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ORIGINAL ARTICLE Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 4  |  Page : 711-713
Physician accessories: Doctor, what you carry is every patient's worry?


Department of Microbiology, Subharti Medical College, Swami Vivekanand Subharti University, Meerut - 250 002, UP, India

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Date of Web Publication27-Oct-2010
 

   Abstract 

Background: Nosocomial infections are on the rise worldwide and many a times they are carried by the health care personnel. Accessories used by physicians and healthcare personnel can be a potential source of nosocomial infection. Materials and Methods: We designed a survey with the aim to investigate the prevalence of microbial flora of accessories such as pens, stethoscopes, cell phones and white coat used by the physicians working in a tertiary care hospital. Observations: It was observed that 66% of the pens, 55% of the stethoscopes, 47.61% of the cell phones and 28.46% of the white coats used by the doctors were colonized with various microorganisms. Staphylococcus spp. was the predominant isolate followed by Escherichia coli. Methicillin resistance in Staphylococcus aureus was also found, which was a matter of concern. Conclusions: Awareness of appropriate hand hygiene is important in order to prevent potential transmission to patients.

Keywords: Hospital infection, nosocomial infection, physician accessories

How to cite this article:
Pandey A, Asthana AK, Tiwari R, Kumar L, Das A, Madan M. Physician accessories: Doctor, what you carry is every patient's worry?. Indian J Pathol Microbiol 2010;53:711-3

How to cite this URL:
Pandey A, Asthana AK, Tiwari R, Kumar L, Das A, Madan M. Physician accessories: Doctor, what you carry is every patient's worry?. Indian J Pathol Microbiol [serial online] 2010 [cited 2017 Dec 16];53:711-3. Available from: http://www.ijpmonline.org/text.asp?2010/53/4/711/72047



   Introduction Top


Nosocomial infections (NIs) are on the rise worldwide. Although microorganisms are most commonly transmitted by the hands of healthcare personnel, materials and articles used in the hospitals could also carry microorganisms. [1],[2] It is known that accessories used by physicians can be a potential source of NI. [3],[4] Detection of bacterial flora on stethoscopes, pens, white coats and fabrics has been carried out individually in different hospitals in the past. [1],[4],[5] However, to the best of our knowledge, studies to detect microbial flora of multiple accessories in the same healthcare settings has not been reported from India. We designed a survey with the aim to investigate the prevalence of the microbial flora of accessories used by the physicians working in a tertiary care hospital.


   Materials and Methods Top


A total of 436 swabs were collected from pens (n = 100), stethoscopes (n = 80), cell phones (n = 126) and white coats (n = 130) of doctors working in various medical specialties in our hospital for microbial culture. Each sample was collected by swabbing the surface of the accessories with a sterile cotton swab moistened with saline. The swabs were then inoculated on Blood agar, MacConkey's agar and Sabauraud's dextrose agar (SDA) plates. The plates were incubated at 37ºC for 24-48 h and examined for microbial growth. The microorganisms were identified using standard methods. [6] Antibiotic susceptibility was tested by the Kirby Bauer disk diffusion method. Methicillin resistance in Staphylococcus aureus was detected using Mueller Hinton agar with 1 μg oxacillin and 30 μg cefoxitin disk (Hi-Media Ltd , Mumbai, India) using CLSI guidelines. [7]


   Results Top


A total of 207 (47.47%) of the samples yielded various microorganisms. The distribution of microorganisms isolated from various accessories is elaborated in [Table 1]. It was observed that 66% of the pens, 55% of the stethoscopes, 47.61% of the cell phones and 28.46% of the white coats used by the physicians harbored various microbial flora.

Overall, Staphylococcus spp. was the predominant isolate in 122 (27.98%). Coagulase-negative Staphylococcus (CONS) was isolated from 68 (15.50%) and S. aureus from 54 (12.3%) samples. Of the S. aureus isolated, 7.3% were methicillin-resistant S. aureus (MRSA). E. coli was the predominant bacteria among the gram negative bacterial flora, i.e. in 40 (9.17%). Acinetobactor spp. 20 (4.58%), P. aeruginosa 6 (3.6%) and Klebsiella spp. 9 (2.06%) were the other gram negative bacteria (GNB) isolated.

Statistical analysis was performed by applying a two-way ANOVA-F test to test the significant difference among bacteria and the items used. A significant difference was observed among the growth of bacteria for different items (e.g., pen, white coat, cell phone and stethoscopes) at a = 0.05 level of significance, i.e. P < 0.05 [Table 1].
Table 1 :Microorganisms isolated from different accessories used by physicians in a tertiary care hospital


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If you look at the individual accessories, S. aureus (27.5%) was the predominant isolate from the stethoscope, CONS from the pens and cell phones (26%) and E. coli from the white coats (10.77%).

A positive and a significant correlation was observed between pens and cell phones (r = 0.72), cell phones and stethoscopes (r = 0.65) and pen and stethoscopes (r = 0.59), i.e. P < 0.05, respectively. Candida species was isolated only from 6.25% of the stethoscopes and 2% of the pens.


