STUDY OF BACTERIAL CONTAMINATION ON MOBILE PHONE

AMONG HEALTHCARE PROFESSIONALS IN WARDI COMMUNITY

HOSPITAL HAMAR JAJAB, MOGADISHU-SOMALIA

BY

ADAN ABDIKADIR ABDIRAHMAN ID:4538

AYAN ABDI DAHIR ID:4458

SALAAM UNIVERSITY
MOGDISHU-SOMALIA

2020
 STUDY OF BACTERIAL CONTAMINATION ON MOBILE PHONE
AMONG HEALTHCARE PROFESSIONALS IN WARDI COMMUNITY
HOSPITAL HAMAR JAJAB, MOGADISHU-SOMALIA

BY

ADAN ABDIKADIR ABDIRAHMAN ID:4538

AYAN ABDI DAHIR ID:4458

A THESIS SUBMITTED IN PARTIAL FULFILLMENTS OF THE

REQUIREMENTS FOR THE AWARD OF BACHELOR DEGREE OF

MEDICAL LABORATOTY FACULTY OF HEALTH SCIENCE AT

SALAM UNIVERSITY

AUGUST 2020
 DECLARATION
We hereby declare that this proposal is our own work and effort and that it has not been
submitted anywhere forward.

Candidates

Adan Abdikadir Abdirahman Signature: ____________ Date_____/_______/2020

Ayan Abdi Dahir Signature: ____________ Date_____/_______/2020

SUPERVISOR:

Dr. Yahye Abdikadir Mohamed

Signature……………………… Date………/……./…..2020

Dean of Health Sciences

Dr. Mohamed Mohamud Shobow

Signature….………….. Date……………./…../…..2020

i
 DEDICATION
First and foremost, all praise to almighty Allah, (SWT) the most merciful and the most
compassionate who made us Muslim society and guide us his pathway and who enabled us to
complete this project.

Secondly, we thank to all our parents, with much love, for their efforts and sacrifices and
there for being supportive to us spiritually, emotionally, morally and even more they
provided us throughout our academic life and career development and without them we
couldn’t reach this stage.

Thirdly, we thanks to all our brothers, sisters, friends, wives/husbands, classmates, teachers,
supervisors, deans, and rector of our University of SU, and anyone, who assisted us during
this process of thesis/study

ii
 ACKNOWLEDGEMENT
All praise to Allah, the Almighty, who gave us the patience and power to finish this work.

After almighty Allah who assist us the completeness of this research, we would like to thank
our parents, brothers and sisters who have been with us since the beginning of our
educational struggle up to now. They have supported us any facility needed such as
financially, morally and spiritually those no one can reach his objectives. Thanks to their
feeling and encouragement.

Next, deepest and very special thanks go to our supervisor, Dr. Yahye Abdikadir Mohamed
for his invaluable assistance guidance, support, constant encouragement, instructions and
suitable corrections that he provided us. Without he guidance, consultancy and assistance this
thesis wouldn’t have been published. And as well, we expressed our deepest and warm
appreciation thanks to our beloved Dean Dr. Mohamed Mohamud Shobow

Finally we would like to express our deep sense of gratitude to everyone, who contributed to
our project development process through encouragement, morally and technical support.

iii
 ABSTRACT (A)
BACKGROUND: Use of mobile phones in the Hospitals by healthcare workers and patients
can lead to contamination and spread of healthcare associated infections among hospitalized
patients. An understanding of dynamics of mobile phone usage as well as contaminating
bacteria forms an important step in developing infection control strategies to regulate its use
in clinical areas.

SPECIFIC OBJECTIVES: To determine the frequency of use o f mobile phones device

among health professionals, identify common bacterial pathogens contaminating on hand
phone among healthcare professional, know level of bacterial contamination on handphone
among health professional, determine sanitation practice among health professionals in Wardi
Community Hospital Hamar JajabMogadisho-Somalia.

RESEARCH DESIGN: We conducted a cross-sectional study to assess mobile phone use,

attitudes about their use among healthcare professionals in Wardi Community Hospital as
well as bacterial contamination of mobile phone devices. The study was conducted over a 3
week period. We used self-administered questionnaire administration and took imprints of
mobile phone devices using Petri Dish plates to achieve the objectives of the study.

RESULT: A total of 52 bacterial isolates were identified from mobile phones of staff at the
WCH. They comprised of Gram positive bacteria (65%) and Gram negative (35%). Among
the Gram negative bacteria isolates, Pseudomonas species and Non-coliform bacteria
constituted close (77%) while 23% was coliforms bacteria. Of the 34 Gram positive bacteria
isolates, the most frequently encountered were Staphylococcus aureus 29% and coagulase
negative Staphylococcus (CoNs) representing 23% of Gram positive bacteria isolates,
followed by Micrococcus species with 12% while 9% was Bacillus species.

CONCLUSIONS: Mobile phones were found to carry these bacteria because count of these
bacteria increases in high temperature and our phones are ideal breeding sites for these
microbes as they are kept warm and snug in our pockets and handbags. Also, there are no
guidelines for the care, cleaning and restriction of mobile phones in our health care settings.
Hence, in a country like ours, mobile phones of HCWs play an important role in transmission
of infection to patients, which can increase the burden of heath care.

RECOMMENDATIONS: There is the need for hospital authorities to institute control

measures as regards mobile phone use during working periods. hospital authorities should
thus develop institutional policies on mobile phone use during work.

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 ABSTRACT (B)
DULUCDA: Adeegsiga taleefannada gacanta ee Cisbitaalada ay leeyihiin shaqaalaha
daryeelka caafimaadka iyo bukaanku waxay u horseedi karaan wasakhaynta iyo fiditaanka
cudurrada la xariira caafimaadka ee bukaannada isbitaalada ku jira. Fahamka isticmaalka
taleefanka iyo sidoo kale wasakheynta bakteeriyada waxay u baahan tahay talaabo muhiim
ah horumarinta istaraatiijiyadaha xakameynta caabuqa si loo habeeyo isticmaalkooda
aagyada caafimaadka.

