Touchscreens: The Hidden High-Frequency Contact Surfaces

Bacteria on Mobile Phones

High-frequency contact surfaces and devices in medical environments can easily spread microorganisms, and their cleaning and disinfection have always been a focus of infection prevention. In addressing the issue of SARS-CoV-2 (the virus causing COVID-19), appropriate and effective surface cleaning/disinfection products and protocols are crucial for maintaining the safety and infection-free status of patients, staff, and visitors in healthcare institutions.

Traditionally, when we think of medical environments, the infection prevention strategies we consider mainly involve hand hygiene and surface cleaning and disinfection. The rapidly evolving healthcare environment now includes various sensitive touch technologies. Mobile phones have infiltrated medical environments, assisting healthcare professionals in patient care as well as serving as personal communication tools. Over the past decade, the use of mobile phones by healthcare professionals has steadily increased. According to reports from doctors, the percentage of physicians using mobile phones for professional purposes rose from 68% in 2012 to 84% in 2015.

Using mobile phones in healthcare institutions can improve communication in the work environment and enhance access to information, allowing healthcare professionals and patients to easily obtain and generate clinical data with just a light touch. Notably, this technology can come into direct contact with patients. Many healthcare institutions utilize touchscreen tablets for patient registration (illustrated with tablets for signing in/inputting personal information) and for remote health consultations with admitted patients (if doctors cannot personally assess patients in emergencies).

Despite the significant convenience provided by mobile phones, there are some downsides to their use in patient care areas. One of these is the potential for infection transmission—microorganisms can survive on the surfaces of devices like mobile phones for extended periods. A meta-analysis reviewing literature from 2005 to 2013 highlighted 39 studies that found nosocomial pathogens on healthcare workers’ mobile phones, with the most common isolate being Staphylococcus aureus. Kanayama et al. (2017) found genetically identical strains on both mobile phones and users, proving that mobile phones can serve as sources of microbial infection in healthcare environments. To further support this, reports indicate that 73.7% of tested mobile handheld devices were colonized by bacteria, and another study reported that all bacteria found on mobile handheld devices were also present on healthcare workers’ hands.

Bacteria are not the only microorganisms found on mobile phones. A study on virus transmission between fingers and glass surfaces found that virus transmission can indeed occur, and the amount transmitted is greatly influenced by the type of virus and the time elapsed since the last handwashing. Pillet et al. studied epidemic viruses (influenza A virus, respiratory syncytial virus, influenza virus, rotavirus, and norovirus) and found that these mobile phones could serve as hosts for viral RNA, concluding that hand hygiene and cleaning/disinfection of mobile phones are necessary.

Mobile Phone Contamination in Healthcare

Kanayama et al.’s research concluded: “If mobile phones are used with bare hands or if gloved hands come into contact with patients before using the phone, then the phone is likely to become contaminated on its surface,” emphasizing the importance of hand hygiene before and after using these commonly contaminated devices to prevent transmission.The World Health Organization (WHO) “Five Moments for Hand Hygiene” model is an excellent template for healthcare institutions to follow to prevent cross-infection (HAIs) caused by careless mobile phone usage:

1. Before touching a patient,

2. Before clean/aseptic procedures,

3. After exposure/risk of body fluids,

4. After touching a patient,

5. After touching the surrounding environment of the patient.

In today’s healthcare environment, touchscreen technology is ubiquitous and widely used. To effectively achieve a safe healthcare environment, it is essential to provide education emphasizing the proper products and methods for cleaning/disinfection and hand hygiene. This educational strategy must include mobile phones!

Device Disinfection

For a long time, there has been a lack of guidance on cleaning mobile phones in healthcare institutions. The American Association of Perioperative Registered Nurses (AORN) recently released guidelines outlining the importance of cleaning mobile phones, tablets, and other handheld electronic devices before introducing them into sterile environments. “Mobile phones, tablets, and other personal communication or handheld devices should be cleaned according to the manufacturer’s instructions before being brought into the operating room, along with hand hygiene.” Given our understanding of pathogen transmission and the use of high-touch technologies, the practice of cleaning these devices should be promoted throughout healthcare institutions, including all patient care areas.

Education and guidance surrounding the cleaning and disinfection of these devices are key to supporting compliance. Providing systems with appropriate guidelines for cleaning/disinfecting these high-touch mobile devices and then educating staff to adhere to these guidelines is an ideal way to improve compliance.

A recent survey of 100 nurses in direct care healthcare environments showed that despite knowing the presence of numerous microorganisms on mobile phones, mobile phones are not disinfected as often as one might expect:

—72% of nurses reported using mobile phones at nursing stations, 76% of nurses used mobile phones in public places such as cafeterias, and 50% of nurses used mobile phones in restrooms.

—84% of nurses indicated that they often touch their phones without gloves during shifts.

