J Community Health DOI 10.1007/s10900-014-9838-6

ORIGINAL PAPER

The Importance of Mobile Phones in the Possible Transmission of Bacterial Infections in the Community A. Bhoonderowa • S. Gookool • S. D. Biranjia-Hurdoyal

Ó Springer Science+Business Media New York 2014

Abstract Mobile phones have become indispensable accessories in today’s life. However, they might act as fomites as they have travelled with their owner to places such as toilets, hospitals and kitchens which are loaded with microorganisms. A cross-sectional study was carried out to isolate and identify bacteria from mobile phones of volunteers in the community. A total of 192 mobile phones from 102 males and 90 females were swabbed and cultured. The bacteria were identified by gram staining and conventional biochemical tests. A total of 176 mobile phones (91.7 %) showed bacterial contamination. Coagulase negative Staphylococcus was the most prevalent (69.3 %) followed by Micrococci (51.8 %), Klebsiella (1.5 %) and Pseudomonas (1 %). The mean colony forming units was higher among females than males (p \ 0.05; 95 % CI 0.021–0.365) and higher on mobile phones which were kept in bags than in pockets (p \ 0.05; 95 % CI 0.019–0.369). Furthermore, the use of phone cover was found to reduce microbial growth (OR 4.2; 95 % CI 1.423–12.39; p \ 0.05). Significant associations were also found between bacterial growth and female participants, agricultural workers, mobile phones older than 6 months and sharing of mobile phones (p \ 0.05). Mobile phones from the community carry potential pathogens. Cleaning of mobile phones should be encouraged and should be preferably stored in pockets or carry cases.

A. Bhoonderowa  S. Gookool Candos Laboratory, Ministry of Health and Quality of Life, Candos, Mauritius S. D. Biranjia-Hurdoyal (&) Department of Health Sciences, University of Mauritius, Reduit, Mauritius e-mail: [email protected]

Keywords Mobile phones  Bacteria  Infections  Community

Introduction The role of fomites in the transmission of infectious diseases has been often investigated in healthcare settings or educational institutions. Clothing and diapers were found to transmit Staphylococcus aureus among infants in nursery [1] and money coins harboured potentially pathogenic bacteria including Escherichia coli, Klebsiella species, Salmonella species and Staphylococcus species [2]. Fomites such as faucet handles, keyboards and pencil sharpeners from classrooms were found to be contaminated with bacteria [3]. Several studies have investigated the role of mobile phones in transmission of infection but they were all limited to health care settings [4–6]. Bacterial growth on mobile phones of staffs from hospitals was found to range from 15.3 to 94.5 % and various types of bacterial and fungal contamination were reported [4, 7, 8]. The most common bacteria isolated were coagulase negative Staphylococcus (CNS), Micrococcus species, Pseudomonas species, E. coli, Methicillin resistant S. aureus and Proteus species [4, 5, 7, 8]. Mobile phones are constantly handled by owners at all places. Given that the hands of human beings and environments such as hospitals, kitchens, toilets have very high density of microorganisms, including potentially pathogenic bacteria, mobile phones could also act as a major vehicle of disease transmission in the community. This study aimed at isolating and identifying bacteria from mobile phones from volunteers in the community.

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J Community Health Table 1 Types of bacteria isolated from mobile phones of males and females Bacteria

Females N = 90

Males N = 102

Total n = 192

p value#

CNS

73 (81.1 %)

60 (58.8 %)

133 (69.3 %)

\0.05

Micrococci

56 (62.2 %)

42 (41.2 %)

98 (51 %)

\0.05

1 (1.1 %)

4 (3.9 %)

GNB (Pseudomonas and Klebsiella)

5 (2.6 %)

NS

CNS coagulase negative Staphylococcus, GNB gram negative bacilli, NS non-significant #

Pearson Chi square test

Methods A questionnaire was designed to gather maximum information concerning the study. Samples were collected from the mobile phones of 192 participants who were chosen at random and had voluntarily consented to participate in the study. The participants were asked questions about their level of education, occupation, knowledge on the importance of fomites in infection transmission, whether they clean or share their mobile phones, place for storing the accessory and length of time since the mobile phone was being used. Sterile swabs moistened with sterile peptone water were rolled over the participants’ mobile phones. The swabs were streaked within 1 h of collection on Mc Conkey agar, Salmonella Shigella agar and Nutrient agar. Bacterial load was read after incubation aerobically at 37 °C for 24 h and the isolates were identified by gram staining, morphological properties and biochemical tests such as catalase, oxidase and urease. The bacterial load was interpreted as mean number of colony forming units (CFU). Furthermore, the presence of 1–5 colonies was read as few growth, 6–15 colonies as moderate growth and more than 15 colonies as heavy growth. The statistical analysis was done using SPSS v.16.0. Relationships and comparisons between variables were determined using Pearson correlation, Pearson Chi square test and Student’s t test. p value \0.05 was established as significant.