HIMILOOYINKA QAASKA AH: Si loo go'aamiyo inta jeer ee la istcimaalo aaladda

taleefannada gacanta ee xirfadleyda caafimaadka, Si loo ogaado cudurada bakteeriyada
caanka ah ee ku sumoota taleefanka gacanta ku haysa, In la ogaado heerka sumowga
bakteeriyada gacanta ku haysa ee xirfadleyda caafimaadka, Si loo go'aamiyo dhaqangalinta
nadaafadda ee ka dhexeysa xirfadlayaasha caafimaadka ee Isbitaalka Wardi Xamar Jajab
Mogadisho-Soomaaliya.

TILMAAMAHA BAADHITAANKA: Waxaan samaynay daraasad qayb ahaan ah si loo

qiimeeyo isticmaalka taleefanka gacanta, fikradaha ku saabsan isticmaalkooda xirfadleyda
daryeelka caafimaadka ee Isbitaalka Wardi iyo sidoo kale wasakheynta bakteeriyada aaladaha
taleefanka gacanta. Daraasadda waxaa la sameeyay muddo 3 toddobaad ah. Waxaan
adeegsanay xog-warysi iskiis u maammuul ah oo waxaan qaadanay sawirro aaladaha
taleefanka gacanta annaga oo adeegsaneyno taarikada Petri Dish si aan u gaarno
ujeeddooyinka daraasadda.

WARCELINTA: Wadar ahaan 52 go'doon ah oo bakteeriyada laga soocay taleefannada

gacanta ee shaqaalaha WCH. Waxay ka kooban yihiin bakteeriyada Gram positive (65%) iyo
Gram negative (35%). Bakteeriyada xunxun ee 'Gram negative' ayaa go'doomisa, noocyada
Pseudomonas iyo bakteeriyada aan col-lalirka ahayn ayaa u dhow (77%) halka 23% ay
ahaayeen bakteeriyada coliforms. 34 ka mid ah bakteeriyada 'Gram positive' ayaa
go'doomisa, kuwa ugu badan ee ay la kulmaan waxay ahaayeen Staphylococcus aureus 29%
iyo coagulase negative Staphylococcus (CoNs) oo matalaya 23% bakteeriyada Gram togan
ayaa go'doomaysa, waxaana ku xiga Micrococcus noocyada leh 12% halka 9% ay yihiin
noocyada Bacillus.

GABOGABO: Taleefannada gacanta ayaa laga helay inay qaadaan bakteeriyadaas sababta
oo ah tirinta bakteeriyadaas ayaa ku kordheysa heerkul sarreeya oo taleefannadeennuna waa
goobo wanaagsan oo taranka loogu talagalay microbes-ka maadaama ay diiran yihiin oo ay

v
ku sii jeedaan jeebabka iyo boorsooyinka gacanta. Sidoo kale, ma jiraan tilmaamo loogu talo
galay daryeelka, nadiifinta iyo xaddidaadda taleefannada mobilada ee goobahayada daryeelka
caafimaadka. Sidaa daraadeed, waddan sidayada oo kale ah, taleefannada gacanta ee HCWs
waxay door muhiim ah ka ciyaaraan u gudbinta bukaanka bukaanka, taas oo kordhin karta
culeyska daryeelka caafimaadka.

TALO BIXINTA: Waxaa jira baahi loo qabo maamulayaasha isbitaalku inay dhisaan
tillaabooyin xakameyn ah oo la xiriira isticmaalka taleefanka moobaylka inta lagu jiro
xilliyada shaqada. Maamulka isbitaalku waa in uu markaa horumariyaa siyaasadaha hayadaha
ku saabsan isticmaalka taleefanka moobaylka inta lagu jiro shaqada. Waxaa jira baahi loo
qabo cilmi baaris baaxad weyn oo ku lug leh cutubyo kala duwan oo cisbitaalka ah si loo
go'aamiyo heerka isticmaalka taleefanka ee shaqaalaha daryeelka caafimaadka iyo heerka ay
gaarsiisan tahay wasakhaynta taleefannada mobilleh wakiilada jeermiga.

vi
 TABLE OF CONTENTS

DECLARATION..........................................................................................................................i

DEDICATION............................................................................................................................ii

ACKNOWLEDGEMENT..........................................................................................................iii

ABSTRACT (A).........................................................................................................................iv

ABSTRACT (B)..........................................................................................................................v

TABLE OF CONTENTS..........................................................................................................vii

LIST OF TABLES.......................................................................................................................x

LIST OF FIGURES...................................................................................................................xii

LIST OF ABBREVIATIONS..................................................................................................xiii

CHAPTER ONE..........................................................................................................................1

INTRODUCTION.......................................................................................................................1

1.0 Introduction............................................................................................................................1

1.1 Background of the study........................................................................................................1

1.2 Statement of the problem.......................................................................................................2

1.3 Research Objectives...............................................................................................................3

1.3.1 General Objective...............................................................................................................3

1.3.2 Specific Objective...............................................................................................................4

1.4 Research Questions................................................................................................................4

1.5 Scope of the Study.................................................................................................................4

1.6 Significance of the study.......................................................................................................4

1.7 Operational Definitions.........................................................................................................5

1.8 Conceptual Frame Work........................................................................................................5

CHAPTER TWO.........................................................................................................................6

LITERATURE REVIEW............................................................................................................6

2.0 Introduction............................................................................................................................6

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2.1 Use of Mobile Phones by Healthcare Workers......................................................................9

2.1.1 mobile phone use for reference........................................................................................10

2.1.2 Mobile phone use as timer................................................................................................10

2.1.3 Mobile phone use as communitaing with other health care workers................................11

2.2Common bacterial pathogens contaminating on hand phone among healthcare professional

...................................................................................................................................................11

2.2.1 Staphylococcus.................................................................................................................13

2.2.2 Staphylococcus aureus......................................................................................................13

2.2.3 Staphylococcus epidermidis.............................................................................................14

2.2.4 Esherichia coli..................................................................................................................14

2.3 Level of bacterial contamination on hand phone among health professional.....................15

2.4 Sanitation practice among health professionals...................................................................16

2.4.1 Use of Alcohol based solvents..........................................................................................16

2.4.2 Use of Tap water and soap................................................................................................17

CHAPTER THREE...................................................................................................................19

METHODOLOGY....................................................................................................................19

Introduction................................................................................................................................19

3.0. Research design..................................................................................................................19

3.1. Study area...........................................................................................................................19

3.2 Target Population.................................................................................................................20

3.3 Study Population..................................................................................................................20

3.4 Study Unit............................................................................................................................20

3.5. Sample Size........................................................................................................................20

