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Does using a cellular mobile phone increase the risk of nosocomial infections in the Neonatal Intensive Care Unit: A systematic review

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The aim of this systematic review is to determine if the cellular mobile phone increases a Neonates risk of contracting a nosocomial infection while admitted to the Neonatal Intensive Care Unit. The following databases were searched: The Cumulative Index to Nursing and Allied Literature (Cinahl) with full text, Medline, Embase, Scopus, Pubmed, The Cochrane Library and Web of Science. Search terms include: Neonates, Neonatal Intensive Care Unit, Nosocomial Infection, Health Care Associated Infection and Mobile Phones. The reference list of relevant research was hand searched. The search was conducted from September 2017–January 2018. 6 studies of various methodologies reveal a growth or contamination pathogenic rate of 40%–100% on surfaces of mobile phones. Studies indicate the majority of these bacteria are potentially nosocomial pathogens and some are multi drug resistant. Secondarily, it appears cleaning the mobile phone and adhering to appropriate hand hygiene after handling the mobile phone does reduce a risk of transmission.
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Journal of Neonatal Nursing
journal homepage:
Does using a cellular mobile phone increase the risk of nosocomial infections
in the Neonatal Intensive Care Unit: A systematic review
Aine Curtis
, Professor Zena Moore
, Dr. Declan Patton
, Dr. Tom O'Connor
, Dr. Linda Nugent
Neonatal StaNurse in Our Lady of Lourdes Hospital, Drogheda, Co. Louth, Ireland
Royal College of Surgeons in Ireland, School of Nursing and Midwifery, 123 St. Stephens Green, Dublin 2, Ireland
Neonatal Intensive Care Unit
Nosocomial infection
Health care associated infection
Mobile phones
The aim of this systematic review is to determine if the cellular mobile phone increases a Neonates risk of
contracting a nosocomial infection while admitted to the Neonatal Intensive Care Unit. The following databases
were searched: The Cumulative Index to Nursing and Allied Literature (Cinahl) with full text, Medline, Embase,
Scopus, Pubmed, The Cochrane Library and Web of Science. Search terms include: Neonates, Neonatal Intensive
Care Unit, Nosocomial Infection, Health Care Associated Infection and Mobile Phones. The reference list of
relevant research was hand searched. The search was conducted from September 2017January 2018. 6 studies
of various methodologies reveal a growth or contamination pathogenic rate of 40%100% on surfaces of mobile
phones. Studies indicate the majority of these bacteria are potentially nosocomial pathogens and some are multi
drug resistant. Secondarily, it appears cleaning the mobile phone and adhering to appropriate hand hygiene after
handling the mobile phone does reduce a risk of transmission.
Nosocomial infections (NI) are causing concern in hospitals, in both
developed and non developed countries. A nosocomial or health care
associtaed infection (HCAI) may be classed as an infection occuring
within 48 h of admission to hospital, 3 days after getting discharged
from hospital or 30 days after undergoing an operation (Inweregbu
et al., 2005). The World Health Organisation (WHO) state a HCAI is
termed as such because the patient acquires the infection during the
hospital incubation period, which was not present at time of admission.
Many studies have conrmed the mobile phone (MP) is a reservoir for
nosocomial infections (Brady et al., 2011 &Mark et al., 2014).
Sumritivanicha et al. (2011) add the MP may not only be a pathogenic
reservoir for NI, but that these bacteria may also be multi drug re-
sistant. Pillet et al. (2016) add respiratory epidemic viruses with a
possible known nosocomial association can live on surfaces for days or
even months. These surfaces include the MP.
Babies admitted to the NICU often have immature immune systems
leaving them susceptible to infections (Polin et al., 2012). It is well
known infections can produce poor outcomes in neonates, from neu-
rodevelopmental impairment to death (Strunk, 2014). In healthcare
settings, copious literature states healthcare workers play a signicant
part in spreading infections (Strunk, 2014;Heyba et al., 2015;Kirkby
and Biggs, 2016). In 1861, Semmelweis demonstrated bacteria is
transmitted via contaminated hands from HCW to patients.
Semmelweis (1861) and WHO (2010) state nosocomial infections result
in longer hospital stays, increased resisitance of micro organisms to
antibiotics and disability longterm on a daily basis. Additionally, this
adds to costs in the healthcare system, for patients and families and
even deaths unnecessarily. For example, WHO (2010) estimate HCAI
costs USD $6.5 Billion in the United States and 7 Billion in Europe
annually indirectly and 16 million extra days of hospital stay.
It is noted, there is very little research specically relating to the
risk of nosocomial infections in the NICU which may be caused by use
of the MP. With regards to published systematic reviews (SRs) relating
to the same topic, as far as the authors are aware there is none available
at present, therefore motivating the justication for our systematic re-
A global telecommunication system was established in Europe in
1982. The idea was to improve the network of communications.
Because of this and ongoing changes in society, the desire for easy ac-
cess to communication and information; the mobile phone has now
become an indispensible tool used by professionals (Haghbin et al.,
2015). Technology's impact on International healthcare has in general
been very positive. Evidence exists suggesting mobile hand held
Received 10 April 2018; Received in revised form 10 May 2018; Accepted 27 May 2018
Corresponding author.
E-mail addresses: (A. Curtis), (Z. Moore), (D. Patton), (T. O'Connor), (L. Nugent).
Journal of Neonatal Nursing xxx (xxxx) xxx–xxx
1355-1841/ © 2018 Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved.
Please cite this article as: Curtis, A., Journal of Neonatal Nursing (2018),
technology improves eciency, aids error prevention and speeds ac-
cessibility of information to health care workers (Mickan et al., 2013).
Therefore, use of such devices is increasing (Ventola, 2014). Until re-
cently, the MP was not permitted within the Neonatal Intensive Care
Unit (NICU)/Intensive Care Unit (ICU) environment as it caused in-
tereference with vital medical equipment. Now, this interefence is not a
problem and the ban has been removed (Haghbin et al., 2015).
Resistance to nosocomial pathogenic bacteria is increasing
(Bockstael and Van Aerschot, 2009). The Health Service Executive
(HSE) in Ireland considers tackling Healthcare Associated Infection
(HCAI) a priority. In 2010, a national clinical programme for preven-
tion of antimicrobial resistance and health care associated infection was
established (HSE, 2010). Included in this programme was education for
health care sta, patients and the general public on HCAI and Anti-
microbial resistance (AMR). AMR has become a considerable threat to
public health and is a growing risk. Over prescribing of antibiotics in-
creases this threat (HSE, 2017).
Allegranzi et al. (2011) found neonatal infection rates are 320
times higher in undeveloped countries than in industrialised nations.
HCAI in Brazil for example, is 9 times higher than in the United States.
