This study aimed to investigate the microbiological contamination of mobile phones of clinicians in ICUs, PICUs, and NCUs in public secondary care hospitals in Kuwait. Approximately, 74 % of mobile phones that belong to clinicians in ICUs, PICUs, and NCUs were contaminated. This is higher than that reported from Saudi Arabia, where 43.6 % of clinicians’ mobile phones in wards, emergency rooms, out-patient departments, and operating rooms were contaminated ; and in India, where 42 % of clinicians’ mobile phones in different wards were contaminated . On the other hand, the prevalence of contamination of clinicians’ mobile phones in our setting was lower than that reported from other studies in Turkey, where 94.5 % of clinicians’ mobile phones in operating rooms and ICUs were contaminated , and 97.8 % of clinicians’ mobile phones in all departments were contaminated . Higher estimates of the contamination of clinicians’ mobile phones have also been reported from UK (96.2 % of mobile phones of all physicians) , Austria (95 % of mobile phones of anesthetists) , Saudi Arabia (96.5 % of mobile phones of clinicians in ICU)  and Nigeria (94.6 % of mobile phones of health care workers in a hospital) . While the direct comparison between the findings of different studies is hindered by various factors, including targeting different hospital wards and different laboratory procedures, the contamination rate of clinicians’ mobile phones in Kuwait seems to be within the range that was reported in other literature.
Although not statistically significant, the contamination rate was higher in NCUs (79.6 %) compared to those in ICUs (72.1 %) and PICUs (65.9 %). This remains evident even after adjusting for other factors using logistic regression. It is not clear why clinicians’ mobile phones in NCUs tended to have higher contamination rate than ICUs and PICUs, but it is worth noting that the rate of late-neonatal infections in Kuwait is extremely high, and that it resembles the one in low-income countries .
A major objective of our study was to describe the microbiological profile of contaminated mobile phones of clinicians working in ICUs, PICUs, and NCUs. Most mobile phones were colonized with non-pathogenic bacteria, especially those bacteria that constitute the normal flora of the skin, such as CoNS, Micrococcus, and diphtheroids. This is similar to other studies which reported CoNS followed by Micrococcus as the most common organisms isolated from clinicians’ mobile phones in clinical settings . CoNS have relatively low virulence, but are becoming increasingly recognized as the most common cause of nosocomial bacteraemia associated with indwelling devices . Despite the fact that CoNS are considered non-pathogenic in normal circumstances, their presence in high levels on objects with frequent hand contact like mobile phones in settings like ICUs may pose a risk of bacteraemia in immunocompromised patients. In addition, CoNS are identified as the most common cause of late-onset neonatal sepsis in developed countries [24–26] and in Kuwait . CoNS have been also reported as the main causative factor for early-onset neonatal infections in Canada , USA , and China .
A number of mobile phones in our study were found to be colonized with potentially pathogenic bacteria, namely MRSA and Gram-negative bacteria. MRSA was identified in three (1.4 %) mobile phones, none were resistant to vancomycin, which is the drug of choice for MRSA infections . The rate of MRSA contamination of clinicians’ mobile phones is slightly lower in our study compared to other literature, in which it ranged from 1.9 % to 10.3 % [8, 10]. Acinetobacter species have been frequently identified as a cause of widespread hospital outbreaks, including those in ICUs . Gram-negative bacteria were identified in 15 (7.0 %) mobile phones, of which six (2.8 %) were Acinetobacter species; but none were resistant to meropenems. The rate of contamination with Acinetobacter species is consistent with other studies, which reported that between 1 % and 12 % of clinicians’ mobile phones were contaminated by Acinetobacter species . Another organism identified in our study was Pseudomonas stutzeri, which was found to be sensitive to gentamicin and amikacin. In addition, Escherichia coli was isolated from one mobile phone, which suggests low level of mobile phone hygiene and hand hygiene since this organism is part of the intestinal flora; and among the leading causes of HAIs.
In terms of self-reported mobile phone hygiene practices, 66.5 % of the participants have never disinfected their mobile phones. This is similar to that reported from Saudi Arabia, where 76.0 % of clinicians have never disinfected their mobile phones ; and in a surgical setting in Northern Ireland, where only 37 % of healthcare workers admitted cleaning their mobile phone regularly . Our study showed that clinicians who have ever disinfected their mobile phones were less likely to have contaminated mobile phones compared to clinicians who have never disinfected their mobile phones, and this was statistically significant after adjusting for potential confounders. No other factors was significantly associated with mobile phone contamination in our study. Other studies have investigated factors related to mobile phone contamination and included gender of the clinician, number of times the mobile phone is used at work, type of phone, and medical specialty of the clinician; but none of these factors was found to be significant [5, 8, 10, 12].
Previous studies have demonstrated that the microbiological profile of the clinicians’ mobile phones correlates with the pathogens isolated from the clinicians’ hands, which may indicate that mobile phone contamination might be a predictor for hand contamination [21, 32], and hence hand hygiene. However, we did not find an association between mobile phone contamination and clinicians’ self-reported hand hygiene practices in our study. Previously, it has been demonstrated that observed hand hygiene practices are unrelated or weakly correlated to self-reported hand hygiene [33–35], which may explain our findings.
In our study, we investigated the opinion of clinicians about the potential role of mobile phones in spreading nosocomial infections. Approximately, 63.0 % of clinicians thought that mobile phones can play a role in spreading infections in healthcare settings. However, 68.0 % of clinicians opposed banning the use of mobile phones in their units. This is slightly lower than what has been reported in a study from UK, in which 78.0 % of clinicians opposed banning the use of mobile phones in hospitals . While losing the momentum to ban mobile phones in ICUs and other clinical settings, it is sensible to increase the awareness about mobile phones disinfection rather than trying to forcefully ban using mobile phones in clinical settings.
This is the first study that investigated the prevalence of contamination of clinicians’ mobile phones and their microbiological profile in all ICUs, PICUs, and NCUs in public secondary care hospitals in Kuwait. We have attempted to enroll all clinicians in ICUs, PICUs, and NCUs, and only 3.8 % of those approached refused to participate. However, of 229 eligible clinicians who were not officially on leave, 18 were not approachable despite the four attempts we made to recruit them (Fig. 1). Nevertheless, there is no obvious reason to assume that mobile phone contamination and mobile phone disinfection practices would be different between those who participated and those who did not. It is possible that some clinicians had disinfected their mobile phones when they overheard about the study and before they were approached to participate (Hawthorne effect). This, if exists, will underestimate the microbiological contamination rate and will also make a fallacious association between self-reported mobile phone disinfection and mobile phone contamination.