3.6. Sampling Procedure/ Technique.........................................................................................20

3.6.2 Bacterial Count, Culture and Identification......................................................................21

3.7 Research Instrument............................................................................................................21

3.9 Data Analysis.......................................................................................................................22

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3.10 Limitation of the study.......................................................................................................22

CHAPTER FOUR.....................................................................................................................23

RESULTS AND DISCUSIONS................................................................................................23

4.0 Introduction..........................................................................................................................23

CHAPTER FIVE.......................................................................................................................51

CONCLUSIONS AND RECOMMENDATIONS....................................................................51

5.0 introduction..........................................................................................................................51

5.1 Conclusions..........................................................................................................................51

5.2 Recommendations................................................................................................................53

5.2.1 Recommendations for Practice.........................................................................................53

5.2.2 Recommendation for policy.............................................................................................53

5.2.3 Recommendation for research..........................................................................................53

REFERENCES..........................................................................................................................54

APPENDEX A: QUESTIONNAIRE........................................................................................62

Appendix B: WORK PLAN......................................................................................................65

APPENDIX C: BUDGET PLAN..............................................................................................66

APPENDIX D: AUTHORITY LETTERS................................................................................67

APPENDIX E: SOMALI MAP.................................................................................................68

APPENDIX F: MOGADISHU MAP........................................................................................69

APPENDIX G: IMAGES..........................................................................................................70

ix
LIST OF TABLES

x
 LIST OF FIGURES

LIST OF ABBREVIATIONS

DECT- Digital Enhanced Cordless Telephones

HAI- Hospital Acquired Infection
HCW- Healthcare Workers
IPC- Infection Prevention and Control
WCH- Wardi Community Hospital
MHD- Mobile Hand-held Devices
MP- Mobile Phone
NHCW- Non-Healthcare Workers
PMP- Personal Mobile Phones
PDA- Personal Digital Assistants
PED- Personal Electronic Devices
SPSS- Statistical Package for the Social Sciences
USA- United State of America
WHO- World Health Organisation

xi
 CHAPTER ONE

INTRODUCTION

1.0 Introduction
This chapter consists of a variety of units including the background of the study, problem
statement, objectives of the study, research questions, reserarch hypothesis, significance of
the study, scope of the study, operational definition and conceptual framework.

1.1 Background of the study

The global system for mobile telecommunication (GSM) was established in 1982 in Europe
with a view of providing and improving communication network. [CITATION Placeholder37 \l
1033 ]

Today, mobile phone is a long-range personal telecommunication device, easy to handle, and
affordable to everybody. It is the most indispensable accessory of professional and social life
throughout the world. [CITATION Placeholder5 \l 1033 ]

In addition to the standard voice function of a telephone, mobile phones can support many
additional services such as SMS for text messaging, email, pocket switching for access to the
Internet, and MMS for sending and receiving photos and video. With all the achievements
and benefits of the mobile phone, it is easy to over look the health hazard it might pose to its
many users.[CITATION Placeholder37 \l 1033 ]

A mobile phone (also known as a cell phone ,cellular phone or a hand phone) is a device that
can make and receive telephone calls over a radio link whilst moving around a wide
geographic area, Research has shown that mobile phone could constitute a major health
hazard. In 2000 WHO Mobile phones have also been reported to be a reservoir for
microorganisms, A mobile phone can spread infectious diseases by its frequent contact with
hands. Mobile phones could be a health hazard with tens of thousands of microbes living on
each square inch of the phone. Staphylococcus aureus, a common bacterium found on the
skin and in the noses of up to 25% of healthy people and animals can cause illnesses from
pimples and boils to pneumonia and meningitis, and is a close relative of methicillin resistant
Staphylococcus aureus (MRSA). This is because the isolated bacteria are subset of the normal
microbiota of the skin as advanced by earlier researchers [CITATION Placeholder6 \l 1033 ]

1
The constant handling of the mobile phones by users (in hospitals, by patients, visitors and
health care workers, etc.) makes it open breeding place for transmission of microorganisms,
as well as Hospital-Associated Infection (HAIs). This is especially so with those associated
with the skin due to the moisture and optimum temperature of human body especially our
palm, axillaries and other parts of the body.[CITATION Placeholder37 \l 1033 ]

In the world, there has been a considerable increase in the use of mobile phones among the
general population, and the use of this communication tool, especially in unnecessary times,
is common in certain areas where the rate of bacteria presence is likely high, i.e. hospitals.
According to recent reports, in terms of mobile provision, Iran now surpassed most of the
countries in the world and over 45 million Iranians have access to personal mobile phones.
According to these reports, high contamination with nosocomial infections in the hospitals
through the frequent use of mobile phones in our country is expectable. [CITATION
Placeholder15 \l 1033 ]

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 preventive measures that could be instituted to avoid this likely vehicle of infection.
[CITATION Placeholder14 \l 1033 ]

In Ethiopia, mobile phones are used without restriction in health care facilities, including
specific, sensitive areas like the operation room and the intensive care units, regardless of
their unknown microbial load.Outside of Ethiopia, a number of investigations were
conducted22-29 to determine bacterial contamination of mobile phones of HCWs. However,
they did not determine the degree of contamination in reference to the acceptable bacterial
load on frequently hand touched equipment in health care environments [CITATION
Placeholder16 \l 1033 ]

1.2 Statement of the problem

Microbial standards in hygiene are necessary for a healthy life. People often believe that
microbes are only present in research labs or in hospitals and clinics and thus they have a
misleading feeling of security in other places. Lack of knowledge about where germs occur

2
could be the cause of health problems. In fact, 80% of infections are spread through hand
contact with hands or other objects[CITATION Placeholder7 \l 1033 ].

Cellphones with buttons and keyboards and other personal mobile phones in general has
been found to be even more conducive to bacterial contamination(Ilusanya OAF, 2012 et
al and Edem EN 2013 et al).
Nosocomial infections pose a serious threat to hospitals all over the world. Healthcare
workers(HCW) play a crucial role in the transmission of bacteria to hospitalized patients.
Strict hygiene standards to prevent nosocomial infection are of paramount importance in a
hospital setting(Razine R, et al, Endalafer N, et al2010 and Colle.G.,1996).

