NHS Connecting for Health: Healthcare Professionals,Mobile Technology,and Infection Control

Abstract

Background: Mobile phones improve the efficiency of clinical communication and are increasingly involved in all areas of healthcare delivery. Despite this, healthcare workers' mobile phones provide a known reservoir of pathogenic bacteria, with the potential to undermine infection control efforts aimed at the reducing bacterial cross-contamination in hospitals. This potential could be amplified further when employers require doctors to carry additional electronic devices for communication, without concurrently providing appropriate guidance on decontamination or use. Methods: Eighty-seven on-call doctors' mobile phones were sampled for bacterial growth prior to, and 12 h after, a cleaning intervention involving 70% isopropyl alcohol. Results: Seventy-eight percent of doctors were aware that mobile phones could carry pathogenic bacteria, but only 8% cleaned their phones regularly. The cleaning intervention reduced the number of phones that grew bacteria by 79% (55% [48 of 87] before versus 16% [14 of 87] after cleaning). Eight percent of the phones grew Staphyloccus aureus, and 44.8% of phones grew Gram-positive cocci. All S. aureus isolates were methicillin-sensitive. Bacterial contamination was not associated with gender, specialty, or seniority of the phone user (p>0.05). Conclusions: Simple cleaning interventions can reduce the surface bioburden of hospital-provided doctors' mobile phones and therefore the potential for cross-contamination. This cleaning intervention is inexpensive, easily instituted, and effective. Healthcare workers should carry the minimum number of electronic devices on their person, maintain good hand hygiene, and clean their device appropriately in order to minimize the potential for cross-contamination in the work place.

Introduction

Ninety-eight percent of healthcare workers (HCWs) own a mobile phone, and 84.5% bring their phone into the hospital every day.¹ Mobile phones are popular with patients and HCWs and are increasingly involved in all aspects of healthcare delivery.^2
–4 This is due to the immediacy and quality of communication, access to patient data, pharmaceutical inventories, or other medical literature/applications available on multiplatform devices.^3,5

However, there exist some pitfalls.³ A compelling body of evidence suggests that mobile communication devices provide a reservoir of bacteria known to cause nosocomial infections, within the hospital ward and sensitive clinical areas such as operating theater environments.^1

–4,6,7 Given the increasing use of mobile communication technology in healthcare delivery and the recent provision of additional phones to doctors by National Health Service (NHS) hospital employers for “on-call” communication (in the absence of any education or guidance regarding decolonization of mobile devices), we aimed to evaluate the impact of a simple cleaning intervention on the level of surface bacterial contamination of these specific devices.

Methods

Over a 3-month period, six sampling events were used to sample hospital-provided “on-call” mobile phones from HCWs for surface bacterial contamination as these phones were returned to the switchboard following a daily shift. In addition, HCWs were asked to complete a questionnaire regarding their demographics and opinions.

A sterile swab moistened with sterile 0.9% NaCl solution was rotated over the keypad surface of each of the doctor's individual phones in a uniform fashion, placed in a transport medium, and stored. These swabs were later transported to the microbiology laboratory within 24 h. Following sampling, phones were decontaminated by wiping the keypad surface several times with wipes containing 70% isopropyl alcohol. Phones were then stored overnight in their chargers and swabbed again using the same technique 12 h later, prior to collection for the next daily shift.

The authors focused on detection of Gram-positive cocci as a measure of surface bioburden and Staphylococcus aureus as an index organism to demonstrate the potential of devices to carry pathogenic bacteria. Swabs were streaked onto CPS 3 chromogenic agar (bioMérieux, Marcy l'Etoile, France) and incubated for 18 h at 37°C. Based on the colony color Gram stain and slide agglutination test for clumping factor and protein A (Staphaurex Plus^®, Remel Europe Ltd., Dartford, Kent, UK), staphylococcal isolates were differentiated into S. aureus and coagulase-negative staphylococci. S. aureus isolates were confirmed by the tube coagulase test. Antibiotic sensitivity testing was performed using Vitek 2 (bioMérieux). Susceptibility breakpoints were in accordance with Clinical and Laboratory Standards Institute guidelines.⁸

Statistical analysis was performed at the Epidemiology and Statistics Core, University of Edinburgh, Wellcome Trust Clinical Research Facility, Western General Hospital. Permissions for the study were provided by the East of Scotland Research Ethics Service (10/GA/176) and Research and Development Office, NHS Fife.

