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

Aztreo

nam

Cefazo

lin

Cefepim

e

Cefotax

ime

Ceftazi

dime

Ceftria

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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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