Isolation and Evaluation of Microorganisms on Mobile Phone Surfaces of Health Care Professionals Working at a Tertiary Care Hospital, Mysuru

Introduction

A mobile phone is a portable, long-range, user-friendly, and reasonably priced personal communication device. It is the most important piece of equipment for both social and professional life worldwide. Since healthcare workers use their mobile phones for medical dictionary, quick reference for drug, laboratory and imaging results, as well as other work-related issues as they treat patients with various illnesses, healthcare professionals' mobile phones are easily and quickly contaminated by microorganisms from the hospital environment, patients, and medical devices.^1,2

Healthcare workers frequently keep mobile phones in their pockets and backpacks or in their hands in a clinical setting with undisciplined hand sanitization practices. Mobile phones that are often used close to patients in hospital settings increase the risk of nosocomial infections for patients. Health professionals' contaminated hands and cell phones can also significantly contribute to the spread of illnesses to oneself, one's family, and other people outside of the hospital.¹

Potentially avoidable causes of mortality and morbidity in healthcare institutions include nosocomial infections. Approximately 1.7 million nosocomial infections from all kinds of microorganisms are thought to be the direct or indirect cause of 99,000 fatalities annually in the United States of America.² In another study conducted in the USA, nosocomial infections were present in 8.7% of hospitalised patients.³ Numerous intensive care units (ICUs) and other critical care settings have been the focus of most nosocomial infection research in India; the prevalence of nosocomial infections in these settings ranges from 4.4 to 33.5 per 100 patients.⁴ In developing nations, there are 15.5 nosocomial infections for every 100 patients, according to a systematic review and meta-analysis. This amount is roughly twice to that stated for Europe.⁵ The prevalence in intensive care units was estimated by the same study to be 34.2 per 1000 patient days, which is around three times higher than that reported in the USA.^5,6 According to these data, nosocomial infections are probably going to have a big impact on the morbidity or mortality of hospitalised patients in India.

According to study done by Sepheri G et al. in Iran, healthcare professionals who give little attention to routine hand washing and hand disinfection leave their phones and those of other people more susceptible to bacterial colonisation.⁷ More than 80% of the common bacteria that make up our bacterial "fingerprints" wind up on mobile phone displays, according to a US study.⁸

Antimicrobial drugs are used to prevent infection by pathogens that are prone to infection. Antimicrobial resistance is on the rise due to nosocomial infection, and is a significant public health issue. Multiple medications have made some germs resistant, and infections from resistant microorganisms are prevalent now.⁹ Antibiotic resistance, which leads to extended hospital stays and the requirement for more expensive and alternative antibiotics, significantly adds to the rising expenses of health care. Due to their severe handicap and decreased quality of life, these problems raise the burden on patients and their families.¹⁰

Therefore, the goal of the current study was to determine whether or not mobile phones belonging to healthcare professionals contain any germs and, if so, what proportion of those microorganisms belong to the class of species that are known to cause nosocomial infections.

Materials and Methods

After receiving approval from the institutional ethical committee, a cross-sectional study was conducted for three months from February 2023 to April 2023 at Cauvery Heart and Multispecialty Hospital, Mysuru.

During the study period, a total of 52 healthcare professionals and their mobile phones were included in the study. Oral and written consent was obtained from all the healthcare professionals and a self-administered questionnaire was employed to collect information regarding the socio-demographic characteristics (age, sex, profession), use of mobile phones, the habit of cleaning, and location of keeping phones with them. All phones were tested for bacterial contamination at the department of microbiology.

The specimen was obtained using sterile cotton swab dipped in sterile peptone water. The swab was rolled on the sides, back and over the screen of the mobile phones. The swabs were surface streaked immediately on blood agar and MacConkey agar and plates were aerobically incubated at 37°C for 24-48 hours. Primary isolation of bacteria was made based on their colony characteristics and Gram’s stain. Different biochemical tests like Indole, Urease, Citrate, Triple sugar iron agar, Oxidase, Motility, Catalase, Coagulase, and Methyl red were used for presumptive identification of the organism. Table 1 shows the results of various biochemical reactions obtained for the organisms isolated.

Antimicrobial susceptibility test was done according to the Clinical Laboratory Standards Institute guidelines (CLSI, 2015) using the Kirby-Bauer disc diffusion method on Muller Hinton agar against commonly used antibiotics.

The data collected were entered to Microsoft Excel spread sheet and analysed using SPSS 16 software.

Results

Characteristics of participants

All the 52 professionals who participated in the study completed self-administered questionnaire and accordingly the collected demographic data is shown in Table 2.

All the participants used their mobile phones at the hospital. About 92.3% of them shared phones with others and 86.5% of them sanitized after using phones and sanitized their hands before attending patients. Usage of phones at the ICU, PICU, and NICUs was restricted to 30.7% and the usage at the bedside was about 38.4%. Frequency of cleaning phones was variable. About 17.3% of the participants cleaned daily, 28.8% did cleaning weekly and 53.8% cleaned their mobile occasionally (Table 3).

