Do Cell Phones Spread Infections in Hospitals?

Keeping Track of Infections

“It’s really hard most of the time to say why a patient got an infection because there’s so many things in the hospital and in the community that could contribute to that,” said Paul Anderson, who is part of the patient safety risk quality group at the ECRI Institute, which tracks risks in healthcare settings.

Nor would we necessarily see a spike in any one type of infection since the iPhone first put touchscreens in millions of pockets in 2007, according to Anderson.

“There are so many different initiatives going on to fight hospital-acquired infections. I don’t know that anybody has gone through those numbers to get to ‘is there or isn’t there?’” he said.

The Centers for Disease Control and Prevention data on hospital-acquired infections isn’t detailed enough to identify such a trend.

But there are a number of studies showing it’s possible for mobile devices to help spread bacteria and viruses.

One team of researchers recently swabbed the phones of orthopedic surgeons and medical residents as they entered the operating room and found that four of five devices had pathogenic bacteria on them.

After the phones were disinfected, 8 percent retained harmful bacteria, and a week later, 75 percent had again accumulated bacteria.

Another similar study took swab samples from portable electronic devices of 106 hospital workers. Every device housed bacteria, either on the device itself or on the cover.

Less than 10 percent of healthcare workers regularly sterilize their phones, a third study found.

Among patients’ phones tested in 2011, 84 percent were positive for microbial contamination, including 12 percent that were growing bacteria linked to hospital-acquired infections.

And as for Ebola, the virus can be found in skin swabs taken from infected patients, and researchers conclude the virus can be transmitted through contaminated surfaces.

“There is no reason to believe that transmission by fomites, or inanimate objects, can’t occur, at least if the transmission events happen quickly enough so that there is still viable virus. So, for example, if your hand comes into contact with contaminated body fluids of a patient with Ebola, then you touch a keyboard, and then someone else touches the keyboard and then rubs their eye, there’s no reason to believe that couldn’t transmit,” said Dr. Daniel Bausch, M.P.H., an associate professor at the Tulane University School of Public Health and a consultant to the World Health Organization.

“But documenting that as a precise route of transmission would be very difficult,” Bausch added.

It may be hard to prove that a mobile device caused any one illness, and the numbers aren’t big enough to speak for themselves.

Why Is the Doctor on the Phone?

If mobile devices are a plausible source of infection, why do doctors use them?

Because mobile phones have largely replaced pagers, doctors need to have some sort of access to them. But there are currently no national rules covering the use of mobile devices in hospitals, even in operating rooms (ORs).

Surgeons scrub in before they operate and can’t touch anything non-sterile during the procedure. But surgeons aren’t alone in the OR. Anesthesiologists, technicians, and nurses are also on hand. Because these providers don’t generally touch the patient once surgery has begun, they aren’t subject to the same demanding hygienic protocol.

“The truth is, in the OR there’s two areas. There’s the sterile field, which is the operating field, and the rest of the room is sub-sterile. It’s cleaned in between surgeries and more thoroughly at the end of the day, but it’s not a truly sterile environment,” said Kaar.

Sometimes medical staff outside the operating field consult their phones to look up lab results or potential drug interactions that will help guide medical decisions for the patient.

“You could create a scenario where there’s a legitimate use,” Anderson said.

But where Anderson and Kaar see legitimate uses, Papadakos sees excuses. It’s almost always easier to access medical information through the hospital- networked computers in most ORs, he said.

“It’s a production to enter into HIPAA-protected records on the phone,” he said. “You’re just creating an excuse as to why you want to look at the phone.”

But one thing seems clear: Hospitals should require electronic devices to be cleaned or stashed into disposable sleeves made for that purpose. These bags don’t interfere with ease of use, researchers have found. And doctors should only access information relevant to the patient on the table.

The trouble is that, like most of us, doctors sometimes use their phones when they shouldn’t.

“Just look around any work environment and people are staring at their phones. Healthcare is no different,” Papadakos said.

Studies back his claim. In one, nearly 80 percent of nurses acknowledged using their devices for nonprofessional activities while on duty.

Reasoned thinking would tell hospital staff to stay away from the phones while they’re caring for a patient. But reason doesn’t always prevail.

So why don’t hospital administrators enforce cell phone policies for medical staff? Papadakos answered with a rhetorical question: “They’re going to make up a policy banning the device that they’re staring at 24/7?”

Get the Facts: Hospital-Acquired Infections »

When Helpful Reminders Aren’t so Helpful

Even clean or gloved, mobile devices can be dangerous in hospitals because they can distract doctors and nurses from their work.

Few cases are so egregious, but distraction is widespread.

In a 2012 survey conducted by the trade magazine OR Manager, 41 percent of respondents said they’d witnessed distracted behavior.

In a survey of perfusionists, technicians who provide blood transfusions for patients during surgery, more than half said they’d seen medical personnel distracted by mobile devices in the OR. A significant percent also said they’d seen an adverse event take place as a result.

ECRI looked through all reported medical accidents and near misses in Pennsylvania between 2010 and 2011. There were slightly more than 1,000 problems blamed on distraction, and 40 reports of error specifically mentioned distractions from technologic devices.

The resident was distracted by an incoming personal text message and didn’t finish the cancellation. As a result, the patient continued to get the medication, causing blood to pool in the sac of the heart. The patient underwent emergency open-heart surgery to fix the problem.

Doctors and nurses, in other words, have their attention just as absorbed by their phones as the rest of us.

“Unless you’re going to frisk doctors and nurses when they come in, you’re never going to stop it,” Anderson said.

Digital Hygiene

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