They also state very high rates of HCAI in neonatal and paediatric po-
pulations were noted not only in NICUs and Paediatric ICUs but, it was
also evident in paediatric wards and children's hospitals. The European
Centre for Disease and Control (ECDC, 2015) statistics state within the
ICU, 8.3% of patients staying in an intensive care unit for more than
two days contracted at least one ICU-acquired healthcare-associated
infection (HAI). This is up on 8% from 2014. Burns et al. (2012) convey
in their report that 10% of babies admitted under the care of a neo-
natologist was due to the presence of a HCAI.
As stated, it is not practical to ban the MP due to its uses in speed
and accessibility to both parents and sta(Beckstrom et al., 2013;
Haghbin et al., 2015). Hartz et al. (2015) convey every piece of
equipment in the NICU is a potential reservoir for NI. They highlight
how immunocompromised infants admitted to the NICU actually are.
However, after copious researching, there are suggestions that MP are a
huge source of HCAI that do in fact cause an increased risk of NI to the
Neonate. Ulger et al. (2009) notes studies at present do not include
direct comparisons of transmission rates of bacteria from surfaces to
hands. These studies state MP which are not cleaned properly, or hands
not washed properly after touching the MP may be the cause of infec-
tion. More importantly, they may be contaminated with nosocomial
Bettany-Saltikov (2012) states the PEO format is more often used in
qualitative research but it can also be used in quantitative research
depending on the search framework. PEO format was deemed most
suitable for this SR as there was no comparing of interventions in this
review. PEO stands for; P: Population, who is being aected, E: Ex-
posure, what is the specic use of the study and O: Outcomes of the
study. The target population is Neonates. The exposure is the risk of the
mobile phone. The outcome is to determine if the mobile phone causes
increased risk of nosocomial infection.
Review question
Does using a cellular mobile phone increase the risk of nosocomial
infection in the Neonatal Intensive Care Unit.
Primary outcome & secondary outcomes
The primary outcome of this SR was to discern if mobile phones can
be a potential source for pathogenic bacteria capable of causing noso-
comial infections in the NICU. Secondary outomes sought to ascertain if
cleaning the mobile phone eradicates bacteria. Further, to identify if
appropriate hand hygiene can prevent transmission of bacteria.
Inclusion & exclusion criteria
Glynn's Evidence-based librarianship (EBL) checklist was used in
this SR to ensure inclusion of relevant studies only. Additionally, all
studies relating to nosocomial infections in the neonate caused by hand
held technology were considered. Articles excluded comprised of stu-
dies relating to the general population or general/surgical wards. They
were not specic to neonates. Those not relating to the primary out-
come were also excluded. This enabled accurate SR development. No
ethical approval was required.
Search strategy
A search of the following databases was conducted; The Cumulative
Index to Nursing and Allied Literature (Cinahl) with full text, Medline,
Embase, Scopus, Pubmed, The Cochrane Library and Web of Science.
This was to ensure all published data relating to the topic is included for
consideration in the SR. Open Grey was searched for any full text
conference papers. LENUS was searched for publications within the
HSE, as the authors are based in Ireland. Also searched was The
National Institute for Health and Care Excellence (NICE) website for
any guidelines or standards of relevance. Medical subject heading
(MeSH) were used to search the terms within Pubmed. Varying limits
were applied depending on the databases. All clinical nurse specialists
in infection control across various Units were contacted but no further
research was achieved in this manner. There were no limits applied to
the year of publication. All publication types were accepted to gather as
much research as possible. Limitations included publications in English
language and publications in full text due to time constraints.
Data extraction
Data was extracted from 6 articles that met the inclusion criteria. All
6 were of quantitative design. No meta-analyses were found and no
qualitative studies were found.
Data analysis
No RCT's were found therefore no meta-analysis could be com-
pleted. A narrative synthesis was conducted. The six studies were re-
viewed, analysed and discussed in a thematic manner as recommended
by The Centre for Evidence Based Intervention (CEBI, 2017).
Quality appraisal
Evidence based literature (EBL) critical appraisal tool (Glynn, 2006)
was used to evaluate the validity of the studies. If overall validity of
study (yes/total) is > 75% or (no + unclear/Total) is < 25% then
study is valid (Glynn, 2006). Included are four cross sectional studies
(Haghbin et al., 2015;Heyba et al., 2015;Beckstrom et al., 2013;
Daoudi et al., 2017), One cohort study (Loyola et al., 2016) and one
convenience sample study (Kirkby and Biggs, 2016). 4 studies received
75% or higher validity score of the EBL Critical Appraisal Checklist and
are as follows; Beckstrom et al., 2013, (80.7%), Haghbin et al., 2015,
(80.7%), Heyba et al., 2015, (80.7%) and Loyola et al., 2016, (88%). Of
the four studies recording greater than 75%, it can be stated conclusions
from these studies are generalizable. 2 studies that did not achieve >
75% overall validity, include Kirkby and Biggs (2016) and Daoudi et al.
The search identied 51 articles which were then screened by two
independent reviewers through reading titles and abstracts. This
A. Curtis et al. Journal of Neonatal Nursing xxx (xxxx) xxx–xxx
resulted in the exclusion of 46 articles. 6 quantitative studies are in-
cluded in this review (See Fig. 1)(Moher et al., 2009).
Overview of the included articles
Study design
Four articles used a cross sectional study design (Beckstrom et al.,
2013;Heyba et al., 2015;Haghbin et al., 2015 and Daoudi et al., 2017).
One study was a cohort design Loyola et al. (2016). One study was a
convenience sample study Kirkby and Biggs (2016).
Geographical location
Studies were conducted internationally. The countries include Peru
(Loyola et al., 2016), Iran (Haghbin et al., 2015), Kuwait (Heyba et al.,
2015) and Morocco (Daoudi et al., 2017). Two studies were conducted
in the USA, Pennsylvania (Kirkby and Biggs, 2016) and Washington
(Beckstrom et al., 2013).
Study settings
Studies varied in settings, some studies included Paediatric ICU or
ICU but all studies involved the environment of the NICU. One study
was performed in a tertiary level NICU (Beckstrom et al., 2013). Four
studies were from general NICU's across various hospitals (Haghbin
et al., 2015;Heyba et al., 2015;Loyola et al., 2016 and Daoudi et al.,
2017). It is unclear what level NICU (Kirkby and Biggs, 2016) is from.
All participants in the studies were parents of babies admitted to the
NICU or stacaring for babies in the NICU. Staincluded doctors,
nurses, healthcare professionals and students. Beckstrom et al. (2013)
study involves parents of infants in the NICU. Haghbin et al. (2015),
Heyba et al. (2015),Loyola et al. (2016) and Daoudi et al. (2017) all use
Fig. 1. PRISMA 2009 ow diagram for all databases.