Prevalence and type of bacterial isolates

A total of 52 mobile phones were swabbed and samples were collected as per the study design. Twenty-seven samples (51.92%) showed bacterial growth; majority of them were from Technicians (29.6%), followed by Nursing staff (14.8%), Physiotherapists (14.8%), Ward boy/Ayas (11.1%), Pharmacists (7.2%), Accountants (7.2%), Nutritionists (7.2%) and Doctors (7.2%). Eighty percent of the cell phones of laboratory technicians were contaminated, followed by accountants, physiotherapists and nutritionists (66%), ward-boys and nursing staff (60%), pharmacists (40%) and doctors (20%) (Table 4).

Overall prevalence of bacterial contamination of the phones was 51.92%. These were isolated and identified phenotypically and confirmed by biochemical reactions (Table 1). Gram positive bacteria were the major isolates, of these, Coagulase negative Staphylococci (CoNS) were prevalent. Amongst Gram negative bacterial isolates, Klebsiella sp. was the main isolate (Table 5 and Figure 1).

Antimicrobial susceptibility pattern of bacterial isolates

The isolated bacteria showed variable susceptibility patterns for different antibiotics, as summarized in Table 6, 7, and 8.

In the present study, 17 isolated CoNS were resistant to Cefoxitin, Ciprofloxacin and four were susceptible to Cefoxitin and Ciprofloxacin. Escherichia coli was sensitive to all tested drugs, while Klebsiella "pneumoniae was resistant to Amoxicillin-clavulanic acid, Cotri-moxazole and sensitive to all others. Pseudomonas sp was susceptible to all the tested antibiotics.

Discussion

Mobile phones are frequently utilised in medical settings as non-medical equipment. It is now more frequently used to gather epidemiological information and keep track of diseases in both community and medical facilities.¹¹ Regardless of their microbiological burden, mobile phone use is not restricted within healthcare facilities in India.

According to this study, 51.9% of the mobile phones belonging to healthcare workers were contaminated with microorganisms. Higher rates of bacterial contamination were recorded in the studies conducted by Pal K et al.,¹² Jamaludeen CV et al.,¹³ while lower rates were reported by Balpriya et al.,¹⁴ and Arora U et al. ¹⁵ The observed variation may be related to the frequency with which hand washing practices are used during working hours, the pattern or policy of mobile usage in the hospital, or the degree to which health professionals are aware of the contribution of mobile phones to the spread of microbes.

The present study demonstrated that 80% of the cell phones belonging to Laboratory technicians were contaminated, while only 20% of the mobiles of doctors showed contamination. Similar results were reported in the study done by Pal K et al. ¹² Direct contact with blood, body fluids, tissues etc. harbouring different pathogenic organisms might be the reasons for higher contamination rate among Laboratory technicians.

In the present study, the two most common isolates were CoNS (77.7%), followed by Klebsiella sp. (14.8%). The majority of studies in Ethiopia^16,17 revealed comparable bacterial isolates with various rates of isolation. Acinetobactor sp. and Micrococcus, which have been identified in prior investigations from India^14,12 were not isolated in the current study.

CoNS isolates in this investigation were higher than those in India (17%),14 Egypt (33%), and reports from Iran,¹⁸ but similar to a study done in Gondar, Ethiopia (47.5%). The most frequent source of nosocomial bacteraemia linked to indwelling devices is CoNS, which has a low virulence and appears to be a normal component of the skin's flora, which is the most common isolate in our study (77.7%).^19,20

In this investigation, Klebsiella sp. (14.8%) was the second most common bacterial infection. This was comparable to studies done in India (19%) and Belgium (15.25%).¹⁹

The third bacterial isolate was Escherichia coli (3.7%), which is consistent with research done in Ethiopia (6.8%).²⁰ Its a known fact that, Escherichia coli being common cause of hospital-acquired infections and a component of the normal gut flora, its contamination indicates poor hand hygiene and mobile-phone hygiene practices.

The greatest health risk while treating patients is resistance to one or more antibiotics.⁹ In the present study, CoNS showed different antibiotic sensitivity patterns to all the antibiotics tested. Escherichia coli was sensitive to Cefotaxime and resistant to others, while Klebsiella pneumoniae was resistant to Amoxicillin-clavulanic acid, Cotrimoxazole and sensitive to all the others.

In our study, Pseudomonas aeroginosa showed the susceptibility to all the antibiotics tested, whereas in the study done by Nwankwo EO and Gashaw M, Pseudomonas aeroginosa showed resistance to various antibiotics tested.^1,20

Conclusion

We could conclude that mobile phone contamination is quite prevalent among healthcare workers and because these contaminants are antibiotic-resistant, they have the potential to spread nosocomial infections. Institutional policies governing mobile phone use during patient care and work hours for healthcare professionals who are actively involved in patient care are required. Frequent decontamination of the mobile phones of healthcare professionals is very important.

Conflict of interest

Nil

Acknowledgment

Authors are very grateful to Rajiv Gandhi University of Health Sciences, Karnataka for granting us the research funds for conducting the undergraduate research project code UG22AHS005 for the academic year 2022-23. We extend our gratitude to study participants and other staffs of Cauvery Heart and Multispecialty Hospital, Mysuru for their voluntary participation in this study.