Surveillance of microbial contamination of mobile phones, reported behaviour and hand hygiene practices of healthcare personnel related to mobile phone use: A prospective observational study

Sunil Kumar Poonia; Poonam Joshi; Rakesh Lodha; Arti Kapil; M Srinivas

doi:10.4103/jpsic.jpsic_6_17

ORIGINAL ARTICLE

Year : 2017 | Volume : 5 | Issue : 1 | Page : 40-44

Surveillance of microbial contamination of mobile phones, reported behaviour and hand hygiene practices of healthcare personnel related to mobile phone use: A prospective observational study

Sunil Kumar Poonia¹, Poonam Joshi¹, Rakesh Lodha², Arti Kapil³, M Srinivas⁴
¹ College of Nursing, AIIMS, New Delhi, India
² Department of Pediatrics, AIIMS, New Delhi, India
³ Department of Microbiology, AIIMS, New Delhi, India
⁴ Department of Pediatric Surgery, AIIMS, New Delhi, India

Date of Web Publication

18-Aug-2017

Correspondence Address:
Sunil Kumar Poonia
College of Nursing, AIIMS, New Delhi
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jpsic.jpsic_6_17

Abstract

Objectives: To compare the microbial flora on the mobile phones of Health care personnel (HCP) and general public (GP) and to study the reported behaviour and observed hand hygiene practices of the HCP related to mobile phone use in paediatric medical and surgical Intensive Care Units (ICUs).
Methodology: Front surface of the mobile phones of enrolled HCP and GP was sampled for culture using sterile swabs. Behaviour of the HCP was assessed using a self-report structured behaviour assessment tool. A total of 360 observations on the hand hygiene practices of the HCP related to mobile phone use in ICUs were carried out over 8 weeks using an observation checklist.
Results: Of the 47 HCPs enrolled in the study, 78.7% were nurses and 21.3% were doctors. Majority of the HCPs had smartphones (85%;). Nearly 77% of mobile phones of HCP and GP were contaminated with various pathogenic, commensal and environmental bacteria. Most of HCPs were using mobile phones 1–3 times during working hours for communication, E-mailing and searching information. Two-thirds of the HCP (66) were not cleaning their phones; 38 seldom practiced hand hygiene before using the mobile phones, while better hand hygiene practices were reported after using the mobile phones (60%). More than 50% of the observed hand hygiene practices related to mobile phone usage were inappropriate or wrong.
Conclusion: Mobile phones of the HCP and GP were equally contaminated; more pathogenic microorganisms were seen on the mobile surfaces of HCP. Reported behaviour and hand hygiene practices of HCP related to mobile phone use in the ICUs were inappropriate or wrong.

Keywords: General public, hand hygiene practices and behaviour related to mobile phones use, healthcare professionals, microbial contamination

How to cite this article:
Poonia SK, Joshi P, Lodha R, Kapil A, Srinivas M. Surveillance of microbial contamination of mobile phones, reported behaviour and hand hygiene practices of healthcare personnel related to mobile phone use: A prospective observational study. J Patient Saf Infect Control 2017;5:40-4

How to cite this URL:
Poonia SK, Joshi P, Lodha R, Kapil A, Srinivas M. Surveillance of microbial contamination of mobile phones, reported behaviour and hand hygiene practices of healthcare personnel related to mobile phone use: A prospective observational study. J Patient Saf Infect Control [serial online] 2017 [cited 2023 Jun 7];5:40-4. Available from: https://www.jpsiconline.com/text.asp?2017/5/1/40/213287

Introduction

Hospital care-associated infections (HCAIs) have become major public health problem, particularly in developing countries.^[1] Transmission of HCAI can be through direct or indirect contact. Hands of the healthcare professionals (HCPs) play a very significant role in the transmission of infection from patients to HCP and vice versa.^[2] Majority of HCAI are inadvertently transmitted through hands of HCP. The environment of the hospital is also recognised as the source of nosocomial agents, which includes both animate and inanimate objects. The environment in the hospital applies to food, water, medications, devices and equipment that harbour the microorganisms.^[1] Inanimate objects such as stethoscope,^[3] computer key pad ^[4] and mobile phone^[5] in the hospital environment are known to be contaminated with microorganisms transmitted to the host.

Nowadays, use of mobile phone is very popular amongst all and becoming indispensable part of one's life and HCPs are no exception. Extensive use of mobile phones by HCP at their workplace may act as a vehicle for transmission of nosocomial agents. A mobile phone was used for personal telecommunications in the past. Now, the smartphones are considered to be the important means of communication as well as for retrieval of healthcare information within and outside the hospital.^[6]

Unchecked use of mobile phones and inappropriate hand washing technique ^[7] by the HCP in hospitals and Intensive Care Unit (ICU) specifically can harbour various potential pathogens and become the exogenous source of nosocomial infection amongst hospitalised patients and a potential health hazard for HCP and their family members. Mobile phones of the general public (GP) are also likely to become contaminated during use, especially in tropical countries like India where high temperature and humid climatic conditions are prevalent.^[8]

Published reports have highlighted the contamination of mobile phones of HCP during patient care ^[3],[5],[9] and the role of hand hygiene practices in transmission of infection.^{[10],[11],[12]} Data related to contamination of mobile phones, reported behaviour and hand hygiene practices of HCP related to mobile phones use are limited. This prospective observational study was undertaken to compare the microbial flora of mobile phones of HCP and GP, study their reported behaviour and observe hand hygiene practices related to mobile phone use while working in paediatric medical and surgical ICUs from June to December 2015.

