cell phones on health care facilitiesâ

English class this research paper is writing in three parts total 6 pages plus Annotated bibliography 1. – Annotated bibliography. Summarize each article in 150-200 words 2. – Outline (2) two pages long 3. – Plan for your research-based report. 4 pages long The following instructions are provided, and 5 articles are including for the research paper. Part- 1- Annotated bibliography. Topic cell phones on health care facilities” (Hospitals) You will prepare to write the annotated bibliography by completing the following steps: – You will then write the annotated bibliography as follows: – Cite each article in APA format – Summarize each article in 150-200 words. – Write a two to three-sentence evaluation at the end of the annotation explaining why this source might be helpful to you for your final report. – – List each reference (followed by its annotation) in alphabetical order. The purpose of writing the annotated bibliography is to help get you started on locating sources and allow you to begin analyzing and summarizing them. Part -2 Write an outline, along with some other brief explanations, for the plan for your research-based report. Topic Education on avoid using cell phones on health care facilities (Hospitals) For your outline, you will submit the following items: Length: It should be (2) two pages long. 1.-Statement of the problem — This section should be one or two sentences stating the problem you are addressing. 2.-Purpose and scope of the work — This section should be one paragraph explaining why you have conducted your analysis. You will state why you think the problem you are addressing needs to be addressed. 3.-Decision-maker or group of decision-makers– This section will identify the individual or individuals to whom you are directing the report. 4.-Sources and methods of data collection — This section should be one paragraph explaining how you went about gathering data. You might mention interviews you conducted, or other methods of information gathering you used. 5.-Preliminary outline — This section should use Roman numerals to outline, even roughly, the plan for the report. You might have, for example, the following: – I. o A. o B. C II.- A B C, – III. – A. – B. – C.. Overall, you {should not need more than three or four Roman numerals}. Again, this can even be a fairly rough outline. Do not feel you have to stick with the outline you have developed when you write your actual report. Part -3 The last part of the-based report that addresses a problem or issue within an organization. (Hospitals). You will write a report of 3 pages long on a problem or issue within your workplace or community. (Infections spread in hospitals) You will identify a problem or issue within your organization. Such as; (Education on avoid using cell phones on health care facilities (Hospitals) You will then include the following in the report: – Define the problem persuasively and accurately – Propose a solution or solutions to the problem or issue – Present that solution to a decision-maker or group of decision-makers who can implement the recommendation. The report will include the following components: – Executive summary – Transmittal letter or memo – Table of contents – Introduction – Body of the report to include headings and subheadings – Conclusion stated as a recommendation for implementation of the solution – References page, with references listed in APA format The complete report should be 2000-3000 words, not including the list of references. The purpose of establishing a word count is to ensure the topic chosen is neither too big nor too small. Also, writing within parameters is a common requirement in business communications. The complete report should also cite at least five sources. At least one of them should come from peer-reviewed, scholarly journals The sources will be integrated into the paper to explain the problem, provide evidence of the problem, and support the solution. Strategies to Consider for this Assignment: – Victoria # of Wellington has a thorough outline and review of the components of this type of business report. – Queen Margaret # has an excellent guide for this type of report. – Murdoch # has an excellent guide for this type of report. – Colorado State # presents excellent tips in organizing the report. – Monash # has a sample case study report that you might find helpful. 1.- Article The potential role of mobile phones in the spread of bacterial infections. Authors: Akinyemi, Kabir O.1 akinyemiko@yahoo.com Atapu, Audu D.1 Adetona, Olabisi O.1 Coker, Akitoye O.2 Source: Journal of Infection in Developing Countries. 