Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. May 18, 2020; 11(5): 252-264
Published online May 18, 2020. doi: 10.5312/wjo.v11.i5.252
Mobile phones in the orthopedic operating room: Microbial colonization and antimicrobial resistance
Nada Qaisar Qureshi, Syed Hamza Mufarrih, Seema Irfan, Rizwan Haroon Rashid, Akbar Jaleel Zubairi, Anum Sadruddin, Israr Ahmed, Shahryar Noordin
Nada Qaisar Qureshi, Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
Syed Hamza Mufarrih, Department of Basic and Biomedical Sciences, Aga Khan University Hospital, Karachi 74800, Pakistan
Seema Irfan, Israr Ahmed, Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi 74800, Pakistan
Rizwan Haroon Rashid, Anum Sadruddin, Shahryar Noordin, Department of Orthopedic Surgery, Aga Khan University Hospital, Karachi 74800, Pakistan
Akbar Jaleel Zubairi, Department of Orthopedic Surgery, Combined Military Hospital, Rawalpindi 46000, Pakistan
Author contributions: Qureshi NQ, Mufarrih SH, Irfan S and Zubairi AJ designed the research; Qureshi NQ, Mufarrih SH and Sadruddin A collected the data; Ahmed I processed the samples; Mufarrih SH analyzed the data; Qureshi NQ and Mufarrih SH wrote the manuscript; Irfan S, Rashid RH and Noordin S edited the manuscript; Zubairi AJ obtained Institutional review board approval; Noordin S obtained funding and acted as the supervising author.
Institutional review board statement: This work was reviewed and approved by the Institutional Review Board of the Aga Khan University Pakistan.
Informed consent statement: All study participants provided informed written consent prior to study enrolment. Written consent was obtained after providing both a verbal explanation and written material about the study.
Conflict-of-interest statement: The authors declare no conflict of interest and the funders had no role in the design of the study; in the collection, analyses, or interpretation of the data; in writing of the manuscript, or in the decision to publish the results.
Data sharing statement: All data produced and relevant to this study are included within the manuscript.
STROBE statement: The STROBE checklist has been followed for conducting and writing the manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Nada Qaisar Qureshi, MBBS, Doctor, Research Associate, Department of Medicine, Aga Khan University Hospital, Aga Khan University, FOB, 1st Floor, Stadium Road, Karachi 74800, Pakistan. nadaqtaq@gmail.com
Received: December 20, 2019
Peer-review started: December 20, 2019
First decision: February 20, 2020
Revised: March 1, 2020
Accepted: April 4, 2020
Article in press: April 4, 2020
Published online: May 18, 2020
Processing time: 149 Days and 17.2 Hours
Abstract
BACKGROUND

Surgical site infections are a major cause of morbidity and mortality following orthopedic surgery. Recent efforts to identify sources of contamination in the operating rooms have implicated mobile phones.

AIM

To investigate microbial colonization on the mobile phones of health care professionals in the orthopedic operating room.

METHODS

We conducted a cross-sectional study involving culture and sensitivity analysis of swabs taken from the mobile phones of orthopedic and anesthesia attendings, residents, technicians and nurses working in the orthopedic operating rooms over a period of two months. Demographic and cell phone related factors were recorded using a questionnaire and the factors associated with contamination were analyzed.

RESULTS

Ninety-three of 100 mobile phones were contaminated. Species isolated were Coagulase-negative Staphylococcus (62%), Micrococcus (41%) and Bacillus (26%). The risk of contamination was increased with mobile covers and cracked screens and decreased by cell phone cleaning.

CONCLUSION

Mobile phones belonging to health care workers are frequently contaminated with pathogenic bacteria with the potential of transferring drug resistance to nosocomial pathogens. Studies investigating the relationship to surgical site infections need to be conducted. The concept of “mobile hygiene” involving the change of mobile covers, replacement of cracked screens or even wiping the phone with an alcohol swab could yield the cost-effective balance that contaminated cell phones deserve until they are established as a direct cause of surgical site infections.

Keywords: Mobile phones; Contamination; Surgical site infections; Orthopedic surgeries; Antimicrobial resistance

Core tip: Mobile phones have been implicated in contamination in the operating room. We cultured samples from the phones of 100 health care professionals in orthopedic operating rooms at a tertiary care hospital in Pakistan. Ninety-three percent of the phones were colonized by potentially pathogenic bacteria. The most common cause of implant related infections, Coagulase-negative Staphylococci, were isolated from 62 mobile phones, 54% of which were resistant to oxacillin. The risk of contamination increased with mobile covers and cracked screens and decreased with cleaning using an alcohol swab. These findings indicate the use of “mobile hygiene” until a relationship with surgical site infections is established.