Therefore, the presence of a pathogen on a surfaceat any concentration may be a risk for
transmission, and this is reflected in proposed guidelines for microbiological hygiene
standards. (Mikyas D et al 2009)

Pathogenic bacteria have been found to survive for long periods on several surfaces making
them a potential source of transmission of HAIs when appropriate hand hygiene procedures
are not observed[CITATION Placeholder8 \l 1033 ]

Demand for more effective cleaning and disinfecting is growing, there is also increasing
evidence that exposure to cleaning and disinfecting can result in acute and chronic health
effects. Cleaning and disinfecting are important parts of acomprehensive infection prevention
strategy.[CITATION Placeholder9 \l 1033 ]

Understanding the potential sources of infection transmission was lead to appropriate

preventive strategies. Thus all efforts to understand the transmission patterns of these
infections among health care workers was contribute to efforts in reducing these bacterial
contamination infections in the hospitals and the country as a whole.

Our study aim should be investigating bacterial contamination of the mobile phone to identify
the microbes regularly associated with mobile phones and their pathogenicity

1.3 Research Objectives

1.3.1 General Objective

To study of bacterial contamination on mobile phone among healthcare professional in Wardi
Community Hospital Hamar Jajab, Mogadishu-Somalia

3
1.3.2 Specific Objective
 To determine the frequency of use o f mobile phones device among health
professionals in Wardi Community Hospital Hamar JajabMogadisho-Somalia
 To identify common bacterial pathogens contaminating on hand phone among
healthcare professional in Wardi Community Hospital Hamar JajabMogadisho-
Somalia
 To know level of bacterial contamination on handphone among health professional in
Wardi Community Hospital Hamar Jajab Mogadisho-Somalia
 To determine sanitation practice among health professionals in Wardi Community
Hospital Hamar JajabMogadisho-Somalia

1.4 Research Questions

1. What is the frequency of use of mobile phones device among health professional?
2. What are the common bacterial pathogens contaminating on hand phone?
3. What is the level of bacterial contamination on handphone among health
professionals?
4. What is the sanitation practice among health professional?

1.5 Scope of the Study

1.5.1Time scope: this study was be conducted from March to July, 2020.

1.5.2Geographical scope: this study was be conduct in Wardi Community Health Center,
Mogadishu-Somalia

1.5.3Content scope: this study was focus on bacterial contamination among healthcare
professionals.

1.6 Significance of the study

This study was provide information on the use of mobile phones among healthcare workers
and the associated bacterial contamination and transmission of infection to aid in institution
of infection prevention and control measures regarding the use of mobile phones in hospitals.

The findings of the study was provide researchers based and up to date information to future
researchers and academician, thus it was contribute to the body of knowledge about the

4
subject under investigation. The findings are also more likely to inform the community about
the study on the factors contribution among population Mogadishu-Somali.

1.7 Operational Definitions

Healthcare professionals- In this study Healthcare professional refer to doctor, lab
technician and nurse who is licensed to work in hospitals in Somalia-Mogadishu

Healthcare Associated infections- Refers to infections acquired and transmitted in

healthcare settings

Mobile phone contamination- Refers to the presence of microorganisms on the mobile

phones of healthcare professionals.

Mobile phone use- Refers to touching of mobile phone while at work for whatever purpose

5
6
1.8 Conceptual Frame Work

Independent Variable Dependent Variable

Use of mobile phones:

1. For reference
2. As timer
Health professionals:
3. Communicating with other
health workers 1. Doctors
2. Nurses
3. Lab technicians
Bacterial contamination on hand
4. Patiens
phone:
1. Staphylococcus aureus
2. Staphylococcus
epidermidis
3. E.Coli

Level of bacterial contamination:

1. High
2. Low

Sanitation practice among health

professionals:
1. Use of Alcohol based solvents
2. Use of Tap water and soap

7
 CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction
Mobile phones also known as cell phones, cellular phones or a hand phones are electronic
devices used for personal telecommunications over a cellular network of specialized base
stations known as cell sites and receive telephone calls over a radio link whilst moving
around a wide geographic area . It is called 'cellular' because the system uses many base
stations to divide a service area into multiple 'cells'. Cellular calls are transferred from base
station to base station as a user travels from cell to cell. Mobile phones are one of the items
which are long-range, portable electronic tools for personal telecommunication over long
distances. They are also frequently in the world of today and are suitable accessories taken
for settled by most people. As a result, the mobile phone telecommunication system is a
exceedingly growing technology all over the world. With the advancement in technology,
mobile era has evolved and the world is on the tip of finger. Despite the fact that mobile
phone telecommunication system is a highly growing technology and provides potential
benefits to human being, studies have shown that mobile phone might constitute a major
serious public health hazard to users [CITATION Placeholder10 \l 1033 ].

Today, mobile phone is a long-range personal telecommunication device, easy to handle, and
affordable to everybody. It is the most indispensable accessory of professional and social life
throughout the world [CITATION Placeholder5 \l 1033 ].

Research shows that the worldwide organization for mobile telecommunication was
established in 1982 in Europe with the idea of providing and refining communication linkage.
But there has been a rapid progress of modern technology in the area of mobile
telecommunication since its establishment in the last two decades contributing greatly to
several fields of study including the medical fields as well as the advancement of knowledge
for personal usage. This technical know-how comprises personal computers, beepers, mobile
hand-held devices (MHDs) (wireless tablets such as iPad, droids, etc.) and mobile phones
(MPs). The global spread of mobile information technology devices and increased access to
internet connectivity has resulted in the use of these devices as resources in several spheres of
daily activity. The healthcare delivery space has not been spared, and has seen increased
adaptation of these devices for different purposes [CITATION Placeholder8 \l 1033 ].

8
In addition to the standard voice function of a telephone, mobile phones can support many
additional services such as SMS for text messaging, email, pocket switching for access to the
Internet, and MMS for sending and receiving photos and video. With all the achievements
and benefits of the mobile phone, it is easy to over look the health hazard it might pose to its
many users[CITATION Placeholder37 \l 1033 ].

Smartphones are becoming a mainstream communication tool in healthcare settings. Prior

studies call for the use of smartphones to enhance clinical communications. However
practicality of use is crucial for smartphones in order to be beneficial in clinical settings
[CITATION Placeholder11 \l 1033 ].