2009, Vol. 3 Issue 8, p628-632. 5p. 2 Charts. Document Type: Article Subject Terms: *WIRELESS communication systems *BACTERIAL diseases *CELL phones *STAPHYLOCOCCUS aureus *COMMUNICABLE diseases *PATHOGENIC bacteria *ESCHERICHIA coli Author-Supplied Keywords: bacteria disease Mobile phone nosocomial transmission NAICS/Industry Codes: 334220 Radio and Television Broadcasting and Wireless Communications Equipment Manufacturing 517210 Wireless Telecommunications Carriers (except Satellite) 443142 Electronics Stores 417320 Electronic components, navigational and communications equipment and supplies merchant wholesalers Copyright of Journal of Infection in Developing Countries is the property of Journal of Infection in Developing Countries and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) Author Affiliations: 1Department of Microbiology, Lagos State #, Ojo PMB 1087, Apapa, Lagos, Nigeria 2Department of Medical Microbiology and Parasitology, College of Medicine, # of Lagos, Idi-Araba, PMB 12003, Lagos ISSN: 2036-6590 Accession Number: 48315066 Brief Original Article The potential role of mobile phones in the spread of bacterial infections Department of Microbiology, Lagos State #, Ojo PMB 1087, Apapa, Lagos, Nigeria, Department of Medical Microbiology and Parasitology, College of Medicine, # of Lagos, Idi-Araba, PMB 12003, Lagos Abstract Background: Mobile phones are indispensable accessories both professionally and socially but they are frequently used in environments of high bacteria presence. This study determined the potential role of mobile phones in the dissemination of diseases. Methodology: Specifically, 400 swab samples from mobile phones were collected and divided into groups categorized by the owners of the phones as follows: Group A was comprised of 100 food vendors; Group B, 104 lecturers/students; Group C, 106 public servants; and Group D, 90 health workers. Samples were cultured and the resulting isolates were identified and subjected to antimicrobial susceptibility tests by standard procedures. Results: The results revealed a high percentage (62.0%) of bacterial contamination. Mobile phones in Group A had the highest rate of contamination (92; 37%), followed by Group B (76; 30.6%), Group C (42; 16.9%), and Group D (38; 15.3%). Coagulase negative Staphylococcus (CNS) was the most prevalent bacterial agent from mobile phones in Group A (50.1%) and least from phones in Group D (26.3), followed by S. aureus. Other bacterial agents identified were Enterococcus feacalis, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella spp. There was no statistical significance difference (P < 0.05) in the occurrence of S. aureus, the most frequently identified pathogenic bacterial agent isolated from the mobile phones in the study groups. Fluoroquinolones and third-generation cephalosporin were found to be effective against most isolates. Conclusion: Mobile phones may serve as vehicles of transmission of both hospital and community-acquired bacterial diseases. Strict adherence to infection control, such as hand washing, is advocated. Key words: Mobile phone, bacteria, disease, transmission, nosocomial J Infect Dev Ctries 2009; 3(8):628-632. Received 12 March 2009 – Accepted 5 August 2009 Copyright © 2009 Akinyemi et al. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction The global system for mobile telecommunication (GSM) was established in 1982 in Europe with a view of providing and improving communication network. Today, mobile phones have become one of the most indispensable accessories of professional and social life. Although they are usually stored in bags or pockets, mobile phones are handled frequently and held close to the face [1,2]. The use of cell phones often occurs in hospitals, by patients, visitors and health care workers, and this is one environment where hospital-associated infection is most prevalent. Also, travellers who go to low-income countries where potable water and good sanitation are limited are exposed to the risk of contracting infections because these individuals carry phones, and the potential of such accessories in the spread of bacteria infection is not yet clear [3,4]. Enteric pathogens are the most frequent cause of diarrhoea and account for an annual mortality rate of about five million people worldwide [5]. The first study of bacterial contamination of mobile phones was conducted in a teaching hospital in Turkey with a bed capacity of 200 and