DOI: 10.18410/jebmh/2015/685
ORIGINAL ARTICLE
ISOLATION AND ANTIBIOTIC SENSITIVITY PATTERN OF MICROORGANISM CAPABLE OF NOSOCOMIAL INFECTIONS THROUGH
MOBILE PHONES OF HEALTH CARE WORKERS IN OBSTETRIC
DEPARTMENT OF TERTIARY CARE HOSPITAL
Neelam Sharma1, Anshul Jhanwar2
HOW TO CITE THIS ARTICLE:
Neelam Sharma, Anshul Jhanwar. ”Isolation and Antibiotic Sensitivity Pattern of Micro-Organism Capable of
Nosocomial Infections Through Mobile Phones of Health Care Workers in Obstetric Department of Tertiary
Care Hospital”. Journal of Evidence based Medicine and Healthcare; Volume 2, Issue 33, August 17, 2015;
Page: 4897-4902, DOI: 10.18410/jebmh/2015/685
ABSTRACT: AIM: To determine the microbial contamination on mobile phones of health care
workers and to know the antibiotic sensitivity pattern. MATERIAL AND METHODS: Swabs from
mobile phones of 40 health care workers (Doctors, nurses, laboratory technicians, ward boys)
were taken & processed by standard bacteriological technique. Antibiotic susceptibility done by
Kirby-Bauer disc diffusion technique. RESULT: Out of 40 mobile phones of Health care workers
of Obstetrics department of Jhalawar Medical College, Jhalawar, 34(85%) showed bacterial
contamination. In our study we found single bacterial growth on 24% of mobile and multiple
growth on 76%. S. aureus was most common isolate (62%) followed by Klebseilla sp. (56%). S.
aureus isolate shows sensitivity to Augmentin while E. coli was resistant to Augmentin and
Ciprofloxacin. Other Gram negative bacterias were sensitive to most of the antibiotics.
Pseudomonas was found sensitive to Ciprofloxacin and Gentamycin. CONCLUSION: This study
emphasizes that mobile phones act as a carriers & may play an important role in spreading of
nosocomial infection.
KEYWORDS: Mobile phones, Nosocomial infections, Health care workers.
INTRODUCTION: With recent advances in the source of information, mobile phone use has
become indispensible in hospitals.1They become part of health professional’s equipment and are
used extensively for communication in a clinical setting.2 The use of cell phones often occurs in
hospital wards, laboratories, theatres, labour room when dealing with severe illnesses. However,
they are seldom cleaned and are often touched during or after examination of patients and even
specimens are handled without proper hand washing.3 The Telecom and Regulatory Authority of
India (TRAI, 2009-10) reported that the mobile phone users in India stood at 584.32 million as
compared to 391.76 million a year before. The growth was 49.15% year-on-year.4 These cell
phones can harbour various potential pathogens and become exogenous sources of infection for
the patients and are also potential health hazard for self and family members. Further, sharing of
cell phones between HCWs and non-HCWs may directly facilitate the spread of potentially
pathogenic bacteria to the community. Nosocomial infections constitute a major problem globally
with major social, economic, moral and personal effects that increase morbidity and mortality of
hospitalized patients.5 Different studies in different parts of the world indicated that medical
equipment and mobile phones of health care workers are potential sources of nosocomial
infections. An article in DAILY MAIL, UK stated that ‘Mobile phones harbor more micro-organisms
than toilet seat.6
J of Evidence Based Med & Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 2/Issue 33/Aug. 17, 2015 Page 4897
DOI: 10.18410/jebmh/2015/685
ORIGINAL ARTICLE
Brady et al in January 2006 came up with the first study ever, addressing the incidence of
bacterial contamination of mobile phones. 96.2% of phones demonstrated evidence of bacterial
contamination, and 14.3% of mobile phones sampled, grew bacteria that are known to cause
nosocomial infections.7,8
Usha et al from Coimbatore, India reported that 91.6% mobile phones were found
contaminated and that the efficacy of decontamination of mobile phones with 70% isopropyl
alcohol was 98%.Several other studies across the globe have shown high contamination rates of
mobile phones with many of the isolated bacteria known to cause nosocomial infections.9
Thus, in this study, we investigated bacterial contamination of the mobile phones of the
healthcare workers (Doctors, nurses, laboratory technicians, ward boys) employed in Obstetric
department of tertiary care hospital of India, and its resistance to commonly used antimicrobials.