A. Curtis et al. Journal of Neonatal Nursing xxx (xxxx) xxx–xxx
staparticipants in the studies. Kirkby and Biggs (2016) study involves
both parents and stain the NICU. All studies involve the MP of either
staor parents.
Sample size
The total sample size of included studies was N = 498. The mean
was 83. The largest sample was N = 203 (Heyba et al., 2015) and the
smallest was N = 17 (Daoudi et al., 2017).
In this SR, no studies involved experimental or control groups re-
lating to an intervention.
Results of data analysis
Primary outcome results
Of the six studies included, a signicant percentage of MP were
contaminated with organisms and bacterial growth (See Table 1). Al-
though results varied, most studies indicate contaminate growths di-
verging from CoNS to Enterobacteriaceae (Beckstrom et al., 2013;
Haghbin et al., 2015;Heyba et al., 2015 and Daoudi et al., 2017).
Kirkby and Biggs (2016) do not indicate what types of bacteria or or-
ganisms were found but they state 100% growth of bacteria on the MP
in this study. Loyola et al. (2016) found Enterobacteriaceae was the
most common growth in this study.
Beckstrom et al. (2013) state 28% MP grew various other bacteria as
well as pathogens such as gram-positive cocci and gram-negative rods
and yeast. Before parents performed hand hygiene, 96% of cultures
identied bacteria with 90% of same organism isolated from the MP.
After hand hygiene, 26% grew nothing on the cultures. The ques-
tionnaire noted no signicance using the Fisher's exact test regarding
the growth of pathologic organisms. The results of this study show all
MP transport bacteria.
Haghbin et al. (2015) noted that 77.11% of MP observed con-
taminate growth in this study with a specic organism evolution of
33.7%. 40% of growth included CoNS and 6% of MP grew Methicillin-
Resistant Staphylococcus Aureus (MRSA).
Heyba et al. (2015) discovered out of 213 MP, 73.7% (95% CI-
condence interval) were contaminated. 4 phones were excluded;
however, it did not change the results noticeably. 62.9% of con-
taminants were due to CoNS, 28.6% due to Micrococcus. 1.4% of MP
were contaminated with MRSA and Acinetobacter from 2.8%. In the
NICU, the MP contamination rate was 79.9% compared to ICU's and
PICUs. They also state 63% of clinicians thought the MP is a cause of
possible infection risk. Yet, clinicians continue to use the MP in this
high-risk area. Data was analysed using SPSS and they found a 95% CI
using exact binomial distribution. Also used was Chi-squared test or
Fisher's exact test for investigating variables categorically. A non-sig-
nicant ρ-value 0.213 was noted regarding a higher MP contamination
rate in NICU (79.6%) compared to PICU (72.1%) or ICU (65.9%).
Although this is a non-signicant nding, it is remarkable because the
MP contamination is higher in the NICU in comparison to the PICU or
ICU across the various hospitals included in the study.
Kirkby and Biggs (2016) found 100% contamination of bacteria on
the MP in the preclean sample in this study. Most of the participants in
the study admit to never cleaning their MP. 56% of the sample con-
veyed they do perform hand hygiene after touching the MP.
Loyola et al. (2016) found 53.5% of MP were colonised with at least
1 Enterobacteriaceae during the study time. A total of 105 En-
terobacteriaceae were isolated. Included are Escherichia coli (E. coli)
12.4%, klebsiella pneumoniae and Klebsiella oxytoca 9.5% and En-
terobacter spp 32.4%. Half of the bacteria isolated are multi drug re-
sistant. They state staMP in the ICU's were contaminated with many
diverse bacteria suggesting they may act as bacterial reservoirs of no-
socomial infection.
Daoudi et al. (2017) found of the 17 MP, 35% were contaminated by
multi drug resistant organisms, Klebsiella pneumoniae totalled a 66.6%
contamination rate and a 33.3% contamination rate of Escheria Coli.
CoNS was isolated in 65% of MP.
It can thus be seen all studies include the contamination of the MP
and the NICU environment is the base for all of these studies.
Secondary outcome results
Beckstrom et al. (2013),Heyba et al. (2015),Haghbin et al. (2015),
Loyola et al. (2016) and Kirkby and Biggs (2016) all collected data
regarding participants and the frequency of their MP cleaning.
Beckstrom et al. (2013) also collected data regarding eectiveness of an
anti-microbial hand gel. Kirkby and Biggs (2016) collected data re-
garding hand hygiene practices in addition to questioning MP cleaning.
Kirkby and Biggs (2016) also collected a survey from participants re-
garding known germs harbouring the MP. Findings can be noted in the
Beckstrom et al. (2013) used SPSS and Fisher's exact test when
analysing the questionnaires of the participants. The participants in this
study were parents of infants in the NICU. They found that only 12% of
parents clean their phone daily, while only 26% clean their phones
weekly. In this study, it is noted that 92% of parents were aware the MP
carried bacteria and 94% used the MP at the baby's bedside. Although
Beckstrom et al. (2013) admit the sample size of the study is small, it
suggests there is a dangerous lack of public knowledge with regards to
how dangerous these bacteria are. Beckstrom et al. (2013) also state,
anti-microbial gel applied by the parent does not always eradicate the
possibility of bacterial transmission from phone to hands. They found
only 22% of parents had no growth on their hands after the anti-mi-
crobial gel was applied. They state this is probably due to inadequate
teaching regarding how to use the gel.
As stated previously, Heyba et al. (2015) used Chi-squared tests and
Fisher's exact to investigate the variables. Heyba et al. (2015) found
only 33.3% of participants or clinicians have ever disinfected their
phones. Half of these clinicians would disinfect the MP daily or weekly
and only 41.1% of clinicians disinfect their phones when they get dirty.
To clean the MP, 73.5% used alcohol wipes and 13.2% used hand
Haghbin et al. (2015) state data was collected using SPSS software
and that only 10% of HCW clean their MP occasionally with an alcohol
wipe. They also state no member of stacleaned the phone prior to
entering the ward with 23% of stawashing their hands before hand-
ling the MP. They include that the small sample was a particular lim-
itation to this study.
Kirkby and Biggs (2016) found only 1 participant out of 18 cleaned
the MP regularly. Of course, of further note, methods and cleaning
products also varied. All participants used the MP within the NICU
setting although they were aware the phone may be harbouring bac-
teria. Only 56% cleaned their hands with anti-microbial gel after
touching the MP. Kirkby & Biggs state also that the small sample size
Table 1
Percentage of MP contaminated with organisms and bacterial growth.