one intensive care unit [6]. One-fifth of the cellular telephones examined in a study conducted in New York were found to harbor pathogenic microorganisms [7]. In Nigeria, there has been an increase in the use of mobile phones among the general population, and the use of phones is common in certain areas of the environment where the percentage presence of bacteria is likely high, such as in hospitals, in animal slaughter areas, and in toilets. Therefore, the present study was conducted to determine whether mobile phones could play a role in the spread of bacterial pathogens and to proffer possible control or Akinyemi et al. – Mobile phones spread of bacterial infections in Nigeria preventive measures that could be instituted to avoid this likely vehicle of infection Methods and Materials Subjects A total of 400 mobile phones randomly sampled from the users of these phones were examined. The phones were obtained from the following study groups for three months between July and September, 2007: Group A, 100 food vendors; Group B, 104 lecturers/students; Group C, 106 public servants; and Group D, 90 health workers. The users of these mobile phones were adult volunteers. The concept of the study was explained to all subjects and their consent sought. Sample collection and bacteriological analysis The samples were collected aseptically using damp cotton swaps by rotating the swabs on the keys, mouthpiece, and ear-piece of the mobile phone. Samples were first inoculated into brain heart infusion (BHI) as transport medium and incubated aerobically at 37°C for 24 hours. Further subcultures were on 5% sheep blood agar and eosin methylene- blue agar plates and were incubated aerobically at 37°C for 24 hours. Plates were observed for growth and colonial morphology of the isolates. The isolates were gram stained, and were further tested for the presence of catalase and oxidase enzymes. Gram- positive catalase-positive cocci were tested for mannitol utilisation and coagulase development. Catalase-negative gram-positive cocci were tested using API Strep (Biometieux, marcy L’etoil, France), and Gram-negative bacilli were tested using API 32 E (Biomerieux, marcy L’etoil, France). All Staphylococcus aureus and Enterococcus feacalis strains were screened for methicillin and vancomycin resistance. Antimicrobial susceptibility testing Sensitivity of isolates to antibiotics was determined on Muller-Hinton agar by the disk diffusion method [8]. Briefly, five colonies of each of the isolates were emulsified in Bijou bottles containing 3 ml normal saline. A cotton swab was dipped into the suspension and the swab turned against the side of the bottles to remove excess fluid. The inoculated swab was then streaked across the surface of the Muller-Hinton agar. The inoculated plates were allowed to dry for 4-5 minutes before each of the following antibiotic disks (Oxoid, U.K) was placed on the plates: Ceftriaxone (30 g), J Infect Dev Ctries 2009; 3(8):628-632. Ofloxacin (5 g), Chloramphenicol (30 g), Erythromycin (15 g), Gentamycin (10 g) Nitroforantoin (300 g), Tetracycline (30 g), Cotrimoxazole (5 g), Amoxycillin (10 g), Pefloxacin (5 g), Cipfloxacin (5 g) Augmentin 12.5 g) and Streptromycin (1 g). The plates were incubated aerobically at 37°C for 18-24 hours. The diameters of the zones of inhibition were measured with a ruler and compared with a zone-interpretation chart [8]. Escherichia coli ATCC 25922 was used as the control. Results Out of 400 samples evaluated, a bacterial agent was observed in 248 and none from 152 samples. The results of this study showed a high percentage (62.0%) of bacterial contamination of mobile phones. Out of the four groups (A-D) studied, Group A (marketers and food vendors) had the highest rate of contamination (92; 37%). Group B (lecturers and students) had the next highest (72; 30.6%); and Group C (Public servants) (42; 16.9%) the next highest. Group D (hospital workers) had the lowest rate of contamination (38; 15.3%) (Table 1). Specifically, coagulase negative Staphylococcus (CNS) strains, the most frequently encountered bacterial agent, were isolated from the mobile phones of 50.1%, 39.5%, 47.5% and 26.3% of Groups A, B C and D respectively. These results were followed closely by S. aureus strains which were found in 34.7%, 23.7%, 28.8% and 36.8% of Groups A, B, and C in that order. Other bacterial pathogens isolated from the mobile phones of all four groups in this study include Enterococcus feacalis, Escherichia coli, and Klebsiella spp. Pseudomonas aeruginosa strains were isolated