Hold the phone: Mobilizing against cell phone pathogens

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ON ANY GIVEN DAY, the CDC estimates that 1 out of 25 hospitalized patients has a healthcare-associated infection (HAI).1 Up to 1.7 million HAIs occur annually in the United States, resulting in an annual financial loss of $6.5 billion.2 HAIs are responsible for approximately 75,000 deaths annually.1,3 Preventing HAIs is essential to keep hospitalized patients safe as well as to control costs.Access to instant communication and information such as medical records and test results, coupled with the ability to share images quickly among providers, patients, and families, are important benefits of mobile device use. However, along with these benefits comes the risk of transmitting pathogens that may be contaminating the surfaces of cell phones and other mobile devices. The purpose of this review is to examine the current evidence to determine whether the use of mobile devices, particularly cell phones, increases the risk of HAIs and what hospitals and individual clinicians can do to minimize the potential for transmitting infection.Hazards of healthcareHAIs are infections that result from receiving treatment in a hospital or other healthcare facility. According to the CDC, types of HAIs include, but are not limited to, surgical site infections, central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonia, Clostridium difficile infections, and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia.3,4The Agency for Healthcare Research and Quality states that the average adjusted length of stay for hospitalized patients is 5 days; this increases to 24 days for patients who develop a HAI.5 The average cost of stay for a patient who develops a HAI increases by $43,000, resulting in an overall direct cost to the healthcare system ranging from $28 to $45 billion annually.5,6The use of cell phones and other mobile devices has become a routine means of communication between nurses, healthcare providers (HCPs), and other clinicians.7 In addition, patients and their visitors handle their devices in patient rooms and throughout the facility. These devices are potential reservoirs for pathogenic microorganisms that can contaminate the user's hands. However, whether this contamination translates into higher rates of HAI is unclear.Reviewing the evidenceThe authors conducted a literature search to evaluate the current evidence about whether the use of mobile communication devices, specifically cell phones, increases the risk of HAIs in hospitals. The aim of this review was to answer a PICOT question (P = population; I = intervention; C = comparison; O = outcome; and T = time): “When healthcare providers (P) use mobile phones (I), does the risk of HAIs increase (O) during hospitalization (T)?” (Comparison [C] was not pertinent to this PICOT question.) The databases Academic Search Premier, Medline, and CINAHL were searched (2010 to present) using the following keywords: mobile device, cell phone, hospital, infection, and HAIs.The evidence clearly demonstrates that cell phones are contaminated with various benign and pathogenic bacteria. In a pilot study conducted in a pediatric unit, researchers found that 95% of phones were colonized with bacteria and 5% contained pathogenic bacteria.8 This study is consistent with a systematic review by Ulger and colleagues that reviewed 39 individual research studies.9 All of the studies identified the proliferation of bacterial growth on devices, most commonly S. aureus (n = 26, 66.7%), followed by coagulase-negative staphylococci (n = 19, 48.7%).Other studies have shown that in addition to natural skin flora, mobile devices supported growth of MRSA, Escherichia coli, Acinetobacter, Enterobacter, Klebsiella, and Pseudomonas. Some devices also tested positive for endemic viruses, including adenovirus, rotavirus, and bocavirus.

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