Study Growth/contamination Percentage
Beckstrom et al. (2013) CoNS 72%
Haghbin et al. (2015) CoNS 40%
Heyba et al. (2015) CoNS 62.9%
Loyola et al. (2016) Enterobacteriaceae 53.5
Kirkby and Biggs (2016) Unknown 100%
Daoudi et al. (2017) CoNS 65%
Klebsiella Pneumoniae 66.6%
Escheria Coli 33.3%
A. Curtis et al. Journal of Neonatal Nursing xxx (xxxx) xxx–xxx
adds to the limitations of this study and that the samples were not
tested for the types of growing organisms. However, they have im-
plemented a MP cleaning station in the NICU and various other wards
with a specic guideline for cleaning the MP.
Loyola et al. (2016) used χ
and Fisher's exact tests. They estimated
the risk ratios using a binomial family generalized linear model. They
found 76% of stareported never cleaning their MP but 47.4% reported
using the MP in the ICU setting. A signicant nding indicated the ρ-
value was (< 0.05) for reporting the use of MP disinfection. A non-
signicant nding of a risk ratio of 1.47 with ρ-value (0.43) suggested a
weak association between disinfectant use and increased rates of MP
contamination. They suggest this may indicate that disinfecting the MP
may not reduce the risk of contamination. Limitations of this study also
include the small sample size and incomplete sampling.
From the results of our systematic review it has been demonstrated
that the MP is a reservoir for bacteria. Yet, most NICU stause their
phones in an area where they care for high risk patients. Considering
the immature immune system of the Neonate, this is a serious concern.
Although Kirkby and Biggs (2016) received a validity score of 73% in
the EBL checklist, they did receive a validity score of 83% in part C,
results. On reading other studies relating to MP and contamination
rates, not pertained to NICU, high percentages were also noted. Pal
et al. (2015) for example, found in their study a 100% contamination
rate on the MP. This study was conducted in relation to general mobile
phone use and not specic to neonates. The data is notable however and
is in line with Kirkby and Biggs (2016) ndings in this SR.
Most of the included studies suggest that only a small percentage of
staand parents occasionally clean their phones. Haghbin et al. (2015)
states that only 23% of stawashed their hands after touching the MP.
Heyba et al. (2015) suggest the possibility of the Hawthorne eect in
their study. It was a possibility that some clinicians may have cleaned
their phones upon hearing of the study, thus underestimating the MP
contamination rate. Both of these studies were of cross sectional design
and both included data regarding HCW and MP contamination. Borer,
2005 suggest that some bacteria even survive for weeks when in a warm
environment. Such bacteria include gram-negative bacilli, which are
known to cause nosocomial infections and are multidrug resistant.
It is also documented in studies which were excluded from this SR,
that CoNS contaminate varies from 76.5% to 80.6% (Brady et al., 2011;
Pal et al., 2015). This is a signicant nding as Ronnestad et al. (2005)
and Sgro et al. (2011) note, CoNS is the principal cause of late onset
sepsis in the developed world. Sgro et al. (2011) state in Canada CoNS is
the most common cause for early onset neonatal infections. In the USA
Frymoyer et al. (2009) also agree stating CoNS is the most frequent
source of early onset sepsis in the neonate. Pillet at al. (2016) found one
third of MPs in their study were contaminated with the RNA group of
viruses, which is inclusive of varied epidemic respiratory viruses such
as rotavirus (RV), metapneumovirus, norovirus and inuenza viruses.
These viruses eect the Neonatal population also. Again, the RNA
viruses are known NI and this study indicates the MP is an eective way
for these viruses to travel.
Most studies in this SR, documented ndings of MRSA or found a
high percentage of bacteria discovered on surfaces of MPs were multi
drug resistant. MRSA infection has grounds to cause huge concern in
any ICU, General Paediatrics or Neonatal. MRSA is the source of high
morbidity and mortality rates in the critically ill patient. Only broad-
spectrum antibiotics will treat this infection (Bassetti et al., 2016).
Pierce et al. (2017) actually consider MRSA as a principal source of NI
in the NICU. As stated previously, AMR is a concern in the Irish and
Global healthcare system (HSE, 2010;WHO, 2018). The concern with
AMR is that microorganisms develop resistance to antimicrobials and
are then denoted as superbugs. The potential detriments are multi
problematic both in illness and in cost. These superbugs are very
dicult to treat and very expensive (WHO, 2018). Bearing in mind the
already immunocompromised infant in the NICU, antibiotic use is
considered both controversial and disparate. Antibiotics are eective
when needed to treat a certain disease. However, these also eect the
neonate's microbiome and can increase the risk of Necrotising en-
terocolitis (Hartz et al. 2016). Necrotising enterocolitis is a serious
condition in the neonate which can at best result in life long morbidity
and at worst is fatal (Thompson and Bizzaro, 2008).
Beckstrom et al. (2013) also scored 80.7% and Loyola et al. (2016)
scored 88% on the EBL checklist. The high validity scores again suggest
high quality papers. Beckstrom et al. (2013) found 90% of participants
in the study had the same bacteria grow on their hands as on the MP.
This is particularly alarming if parents do not wash their hands between
holding the MP and touching the baby. Parents use the MP to take
pictures and often update families upon arrival to the baby's bedside
and this increases transmission risk. Heyba et al. (2015) record that
clinicians who did clean the MP, were more likely to have a deconta-
minated phone when compared to those who never cleaned the MP.
Kirkby and Biggs (2016) are condent cleaning the MP does decrease
contamination risks. They discuss the benets of MP cleaning stations
and use of guidelines to this eect. Haghbin et al. (2015),Loyola et al.
(2016) and Daoudi et al. (2017) all suggest daily cleaning and decon-
tamination of the MP. Sumritivanicha et al. (2011) &Pal et al. (2015)
also suggest regular MP decontamination. It is also noteworthy,
Haghbin et al. (2015) and Loyola et al. (2016) state it is unknown if
bacteria found on phones are transient or if they are permanent. Loyola
et al. (2016) suggest the value of the MP as a potential surveillance
means in the NICU. Both studies recommend further research in this
area. Loyola et al. (2016) sample included 114 HCW's across varied
ICU's in Peru. Limitations of this study included incomplete sampling
and a small sample size.
All studies in this SR state hand hygiene is the most important
strategy in preventing HCAI. Worth mentioning is the statistic in
Beckstrom et al. (2013) study, as they found only 22% of non-bacterial
growth on parent's hands, even after hand hygiene. They do state this
was possibly due to improper instructions given to parents on how to
perform appropriate hand hygiene. However, it may also have been due
to the complex hand ora reducing the eectiveness of the hand gel.