Mobile technology offers ways to help with these challenges. Through mobile health
applications, sensors, medical devices, and remote patient monitoring products, there are
avenues through which health care delivery can be improved. These technologies can help
lower costs by facilitating the delivery of care, and connecting people to their health care
providers. Applications allow both patients and providers to have access to reference
materials, lab tests, and medical records using mobile devices. Complex mobile health
applications help in areas such as training for health care workers, the management of chronic
disease, and monitoring of critical health indicators. They enable easy to use access to tools
like calorie counters, prescription reminders, appointment notices, medical references, and
physician or hospital locators. These applications empower patients and health providers
proactively to address medical conditions, through near real-time monitoring and treatment,
no matter the location of the patient or health provider [CITATION Placeholder12 \l 1033 ].

The health of healthcare professionals has been adversely affected increasingly in recent
years. While the 24/7 services of health institutions and the characteristics of the work
environment are already a threat, conditions that are changing in both public and private
sectors every passing day have brought more risks for healthcare professionals. The primary
ones among the risks negatively affecting the health of healthcare professionals are sharp
object injuries, musculoskeletal system diseases due to heavy lifting, cancer or allergies as a
result of contact with chemical factors, respiratory distress, and serious occupational
accidents due to slipping and crashing[CITATION Placeholder13 \l 1033 ].

Health care professionals’ mobile phones can be easily and quickly contaminated by
microorganisms from the hospital environment, patients, and medical devices, since they use
it for a medical dictionary, hand reference for drug, laboratory, and imaging results, and other

9
work-related issues as they deal with patients having different illnesses. Health care
professionals constantly handle mobile phones without disinfection in their bags and pockets
or on their hands in a clinical setup. Patients are more vulnerable to nosocomial infections
from a mobile phone which is often used near patients in hospital areas. Contaminated hands
and mobile phones of health professionals can also play a great role in spreading infections to
self, family member, and others outside the hospital [CITATION Placeholder5 \l 1033 ].

Health care workers was contribute to efforts in reducing these bacterial contamination
infections in the hospitals and the country as a whole. 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. Enteric pathogens are the most
frequent cause of diarrhoea and account for an annual mortality rate of about five million
people worldwide [CITATION Placeholder14 \l 1033 ].

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. One-fifth of the
cellular telephones examined in a study conducted in New York were found to harbor
pathogenic microorganisms [CITATION Placeholder14 \l 1033 ].

However, the potential transmission of diseases via contaminated devices or other items that
are not considered in routine cleaning schedules is often overlooked and they are a possible
source of microbes in the health care environment. Gowns, gloves, bedside stethoscopes,
neck ties, bed rails, sheets, telephones, horizontal surfaces, door knobs, thermometers, nurse’s
clothing and personal bags are contaminated by pathogenic bacteria.. The hands and gloves
of healthcare workers readily acquire the pathogens after contact with contaminated hospital
surfaces and equipment, then transfer these organisms to subsequently touched patients.
[CITATION Placeholder9 \l 1033 ].

10
2.1 Use of Mobile Phones by Healthcare Workers
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. 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 [CITATION
Placeholder17 \l 1033 ].

According to Pillet et al., (2016), MPs have become common in both public and hospital
locations and have become an inevitable part of our lives nowadays. The global spread of
mobile information technology devices and increased access to internet connectivity has
resulted in the use of these devices as resources in several spheres of daily activity and the
healthcare delivery space has not been spared, and has seen increased adaptation of these
devices for different purposes. These devices may be used as sources of reference material
during patient care, data collection instruments in research, as well as instruments of care e.g.
taking a pulse and respiratory. In settings where there is poor hospital communication
network they serve as the main form of communication among healthcare workers at
different locations. Several studies have reported that above fifty percent of healthcare
workers HCWs admit using MPs (either personal or professional devices) in their practice,
which includes physical interaction with patients[CITATION Placeholder8 \l 1033 ].

Mobile phones technology has spread rapidly throughout the world and has caused too many
changes in our lifestyles. Statistics demonstrate that 79% of the United States population and
90% of European and Asian teens have personal mobile phones. According to the
communication through internet, the mobile subscribers have grown from about 110 million
subscribers in 2000 to over 303 million subscribers in the year 2010. In the past 5 years, the
worldwide mobile phone market has grown to 3.2 billion and now with 5.4 billion subscribers
in 224 countries, it represents 146% annual growth rate. In the process of development,
number of mobile users has been 73 million in Iran. Nowadays, mobile phones have become
one of the essential accessories in our social and professional life, and the uses of mobile
phones with health care workers have increased. Mobile phones increase the spread of
communication and contact within healthcare institutions, result in faster and more efficient
healthcare delivery. Although, the use of mobile phones in hospitals (that the percentage
presence of bacteria is high) may cause in spread of pathogens. Mobile phones are usually
stored in bags or pockets and handled frequently and held close to the face. Moreover, the use

11
of mobile phones often occurs in hospitals, by patients, visitors and health care workers.
However, mobile phones are usually touched during or after the examination of patients
without hand washing, but not cleaned and can harbor various pathogens and become a
potential source of hospital associated infections among patients and even medical staff.
Mobile phones harbor pathogens microorganism, and high temperature cause increasing the
amount of microorganisms. On the other hand, there are no guidelines for cleaning and
prevention of bacterial contamination of mobile phones[CITATION Placeholder18 \l 1033 ].

Health care workers of the children and adult emergency rooms, and those of the common
children‘s units and the contagious illnesses units, were involved. The term mobile phones‘
was used to indicate both Personal Mobile Phones (PMPs) and Digital Enhanced Cordless
Telephone (DECTs)[CITATION Placeholder19 \l 1033 ].

2.1.1 mobile phone use for reference

The concept of reference has greatly changed because of the increasing digital presence of
reference material. The advent of mobile communication systems and the need for getting
correct reference on the move has prompted many libraries to offer mobile related services.
Most of the reference sources are now available as mobile-specific products, but there is no
comprehensive single mobile interface that can be called as an alternative to the traditional
reference desks [CITATION Joh16 \l 1033 ].

A core activity of any health system is the initial and continuous training of its health
workers. Health workers of every cadre need to be trained before they begin their work and
retrained frequently as new procedures are introduced. Technologies that have the potential to
make training more efficient, less expensive, or more effective can greatly benefit a health
system[CITATION Bri11 \l 1033 ].

