الفهرس 
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Abstract
Mobile phones have recently become the most touchable and accessible item in everyday life. In the last decade, the cell phone industry revolution has encouraged users of all ages and professions to use phones for more than the basic voice feature, as users are able to send text messages, emails and access the internet, along with many other services. Nonetheless, these benefits can put the people particularly in hospital sittings at a higher risk associated with their use due to contact with various forms of microorganism. As personal mobile phone is not concluded in routine cleaning in hospital settings and has been touched frequently during patient’s examination, mobile phones can become contaminated with various hospital pathogens that may cause Health Care Associated Infection (HCAIs) and even be multi-drug resistant.
Researchers belief that the constant handling of the mobile phone by the Health Care Workers (HCWs) exposes it to an array of microorganisms. As the skin provides the moisture plus the optimum temperature of human body especially palms of the hand. Additionally, the heat generated by the device, in turn, create a prime breeding place for many organisms. Hence, they expressed mobile phone being the ‘‘Technological Petri Dish’’. So the aim of this study was to screen the mobile phones of HCWs for microbial contamination, identify various bacteria and fungi isolates and assess their antimicrobial susceptibility patterns with special reference to Multi-drug Resistance Organisms (MDROs), also assess the awareness of HCWs towards mobile phones as a possible vehicle that can transmit many pathogens, their practice regarding usage of the mobile phones in the high-risk areas and verify the effectiveness of different disinfectants in the reduction of microbial contamination of mobile phones. This study was carried out in Medical Microbiology and Immunology Department, Faculty of Medicine, Tanta University. One hundred and sixty samples were collected during the period from July 2019 to July 2020 from HCWs in the Operating Rooms (ORs) and surgical Intensive Care Units (ICUs) at Tanta University Hospitals. The researcher informed the participants about the aims of this study and received their consent after confirming the confidentiality of the results. The participant was asked to complete the questionnaire. Privacy was guaranteed, and the results were kept confidential. Samples were collected using sterile cotton swabs. Each swab was first moisturized with sterile peptone water and then rotated over the surface of both sides of the tested mobile phone, covering the entire surface without removal of the protective case followed by application of a certain disinfectant (70% ethyl alcohol, 70% isopropyl alcohol, or 0.5% chlorhexidine). After 10 minutes of using the selected disinfectant, another swab was obtained using the same manner. Pour plate method was used to obtain Aerobic Colony Counting (ACC) in each sample. Colony counting was done before and after the use of disinfectant on each mobile phone that was involved in this study. All samples were subjected to bacteriological isolation and identification using the routine standard laboratory methods. Antimicrobial susceptibility test was done using the disc diffusion method according to CLSI guidelines. ESBL detection among isolated Enterobacriaceae was done by modified double disk synergy test and phenotypic AmpC screening was done by testing sensitivity to Cefoxitin disk. For Carbapenem resistant isolates, MBL detection by (IMP)-EDTA combined disc test was done.
Multi-drug resistant isolates (MDROs) were further investigated by VITEK 2 compact system. It was found that participants use their mobile phones constantly at hospital mostly for work purposes. One hundred and fifty (93.75%) admitted to use their mobile phones in critical care areas. Out of those, 129 (80.63%) admitted to answer calls while caring for patients, 125 (78.12%) admitted to share their mobile phones with colleagues, 150 (93.75%) use the same mobile phone at home and 117 (73.12%) shared their mobile phones with a family member. There were 51 HCWs (31.88%) who regularly clean their mobile phones. As regard hand hygiene, out of 160 HCWs, 99 (61.88%) wash their hand before patient care, 124 (77.5%) wash their hands after caring for patients, and only 18 (11.25%) wash their hands after using their mobile phones in hospitals. Upon studying ACC present on mobile phone surface, we divided the samples into three groups to test the reduction in count after applying a disinfectant agent. group A was tested by 70% ethyl alcohol spray, group B was tested by 70% isopropyl alcohol, while group C was tested by 0.5% chlorhexidine wipes. In this study, we found that the mean CFU/ml before disinfection was 130.68 ± 76.97, 124.25 ± 70.65 and 130.44 ± 78.98 in group A, B, C respectively and the mean CFU/cm2 was 5.22 ± 3.08, 4.97 ± 2.82 and 5.21 ± 3.16 in group A, B, C respectively. All applied disinfectants significantly decreased the colony count on mobile phone surface. It was also noted that the mean colony count was significantly higher in mobile phones of HCWs who use it while caring for patients or use it inside the restrooms. While it was significantly lower in mobile phones of HCWs who regularly clean their mobile phones. As regard the microbial isolation from mobile phone surface, we found that 84.38% of tested mobile phones were contaminated with nosocomial pathogens. Two pathogens were isolated from 57 samples (35.63%) and three or more pathogens were isolated from 55 samples (34.38%). Totally, out of 320 isolated organisms, gram positive organisms were the most frequently found, particularly Coagulase Negative Staphylococci (28.4%) followed by Staphylococcus aureus (Staph. aureus) (23%). Other gram-positive organisms were isolated, as Enterococci (9.4%) and Streptococcus pyogens (1.6%). The most common isolated gram-negative organisms in this study were Klebsiella spp. (10.6%). Followed by Pseudomonas spp. (8.2%), Escherichia coli (7.5%), Acinetobacter spp. (5.6%), proteus spp. (1.6%), Enterobacter (1.6%), and Salmonella spp. (0.6%). Fungi accounted for 1.9% of isolated organisms. As regard isolation of MDROs, out of 320 isolated organisms, 116 (36.25%) were MDROs. In the present study, all gram-positive isolates were sensitive to Linezolid, and all Staphylococci were sensitive to Vancomycin. Out of isolated Staph. aureus, (28.4%) were Methicillin Resistant Staph. aureus (MRSA) and (25.27%) of isolated CoNS were Methicillin Resistant (MR-CoNS). Out of isolated Enterococci, 8 isolates (26.6%) were Vancomycin resistant (VRE). Out of 114 isolated gram-negative bacteria, 38 (33.33%) were Extended Spectrum Beta Lactamase (ESBL) producer, 17 (14.91%) were AmpC beta lactamase producers and 5 (4.38%) were Metallo- Beta Lactamase (MBL) producers. Isolated ESBL producing organisms, MRSA, VRE, MDR E. coli and MDR Acinetobacter were significantly higher in ICU samples compared to the OR samples.