Mobile Phones - Source

of HAI

Presenter
: Dr.N.Ramakrishna,
Senior Resident
Moderator:
Dr.B.V.Ramana,
Assistant Professor

Introduction
Healthcare-associated infections (HAIs) are a major
challenge to the healthcare system and are associated
with significant mortality, morbidity, and high
economic burden.1
HAIs are becoming increasingly common due to the
expansion of the population at risk, which results from
aging population, increase of chemotherapeutic
options for cancer treatment, increase in the number of
patients with transplants, in addition to complex and
invasive surgical and medical care procedures that are
increasingly being provided in acute and non-acutecare settings.2
1. World Health Organization. 2011. WHO Report on the burden of endemic health care-associated
infection worldwide. http://www.who.int/iris/bitstream/10665/80135/1/9789241501507_eng.pdf
2. Sydnor ER, Perl TM. Hospital epidemiology and infection control in acute-care settings. Clin Microbiol

Introduction
Patients in intensive care units (ICUs) are
particularly susceptible to HAIs because of their
poor health status in addition to the use of invasive
equipment like catheters and cannulae.
Infants
in neonatal care units (NCUs) have a
higher risk of HAIs because of their immature
immune systems, their skin does not provide a
strong
barrier
against
organisms
in
the
environment and a large number of these infants
are premature and often require invasive
procedures to sustain their life such as mechanical
ventilation and total parenteral nutrition. 3
3. Newby J. Nosocomial infection in neonates: inevitable or preventable? J Perinat Neonatal Nurs.
2008;22(3):2217. quiz 228229.

Introduction
Contaminated hands of healthcare providers play a
major role in spreading infections in healthcare
settings.
Hand hygiene is one of the most important
preventive interventions against the spread of
infections in healthcare settings.4
Objects with frequent hand contact can serve as
reservoirs from which infections can spread to the
hands of healthcare providers and then to patients. 4
4. NCCNSC.: National Collaborating Centre for Nursing and Supportive Care (UK) 2003. Infection
Control-Prevention of Healthcare-associated Infections in Primary and Community Care. London:
Thames Valley University; 2003.

Introduction
Examples of these objects include medical
equipment
like
stethoscopes
and
other
accessories such as mobile phones.5
Mobile phones have become an indispensable
accessory of todays society, and they are being
used extensively in hospital settings.
They are commonly handled irrespective of the
cleanliness of hands and rarely disinfected, thus
may harbour pathogenic bacteria.6
5. Wong D, Nye K, Hollis P. Microbial flora on doctors' white coats. BMJ. 1991;303(6817):16024
6. Julian T, Singh A, Rousseau J, Weese JS. Methicillin-resistant staphylococcal contamination of
cellular phones of personnel in a veterinary teaching hospital. BMC Res Notes. 2012;5:193.

How do mobile devices breed

bacteria ?
During every phone call the mobile phone come
into close contact with contaminated human
body areas with hands to hands, and hands to
other areas like mouth, nose and ears.

Common organisms isolated from mobile

phones of HCWs

Staphylococcus aureus
CoNS
Escherichia coli
Klebsiella
Pseudomonas
Acinetobacter
Bacillus spp.
Citrobactor
Streptococcus
Enterococcus
Micrococcus

 Several studies have described the contamination

of clinicians mobile phones in healthcare settings,
and reported a level of contamination and type of
bacteria that depend on the clinical and
geographical setting.

 Studies that investigated the contamination of

clinicians mobile phones in developed countries, like
USA and UK, reported a level of overall mobile phone
contamination
(pathogenic
and
non-pathogenic
organisms) ranging from 65% to 90%. 7
The most common isolated organisms were coagulasenegative staphylococci (CoNS) and Micrococcus; while
between 9% and 25% of mobile phones were
contaminated by other pathogenic bacteria known to
cause
HAIs,
including
methicillin-sensitive
and
methicillin-resistant Staphylococcus aureus (MSSA &
MRSA), Acinetobacter species, and Pseudomonas
species.7
7. Goldblatt JG, Krief I, Klonsky T, Haller D, Milloul V, Sixsmith DM, et al. Use of cellular
telephones and transmission of pathogens by medical staff in New York and Israel. Infect

 In addition, studies in healthcare settings in

developing countries, including India, Nigeria, and
Turkey, demonstrated that 72% to 97% of
clinicians mobile phones are contaminated. 8
CoNS were the most common isolated organisms;
while other microorganisms, such as Escherichia
coli,
Acinetobacter
species,
Pseudomonas
species, and MRSA, were isolated from 8% to
31% of the clinicians mobile phones.8
8. Nwankwo EO, Ekwunife N, Mofolorunsho KC. Nosocomial pathogens associated with the
mobile phones of healthcare workers in a hospital in Anyigba, Kogi state, Nigeria. J Epidemiol
Glob Health. 2014;4(2):13540.