2.1.2 Mobile phone use as timer

To use mobile system there are need of tools designed, to help CHWs collect health
data,receive,remindersin the field, facilitate community member. timely collection of patient
data and reporting to the health facility facilitated the process of Developing and alert system
for emergency referrals of patients, alerts and reminders. This theme includes mobile-based
work planning through customized patient-specific alerts and reminders about follow-up
visits sent to an FHW‟s mobile phones. Nine reported on the utility of sending appointment
and care reminders to FHWs. Once relevant patient data are entered onto a system, regular
alerts and reminders can be sent to both the FHW and the patient for follow-up care based on

12
pre-programmed treatment algorithms, reported thatsending mobile remindersto
CHWsresulted in an 85% reduction in average number of days clients were overdue for a
visit.[CITATION Gah18 \l 1033 ].

2.1.3 Mobile phone use as communitaing with other health care workers
Health workers must often talk to each other for advice or expertise, or to manage referrals to
other clinics. Mobile phones provide an obvious benefit for facilitating communication
among distributed workers in LMICs. Various studies have documented the use of cell
phones by medical residents,19 health workers,20 and nurse midwives21 to communicate
with peers, supervisors, or patients on health issues. World Vision’s Aceh Besar Midwives
with Mobile Phones Project was started to use mobile communications and technology to
facilitate, accelerate, and improve the quality of health services by connecting midwives to
obstetrician-gynecologists. Mobile phones are used for coordination in responding to
emergencies, consulting with subspecialists, accessing second-line staff, obtaining consent or
permission for action, and receiving and discussing results from lab tests. In other instances,
birth attendants coordinate care with delivery nurses and physicians in cases of complicated
births. Physicians are also using smartphones to access sensor or image data on their mobile
phones. Telemedicine is an important example of how health providers can communicate
remotely. Projects have used phones to capture images for assessment by specialists and have
even been used to help assess stroke victims[CITATION Bri11 \l 1033 ].

2.2Common bacterial pathogens contaminating on hand phone among healthcare

professional
As healthcare workers carry out various activities in the hospital in caring for patients while
touching their mobile phones at the same time, they can easily transmit microorganisms from
patients to their mobile phones and vice versa. Evidence from research indicates that the
possible infection of telephones was first suggested by Aronson et al. in 1977 [CITATION
Placeholder8 \l 1033 ].

Mobilephones could be contaminated through sources such ashuman skin or hand, bag, phone
pouch, bags, pockets,environment and food particles, these sources are linksthrough which
microorganisms colonized the phone, thuscausing diseases that range from mild to
chronic[CITATION Placeholder20 \l 1033 ].

The combination of constant handling and the heat generated by the phones create a prime
breeding ground for all sorts of microorganisms. The human surface tissue is constantly in

13
contact with environmental microorganisms and becomes readily colonized by certain
microbial species [CITATION Placeholder21 \l 1033 ].

The range of micro-organisms, which are present, can vary from one person to another, and
HCWs may have different hand flora from ordinary members of the public.The hands, thus,
are permanentlycolonized with pathogenic flora acquired from the hospital environment
[CITATION Placeholder22 \l 1033 ].

MRSA contamination surrounding infected patients can be widespread, especially in hand-

touch areas. One study found that 74% of surfaces in the rooms of infected or colonized
patients were contaminated with MRSA (French et al., 2004). Another study found that
microbial contamination of mobile phones of college students was 98%: Gram-positive
bacillus (30%), Gram-negative bacillus (8%), Staphylococcus spp. (14%), Esherichia coli
(16%), Enterococcus(18%), Coliform (8%), Micrococcus(1%) and aerobic spores (1%)
[CITATION Jag13 \l 1033 ]. The rate of bacterial contamination of personal mobile phone was
80.0% and public mobile phone was 100% in a study conducted on personal and public
mobile phones in Bayero University, Nigeria: S. aureus (84%), Streptococcus spp. (16%), in
public mobile phones. However, S. aureus (76%), Streptococcus spp. (48%), were isolated
from personal mobile phones[ CITATION Yus10 \l 1033 ]). Another study conducted on HCWs
mobile phones showed that 34% of the subjects were colonized with bacteria or fungi.
Twenty percent of S. aureus was methicillin resistant Staphylococcus aureus (MRSA)
([CITATION Meh13 \l 1033 ]). In Nigeria, the rate of bacterial contamination of mobile phones
of HCWs was 94.6%. Staphylococcus epidermidis (42.9%) was the most frequently isolated
bacteria followed by Bacillus spp. (32.1%), S. aureus (25%), Pseudomonas aeruginosa
(19.6%), E. coli (14.3%), Streptococcus spp. (14.3%), Proteus spp. (12.5%), Klebsiella spp.
(7.1%), and Acinetobacter spp. (5.3%) ([ CITATION Nwa14 \l 1033 ]). In another study
conducted on HCWs mobile phones, bacteria were isolated from 90% of the examined
mobile phones: CNS (69%), Bacilli (20.6%), Acinetobacter spp. (6%), Klebsiella pneumonia
(1.8%), Pseudomonas aeruginosa (1.2%), S. aureus (1.2%) and E. coli (0.6%) [CITATION Par13
\l 1033 ].

In an Indian study on mobile phones used by physicians and surgeons in a hospital, the
presence of bacterial growth was positive with 65%. The various microorganisms detected
were CNS (16%), S. aureus (18%), E. Coli (16%), Klebsiella spp. (19%), Micrococcus
(16%), Citrobacter (4%), Pseudomonas spp. (4%), Candida (2%) and MRSA (5%) [CITATION

14
Tan12 \l 1033 ]. ([CITATION Kar07 \l 1033 ]). Reported that E. coli, Bacillus spp. And CNS,
which are agents of nosocomail infection, were isolated from mobile phones of healthcare
staffs. The presence of E. coli in personal mobile phones for male suggests faecal
contamination of these phones, which can result in community-acquired infections and
disease outbreaks[ CITATION Sha09 \l 1033 ] concluded that Staphylococcus epidermidis was
the most commonly cultured microorganism isolated from mobile phones. S. epidermidis and
other CNS have emerged as major causative agents of nosocomial infections [CITATION
Placeholder21 \l 1033 ].