MATERIAL AND METHODS: After getting ethical approval from the institute, swabs taken from
mobiles of 40 HCWs employed in Obstetric department of Jhalawar medical college, during July
2015. A sterile swab moistened with sterile saline was rotated on the sides, back of mobile
phone. These swabs were brought immediately to private Microbiological laboratory, where they
were subjected to culture on blood agar and Mac-Conkey’s agar. Plates were incubated
aerobically at 37˚C for 24 hours. Isolated organisms were processed & identified according to
standard bacteriological technique. The isolates were further subjected to antibiotic sensitivity
testing by Kirby- Bauer disc diffusion method on Mueller-Hinton agar according to Clinical
Laboratory Standards Institute (CLSI) antibiotic disc susceptibility testing guidelines. The
antibiotics studied were Augmentin (AU), Ceftriaxone (CA), Nitrofurantoin (NIT) Ciprofloxacin
(CP), Gentamicin (GEN), Ofloxacin (OFL), Tetracycline (TET), Nalidixic acid (NAL), Cotrimoxazole
(COT).
RESULTS: Out of 40 mobile phones of Health care workers of Obstetrics department of Jhalawar
Medical College, Jhalawar, 34(85%) showed bacterial contamination. Isolation of microorganism
was maximum in laboratory technicians and wardboys (100%), while in nurses it was 80% and
least among Doctors (60%) as shown in Table-1.In our study we found single bacterial growth on
24% of mobile and multiple growth on 76 % as shown in Table-2.
S. Aureus was most common isolate (62%) followed by Klebseilla sp.(56%), while
Enterococcus 6% only as shown in Table-3.S.aureus was isolated from almost all contaminated
mobiles while Enterococcus and Psedomonas present only on mobiles of techniciansas shown in
Table-4.
Antibiotic sensitivity test was done for various pathogenic bacteria. AST pattern of
S.aureus isolate shows sensitivity to Augmentin while E.coli was resistant to Augmentin and
Ciprofloxacin. Other Gram negative bacterias were sensitive to most of the antibiotics.
Pseudomonas was found sensitive to Ciprofloxacin and Gentamycin. Overall sensitivity pattern is
shown in Table-5.
DISCUSSION: Out of 40 mobile phones, 34(85%) were contaminated which was similar to
studies by Killic I.et al. who found 75% contamination of mobile phones.10 The isolation of
J of Evidence Based Med & Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 2/Issue 33/Aug. 17, 2015 Page 4898
DOI: 10.18410/jebmh/2015/685
ORIGINAL ARTICLE
bacteria in this study was less (85%) compared to that of Brady et al (95%), Usha et al (91%)
and Karabay et al.(90%). In the present study S.aureus was the main organism isolated (62%)
while in studies of Brady and Karabay showed higher isolation of coagulase negative
staphylococcus and no isolation of S.aureus.11,12
In the research work carried out by Golblatt et al. (2007), indicated that the most
commonly isolated bacterial pathogens are Methicillin-Sensitive Staphylococcus aureus (MSSA),
Methicillin-Resistance Staphylococcus aureus (MRSA), Micrococcus species, Bacillus species,
Diphtheroids, Streptococcus viridians, Escherchia coli and P. aeruginosa.13
Furthermore, study by Nikhil and Chitra (2012) in India from swabs of 120 mobile phones
of healthcare personnel revealed that harbored S. aureus (54.16%), Micrococci (20.83%),
Diptheroids (7.5%), Enterococci (4.1%), Pseudomonas, Citrobacter and Bacillus each 3.3%,
Acinetobacter, Enterobacter and Streptococcus viridians each 1.6%, respectively.14
Recently in one report, 59 bacterial isolates were identified from 58 mobile phones
sampled. From the isolates Gram-positive bacteria accounted for 77.9%, coagulase negative
staphylococci being most frequently (47.5%) isolated bacteria followed by S. aureus (27.1%) and
S. pyogenes (3.4%). E. coli (6.8%) was most frequently isolated Gram-negative bacteria followed
by P. stuartii (5%)(Muktar et al., 2014).15
The isolation of bacterial flora was seen to a greater extent among the laboratory
technicians and the ward boys as compared to the nurses and the doctors.