Methodology

Ethical clearance was obtained from the Institute Ethics Committee. The study participants were the HCP working in paediatric medical and surgical ICU and GP-non-clinical personnel consisting of nursing students from College of Nursing (before the commencement of their clinical training) and the administrative staff of a selected tertiary care facility. Written informed consent was obtained from the participants. The study participants were assured that the obtained findings would be used for the research purpose only. After collecting data on demographic profile, the front surface of the mobile phone including keypads of 45 HCPs (2 refusals) and all GP were cultured using sterile swab using five strokes. The sterile swabs were transported in Thioglycollate broth media to the laboratory. The samples were inoculated on MacConkey Agar Plate and incubated at 37°C for 24 h. Total colony-forming units were calculated by a deputed technical staff.

Behaviour related to hand hygiene while using mobile phone was assessed using self-report behaviour assessment questionnaire (5 items, α = 0.87). The tool included questions related to the use of mobile phone during working hours in ICU, frequency and reason for using mobile phones, whether cleaning mobile phones or not; in case of cleaning what was being used; disinfecting hands before and after using mobile phones or not.

During the study period, researcher worked as part of the healthcare team in the ICUs. A total of 360 participatory observations on the hand hygiene practices of the HCP related to mobile phone use in both the ICUs were carried out for a total period of 8 weeks (4 weeks in each ICU) using an observation checklist (inter-rater agreement 100%) to find whether HCP practiced hand hygiene before and after the use of mobile phone or not (as per the WHO guidelines). The hand hygiene practices were categorised as correct (hand rub - mobile phone use - hand rub), inappropriate (no hand rub - mobile phone use - hand rub or vice versa) and wrong (no hand rub - mobile phone use - no hand hygiene). Observations made by the researcher during the 1^st week in both the ICUs were ignored.

Data analysis

Data were coded, entered in MS Excel worksheet and analysed using SPSS 23.0. SPSS is a Statistical Package for the Social Sciences a software being used for statistical analysis purpose Descriptive analysis was used using frequency, percentage, mean, standard deviation and Chi-square tests; P < 0.05 was considered statistically significant.

Results

Forty-seven HCP were enrolled; of these, 78.3% were nurses and 21.3% were doctors. Most of the HCPs (49%) working in the paediatric medical and surgical ICUs were in the age group of 20–30 years. All HCPs were using mobile phone during their duties in the unit. [Table 1] shows the demographic characteristics and the information related to mobile phones.

Table 1: Demographic profile of healthcare personnel (n=47)

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Microbial contamination was found more often on ordinary than smartphones (P < 0.001); however, no association was found between microbial contamination and the use of cover on mobile phones (P > 0.05) [Table 2]. Nearly 77% of mobile phones of HCP and GP were contaminated. Various bacteria found on the mobile phones of the HCP were Pseudomonas (22.2%), coagulase-negative Staphylococcus (CONS) (15.6%), Klebsiella pneumoniae (2.2%), Enterobacter (2.2%), three types of Gram-positive cocci (GPC) 6 (13.3%), three types of Gram-negative bacilli (GNB) (2.2%) and polymicrobes (2.2%). On the other hand, microorganisms isolated from the mobile phones of GP were mainly CONS (43.1%), Staphylococcus aureus (15.4%), antibiotic-susceptible bacteria (ASB) (9.2%), ASB with GNB and GPC (3.1%), Micrococci (3.1%), Escherichia coli (1.5%) and Acinetobacter (1.5%).

Table 2: Association of microbial contamination with type of mobile phones and cover (n=45)

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Majority of microorganisms (62.2%) on mobile phones of HCP were of pathogenic type and environmental bacteria in contrast to the mobile phones of GP having more of commensal bacteria (46.2%) [Table 3]. On the basis of Gram staining, more Gram-negative bacteria were found on the mobile phones of HCP (27%) as compared to GP (6%) while Gram-positive bacteria were found more on the mobile phones of GP (71%) as compared to HCP (33%). Similarly, the polymicrobial flora was also more on the mobile phones of HCP (18%) as compared to GP (3%). In both the groups, no organism could be cultured from surfaces of nearly 22% of mobile phones.

Table 3: Microbial flora on mobile phones of healthcare personnel and general public

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All HCPs were using mobile phones during working hours in ICU, of these most of HCPs reported using it 1–3 times for various reasons. Most of the HCPs (66%) reported of not cleaning their mobile phones. Most of the HCPs reported of seldom observed hand hygiene before using mobile phones (38%) while more HCP reported of observing hand hygiene after using mobile phones always (60%) [Table 4]. Amongst all three shifts, majority of the hand hygiene practices of HCP related to mobile phone use were either wrong or inappropriate [Table 5].

