Smartphone - An Aid to Healthcare Delivery or a Reservoir of Infection?

Introduction

Mobile phone usage worldwide has become a basic necessity, and 64% of smartphone users are in Asia.¹ Mobile phones have become more common than fixed lines. One of the most important accessories for both social and professional life nowadays is a mobile phone.

In recent times, the application of mobile communications to improve health care is being explored. In some areas, mobiles are being used to send SMS text alerts to enable patient adherence to their prescriptions, in education programmes to improve health awareness, for data collection and in training of healthcare workers. It has been extensively used as a means for communication and for transfer of information in the healthcare delivery system.

On the other hand, cell phones can serve as a source of infection transmission in healthcare environments, which exacerbates the already rising number of nosocomial illnesses. Mobiles are being carried by everyone in the hospital, from the consulting physicians to the lower level class four staff who also are in regular contact with the patients at the hospitals. Mobiles are used in hospital halls, laboratories, intensive care units and operating rooms. Surgeons can request immediate assistance from their seniors and colleagues in an emergency using mobile phones. If a mechanical or instrument malfunction occurs during surgery, they can also consult the electrical staff for advice. However, cell phones can spread infection to patients when used carelessly in the intensive care units (ICUs) or surgical wards (for example, while dressing surgical wounds). The laboratory personnel while handling blood products, the class four workers while handling patients, can actively transmit infections through their mobile phones.

In addition, there are no protocols at present for disinfection of mobile phones that meet hospital standards. Alongside, the frequent use of mobile phones—both within and outside the hospital raises the possibility that they could be a source of infection for the general public. A knowledge of the disease burden caused by mobile phones will help the institution to rethink and initiate measures in this regard and also will enable to review the antibiotics preferred in the institution.

In this perspective, it was proposed to carry out a crosssectional study with the following objectives:

1. To estimate the proportion of infected mobile phones used by the hospital staff in a tertiary care hospital.
2. To assess the pattern of infection in the mobile phones of the hospital staff.

Materials and Methods

This cross-sectional study was conducted in a tertiary care medical college teaching hospital in Bengaluru between August 2019 to October 2019. The study population comprised of healthcare providers working at all levels in the hospital. Considering a prevalence of 50%, the sample size was calculated as 400. The healthcare providers comprising of faculty, postgraduate and undergraduate students, interns, staff nurses, laboratory personnel and other staff like technicians, attenders, housekeeping staff at each level were selected using the population to proportionate sampling.

Following approval by the Institutional Ethics committee, data collection was done after taking written consent from the participants. A questionnaire was submitted to all the participants of the study to collect information on the extent of usage of mobile phones, especially during working hours, and regarding the usual place of keeping the mobile phones, handling of mobile phones, the awareness of hand hygiene, knowledge about health hazards of mobile phones.

Following this, sterile swabs moistened in peptone water were used to collect specimens from the mobile phones of all the participants, on the front and back sides where hands often contact the phone (both the sides and keys of mobile phones). The swabs were inoculated on nutrient agar, blood agar, MacConkey agar. The culture plates were incubated at 37° C for 24 hrs. Isolation and identification of bacterial species were done as per the standard microbiological guidelines.

Results

The study was carried out at a tertiary care institution with swab samples collected from all groups of healthcare providers (Figure 1). Around 400 samples were collected and processed.

Out of 400 participants, 85% reported using smartphones regularly in the hospital setting.

Among the faculty, 70% used smartphones during working hours, mainly for work-related communication and information retrieval.

The mobile phone cleaning habits of the study participants revealed that 20% of participants cleaned their phones at least once daily, whereas 40% reported occasional cleaning, typically on a weekly basis and 40% reported that they rarely or never clean their mobile phones.

About 90% of participants were aware of hand hygiene guidelines related to smartphone use in healthcare settings.

About 89% were aware that smartphones could harbour pathogens that contribute to healthcare-associated infections. The proportion of infected mobile phones handled by the hospital staff was estimated to be 82.25% (329 out of 400 samples).

Around 71 samples (17.75%) showed no growth. The most common contaminant was Staphylococcus aureus (Figure 2) followed by micrococci and CoNS (Coagulase negative Staphylococci).

Discussion

Mobile phones are integral to healthcare settings but are also recognized as significant carriers of nosocomial infections. Studies indicate that one-third of mobile phones owned by healthcare workers are contaminated with potential pathogens. Reducing the incidence of such infections involve maintaining proper hygiene practices among healthcare workers and ensuring a clean hospital environment.

In a study done at a pediatric hospital, 98% of respondents acknowledged that their phones could be contaminated; yet 56% never cleaned their devices.² This aligns with our f indings, where the extensive use of smartphones raises concerns about potential contamination and infection risk. Moreover, a survey among medical staff at Queen Elizabeth Hospital indicated that 67% used their mobile phones for hospital-related matters, with 47% reporting usage while attending to patients.³ This suggests that mobile devices are frequently employed in clinical interactions, potentially facilitating communication but also increasing the risk of pathogen transmission.

Among faculty members, 70% reported using smartphones during working hours primarily for work related communication and information retrieval. This pattern is echoed in other studies, where healthcare providers often utilize personal devices for both professional and personal purposes.^4,5 For instance, a study on nurses revealed that a significant proportion used smartphones for communication related to patient care, highlighting the dual role these devices play in clinical settings.⁵

Among the study participants, 50% kept their phones in pockets of lab coats which aligns with a study carried out at a regional hospital in Australia where 70% of the participants carried their phones in pockets.

In our study, 329 (82%) mobile phones showed high contamination with nosocomial pathogens. This aligns with the previous findings from Turkey (94.5%), Himachal Pradesh, India (94.5%), Karnataka, India (92.5%), Chandigarh, India (72%), and Nigeria (82.6%).^6-10

S. aureus is one of the frequently isolated bacteria in hospital acquired infections and in the present study was isolated from 183 (45.8%) mobile phones. This finding is consistent with that of Khivsera et al. who found that 40% of the mobile phones at Mangalore hospital were contaminated with S. aureus.¹¹ In contrast, J Omololu Aso et al. from Nigeria reported that 17.14% to 25.71% of the mobile phones in various wards were contaminated with S. aureus.¹²

In the present study, other isolated organisms included CoNS (10%), Klebsiella (5%), and Pseudomonas (3.75%). In comparison, a study by Juyal et al. conducted at a tertiary healthcare teaching hospital in Uttarakhand reported contamination rates of CoNS (38%), Klebsiella (3%), and Pseudomonas (1%).¹³

Conclusion

Mobile technology plays an important role in healthcare by improving communication, data management, and service delivery. Mobile devices enable healthcare providers to attend virtual meetings. Numerous studies conducted regarding the role of mobile phones in spreading the nosocomial illnesses have shown that the heat produced by these devices and the continual handling makes it a perfect surface for the growth of bacteria that are normally found on human skin. This is likely because these bacteria flourish at optimal temperatures, and with the mobile phones being kept warm and easily accessible in pockets, handbags, and briefcases, provide the perfect breeding conditions for these microbes. Thus, the role of mobile phones used by healthcare workers in spreading illnesses in our nation should not be disregarded. Reducing the risk of cross contamination from mobile phones can be accomplished by implementing basic measures, such as improving hand hygiene and regularly cleaning them with alcohol wipes.

Conflict of Interest

Nil