only from the phones of Group D (Table 1). Antimicrobial susceptibility tests for the isolates revealed that ciprofloxacin, ofloxacin, and perfloxacin were found to inhibit 80.7%, 81.5% and 82.3% of the bacterial agents isolated, respectively. Ceftriaxone inhibited 79.0% of the organisms, while amoxacillin was 100% effective against P. aeruginosa and moderately active against Klebsiella species (Table 2). Discussion In this study, 62% of 400 mobile phones from all the study groups were found to be contaminated by 629 Akinyemi et al. – Mobile phones spread of bacterial infections in Nigeria Table 1. Bacterial agents identified in the study bacterial agents. Isolation of bacterial agents from electronic devices such as handheld computers and personal digital assistants has shown these devices to be possible modes of transmission of nosocomial pathogens [9]. In a study conducted in Queen Elizabeth hospital in Barbados, West Indies, over 40% of mobile phones of 266 medical staff and students were culture positive [10]. Ulger et al. [11] reported that 94.5% of 200 health care workers and their mobile phones were contaminated with various microorganisms, including nosocomial pathogens, in a study conducted in New York and Israel. The present study concurs with their findings; thus contaminated, close-contact objects could serve as reservoirs of bacterial agents which could be easily transmitted from the mobile phones to the hands, and then from the hands to other areas of the body such as mouth, nose and ears. Out of the four groups (A-D) studied, Group A had the highest rate of bacterial contamination (92;37%), followed by Group B (72; 30.6%), Group C (42; 16.9%), and Group D (38; 15.3%). The high prevalence of bacterial agents isolated from the mobile phones of Group A could be attributed to the poor hygienic and sanitary practices associated with the low level of education among marketers and food vendors, especially those involved in handling raw meats and vegetables, compared to individuals working in a hospital environment (Group D) where there is regular disinfection. Similarly, poor handling, among other factors, may account for high levels of bacterial pathogen contamination observed in the mobile phones of individuals from groups B and C. Coagulase negative Staphylococcus (CNS) was the most prevalent bacterial agent isolated from 106 (42.7%) mobile phones in this study. This result corroborates the findings of Karabay et al. [6], in which CNS was the most frequently encountered bacterial agent isolated from 68.4% of the subjects evaluated. Brady et al. [3] had shown that the combination of constant handling and heat generated by the phones creates a prime breeding ground for microorganisms that are normally found in our skin. This may be because these types of bacteria increase in optimum temperature and phones are perfect for breeding these germs as they are kept warm and easy to handle in pockets, handbags and briefcases. In this study, other organisms isolated included S. aureus, P. aeruginosa and K. pneumoniae, E. coli, and Enterococcus faecalis. It is a well-established fact that these bacteria are agents of nosocomial infections. Rusin et al. [12] had documented both gram-positive and gram-negative bacteria in the hand-to-mouth transfer during casual activities. The present findings imply that mobile phones may serve as vehicles of transmission of diseases such as diarrhoea, pneumonia, boils, and abscesses. Also, P. aeruginosa has been reported in the United States by the Centre for Disease Control and Prevention to be the most isolated nosocomial pathogen accounting for 10.1% of all hospital- acquired infections, and has been implicated in gastrointestinal infection, primarily in immunocompromised individuals [13]. It is interesting to note that there was no statistical significant difference (p > 0.05) in the occurrence of S. aureus, the pathogenic bacterial agent most frequently isolated from the mobile phones of all the study groups, occurring in 32 (34.7%), 18 (23.7%), 12 (28.8%) and 14 (36.8%) of Groups A to D respectively (Table 1). The implication of this observation is that the possibility of being infected with bacterial pathogens simply by using other people’s mobile phones is high. Antimicrobial sensitivity testing revealed that over 75% of the isolates were susceptible to the fluoroquinolone and ceftriaxone antibiotics that were evaluated. Previous reports in Nigeria had shown that fluoroquinolones and third-generation cephalosporin are effective against a wide