2.2.1 Staphylococcus
Staphylococci are Gram-positive bacteria, with diameters of 0.5 – 1.5 µm and characterised
by individual cocci, which divide in more than one plane to form grape-like clusters. To date,
there are 32 species and eight sub-species in the genus Staphylococcus, many of which
preferentially colonise the human body [ CITATION Klo94 \l 1033 ]), however Staphylococcus
aureus and Staphylococcus epidermidis are the two most characterized and studied strains.
The staphylococci are non-motile, non-spore forming facultative anaerobes that grow by
aerobic respiration or by fermentation. Most species have a relative complex nutritional
requirement, however, in general they require an organic source of nitrogen, supplied by 5 to
12 essential amino acids, e.g. arginine, valine, and B vitamins, including thiamine and
nicotinamide[ CITATION Klo97 \l 1033 ]. Members of this genus are catalase-positive and
oxidase negative, distinguishing them from the genus streptococci, which are catalase-
negative, and have a different cell wall composition to staphylococci [CITATION Placeholder2 \l
1033 ].

2.2.2 Staphylococcus aureus

S. aureus is considered to be a major pathogen that colonizes and infects both hospitalized
patients with decreased immunity, and healthy immuno-competent people and animals in the
community. This bacterium was found naturally in different parts of some animals and also in
human body like, the nares (primary reservoir), pharynx, axilla, groin, vaginal cavity,
ingastrointestinal tract, or damaged skin surfaces etc. and is a disease producing pathogen. S.
aureus is a major human pathogen that causes a broad range of serious diseases in humans,
associating with numerous mild skin and soft tissue infections, as well as life-threatening
pneumonia, bacteraemia, osteomyelitis, endocarditis, sepsis, and toxic shock syndrome.
Staphylococcus aureus bacteremia (SAB) is an important infection with an incidence rate

15
ranging from 20 to 50 cases/100,000 population per year. Between 10% and 30% of these
patients was die from SAB. Comparatively, this accounts for a greater number of deaths
when compared with AIDS, tuberculosis, and viral hepatitis combined. Нere are many cases
about the situation in hospital-associated (HA) and community-associated (CA) S. aureus
infection in Albanian population[CITATION Placeholder24 \l 1033 ].

2.2.3 Staphylococcus epidermidis

S. epidermidis, the most frequently isolated species of coagulase-negative staphylococci, is
the leading cause of infections related to implanted medical devices (IMDs) ( [ CITATION Rup94
\l 1033 ]). This is directly related to its capability to establish multilayered, highly structured
biofilms on artificial surfaces. The adherence of pathogenic bacteria to medical devices and
their subsequent colonisation and biofilm formation results in infection and often device
dysfunction. Furthermore, infectious agents can disperse from the original site of colonisation
and cause infection in other suitable niches. As antimicrobial treatment has little or no effect
against biofilm populations on colonised medical devices, surgical removal and replacement
of the device is often necessary and in cases where this is not a viable option, patients require
intermittent antibiotic therapy for the remainder of their lives [ CITATION Cos03 \l 1033 ],
leading to a significant morbidity and mortality [ CITATION Roh06 \l 1033 ] . Infecting organisms
can originate from a number of sources, including the skin at the insertion site, colonisation
of the medical device before implant, airborne contamination and microorganisms shed from
theatre staff and other healthcare workers. The pathogenesis of medical device-related
infections associated with S. epidermidis is characterised by the microorganism’s ability to
colonise the surface of IMDs by the formation of highly resistant biofilms. S. epidermidis
biofilms are characterised by the reduction in basic cell processes and the induction of
protective factors (Kong et al 2006). Physiological changes in S. epidermidis biofilms protect
the bacteria from the host immune defence system by lowering the sensitivity toward harmful
molecules, including antibiotics, cytokines and antibacterial peptides, and by causing a shift
to a non-aggressive state reducing inflammation and the chemotaxis of immune cells to the
site of infection ([ CITATION Yao05 \l 1033 ]. Such immune-evasion tactics enable the bacteria
to persist during infection. Yao et al described a global change in gene expression in S.
epidermidis biofilms, including low metabolism, decreased transcription and translation and a
shift from aerobic production of energy to fermentation, resulting in a non-aggressive and
protected mode of growth that is less sensitive to antibiotics and the host immune defence

16
and optimally suited to guarantee long-term survival during chronic infection. [CITATION
Placeholder3 \l 1033 ].

2.2.4 Esherichia coli

Escherichia coli are normal inhabitants of the human large intestine. Most strains are
harmless, but some strains acquire bacteriophage or plasmid DNA-encoding enterotoxins or
invasion factors and become pathogenic. These virulent strains are responsible for diarrheal
infections worldwide, as well as neonatal meningitis, septicemia, and urinary tract infections
(UTIs). E coli are gram-negative bacilli of the family Enterobacteriaceae. They are facultative
anaerobes and nonsporulating.E coli strains with the K1 capsular polysaccharide antigen
cause approximately 40% of cases of septicemia and 80% of cases of meningitis. Different
strains of E coli are associated with a number of distinctive diarrheal illnesses. Among these
are the enterotoxigenic E coli (ETEC), enteroinvasive E coli (EIEC), and Shiga toxin–
producing E coli (STEC). Of the STEC, E coli O157:H7 is the prototypic strain. Each class of
E coli has distinct somatic (O) and flagellar (H) antigens and specific virulence
characteristics. The source of E coli and other gram-negative bacteria pathogens in neonatal
infections is often through the maternal genital tract. Hospital acquisition of gram-negative
organisms through person-to-person transmission from nursery personnel or environmental
sites can occur. The incubation period is variable with time of onset of infection ranging from
birth to several weeks after birth[CITATION Placeholder23 \l 1033 ].

E. coli are a large and diverse group of bacteria. Although most strains of E. coli are
harmless, others can make people sick. Some kinds of E. coli cause disease by making a toxin
called Shiga toxin. The bacteria that make these toxins are called “Shiga toxin-producing E.
coli”, or STEC for short. STEC bacteria live in the intestines of many animals and are usually
transmitted to people when they eat foods contaminated with the bacteria. The most
commonly reported type of STEC in the United States is O157. Other STEC are called non-
O157. Some types of STEC frequently cause severe disease, including bloody diarrhea and
hemolytic uremic syndrome, which is a type of kidney failure.An estimated 265,000 STEC
infections occur each year in the United States. STEC O157 causes about 36% of
them.People of any age can become infected with STEC. Groups at highest risk for severe
illness include: Children younger than 5 years, Adults older than 65 and People with
weakened immune systems, such as people with HIV, diabetes, or undergoing cancer
treatment. Young children and older adults are more likely to develop HUS. People infected
with non-O157 STEC are much less likely to develop HUS.Most people infected with STEC

17
develop diarrhea, often bloody, with abdominal cramps within a week after being exposed to
the bacteria. Many also have vomiting.[CITATION Placeholder4 \l 1033 ].