Daoudi et al. (2017) score 67% on EBL checklist. This is a limitation
to this study along with the small sample size. However, ndings in this
paper are remarkable. They also discuss their ndings regarding bac-
terial contamination of stethoscopes in this study. They found a 100%
bacterial growth on stethoscopes. Again, this is an instrument used
regularly in any ICU. They were also contaminated by multi drug re-
sistant organisms by 7.7%. Hartz et al. (2016) conveys almost all ob-
jects and equipment in the NICU may be considered a source of mi-
crobial contamination. They suggest following practices within the
NICU to optimise the neonates skin care and recommend stafollow all
infection control procedures to prevent high risk babies getting infected
by pathogens.
Many studies suggest parents and HCW are aware the MP is con-
taminated, yet continue to use it at the bedside. Beckstrom et al. (2013)
state the best prevention of NI via MP is to ban the use of MP at the
bedside. However, Brady et al. (2011) and Haghbin et al. (2015) are of
the view this is not practical. Beckstrom et al. (2013) suggest the public
are unaware pathogens discussed in this SR can cause harmful eects to
an infant in the NICU. However, it appears HCW are aware and yet
continue to use the MP without appropriate disinfection. All studies in
this SR recommend MP cleaning and appropriate hand hygiene. As
Hartz et al. (2016) state all environments in the NICU are potential NI
As Polin et al. (2012) convey, infants in the NICU are high risk and
already immunocompromised. Hartz et al. (2016) conrm the NICU is a
location which harbours potential NI threats to such an im-
munocompromised population. It is worth noting that while the HCW is
thought to be aware of the possible pathogenic transmission capability
A. Curtis et al. Journal of Neonatal Nursing xxx (xxxx) xxx–xxx
of the MP, only 63% of staclean it (Heyba et al., 2015). Beckstrom
et al. (2013) found that very few parents clean the MP, however they
are possibly unaware of the disease potential.
This SR set out to question if using a MP increases the risk of NI in
the NICU. All studies state the MP is a substantial carrier of nosocomial
bacteria and organisms. The diculty with some of the pathogens is the
inability to treat them with antimicrobials. When they can be treated,
they then leave the neonate more susceptible to perhaps worse illnesses.
AMR is internationally a cause of serious concern (WHO, 2018).
Secondarily, this SR questioned if cleaning the MP eradicates bac-
teria and if appropriate hand hygiene practices prevent transmission.
All studies overwhelmingly state appropriate cleaning and disinfection
of the MP can prevent transmission of pathogens. Brady et al. (2011),
Haghbin et al. (2015),Heyba et al. (2015) and Daoudi et al. (2017) all
recommend MP cleaning guidelines and policies. Kirkby and Biggs
(2016) agree and add that an MP cleaning station would be benecial.
Considering that the bacteria or organism can live on a surface for
lengthy periods of time, this is paramount (Borer, 2005;Heyba et al.,
One study suggested hand hygiene did not prevent the growth of
pathogens but the authors suggest this was due to inadequate knowl-
edge of the practice itself (Beckstrom et al., 2013). Otherwise, all stu-
dies promote the ve moments of hand hygiene and/or alcohol hand
gel as promoted by WHO (2009).
It is thought if practiced correctly, transmission of pathogens from
the MP to the baby will be prevented. All studies reviewed suggest
further research is needed and thus recommend same in this area.
Considering the growing risk of AMR and the diculties in treating
many nosocomial infections presently, it is our responsibility as HCW to
continue research in this area. As stated, MP use along with other in-
struments in the NICU and further aeld within healthcare will only
continue to rise. Therefore, it is paramount that all HCW and families
are aware of the dangers they actually pose and how we can prevent
transmission, thereby preventing treatments which can aid minimising
Ethical statement
Ethical approval was not required.
Conicts of interest
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... The presence of drug-resistant microbes that can cause nosocomial infection was observed from 40 to 70% of mobile phones of medical professionals working in neonatal ICUs. This finding indicates that there is a serious need of regular phone cleaning practices to prevent the chances of cross-contamination in hospitals (Curtis et al., 2018). In several other studies, highly pathogenic microbes have been isolated from the mobile phones of healthcare workers (HCWs). ...
... In several other studies, highly pathogenic microbes have been isolated from the mobile phones of healthcare workers (HCWs). These microbes were identified to be responsible for several skin, mouth, and other infectious diseases (Brady et al., 2009b;Curtis et al., 2018;Pérez-Cano et al., 2019;Ulger et al., 2015). The design of mobile phones with a touchscreen and type of keypad surface is known to influence the type and load of bacterial contamination. Lee et al. reported that smartphones with a touchscreen are more prone to contamination by microorganisms due to the wider screens and more intense usage pattern than the simpler types of smartphones . ...
... Such antibiotic-resistant bacteria are a major threat to patients and play a major role in healthcare-associated infections in pediatric and neonatal ICUs (Merzougui et al., 2018;Morgan et al., 2010;Nordberg et al., 2018). As summarized in Table 1, the cellphones of HCWs are prone to carry various pathogenic and drug-resistant bacterial species such as S. aureus, A. baumannii, P. aeruginosa, E. coli, Klebsiella spp., Enterobacter spp., Enterococci, and Streptococci (Curtis et al., 2018;Shakir et al., 2015); (Pérez-Cano et al., 2019;Ulger et al., 2015). The phones contaminated with pathogenic bacteria can function as bacterial reservoirs and sources of cross-contamination of medical devices in sensitive hospital areas like operation theaters, ICUs, and pediatric and burn units (Shakir et al., 2015). ...
Mobile communication devices (MCDs), including cell phones and smart phones, have become an essential part of everyday life. Despite their frequent usage, most people, even healthcare personnel, often ignore the possibility that these devices might accumulate to carry a variety of microbial flora during and after the inspection of patients. The handling of MCDs with unwashed hands and their seldom cleaning can aggravate potential health risks. Many of the harbored bacteria are harmful to immune-suppressed patients for whom the disinfection precautions should be taken more seriously. In this review, we discuss the significance of maintaining the cleanliness of mobile devices, especially in healthcare settings, to prevent the spread of nosocomial infections in patients. Furthermore, we discuss strategies to address microbial contamination of MCDs to maintain good hand hygiene for the users of smartphones or other mobile communication devices. These techniques are capable of providing instant disinfection of the devices along with residual effects over prolonged periods.
... Irrespective of the COVID-19 pandemic, infection risk related to phones has historically been a common concern in NICUs. A recent systematic review examined this concern (Curtis et al., 2018). Having shown that stethoscopes harbour similar bacteria contamination as phones, it becomes clear that the focus should be on encouraging proper hand hygiene over restricting the presence of phones (Curtis et al., 2018). ...
... A recent systematic review examined this concern (Curtis et al., 2018). Having shown that stethoscopes harbour similar bacteria contamination as phones, it becomes clear that the focus should be on encouraging proper hand hygiene over restricting the presence of phones (Curtis et al., 2018). Another review discusses potential decontaminating options for devices in order to mitigate this concern (Bhardwaj et al., 2020). ...