range of bacteria, and are expensive and less abused [14] than other antibiotics. Other antibiotics evaluated in this study ranged between 25.0 to 51.6% efficacy. However, the isolation of methicillin-resistant S. aureus strains from the mobile phones of health care workers had been documented [11]. Neither methicillin-resistant S. aureus strains nor strains of vancomycin resistant Enterococci were observed in this study. Today’s mobile phones are important devices for both the professional and social lives of their users. However, restrictions on the use of mobile phones by the Nigerian populace in certain areas of the environment where the percentage presence of bacteria is likely high (such as in hospitals, lecture theatres, animal slaughter areas, canteens, business centres, toilets and other such places) is difficult and thus not a practical solution. Users of mobile phone are hence advised to use antibacterial wipes to make their mobile phones germ free at all times. Also, strict adherence to infection control and precautions such as hand washing and good hygienic practice among the users of mobile phones is advocated, to prevent the possibility of phones as vehicles of transmission of both hospital and community- acquired bacterial diseases. 631 Akinyemi et al. – Mobile phones spread of bacterial infections in Nigeria J Infect Dev Ctries 2009; 3(8):628-632. Acknowledgements The authors are grateful to members of the department of Microbiology, Health Centre, Lagos State #, and the student volunteers for their support and assistance. References 1. Neubauer G, Röösli M, Feychting M, Hamnerius Y, Kheifets L, Kuster N, Ruiz I, Schüz J, Ãœberbacher R., Wiart J (2005) Study on the Feasibility of Epidemiological. Studies on Health Effects of Mobile Telephone Base Stations – Final Report: A workshop Organized by Swiss Research Foundation on Mobile Communication Swiss Agency for the Environment, Forests and Landscape Swiss Federal Office of Public Health FSM – Project No. A2003- 9. 2. Sowah LN (2008) The future of the Mobile Internet: How do we tap into its fullest benefits? Technology Blogs, 1-2. 3. Brady RR, Wasson A, Stirling I, McAllister C, Damani NN (2006).. Is your phone bugged? The incidence of bacteria known to cause nosocomial infection in healthcare workers mobile phones. J Hosp Infect 62: 123-125 4. Fleming K, Randle J (2006) Toys–friend or foe? A study of infection risk in a paediatric intensive care unit. Paediatr Nurs 18: 14-18. 5. Kosek M, Bern C, Guerrant RL(2003) The global burden of diarrhoeal disease, as estimated from studies published between 1992 and 2000. Bull World Health Organ. 81: 197-204. 6. Karabay O, Kocoglu E, Tahtaci M (2007) The role of mobile phone in the spread of bacteria associated with nosocomial infections. J. Infect. Develop. Countries. 1: 72-73. 7. Goldblatt JG, Krief I, Haller TD, Milloul V, Sixsmith DM, Srugo I, Potasman I (2007) Use of Cellular Telephones and Transmission of Pathogens by Medical Staff in New York and Israel. Infect Control Hosp Epidemiol 28: 500-503. 8. Bauer AW, Kirby WM, Sherris JC, Turck M (1966) Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol 45: 493-6. 9. Bures S, Fishbain JT, Uyehara CF, Parker JM, Berg BW (2000) Computer keyboards and faucet handles as reservoirs of nosocomial pathogens in the intensive care unit. Am J Infect Control 28: 465-471. 10. Ramesh J, Carter AO, Campbell MH, Gibbons N, Powlett C, Moseley H. Sr., Levis D, Carter T (2008) Use of mobile phones by medical staff at Queen Elizabeth Hospital Barbados: evidence for both benefit and harm. J Hospt Infect 70: 160-165. 11. Ulger F, Essen S, Dilek A, Yanik K, Gunaydin M, Leblebicioglu H (2009) Are we aware how contaminated our mobile phones are with nosocomial pathogens? Ann Clin Microbial Antimirob 8: 7. 12. Rusin P, Maxwell S, Gerba C (2002) Comparative surface- to-hand fingertip to-mouth transfer efficiency of gram- positive bacteria, gram negative bacteria and phage. J Appl Microbiol 93: 585-592. 13. Todar M (2004) Pseudomonas aeruginosa in Web Review of Todar’s Online Textbook of Bacteriology “The Good, the Bad, and the Deadly” Science Magazine 304: 1-12. 