2.4 Microorganisms associated with Mobile Phone use in healthcare settings As healthcare workers carry out various activities in the hospital in caring for patients while touching their mobile phones at the same time, they can easily transmit microorganisms from patients to their mobile phones and vice versa. Early in the 1980s, White-Rafferty and Pancoast buttressed these reports with different studies in which thirty-nine studies published between 2005 and 2013 were reviewed. Of these, 19 (48.7%) identified coagulase-negative staphylococci (CoNS), and 26 (66.7%) identified Staphylococcus aureus. The frequency of growth of organisms varied. It was observed that the use of MPs by healthcare workers increases the risk of repetitive cyclic contamination between the hands and face (e.g., nose, ears, and lips), and differences in personal hygiene and behaviors can further contribute to the risks.
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For instance, a study conducted in a mixed tertiary intensive care unit with eight beds and 14 operating rooms examined the contamination of mobile phones with nosocomial pathogens. In total, 200 healthcare workers comprising 15 seniors, 79 assistant doctors, 38 nurses, and 68 healthcare staff were included in the study. They were screened and cultures were subsequently obtained from the dominant hand of participants and their mobile phones at the same time.
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Data was collected on the Gender, profession, and duration of their profession, ring use, dominant hands of HCWs, and routine cleaning of the mobile phones. The data collection procedures include rotating over the surface of both sides of the mobile phones of healthcare workers with a sterile swab moistened with sterile saline. Secondly, the entire ventral surface of the dominant hand (including ventral surfaces of the thumb and the fingers) of HCWs was rubbed with a sterile swab. The sampling of the dominant hand and mobile phone swabs (twice for hands and twice for mobile phones) were then immediately streaked onto two plates that consist of blood agar supplemented with 5% defibrinated sheep blood and eosin methylene blue agar. The plates were incubated aerobically at 37°C for 48 hours. Isolated microorganisms were identified using gram stain, colony counts, morphology, catalase, and oxidase reaction, and all isolates were allocated to the appropriate genera. They found that the rate of bacterial contamination of mobile phones is 94.5% and the microorganisms identified included Staphylococcus aureus, Streptococcus spp., CoNS, Enterococcus spp., Non-fermentative gram negatives, Coliforms, Moulds, and Yeasts. They thus concluded that the hands and mobile phones of HCWs’ were contaminated with various types of microorganisms and Mobile phones used by HCWs in daily practice may be a source of nosocomial infections in hospitals [15]. 2.5 Mobile Phone use among healthcare workers and transmission of Healthcare-Associated Infections Healthcare-Associated Infection also known as Nosocomial infection is an important problem in all modern hospitals globally. Research shows that as early as 1861 a Physician named Semmelweis demonstrated that bacteria were transmitted to the patients by the contaminated hands of healthcare workers. HAIs typically occur as a result of cross-infection between patients, between patients and staff, and between patients and inanimate objects; with the major mode of transmission being the unclean hand. Thus most campaigns against HAIs have focused on hand hygiene. Studies have shown that bacteria can survive on several inanimate objects found in the hospital environment and serve as a source of transmission of HAIs. Frequently touched surfaces such as door handles, bed rails, computer keypads have been shown to harbor bacteria such as methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus sp, Acinetobacter sp, Escherichia coli, Klebsiella sp, Pseudomonas sp for extended periods and continues to be a source of transmission of infection if regular surface disinfection is not conducted. Since the hand of healthcare workers are used to handling mobile phones in their attempts to use them during working periods, there is the potential for contamination of mobile phones and transmission of microorganisms to patients and vice versa. The touchscreen nature, portability, and high probability of coincidental use during patient encounters make mobile phones and other portable electronic devices (PEDs) a possible reservoir for the transmission of pathogens. Another study found that mobile phones are exposed to many microbes including those associated with the skin due to the regular use of the mobile phone by HCWs thus making them a good carrier for microbes, resulting in the spread of different microorganisms from the user. Additionally, many epidemiological studies reveal that contaminated surfaces contribute greatly to the spread of infectious diseases in the healthcare setting and Mobile phones are more problematic as far as infection transmission is concerned compared with other stationary fomites. Other studies have found that mobile phones in healthcare settings are hardly cleaned once handled and may transmit microorganisms, comprising multiple resistant ones, after contact with the patient, and can be a basis for bacterial cross-contamination. The high usage of mobile phones in healthcare settings is likely to lead to the contamination of these devices, making them a possible source of a hospital-acquired infection, especially if appropriate infection prevention practices are not observed. The risk of transmission is heightened because they are likely to be operated with an ungloved hand and their fragile electronics preclude regular disinfection. They also have the potential to undermine hand hygiene efforts since healthcare workers are less likely to observe hand hygiene after contaminating their hands with their phones after initial observation of hand hygiene. 2.6 Prevalence and impact of Hospital Acquired infections (HAIs) among patients Hospital-Acquired infections are also referred to as ―nosocomial‖ infections that affect patients in a hospital or healthcare setting, 48hrs after admission. These infections are usually not present or incubating in the patient at the time of admission. They may also be acquired in hospitals but manifest after discharge. Globally these infections are regarded as the greatest challenge to issues of patient safety, since they are associated with a prolonged hospital stay, increased medical cost, the spread of antibiotic-resistant bacteria and increased mortality . At any given time, the prevalence of health care-associated infection in developed countries varies between 3.5% and 12%, whilst in resource limited settings the prevalence it is 15.5 per 100 patients. The risk of acquiring these infections is higher among critically ill patients. Among patients in high-income countries, approximately 30% of patients are affected by at least one health care-associated infection . In low and middle-income countries, the frequency of patients-acquired infection is at least 2─3 fold higher than in high-income countries; device-associated infection densities are up to 13 times higher than in the USA. This situation is attributed to poor infection prevention and control practices observed in these Hospitals. Other documented risk factors of HAIs are • Use of indwelling devices, • Prolonged hospital stay, • Inappropriate antibiotic use • Immunosuppression 2.7 Prevention strategies of HAIs Preventing HAIs has been one of the cornerstones of the WHO patient safety program. Through several campaigns such as clean care saves lives, fight antibiotic resistance it is in your hands and launching of policy documents etc. The WHO has sought to reduce the global burden of hospital acquired infections. Effective hand hygiene has been found to be reduce HAIs by at least 50 % [18]. Studies from developing countries however, show very low rates of compliance to hand hygiene practices in health care institutions [18]. Previous hand hygiene studies conducted among healthcare workers in two tertiary hospitals showed very low rates of hand hygiene compliance.

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