SVIMS-DATA
We also conducted a study on Bacteriological
isolation and their resistance patterns from mobiles
of HCWs working in ICUs of the SVIMS hospital.
The total of 50 mobile phones were studied.
The swabs were taken from the mobile phones of
HCWs.
Isolation of the organisms and antibiotic sensitivity
testing is performed according to the CLSI guidelines.

SVIMS-DATA
Results:
In our study all the mobiles tested were
contaminated with one or more bacterial
pathogens.
NUMBER OF
MOBILES
TESTED

50

100%

NUMBER OF
MOBILES
CONTAMINATED

50

100%

SVIMS-DATA

SVIMS-DATA

SVIMS-DATA
Present study showed that common organisms
isolated were Coagulase Negative staphylococcus
(CONS).
CONS is a normal skin flora, but it is responsible for a
large number of hospital acquired infections.
Most of the coagulase negative staphylococcal strains
are resistant to penicillin (54.5%), followed by
erythromycin (45.4%), and ampicillin (36.3%).
Other organisms include Staphylococcus aureus,
pseudomonas, klebsiella, E.coli and Streptococcus spp.

SVIMS-DATA
Staphylococcus is especially troublesome in
hospitals where patients with open wounds,
invasive devises and weakened immune systems
are at greater risk of infection than the general
population.
Staphylococcal strains showed high resistance to
pencillin
(33.3%),
erythromycin
(33.3%),
ampicillin
(33.3%)
followed
by
cotrimaxazole(16.7%).

SVIMS-DATA
Citrobacter showed resistance to ampicillin (100%),
amoxyclav (100%), piperacillintazobactum (100%)
and Imipenem (100%).
Klebsiella showed resistance
sulbactum (66.7%).

to

cefaparazone

E.coli showed high resistance to gentamycin (100%)

and Cotrimaxazole (100%)
Pseudomonas showed
gentamycin
(66.7%)
(33.3%).

high
followed

resistance to
by ciprofloxacin

SVIMS-DATA
These results showed that HCWs mobile phones
were
contaminated
with
various
types
of
microorganisms.
Thus mobile phones are colonized by pathogenic bacteria
and thus potential sources of disease transmission
requiring application of preventive methods.
Isolation of MRSA from HCWs mobile phones is a
cause for concern, indicating the potential threat of
mobile phones spreading infections and the importance
of hand hygiene to prevent infection.

Mobile Phones- Disinfection

In addition to washing the hands both before and
after treating patients, there are a number of
ways in which providers can ensure their mobile
devices are kept clean.
UV sanitizing devices are an additional way to
disinfect mobile technology.
UV-C wavelength light the specific type of light
used in UV sanitizing devices is effective in
destroying
germ
DNA
and
preventing
microorganisms from reproducing.

Mobile Phones- Disinfection

According to the CDC 2008 Guideline for Disinfection
and Sterilization in Healthcare Facilities, mobile
devices are noncritical items objects that come in
contact with intact skin but not mucous
membranes.
Noncritical items can be disinfected with
intermediate-level disinfectants: phenolic, iodophor,
alcohol or chlorine.
Using disinfecting wipes to thoroughly clean devices
is easy and effective.
http://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf

Mobile Phones- Disinfection

Antimicrobial wipes: (CDC Recommended)
70% isopropyl alcohol wipes
Works by damaging the cell membrane and denaturing
proteins found in the cytosol.
The efficacy of decontamination with 70% isopropyl
alcohol was found to be 98%.

UV- light:
UV- light effects the microbes the DNA structure and
effectively kills the microbes.
UV- light is safe, economical and ecological way of
disinfection, and will not effect the object disinfected.

Mobile Phones- Disinfection

Antimicrobial wipes: (CDC Recommended)

Mobile Phones- Disinfection

UV- light:

Mobile Phones- Disinfection

UV- light:

Mobile Phones- Disinfection

UV- light:

Conclusion
The prevalence of clinicians mobile phones that are
contaminated by various microorganism in the ICUs
was high.
Although most microorganisms can be considered
non-pathogenic in normal circumstances, these are
potentially harmful in ICU settings, where patients
are extremely vulnerable to infections.
Some mobile phones harboured extremely harmful
bacteria, such as MRSA or Gram-negative organisms.

Conclusion
Restriction of using mobile phone while working
hours is not the practical solution of the problem.
Healthcare workers should be advised to limit their
use or due care of mobile phones in high risk areas
to reduce the risk of transmission of bacterial
agents..
As Hand Hygiene compliance is part of Infection
Control Programme, Mobile phones are also source
of infection for HCAI on par with hands.

Conclusion
To reduce the rate health care associated
infections we recommend simple measures like
hand washing
cleaning of mobile phones with 70%
isopropyl alcohol
using hand free mobile phone while
working in high risk areas
well controlled infection control plan
regular training to HCWs.