Table 4: Self-reported behaviour of healthcare personnel related to mobile phone use (n=47)

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Table 5: Observations of practices related to the use of mobile phones amongst healthcare personnel (number of observations=360)

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Discussion

Findings of the present study reveal that all HCPs used mobile phone during patient care for multiple reasons. Microbial contamination was found more on ordinary than smartphones. Majority mobile phones of HCP and GP were contaminated. More pathogenic microorganisms were seen on the mobile phones of HCP in comparison to GP. Most of the HCPs reported of not cleaning their mobile phones and seldom observed hand hygiene before using mobile phones, while more HCP observed hand hygiene always after the use of mobile phone. Majority hand hygiene practices of HCP related to mobile phone use in all three shifts were either wrong or inappropriate.

Mobile phone use amongst HCP such as GP is also becoming common and playing a significant role in communicating issues related to hospital. Smartphones are being used for quick retrieval of health-related information in relation to diagnosis, treatment of patients including deciding drug dosage, etc. The probable reason for ordinary phones to be more contaminated in the present study could be attributed to the presence of crevices and grooves with prominent keypad allowing more microbial growth on them. In the present study, majority of HCP had smartphones with added applications, being used for E-mailing, searching information along with calling. Findings of our study are in tune with the findings of Mark et al.,^[12] Gibbon et al.^[13] and Singh et al What scholar.^[14]

Mobile phones can become contaminated at any place, be a hospital or community as suggested by the findings of the present study, in which the contamination of mobile phones of HCP was comparable with the mobile phones of GP. Findings of the present study support the findings reported by Abbas et al.,^[15] Arora et al.,^[16] Trivedi et al.,^[17] Ulger et al.^[18] and Datta et al.^[19] that showed contamination in the mobile phones of dentists and patients visiting the dental institution and HCP from clinical and non-clinical departments. However, in our study, more pathogenic, Gram-negative and polymicrobial organisms were isolated from the mobile phones of HCP.

In the present study, majority of HCP were not cleaning their mobile phones; only one-third of HCP used cleaning agents such as spirit, sterillium and simply clean cloth. There are no officially recommended guidelines for cleaning of mobile phones so far either from the healthcare facility or the mobile companies. HCP might fear some damage to their expensive mobile phones due to the use of chemical agents such as sterillium or spirit that could be the reason for them not cleaning the mobile phones. In contrast to our findings, Mark et al.^[12] and Brady et al.^[5] had reported of more HCP cleaning their mobile phones in NICU and surgical wards, respectively.

In the clinical setup, hand hygiene should be ideally practiced by all HCPs before and after the use of mobile phones to prevent the contamination of mobile phones and transmission of microorganisms to the patients and HCP. In the present study, more than one-third of HCP seldom practiced hand hygiene before using the mobile phone; however, hand hygiene practices were more reported by HCP after the use of mobile phones. Majority observed hand hygiene practices of HCP were wrong or inappropriate. There is no study available to compare our results.

Possibility of participants being influenced and modifying their behaviour “Hawthorne effect” during the study was taken care of by making the participatory observation and ignoring the first observations made in 1^st week by the researcher; however, the use of close circuit television observations is considered to be more accurate and unbiased.

There are several studies reporting contamination of mobile phones of HCP.^{[3],[5],[7],[9]} This is a study, one of its kind, in which we have tried to explore the behaviour and hand hygiene practices of HCP while using mobile phones; however, relating isolated microorganisms from the mobile phones of HCP with the organisms isolated from the hands of HCP and positive blood and body fluids culture report of the patients could have helped us to confirm the role of contaminated mobile phones in transmission of HCAI conclusively.

The present study has certain limitations. The GP was the administrative staff and the nursing students (who had not started their clinical posting). There is a possibility of the administrative staff and the nursing students going to the clinical area, therefore, may not have truly represented the GP. Behaviour of the HCP was assessed using self-report questionnaire, might be underreported and therefore limits the generalizability of the study.

HCP should be sensitised about the microbial contamination of the mobile phones and restrict the use of mobile phones for communication, updating knowledge and E-mailing, etc., in patient care area. Supervisory checks and audits by authorities can also be the important steps in reducing the use of mobile phones in ICUs. Posters informing the HCP regarding the restricted use of mobile phones at workplace and practicing hand hygiene before and after the use of mobile phones can be displayed as reminders. The study can be replicated in general wards on a larger sample as ICU is relatively a confined area with limited patients and HCP. There is a need to formulate the mobile phone friendly disinfection policies after finding out the safe disinfectants for the mobile phones.

Conclusion

Mobile phones of the HCP and GP were contaminated; more pathogenic microorganisms were seen on the mobile surfaces of HCP. Reported behaviour and hand hygiene practices of HCP related to mobile phone use in the ICUs were inappropriate.[20]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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