14. Akinyemi KO, Bamiro BS, Coker AO (2007) Salmonellosis in Lagos Nigeria: Incidence of Plasmodium falciparum-associated Co-infection, Pattern of Antimicrobial Resistance, and Emergence of Reduced Susceptibility to Fluoroquinolones. J Health Popul Nur 25: 351-358. Corresponding Author Dr. K. O. Akinyemi Department of Microbiology Lagos State # Ojo, PMB 1087, Apapa Article .2 Bacterial contaminations of cell phones of medical students at King Abdulaziz #, Jeddah, Saudi Arabia Shadi Zakaia, , , Abdullah Mashatb, Abdulmalik Abumohssinb, Ahmad Samarkandib, Basim Almaghrabib, Hesham Barradahb, Asif Jiman-Fatania, cVALIDHTMLVALIDHTMLVALIDHTML doi:10.1016/j.jmau.2015.12.004 Get rights and content Open Access funded by The Saudi Society of Microscopes Under a Creative Commons license Referred To By FRAGMENTEND VALIDHTML Abstract Cell phones are commonly used in healthcare settings for rapid communication within hospitals. Concerns have been increased about the use of these devices in hospitals, as they can be used everywhere, even in toilets. Therefore, they can be vehicles for transmitting pathogens to patients. This study aimed to examine the presence of pathogenic bacteria on the surfaces of cell phones that are used frequently by preclinical medical students. This cross-sectional study identified both pathogenic and nonpathogenic bacteria on cell phones of 105 medical students at King Abdulaziz #, Jeddah, Saudi Arabia, using standard microbiological methods. Out of 105 cell phones screened, 101 (96.2%) were contaminated with bacteria. Coagulase-negative staphylococci were the most abundant isolates (68%). Seventeen (16.2%) cell phones were found to harbor Staphylococcus aureus. Gram-positive bacilli were isolated from 20 (19%) samples. Viridans streptococci and Pantoea species were also isolated but at lower levels. Our findings indicate that cell phones can act as reservoirs of both pathogenic and nonpathogenic organisms. Therefore, full guidelines about restricting the use of cell phones in clinical environments, hand hygiene, and frequent decontamination of mobile devices are recommended at an early stage in medical schools, to limit the risk of cross-contamination and healthcare-associated infections caused by cell phones. VALIDHTML Keywords Bacterial contamination; cell phones; hospitals; healthcare facilities; infection; medical students; toilets 1. Introduction Cell phones have become one of the essential devices used for communication in daily life, and they are commonly used almost everywhere. Medical students and healthcare workers use these phones for rapid communication within hospital settings. Evidence shows that many medical conditions have been controlled after the innovations of mobile communications [1] and [2]. These conditions include diabetes [3] and asthma [4], and an increased rate of vaccination by travelers reminded by short message service (SMS) [5]. However, one of the most common concerns regarding heavy use of mobile devices is that they can act as a vehicle for transmitting pathogenic bacteria and other microorganisms [6] and [7]. Contamination can spread from outside surfaces to > 80% of exposed hands [8]. Moreover, a previous study reported that > 90% of cell phones of healthcare workers were contaminated with microorganisms and > 14% of them carried pathogenic bacteria that commonly cause nosocomial infections [9]. People rarely disinfect mobile phones and they are cumbersome to clean. As a result, these devices have the potential for contamination with various bacterial agents [10]. Many researchers have studied cell phone contamination among healthcare workers and in the community. However, little work has been reported in our region on bacterial contamination on cell phones used by medical students. So, the present study aimed to investigate the presence of pathogenic bacteria on cell phones that are frequently used by preclinical medical students. 2. Materials and methods 2.1. Study design This cross-sectional study was performed from April 2015 to June 2015, at the Department of Medical Microbiology and Parasitology, Faculty of Medicine, King Abdulaziz # (KAU), Jeddah, Saudi Arabia. A total of 105 samples were collected from the cell phones of 105 volunteer 2nd- and 3rd-year medical students who were asked to complete a written questionnaire for data collection. The questionnaire included variables such as the use of cell phones in toilets, the use of disinfectants to clean the surface of the cell phone, and the use of cell phones at work. Also, written informed consent was signed by the students prior to sample collection. The study was approved by the Unit of Biomedical Ethics at the Faculty of Medicine, KAU. 2.2. Sample collection Samples were obtained from cell phones of all participants using sterile cotton swabs. Prior to sample collection, swabs were moistened in sterile water and were rotated over the front screen and the back of the cell phones. All swabs were immediately inoculated into Amies transport media (Amies, Copan, Italy) and processed within 1 hour. Swabs were then inoculated onto fresh brain–heart infusion broth and incubated overnight at 37 °C with aeration at 190 rpm. A subsequent culture was carried out on blood and MacConkey agar plates, and incubated aerobically at 37 °C for 18 hours. 