Study shows no difference in bacterial contamination of doctors’ wrists with short or long sleevesBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1079 (Published 16 February 2011) Cite this as: BMJ 2011;342:d1079
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Re: Study shows no difference in bacterial contamination of doctors’ wrists with short or long sleeves
Thomas C Morris MRCP, Luke P Moore FRCPath, Sunil Shaunak FRCP
Department of Infectious Diseases, Imperial College NHS Trust at Hammersmith Hospital London.
We are writing in response to the article posted by Susan Mayor on 16 February 2011 “Study shows no difference in bacterial contamination of doctors’ wrists with short or long sleeves.” The UK Department of Health has imposed hand decontamination procedures on NHS staff that require sleeves to be rolled up and jewellery and wrist watches to be removed.[2,3] As well as representing a move away from the white coat, this has also led to a change in medical practice with regard to the timepiece being used to measure pulse and respiratory rate. In order to take a pulse, our observation was that doctors would commonly apply alcohol hand gel to both hands and then attend the patient’s bedside using their own mobile phone as a timepiece. After completing the examination, the phone was put back into their pocket or handbag. As evidence is accumulating that bacterial contamination of mobile phones is both extensive and widespread[4-6], we set out to determine the impact of using a personal phone as a timepiece upon the onward transmission of Staphylococcus aureus by hospital based medical staff.
We conducted a one day survey of bacterial contamination of doctors’ fingertips before and after use of a mobile phone or watch kept either on a belt or in a bag or pocket for taking a radial pulse. Twenty hospital doctors were enrolled across all grades. All were invited to clean their hands with alcohol hand gel. Their dried five fingertips from their non-dominant hand were then applied to a blood agar plate. They were then asked to take a radial pulse and to hold the timepiece in their non-dominant hand. These same five fingertips were then reapplied to a second blood agar plate. The 40 plates were incubated at 370C and colony counts assessed by two microbiologists at 24 hours. Colonies were sampled and subcultured on methicillin-resistant Staphylococcus aureus (MRSA) selective chromogenic agar after latex agglutination testing for Staphylococcal protein A and clumping factor.
The bacterial colony counts from doctors’ fingers were significantly higher for Bacillus species, Coryneform bacteria and Staphylococcus aureus after use of a phone or a watch as the timepiece to take a pulse. The MRSA isolation rate increased from zero to 15% after a single handling of the timepiece, which in this small study, was always a mobile phone when MRSA was grown.
These results should act as an alert that the use of mobile phones by doctors as timepieces which has occurred because of current NHS guidelines, could be unwittingly contributing to the spread of MRSA across wards. At a time when mobile phone applications (“apps”) are rapidly being introduced into hospitals to accelerate clinical decision-making processes, it is possible that we could be compounding the problem of nosocomial spread of bacterial pathogens, including MRSA. Our results identify a pressing need to accurately define the extent of this problem and to modify infection control policies accordingly.
Role of the Funding Source
No funding was required for this publication and no personal gain was at stake for any of the authors.
No competing interests
All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.
Thomas Morris: Literature search, Study Design, Data Collection, Data Analysis, Data Interpretation, Writing
Luke Moore: Literature search, Study Design, Data Collection, Data Analysis, Data Interpretation, Writing
Sunil Shanak: Literature search, Study Design, Data Collection, Data Analysis, Data Interpretation, Writing
No ethical issues.
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2. Burden, M., Cervantes, L., Weed, D., Keniston, A., Price, C. S. and Albert, R. K. (2011). Newly cleaned physician uniforms and infrequently washed white coats have similar rates of bacterial contamination after an 8-hour workday: A randomized controlled trial. Journal of Hospital Medicine, 6: 177–182. doi: 10.1002/jhm.864
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Competing interests: No competing interests