Objective To explore parental perspectives on the use of technology in neonatal intensive care units (NICU), and its impact during COVID-19 parental presence restrictions. Methods Co-designed online survey targeting parents of infants admitted to a Canadian NICU from March 1st, 2020 until March 5th, 2021. Results Parents (n = 117) completed the survey from 38 NICUs. Large variation in policies regarding parental permission to use technology across sites was reported. Restrictive use of technology was reported as a source of parental stress. While families felt that technology helped them feel close to their infant when they could not be in the NICU, it did not replace being in-person. Conclusion Large variation in policies were reported. Despite concerns about devices in NICUs, evidence on how to mitigate these concerns exists. Benefits of using technology to enhance parental experiences appear substantial. Future study is needed to inform recommendations on technology use in the NICU.
... This is higher than the reported percentage by Gashaw et al. 23 where MDROs represented 18% of the isolated bacteria, and less than the result of Bodena et al. 29 as most of isolated organisms (69.9%) were MDROs. This variation of antimicrobial susceptibility among studies might be explained by the difference in bacterial strains, hospital environment and empirical treatment practice 29, 36 . ...
Background: As Mobile Phones (MPs) aren’t cleaned routinely and have been touched during patient’s examination, they may become contaminated with hospital pathogens. Objectives: Screen MPs of Health care workers (HCWs) for pathogens and verify the effect of disinfectants in their decontamination. Methods: A questionnaire was submitted by 160 HCWs in Tanta University Hospitals. Samples were taken from their MPs and subjected to pour plate counting before and after disinfection. Standard identification and antibiotic susceptibility of isolates were done. Results: Colony count was greater in MPs used while caring for patients or inside restroom, and was less in regularly cleaned MPs. All tested disinfectants reduced the colony count significantly. Pathogens were isolated from 84.38% of samples and 36.25% of them were Multi-Drug Resistant Organisms (MDROs). Conclusion: Using MPs at critical care areas and restroom may contribute to their contamination with pathogens. Regular disinfection of MPs can reduce this contamination.
... However, the limited HL in this study was much higher than international findings. A survey among 353 asthmatic adults in Chicago showed 34.2% limited literacy skills (Curtis, Moore, Patton, O'Connor, & Nugent, 2018). This could be due to the age factor. ...
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Background: Asthma is a significant health issue among Vietnamese adults in both urban and rural areas. The disease needs serious concern to minimize impact and improve the situation. Objective: This study aimed to describe the level of health literacy, symptom control, and medication management and determine the relationships among them in patients with asthma in Da Nang, Vietnam. Methods: A cross-sectional descriptive study was conducted among 84 patients with asthma. The questionnaires were used in this study, including demographic form, the Short-Form Health Literacy questionnaire (HL-SF12), Asthma Control Test (ACT), and Medication Adherence Reporting Scale for Asthma (MARS-A). Pearson product-moment correlation was applied to determine the relationship between health literacy, symptom control, and medication management. Results: The score revealed for general-health literacy, symptom control, and medication management were 28.70 (SD = 9.66), 17.72 (SD = 4.67), and 3.63 (SD = 0.75), respectively. Health literacy level had moderate positive relationships with symptom control (r = 0.41) and medication management (r = 0.44). Conclusion: The patients had limited health literacy, partially controlled symptom, and poor adherence to the medication. Health literacy level had moderate positive relationships with symptom control and medication management. These findings are crucial for effective treatment and management of the disease in Vietnam. To improve medication management and symptom control among patients with asthma, nurses should concern patients’ health literacy level. Funding: This research was funded by the Research and Training Center for Enhancing Quality of Life of Working-Age People and the Department of Student Development and Alumni Affairs at the Faculty of Nursing, Khon Kean University, Thailand.
... Longer stay in the ICU and using various tools increase the risk of microbial colonization and subsequent infections. [15][16][17] In a study conducted in Europe, it was reported that 20.6% of the patients in adult ICU developed HI at least once. [18] In a study conducted in our country, it was found that 49% of patients in the ICU developed one or more HIs. ...
Objectives: Healthcare-associated infections (HCAI), which are important causes of mortality and morbidity, are high cost but preventable infections. This study aimed to determine hospital infections and isolates in Şişli Hamidiye Etfal Training and Hospital and to determine our local data. The changes in the distribution of the isolates in this process were evaluated by comparing the data of 1995 and today. Methods: Materials sent to the microbiology laboratory of our hospital in 1995 and 2017 from the patients hospitalized in the period between June 1-December 31 were evaluated concerning hospital infection. The standard manual methods were used in 1995, while in 2017, MALDI-TOF MS was used for identification and BD Phoenix automated system for antibiotic susceptibility. Results: In 1995, in total, 100 bacteria were isolated from pediatric and adult patients, of which 48 Pseudomonas aeruginosa (48/100), 37 Klebsiella spp (37/100). In 2017, Acinetobacter baumannii causing an important resistance problem was found to be increased in number. The main hospital infection causes were Acinetobacter baumannii (37/179), Klebsiella spp (41/179). In 2017, bacterial diversity was also increased. Conclusion: Isolated strains, as in the past, are gram-negative bacteria, Pseudomonas spp decreased in 2017, and Acinetobacter spp increased. The findings suggest that the automated systems used in microbiology laboratories may have a role in the detection of bacterial diversity.
BACKGROUND : Current literature identifies mobile phones of staff as potential vectors for hospital-acquired infection. METHODS : A pre-post, quasi-experimental study was conducted in a 20-bed intensive care unit (ICU). Surface bioburden of personal and shared mobile phones was estimated with a luminometer, expressed in Relative Light Units (RLU). Effects of a simple sanitizing wipe-based disinfection routine were measured at baseline, and at 1-, 3-, 6-, and 12-months after implementation of the disinfection routine. RESULTS : Personal mobile phones and shared phones of 30 on-shift ICU nurses were analyzed at each collection. RLUs for personal phones decreased from baseline to 12-months post-intervention (Geometric mean 497.1 vs. 63.36 RLU; adj P<0.001), while shared unit phones also demonstrated a decrease from baseline to 12-months post-intervention (Geometric mean 417.4 vs. 45.90 RLU; adj P<0.001). DISCUSSION : No recommended practice yet exists for disinfection of mobile phones in the acute care setting. The disinfection method and routine used in this study may have implications for use in acute care settings to reduce opportunities for infectious disease transmission.