Results

Eighty-seven doctors' phones were sampled. These hospital-provided phones had been used every day by the respective HCW for an average of 3.2 months (SD 2.4). Fifty-seven percent (50 of 87) of HCWs carried an additional personal mobile phone. HCWs (85% [74 of 87]) stated that their hospital-provided “on-call” phones were vital for their clinical duties. Seventy-eight percent (68 of 87) of doctors were aware that mobile phones could carry pathogenic bacteria, but only 8% (7 of 87) of doctors cleaned their phones regularly (five with alcohol gel/wipes and two with water and paper towels/cloth).

Fifty-five percent (48 of 87) of phones grew bacteria before cleaning and 16% (14 of 87) after cleaning, representing a reduction of 79% in the number of phones demonstrating positive growth for bacteria. Four (4.6%) phones not positive for bacterial growth before cleaning became positive after the cleaning intervention. Eight percent (7 of 87) of phones demonstrated positive growth for S. aureus (two phones before, five after cleaning). Gram-positive cocci grew from 44.8% (39 of 87) of phones (35 phones before, 14 after cleaning). All S. aureus isolates were methicillin-sensitive. Bacterial contamination was not found to be associated with HCWs' gender, specialty, or seniority (p>0.05).

Conclusions

This is the first study to evaluate the surface microbiological bioburden of “on-call” mobile phones in a modern NHS setting, with a specific focus on an effective cleaning intervention. Here, we report that a majority of doctors are aware of the risks of phone bacterial contamination but that few clean their devices effectively. Similarly, we report that the potential risk is further amplified by the carriage of additional personal devices by HCWs while on duty. We report high levels of bacterial contamination on “on-call” mobile phones (consistent with previous studies) and the detection of a subset of phones carrying bacterial species known to cause hospital-associated infections. Finally, we report that an effective reduction in bacteria detected was achieved after the institution of a simple and practical means of decolonization.

It is concerning that mobile communication devices in our study have been found to harbor S. aureus in the clinical environment. We have also recently reported that there is an association between S. aureus nasal colonization and the detection of this bacterium on mobile phone surfaces,⁴ and further associations between mobile phone bacteria and hand contamination have also been reported, suggesting a causal link.^3,6 However, to date, the link between mobile phone surface bacteria to clinical infection has not been adequately demonstrated.

The microbiological laboratory process focused on detection of sentinel bacterial species and therefore potentially underestimated the overall bacterial contamination levels of phones in this group. Cross-contamination from phone chargers at the switchboard or handling between sampling could account for the new S. aureus detected on previously negative phones.

Previous studies on pagers or personal digital assistants have found a significant decrease in bacterial contamination after cleaning with 70% isopropyl alcohol wipes, but mobile phones have not been previously evaluated.⁹ New technologies including antibacterial covers and ultraviolet light sanitizers, which could also decolonize the surface of devices, hold future potential but are yet to be tested fully in clinical trials.⁶

Therefore, we recommend that HCWs are urgently provided with education and guidance on this issue, specifically in regards to the need to regularly clean devices by an effective evidence-based method. In addition, we recommend they continue to institute strict hand hygiene practices and reduce the number of devices carried in order to reduce potential risk.

Footnotes

Acknowledgments

This work was supported by the Microbiology Research Fund, NHS Fife.

Disclosure Statement

R.R.W.B., S.C., R.W.S., S.Y., and K.M. are employees of the healthcare organization in which sampling took place. C.G. declares there are no competing interests. There was no outside influence in the performance, analysis, or write-up of the study.

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