.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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