Results Out of the 192 samples, 90 were from females and 102 from males. There were 67 office staffs, 57 technical and 68 manual workers. A total of 10 (5.2 %) of participants used phone covers, 53 (27.6 %) shared their mobile phones, 48 (25 %) cleaned their mobile phones regularly, 70 (36.5 %) carry their phones in their bags, 113 (58.9 %) in their pockets and 9 (4.7 %) used carry cases attached to their waists. Bacterial growth was observed in 176 (91.7 %) mobile phones, out of which 145 (82.4 %) showed few growth, 23 (13.1 %) moderate and 8 (4.5 %) heavy growth. It should

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be noted that 31.7 % (61/192) of the samples had two types of colonies and 59.8 % had single type of bacterium growing on the media. The most common bacterium isolated was CNS (69.3 %) followed by Micrococcus (51.8 %), Klebsiella species (1.5 %) and Pseudomonas aeruginosa (1 %) (Table 1). There was no statistical significant difference between the rate of bacterial growth from the mobile phones of males and females (91.1 vs. 92.2 %). However, the mean CFU was higher among females than males (p \ 0.05). It was noted that female participants shared their mobile phones with colleagues and family members at a higher rate than males (94.3 vs. 5.7 %; p \ 0.05). Statistically significant associations were found between increasing bacterial load and females (p \ 0.05; 95 % CI 0.021–0.365), sharing of mobiles and bacterial growth (p \ 0.05; 95 % CI 0.177–0.713), presence of mobile cover and decreasing bacterial load (OR 4.2; 95 % CI 1.423–12.39; p \ 0.05), absence of cover and increase in microbial growth (p \ 0.05) and keeping mobile phones in bag and increase in bacterial load (p \ 0.05). The mean CFU was also higher on mobile phones which were kept in bags than in pockets (p \ 0.05; 95 % CI 0.019–0.369). Among the males, bacterial load was associated with increasing age and occupation of the participant (p \ 0.05). Manual workers had higher prevalence of bacterial load than office workers (p \ 0.05). It was also found that mobile phones which had covers and were more than 6 months old had higher mean CFU (p \ 0.05). Furthermore, a reduced bacterial load was observed from mobile phones which were cleaned by their owners (p \ 0.05).

Discussion In this study, out of the 192 samples, 91.7 % showed bacterial growth which confirmed that mobile phones from the community also harboured high number of bacteria in a similar manner as the mobile phones from health care settings [6, 8]. CNS was the most prevalent organism isolated (69.3 %) which corroborated with the findings from previous studies [6, 7]. Although majority of the

J Community Health

bacteria isolated in this study were normal flora, it should be noted that these bacteria could cause opportunistic infections [9–11]. CNS has been recognised as an important nosocomial pathogen and has also been responsible for various types of infections in both immuno-competent and immuno-compromised individuals in the community [9, 10]. Other bacteria isolated included Micrococcus species, P. aeruginosa and Klebsiella species. Despite Micrococcus has always been considered as non-pathogenic, the bacterium has been reported as the causative agent of opportunistic infections in cancer patients [11, 12]. Communityacquired infections such as pneumonia, suppurative otitis media, urinary tract and soft tissue infections caused by the gram negative bacteria P. aeruginosa and Klebsiella species have been previously reported [13–15]. Females shared their mobile phones at higher rate and were associated with an increased bacterial load. Sharing of commodities such as telephones and computers have been previously associated with microbial colonisation [16, 17]. A decrease in bacterial load was observed on mobile phones which were cleaned often by their owners. Similar result has been reported previously Singh et al. [6]. Furthermore, the absence of mobile phone cover and storage of mobile phones in bags were found to accentuate microbial load. In our study it was noted that ladies stored their mobile phones mostly in their bags as compared to men who used their pockets or carry cases. Previous studies have reported that ladies handbags and shopping bags contained high levels of bacteria [18, 19] and the heat generated by mobile phones and the internal areas of bags have been found to support breeding of bacteria [20]. The present findings demonstrated that mobile phones from the community carry potential pathogens. Users of mobile phones should be advised to reduce sharing, ensure cleaning and store their mobiles in pockets or carry cases. Acknowledgments We are thankful to all the volunteers who participated in this study.

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The importance of mobile phones in the possible transmission of bacterial infections in the community.

Mobile phones have become indispensable accessories in today's life. However, they might act as fomites as they have travelled with their owner to pla...
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