   Discussion Top


NIs are an important cause of hospital morbidity and mortality, creating an increase in medical cost. [8] The most common mode of transmission of exogenous nosocomial pathogen is hand carriage by medical personnel. [9] Our findings show that pens, cell phones, stethoscopes and white coat, the common accessories used by doctors in healthcare settings, are colonized with various microorganisms. This is in agreement with other previous studies. [10],[11] Staphylococcus spp. was the predominant isolate in our study. Similar results have been shown by other workers. [11] Isolation of MRSA from 7.3% of the samples in our study is a matter of concern. These MRSA have emerged as a significant NI threat. According to the Centers for Disease Control and Prevention, MRSA is the cause of more than 60% of all hospital infections in the United States. [12],[13] Because of frequent dermal contact, the pens, cell phones, stethoscopes and white coat harbor these resistant bacteria. [14]

We could isolate pathogenic GNB from various samples. This is in contrast to a study carried our by Wong et al. 1 , where pathogenic GNBs were not isolated from white coats. However, they have been reported infrequently in other studies. [15],[16] These GNBs are potential causes of hospital-associated infections as they are multidrug resistant. Cross-transmission of these resistant microorganisms by the hands of healthcare personnel from various accessories in different wards and intensive care units might introduce an additional risk for critically ill patients.

However, even though we know that these devices used in the hospital harbor pathogenic microorganisms, their use cannot be banned in healthcare settings as they are essential tools used by the doctors and the healthcare personnel. Therefore, handling of accessories such as pens, cell phones, stethoscopes and white coats thus necessitates strict compliance with hand disinfection policies. Simple recommendation of handwashing between patients will prevent contamination of almost all these accessories.

Simultaneously, it is also advisable to regularly decontaminate the used accessories with alcohol-based disinfectants in order to effectively reduce the bacterial load of the devices.

Moreover, in future, pilot studies to detect the microbial flora from accessories used by nonphysician common men (visitors) in the community and the hospital environment can be carried out to highlight the role of healthcare workers in the epidemiology of NIs along with typing of the isolates.


   Acknowledgment Top


The authors thank Dr. A. K. Asthana, Chief Medical Superintendent, for giving us permission to carry out this work in the CSS Hospital. We also thank the physicians who permitted us the use of their accessories for the study.

 
   References Top

1.Wong D, Nye K, Hollis P. Microbial flora on doctor's white coats. BMJ 1991;303:1602-4.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Chacko L, Jose S, Isac A, Bhat KG. Survival of nosocominal bacteria on hospital fabrics. Indian J Med Microbiol 2003;21:291.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.Jones JS, Hoerle D, Riekse R. Stethoscopes: a potential vector of infection? Ann Emerg Med 1995;26:296-9.  Back to cited text no. 3
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4.Cohen HA, Amir J, Matalon A, Mayan R, Beni S, Barzilai A. Stethoscope and otoscopes: a potential vector of infection? Fam Pract 1997;14:446-9.  Back to cited text no. 4
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5.Breathnach AS, Jenkins DR, Pedler SJ. Stethoscopes as possible vector of infection by staphylococci. BMJ 1992;305:1573-4.  Back to cited text no. 5
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6.Collee JG, Miles RS, Watt B. Tests for the identification of bacteria. In: Collee JG, Marmion BP, Fraser AG, Simmons A, editors. Mackie and Mc Cartney Practical Medical Microbiology. 14th ed. Edinburg: Churchill Livingstone; 1996. p. 131-50.  Back to cited text no. 6
    
7.Clinical Laboratory Standards Institute. Performance standards for antimicrobial disk susceptibility tests. Approved standarad M2-A7, 11th ed. Wayne PA: USA; 2007.  Back to cited text no. 7
    
8.Jarvis WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost and prevention. Infect Control Hosp Epidemiol 1996;17:552-7  Back to cited text no. 8
    
9.Pittet D, Dharan S, Touveneau S, Sauvan V, Perneger TV. Bacterial contamination of the hands of hospital staff during routine patient care. Arch Intern Med 1999;159:821-6.  Back to cited text no. 9
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10.Datz C, Jungwirth A, Dusch H, Galvan G, Weiger T. What's on doctor's ball point pen? Lancet 1997;350:1824.  Back to cited text no. 10
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11.Bhat GK, Singhal L, Philip A, Jose T. Writing pens as fomites in hospital. Indian J Med Microbiol 2009;27:84-5.  Back to cited text no. 11
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12.Boyce JM, Potter-Bynoe G, Chenevert C, King T. Environmental contamination due to methicillin resistance Staphylococcus aureus: possible infection control implication. Infect Control Hosp Epidemiol 1997;18:622-7.  Back to cited text no. 12
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13.Blythe D, Keenlyside D, Dawson SJ, Galloway A. Environmental contamination due to methicillin resistant S. aureus (MRSA). J Hosp Infect 1998;38:67-9.  Back to cited text no. 13
[PUBMED]    
14.Bandi S, Uddin L, Milward K, Aliyu S, Makwana N. How clean are our stethoscopes and do we need to clean them? J Infect 2008;57:355-6.  Back to cited text no. 14
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15.Babb JR, Davies JG, Ayliffe GA. Contamination of protective clothing and nurses uniforms in an isolated wards. J Hosp Infect 1983;4:149-57.  Back to cited text no. 15
[PUBMED]    
16.Robinton ED, Mood EW. A study of bacterial contaminations of cloth and paper towels. Am J Public Health 1968;58:1452-9.  Back to cited text no. 16
    

Top
Correspondence Address:
Anita Pandey
Department of Microbiology, Subharti Medical College, Swami Vivekanand Subharti University, Meerut - 250 002, UP
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.72047

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    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
    Acknowledgment
    References
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