Mobile phones are ideal breeding sites for these microbes as they are kept warm and snug
in our pockets and handbags. Also, there are no guidelines for the care, cleaning and restriction
of mobile phones in our health care settings. Hence, in a country like ours, mobile phones of
HCWs play an important role in transmission of infection to patients, which can increase the
burden of heath care. Simple measures such as increasing hand hygiene and regular
decontamination of mobile phones with alcohol disinfectant wipes may reduce the risk of cross
contamination caused by these devices. One study reported the use of 70 % isopropyl alcohol as
an effective disinfectant.16
CONCLUSIONS: Since restrictions on the use of mobile phones by Healthcare workers in
hospitals is not a practical solution, we suggest that Healthcare workers should practice increased
adherence to infection control precautions such as hand washing after each use of the telephone.
In addition, they should be informed that these devices may be a source for transmission of
hospital-acquired infections. Further studies for the possible methods of decontamination of
mobile phones, such as using alcohol and/or disinfection tissues, should be conducted in
hospitals.
REFERENCES:
1. Gurang B, Bhati P, Rani U, Chawla K, Mukhopodhyay C, Barry I. Do mobiles carry
pathogens. Microcon 2008 Oct.
2. J. Ramesh, A. O. Carter, M. H. Campbell et al., “Use of mobile phones by medical staff at
Queen Elizabeth Hospital, Barbados: evidence for both benefit and harm,” Journal of
Hospital Infection, vol. 70, no. 2, pp. 160–165, 2008.
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ORIGINAL ARTICLE
3. Jayalakshmi J, Appalaraju B, Usha S. Cell phones as reservoir of nosocomial pathogens.
JAPI 2008; 56: 388-89.
4. Telecom regulatory authority India. Annual report 2009- 2010. Available at
http://www.trai.gov.in/annualreport/AnnualReport_09_10English.pdf.
5. S. A. Sallam, M. A. Arafa, A. A. Razek, M, and “Device- related nosocomial infection in
intensive care units of Alexandria University Students Hospital,” Eastern Mediterranean
Health Journal, vol. 11, no. 1-2, pp. 52–60, 2005.
6. Fiona McRae. ‘Wash your hands caller, your mobile is dirtier than you think’, Science
Reporter, DAILY MAIL. 2006, 2nd August.
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incidence of bacteria known to cause nosocomial infection on health care workers’ mobile
phones J Hosp Infect 62:123-125.2006.
8. Brady RR, Fraser SF, Dunlop MG, Gibb AP, ‘Bacterial contamination of mobile
communication devices in the operative environment’ J Hosp Infect 66: 397-398.2007,
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Abstract no: OA -10, IX– National Conference of Hospital Society of India, Chandigarh,
India.2007, 16th February.
10. Killic, I.H., Ozaslan, M., Karagoz, I.D., Zer, Y. and Da- vatoglu, V. (2009) The microbial
contamination of mo- bile phones used by healthcare staff. Pakistan Journal of Biological
Sciences, 12, 882-884.
11. Brady RR, Fraser SF, Dunlop MG, Gibb AP, ‘Bacterial contamination of mobile
communication devices in the operative environment’ J Hosp Infect 66: 397-398.2007,
August.