—41% of nurses reported regularly cleaning their phones throughout the day. These numbers are likely due to a lack of formal training.

—Only 3% of respondents received formal training on mobile phone disinfection.

—Only 25% of respondents believed that hospitals needed to establish stricter policies and procedures to prevent contamination of these handheld, high-touch devices.

Cleaning During the Pandemic

The only comfort from this data is the finding that nurses often use disposable alcohol-based disinfectant wipes when cleaning their phones. Overall, these results highlight that once reviewed, gaps can be identified and education and planning can be initiated to ultimately mitigate. Visual educational tools—such as reminders posted on walls and computer learning modules—can help improve compliance with mobile phone cleaning among healthcare personnel.

During this pandemic, environmental cleaning and disinfection efforts have been intensified. The SARS-CoV-2 pandemic has prompted the most well-known mobile phone manufacturers to provide detailed cleaning procedures—both Apple and Samsung have issued cleaning recommendations for products compatible with their brand of mobile phones. Information on cleaning products, combined with proper cleaning and hand hygiene, will help reduce the risk of mobile phones serving as sources of infection transmission.

References:

1. US Centers for Disease Control and Prevention. Healthcare-Associated Infections Data Portal. CDC website. https://www.cdc.gov/hai/data/portal/index.html. Updated January 2, 2020. Accessed May 6, 2020.

2. Statistica Research Department. Physicians’ usage of smartphones for professional purposes in the US from 2012 to 2015. Statistica website. https://www.statista.com/statistics/416951/smartphone-use-for-professional-purposes-among-us-physicians/. Published March 26, 2015. Accessed May 6, 2020.

3. Farrell M. Use of iPhones by nurses in an acute care setting to improve communication and decision-making processes: qualitative analysis of nurses’ perspectives on iPhone use. JMIR Mhealth Uhealth. 2016 Apr-Jun; 4(2): e43. Published online 2016 May 31. doi: 10.2196/mhealth.5071.

4. Ulger, Fatma, Dilek A, Esen S, Sunbul M, Leblebicioglu H. Are healthcare workers’ mobile phones a potential source of nosocomial infections? Review of the literature. J Infect Dev Ctries. 2015 Oct 29;9(10):1046-53. doi: 10.3855/jidc.6104.

5. Kanayama AK, Takahashi H, Yoshizawa S, Tateda K, Kaneko A, Kobayashi I. Staphylococcus aureus surface contamination of mobile phones and presence of genetically identical strains on the hands of nursing personnel. Am J Infect Control. 2017 Aug 1;45(8):929-931. doi: 10.1016/j.ajic.2017.02.011. Epub 2017 Apr 11.

6. Heyba M, Ismaiel M, Alotaibi A, et al. Microbiological contamination of mobile phones of clinicians in intensive care units and neonatalcare units in public hospitals in Kuwait. BMC Infect Dis. 2015 Oct 15;15:434. doi: 10.1186/s12879-015-1172-9.

7. Pal S, Juyal D, Adekhandi S, et al. Mobile phones: Reservoirs for the transmission of nosocomial pathogens. Adv Biomed Res. 2015 Jul 27;4:144. doi: 10.4103/2277-9175.161553. eCollection 2015.

8. Julian, TR, Leckie JO, Boehm AB. Virus transfer between finger pads and fomites. J Appl Microbiol. 2010 Dec;109(6):1868-74. doi: 10.1111/j.1365-2672.2010.04814.x.

9. Pillet S, Berthelot P, Gagneux-Brunon A, et al. Contamination of healthcare workers’ mobile phones by epidemic viruses. Clin Microbiol Infect. 2016 May;22(5):456.e1-6. doi: 10.1016/j.cmi.2015.12.008. Epub 2015 Dec 20.

10. World Health Organization. My 5 Moments for Hand Hygiene. WHO website. https://www.who.int/infection-prevention/campaigns/clean-hands/5moments/en/). Published 2007. Accessed May 5, 2020.

11. AORN. Perioperative Guidelines for Surgical Attire. AORN website. https://aornguidelines.org/tool/content?gbosid=426382. Accessed May 6, 2020.

12. Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system. Vol. 6. Washington, DC: National Academy Press; 2000.

13. PDI Healthcare. 9 stats on cell phone cleaning in hospitals: results from our survey of 100 nurses. PDI website. https://pdihc.com/blog/9-stats-on-cell-phone-cleaning-in-hospitals-results-from-our-survey-of-100-nurses/. Published May 20, 2020. Accessed May 20, 2020

14. Apple Support. Cleaning your iPhone. Apple website. https://support.apple.com/en-us/HT207123. Accessed May 6, 2020.

15. Samsung. Samsung guide on how to clean your phone to protect against coronavirus. Samsung website. https://www.sammobile.com/news/samsung-guide-how-to-clean-your-phone-coronavirus/. Accessed May 6, 2020.

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