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Background: Healthcare-Associated Infections (HAIs) are infections that often occur in hospitals with Staphylococcus aureus as the primary cause. Staphylococcus aureus is usually found on nurses' hands and easily transferred by contact. Cell phones can be a convenient medium for transmitting bacteria. Accordingly, hand washing is one of the effective ways to prevent the transmission of Staphylococcus aureus. Objective: This study aimed to determine the relationship between hand hygiene behavior and the colonization of Staphylococcus aureus on cell phones of nurses in the intensive care unit of the academic hospital. Methods: This was an observational study with a cross-sectional design conducted from December 2019 to January 2020. The observations of hand hygiene behaviors were performed on 37 nurses selected using total sampling. Colonization of bacteria on each nurses' cell phone was calculated by swabbing the cell phones' surface. Colony counting was done using the total plate count method. Spearman Rank test and Mann Whitney test were used for data analysis. Results: The nurses' hand hygiene behavior was 46.06%. Staphylococcus aureus colonization was found on 18.2% of the nurses' cell phones. However, there was no significant relationship between the nurses' hand hygiene behavior and the colonization of Staphylococcus aureus on their cell phones. Conclusion: The hand hygiene behavior of nurses was still low, and there was evidence of Staphylococcus aureus colonization on their cell phones. As there was no relationship between the nurses' hand hygiene behavior with the colonization of Staphylococcus aureus on the cell phones, further research is needed to determine if there is an increase or decrease in colonization before and after regular observations.
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Nosocomial infections or healthcare associated infections occur in patients under medical care. Infections acquired in hospitals have existed since the very inception of hospitals themselves, and continue to be an important health problem even in the modern era of antibiotics. Today, they result in high morbidity and mortality, extended hospitalization, greater use of antibiotics, and increased costs. The overuse and inappropriate consumption and application of antibiotics have driven the rapid emergence of multidrug-resistant drugs (MDR) pathogens. Combating MDRs which cause serious life threatening nosocomial infections and appear to be biologically compatible with their environment, are difficult to manage due to the limited treatment options. The worldwide emergence of multidrug resistance (MDR) among Gram negative and Gram-positive bacteria has caused a great threat to fight the bacterial pathogens. It is clear that in the lack of a timely, efficient solution the challenge of antibiotic resistance becomes alarming and will cause a great challenge in the forthcoming years. In this review article we will discuss the most important MDR nosocomial infection agents, including Staphylococcus aureus, Enterococcus faecium, Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa as major threats throughout the world. © 2020. This is an original open-access article distributed under the terms of the Creative Commons Attribution-noncommercial 4.0 International License which permits copy and redistribution of the material just in noncommercial usages with proper citation. All rights reserved.
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Background Mobile phones and stethoscopes used in neonatology units could be colonized by potential bacteria pathogens. It can be a vector of severe nosocomial infections and multi-drug-resistant pathogens. The aim of this study was to evaluate the microbial contamination of mobile phones and stethoscopes, used by medical and paramedical staff. Materials and Methods The study was conducted in neonatal intensive care unit (NICU) of Mohamed VI University Hospital, Marrakech (Morocco) in April 2016. The bacteriological study was made on 17 mobile phones and 13 stethoscopes. Samples were taken from all surfaces of mobile phones and stethoscopes, with a sterile swab. These swabs were inoculated onto sheep blood agar plates and incubated for 3 days at 37°C. Results: Bacterial contamination rate of all mobile phones and stethoscopes was 100%. The cultures of bacteria isolated were polymorphic. Of the 17 mobile phones, 6 were contaminated with multidrug-resistant pathogens, with a contamination percentage of 35%. The isolated germs correspond to 4 (66.6%) Klebsiella pneumoniae and 2(33.3%) Escherichia coli both were expanded-spectrum betalactamase (ESBL). A strain of Klebsiella pneumoniae ESBL (7.7%) was found on a stethoscope. Conclusion This study showed that mobile phones and stethoscopes could be involved in the transmission of severe nosocomial infections, with multidrug-resistance.
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In the last decade, we have witnessed a dramatic increase in the number of multidrug resistant Gram-negative (MDRGN) bacterial pathogens, both in Italy and worldwide, with Enterobacteriacae (mostly Klebsiella pneumoniae), Pseudomonas aeruginosa and Acinetobacter baumannii being the major threats in clinical practice. Inadequate empirical antimicrobial therapy of severe infections caused by MDR Enterobacteriacae has been associated with an increased morbidity and mortality. However, a careful selection of patients who may receive empirical treatment covering MDR Enterobacteriacae is important to avoid the overuse of broad-spectrum antibiotics. The aim of this review is to describe the mechanism of resistance, epidemiology, risk factors, clinical issues, and therapeutic options for MDRGN pathogens.
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Background The objective of this study was to explore the prevalence of microbiological contamination of mobile phones that belong to clinicians in intensive care units (ICUs), pediatric intensive care units (PICUs), and neonatal care units (NCUs) in all public secondary care hospitals in Kuwait. The study also aimed to describe mobile phones disinfection practices as well as factors associated with mobile phone contamination. Methods This is a cross-sectional study that included all clinicians with mobile phones in ICUs, PICUs, and NCUs in all secondary care hospitals in Kuwait. Samples for culture were collected from mobile phones and transported for microbiological identification using standard laboratory methods. Self-administered questionnaire was used to gather data on mobile phones disinfection practices. Results Out of 213 mobile phones, 157 (73.7 %, 95 % CI [67.2–79.5 %]) were colonized. Coagulase-negative staphylococci followed by Micrococcus were predominantly isolated from the mobile phones; 62.9 % and 28.6 % of all mobile phones, respectively. Methicillin-resistant Staphylococcus aureus (MRSA) and Gram-negative bacteria were identified in 1.4 % and 7.0 % of the mobile phones, respectively. Sixty-eight clinicians (33.5 %) reported that they disinfected their mobile phones, with the majority disinfecting their mobile phones only when they get dirty. The only factor that was significantly associated with mobile phone contamination was whether a clinician has ever disinfected his/her mobile phone; adjusted odds ratio 2.42 (95 % CI [1.08–5.41], p-value = 0.031). Conclusion The prevalence of mobile phone contamination is high in ICUs, PICUs, and NCUs in public secondary care hospitals in Kuwait. Although some of the isolated organisms can be considered non-pathogenic, various reports described their potential harm particularly among patients in ICU and NCU settings. Isolation of MRSA and Gram-negative bacteria from mobile phones of clinicians treating patients in high-risk healthcare settings is of a major concern, and calls for efforts to consider guidelines for mobile phone disinfection.