2.3. Bacterial identification and antibiotic susceptibility Single colonies grown on both blood and MacConkey agar plates were tested using standard microbiological methods. Single colonies were tested using colonial morphology, Gram stain, and catalase test. A slide coagulase test (Microgen Staph, Microgen Bioproducts, Camberley, UK) was used to differentiate Staphylococcus aureus from other coagulase-negative staphylococci. Further antimicrobial susceptibility tests were carried out for S. aureus isolates to test their methicillin susceptibility, using 1 ?g oxacillin and 30 ?g cefoxitin (Oxoid, Basingstoke, Hants, UK) placed on Muller–Hinton agar. The zones of inhibitions were measured and interpreted according to the Clinical and Laboratory Standards Institute [11]. 2.4. Statistical analysis Statistical data analysis was carried out using SPSS version 16.0 (SPSS Inc., Chicago, IL, USA). Using one-way analysis of variance, the means of all bacterial isolates were compared to determine the significant abundance of each organism. Grouping of results was based on variables included in the questionnaire, and the type of organisms found. VALIDHTML 3. Results and discussion One hundred and five samples were obtained from the surface of the cell phones of 105 volunteer preclinical medical students at the Faculty of Medicine, KAU. Sixty-two (59%) participants used their cell phones in the toilets, whereas the remaining 43 (41%) participants did not. The questionnaire also revealed that all participants used their cell phones at work at least once a day, and 71 (67.6%) admitted that their cell phones had never been cleaned (Figure 1). Figure 1. Behavioral distribution of cell phone usage among medical students at King Abdulaziz #. caption Figure options VALIDHTML The percentage of bacterial contamination on the tested cell phones was 96.2%, of which the most abundant isolates were coagulase-negative staphylococci, which accounted for > 68% of the total samples. S. aureus was isolated from 17 (16.2%) samples. Gram-positive bacilli were isolated from 20 (19%) samples. Viridans streptococci and Pantoea species were also isolated but at lower levels ( Figure 2). VALIDHTML Figure 2. Percentages of bacterial isolates found in cell phones of medical students. CoNS = coagulase-negative staphylococci. caption Figure options Although most cell phones tested were contaminated with one or more microorganisms, contamination with S. aureus was found in 17 cell phones. This represents a high percentage of contamination with this pathogenic organism that is commonly found in toilets [12]. Nevertheless, according to our statistical analysis, there was no correlation between the use of cell phones in toilets and the presence of S. aureus (p = 0.085). Evidence from previous studies revealed that ?20% of cell phones belonging to doctors and nurses are contaminated with pathogenic bacteria [13], [14] and [15]. Given that medical students are present in healthcare settings, mobile devices belonging to this group may act as vehicles for transmission of infection to patients if these devices are not used cautiously. The concern about cell phone contamination in medical settings is increased due to the possibility of cross-contamination of these devices that act as an environmental reservoir and source of bacterial cross-contamination, particularly in the most sensitive clinical areas such as operating theaters, intensive care units and burn units [7] and [16]. A crucial part of patient safety is reduction of the bio-transfer potential of these objects, especially to susceptible patients [17]. Thus, we suggest involving medical students at an early stage in training programs in patient safety, to increase their awareness about infection transmission, prevention, and control in medical environments before they begin clinical work. VALIDHTML Two-thirds of the cell phones examined in our study had never been decontaminated. This rate is less than in previously reported studies, which showed that 80–92% of staff had never decontaminated their cell phones [9], [14] and [18]. One of the most recommended methods of

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