12. Karabay O, Kocoglu E, Tahtaci M, ‘The role of mobile phones in the spread of bacteria
associated with nosocomial infections’ J Infect Developing Countries 1:72-73.2007,14th
June.
13. Golblatt, J.G., Krief, I. and Klonsky, T. (2007).Use of cellular telephones and transmission of
pathogens by medical staff in New York and Israel. Infe Contr and Hosp Epidemol.28: 500503.
14. Nikhil, N.T. and Chitra, P. (2012).A Study of Microbial Flora and MRSA Harbored by Mobile
Phones of Health Care Personnel. Interl J Rec Tren in Scie and Techno.4: 14-18.
15. Muktar, G., Daniel, A. and Zelalem, A. (2014). Prevalence and Antimicrobial Susceptibility
Pattern of Bacteria Isolated from Mobile Phones of Health Care Professionals Working in
Gondar Town Health Centers. ISRN Public Health.
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the Association of Physicians of India 2008; 56: 388–389.
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DOI: 10.18410/jebmh/2015/685
ORIGINAL ARTICLE
Number of
Number of mobiles Percentage
mobiles
contaminated
(%)
Doctors
10
06
60
Nurses
10
08
80
Lab Technicians
10
10
100
Ward Boys
10
10
100
Total
40
34
85
Table 1: Mobile sample distribution among Obstetrics department staff
HCWs
Pattern of
growth
No Growth
One Bacteria
Multiple Bacteria
Doctor Nurses
Lab
Technician
Ward
Boys
04
02
Nil
Nil
02
05
Nil
01
04
03
10
09
Table 2: Patten of growth on mobiles
Type of Organism
Isolated
Total
Percentage
(%)
8(24%)
26(76%)
Number of Percentage
mobiles
(%)
Staphylococcus aureus
21
62
Gram (+ve)
Staphylococcus albus
07
20.5
Enterococcus species
02
6
Klebseilla species
19
56
E.c oli
10
30
Gram (-ve)
Pseudomonas
03
9
Table 3: Different type of micro-organism isolated
Name of Bacteria
Bacteria
Doctors Nurses Lab. Tecnicians Ward Boys Total
Staphylococcus aureus
04
04
06
07
21
Staphylococcus albus
01
03
03
07
Enterococcus species
02
02
Klebseilla species
02
03
03
02
10
E. coli
02
04
06
07
19
Pseudomonas
03
03
Table 4: Number and types of isolates on mobile phones of different groups
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DOI: 10.18410/jebmh/2015/685
ORIGINAL ARTICLE
Drugs
Sensitivity of Bacteria (%)
Augmentin (AUG)
86
Ceftriaxone (CA)
80
Nitrofurantoin (NIT)
73
Gentamycin (GEN)
75
Cotrimoxazole (COT)
65
Ofloxacin (OFL)
51
Ciprofloxacin (CPX)
70
Tetracycline (TET)
40
Nalidixic acid (NAL)
48
Table 5: Overall sensitivity pattern of micro-organisms
AUTHORS:
1. Neelam Sharma
2. Anshul Jhanwar
PARTICULARS OF CONTRIBUTORS:
1. Assistant Professor, Department of
Obstetrics & Gynecology, Jhalawar
Medical College.
2. Assistant Professor, Department of
Pharmacology, Jhalawar Medical
College.
NAME ADDRESS EMAIL ID OF THE
CORRESPONDING AUTHOR:
Dr. Anshul Jhanwar,
III/2, Doctors, Residence,
Medical College Campus,
Jhalawar-326001.
E-mail: dranshul123@gmail.com
Date
Date
Date
Date
of
of
of
of
Submission: 05/08/2015.
Peer Review: 06/08/2015.
Acceptance: 08/08/2015.
Publishing: 11/08/2015.
J of Evidence Based Med & Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 2/Issue 33/Aug. 17, 2015 Page 4902