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Global burden of hospital-associated infection (HAI) is on the rise and contributes significantly to morbidity and mortality of the patients. Mobile phones are indispensible part of communication among doctors and other health care workers (HCWs) in hospitals. Hands of HCWs play an important role in transmission of HAI and mobile phones which are seldom cleaned and often touched during or after the examination of patients without hand washing can act as a reservoir for transmission of potent pathogens. This study aimed to investigate the rate of bacterial contamination of mobile phones among HCWs in our tertiary care hospital and to compare it with personal mobile phones of non-HCWs (control group). The mobile phones and dominant hands of 386 participants were sampled from four different groups, hospital doctors and staff (132), college faculty and staff (54), medical students (100) and control group (100). Informed consent and questionnaire was duly signed by all the participants. Samples were processed according to standard guidelines. 316 mobile phones (81.8%) and 309 hand swab samples (80%) showed growth of bacterial pathogens. The most predominant isolates were Coagulase-negative Staphylococcus, Staphylococcus aureus, Acinetobacter species, Escherichia coli, Klebsiella pneumoniae, Pseudomonas species and Enterococcus species. Hundred percent contamination was found in mobile phones and hands of HCWs indicating mobile phones can be the potential source of nosocomial pathogens. Our study results suggest that use of mobile phones in health care setup should be restricted only for emergency calls. Strict adherence to infection control policies such as proper hand hygiene practices should be followed.
Background Meticillin-resistant Staphylococcus aureus (MRSA) is a leading cause of healthcare-associated infection in the neonatal intensive care unit (NICU). Decolonization may eliminate bacterial reservoirs that drive MRSA transmission. Aim To measure the association between colonization pressure from decolonized and non-decolonized neonates and MRSA acquisition to inform use of this strategy for control of endemic MRSA. Methods An eight-year retrospective cohort study was conducted in a level-4 NICU that used active surveillance cultures and decolonization for MRSA control. Weekly colonization pressure exposures were defined as the number of patient-days of concurrent admission with treated (decolonized) and untreated (non-decolonized) MRSA carriers in the preceding seven days. Poisson regression was used to estimate risk of incident MRSA colonization associated with colonization pressure exposures. The population-attributable fraction was calculated to assess the proportion of overall unit MRSA incidence attributable to treated or untreated patients in this setting. Findings Every person-day increase in exposure to an untreated MRSA carrier was associated with a 6% increase in MRSA acquisition risk [relative risk (RR): 1.06; 95% confidence interval (CI): 1.01–1.11]. Risk of acquisition was not influenced by exposure to treated, isolated MRSA carriers (RR: 1.01; 95% CI: 0.98–1.04). In the context of this MRSA control programme, 22% (95% CI: 4.0–37) of MRSA acquisition could be attributed to exposures to untreated MRSA carriers. Conclusion Untreated MRSA carriers were an important reservoir for transmission. Decolonized patients on contact isolation posed no detectable transmission threat, supporting the hypothesis that decolonization may reduce patient-to-patient transmission. Non-patient reservoirs may contribute to unit MRSA acquisition and require further investigation.
Background: Infants admitted to the neonatal intensive care unit (NICU) are more susceptible to infections due to immature immune systems or invasive procedures that compromise protection from bacteria. These infants may stay in the NICU for extended periods of time, are exposed to many caregivers, and may be exposed to other infections. Cell phone use by both family and staff introduce unwanted bacteria into the NICU environment, thereby becoming a threat to this high-risk population. Purpose: A quality improvement initiative to evaluate and improve the cleanliness of cell phones used in the NICU. Methods: A convenience sample of 18 NICU parents and staff. The participants' cell phones were sampled for bacteria pre- and postcleaning with disinfectant wipes and sent to the microbiology laboratory for a 2-day incubation period. In addition, each participant completed a survey on cell phone cleaning habits. Results: Microbial surface contamination was evident on every phone tested before disinfecting. All phones were substantially less contaminated after disinfection. Implications for practice: A standardized cleaning process with a surface disinfectant reduced the amount of germs and potential transmission of nosocomial pathogens within the NICU. The simple exercise illustrated the importance of cell phone hygiene in a high-risk population. The implementation of a simple cleaning process has been an easy and effective way to rid unwanted organisms from this high-risk population. Implications for research: Further research evaluating transmission of nosocomial infections from cell phones would enhance the evidence to establish hospital policies on cleaning devices.
Mobile phones (MPs) have been proved to be potential reservoirs of nosocomial bacteria. Few data are available concerning viruses. We aimed to evaluate the presence of viral RNA from epidemic viruses including metapneumovirus (hMPV), respiratory syncytial virus (RSV), influenza viruses, rotavirus (RV) and norovirus (NV) on the MPs used by healthcare workers (HCWs) and to rely it with hygiene measures. An anonymous behavioral questionnaire about MP use at hospital was proposed to the HCWs of 4 adult and pediatric departments of a University hospital. After sampling of personal (PMP) and/or professional MPs (digital enhanced cordless telephone, DECT), viral RNAs were extracted and amplified by one step reverse transcription/real time PCR assays (RT-qPCR). The molecular results were analyzed blindly to the behavioral survey. Questionnaires of 114 HCWs (35 senior physicians, 30 residents, 32 nurses, 27 nurses assistant) working either in adults (n=58) or pediatric (n=56) departments were recorded. Medical personnel used their PMP more frequently than paramedical HCWs (33/65 vs 10/59, P<0.001). MPs were used during care more frequently in adult wards than in pediatric ones (46/58 vs 27/56, P<0.001). Viral RNA was detected on 42 phones of the 109 collected ones (38.5%), with RV=39, RSV=3, hMPV=1. The presence of viral RNA was significantly associated with MPs from the pediatric HCWs (P<0.001). MPs routinely used in hospital, even during care, can host viral RNA, especially RV. Promotion of frequent hand hygiene before and after MP use associated to frequent cleaning of the MPs should be encouraged.
To identify how the neonatal intensive care unit (NICU) environment potentially influences the microbiome high-risk term and preterm infants. Electronic databases utilized to identify studies published in English included PubMed, Google Scholar, Cumulative Index for Nursing and Allied Health Literature, and BioMedSearcher. Date of publication did not limit inclusion in the review. Two hundred fifty articles were assessed for relevance to the research question through title and abstract review. Further screening resulted in full review of 60 articles. An in-depth review of all 60 articles resulted in 39 articles that met inclusion criteria. Twenty-eight articles were eliminated on the basis of the type of study and subject of interest. Studies were reviewed for information related to environmental factors that influence microbial colonization of the neonatal microbiome. Environment was later defined as the physical environment of the NICU and nursery caregiving activities. Studies were characterized into factors that impacted the infant's microbiome-parental skin, feeding type, environmental surfaces and caregiving equipment, health care provider skin, and antibiotic use. Literature revealed that various aspects of living within the NICU environment do influence the microbiome of infants. Caregivers can implement strategies to prevent environment-associated nosocomial infection in the NICU such as implementing infection control measures, encouraging use of breast milk, and decreasing the empirical use of antibiotics.