2.3 Level of bacterial contamination on hand phone among health professional

A mobile phone can spread infectious diseases by its frequent contact with hands. There is
much evidence that contaminated fomites or surfaces play a key role in the spread of bacterial
infections. The sources of infection can be divided into two main groups: exogenous and
endogenous. Endogenous infections occur when the infectious agent comes from the patient’s
own body, usually from his/her own normal flora. Endogenous sources of infections are
particularly important when the person’s own immunity against his/her normal flora becomes
compromised (e.g. the bacterial flora at a surgical site).The exogenous infection, on the other
hand, develops from bacteria outside the body, which is the case most of the time. To be
more specific, exogenous sources of infections can be human, animal, or environmental in
origin. Humans can be a source of infection in three cases: when they are clinically infected
(symptomatic infection), when they are asymptomatically infected or when they are carriers.
Air, mobiles, toys; hands of surgeons are exogenous source of infections [CITATION
Placeholder21 \l 1033 ].

2.4 Sanitation practice among health professionals

The importance of hand hygiene was recognised as early as 1840s, by Dr. Oliver Wendell
Holmes to prevent childbed fever and in the late 1840's, by Dr. Ignaz Semmelweis to reduce
maternal mortality in a Vienna hospital, however, adherence still remains low (40% or
below) in most of the health care institutions. Improper hand hygiene by healthcare workers
(HCWs) is responsible for about 40% of nosocomial infections. Lack of knowledge and lack
of recognition of hand hygiene opportunities during patient care and before using mobile
phones are mainly responsible for poor hand hygiene among HCWs. Although many
countries have guidelines regarding hand hygiene for healthcare settings, overall compliance
among HCWs remains poor.  Despite hand hygiene being regarded as one of the most
important elements of infection control activities. WHO, in 2005 issued guidelines regarding
specific steps and procedures to be followed during hand washing. The spread of infections in
developing countries remains a serious problem, especially in high-risk settings such as
health care facilities due to lack of awareness in health care workers and compounded by

18
“omo syndrome” (a belief that they are super clean and sterile)[ CITATION WHO12 \l
1033 ].

2.4.1 Use of Alcohol based solvents

Hand hygiene is key to preventing the spread of infectious diseases, especially in low-
resource health care settings. In 2018 and 2019, the CDC collaborated with the IDI of
Makerere University, IRC-WASH, and a district government of Uganda to implement and
evaluate the feasibility and impact of local production and district-wide distribution of ABHR
on health care worker hand hygiene. Where CDC conducted a district-wide assessment of
water, sanitation, and hygiene (WASH) in health care facilities in 2018 and found that access
to water and soap was limited and health care worker hand hygiene compliance was very low.
During the one-year intervention, IDI helped produce and distribute locally made ABHR,
CDC designed and led the monitoring and evaluation efforts, and IRC-WASH and the district
government facilitated implementation. All 30 government health clinics received ABHR in
the first or second phase of the program. Each month, evaluators checked availability,
quality, and functionality of traditional soap and water handwashing stations. Alcohol
concentrations of ABHR were monitored after production and at health care facilities several
months after distribution. The program evaluated health care worker perceptions of the
acceptability of ABHR and health care worker hand hygiene compliance three times: before,
in the middle, and at the end of the program. Use of ABHR improved hand hygiene
compliance among health care workers [CITATION CDC20 \l 1033 ].

2.4.2 Use of Tap water and soap

The term “WASH in health care facilities” refers to the provision of water, sanitation, health
care waste management, hygiene and environmental cleaning infrastructure, and services
across all parts of a facility. “Health care facilities” encompass all formally- recognized
facilities that provide health care, including primary (health posts and clinics), secondary, and
tertiary (district or national hospitals), public and private (including faith-run), and temporary
structures designed for emergency contexts (e.g., cholera treatment centers) [CITATION
WHO19 \l 1033 ].

WASH services in healthcare facilities are fundamental to the provision of quality, people-
centred care. Benefits include increased trust in, and uptake of, healthcare; increased
efficiency and decreased costs of healthcare services; and improved staff working conditions
and morale. All major initiatives to improve global health depend on sustainable provision of

19
basic WASH services in healthcare facilities, yet data from 54 low- and middle-income
countries’ healthcare facilities show that 38% do not have a basic water source (defined as
tap water or a protected groundwater source), 19% do not have basic sanitation (defined as
private and hygienic toilets/latrines) and 35% do not have water and soap for handwashing.
This lack of WASH services undermines the ability to provide safe, quality healthcare, and
places both those providing and those seeking care at risk[CITATION AMR16 \l 1033 ].

WASH services provide for water availability and quality, presence of sanitation facilities,
and availability of soap and water for hand washing. The most common indicator for hygiene
was availability of soap and water or alcohol based hand rubs at key points of care. Globally,
provision of WASH services in health care facilities is low, and the current levels of service
are far less than the required 100% coverage by 2030. Provision of water was lowest in the
African Region, with 42% of all health care facilities lacking an improved source on-site or
nearby. However, provision of sanitation services was much better with only 16% of all
health care facilities in the African Region lacking access to improved sanitation. [CITATION
Edg18 \l 1033 ].

20
 CHAPTER THREE

METHODOLOGY

Introduction
This chapter contains research design, study area, target population, Study Population,Study
Unit, sample size, sampling procedure, research instrument, data gathering procedure, data
analysis, limitation of the study.

3.0. Research design

A cross-sectional study using quantitative tools was used to assess mobile phone use,
attitudes about their use and bacterial contamination of phones in the Wardi Cummunity
Health Center. The study was conducted over a three week period and involved the
following:

1) Two week of Microbiological sample taking and analysis

2) one week of questionnaire distribution and retrieval of questionnaire

3.1. Study area

Wardi Community Hospital was established in June2010. It is located in Mogadishu-Somalia
espcially in Hamar Jajab district. It also consists of several branchs such as Kalkal, Kaxda,
Dherkeynley, Shangani, Hamar Jajab, Hamar Weyne, Baladweyne, Bulo Barde,
Jalalaqsi, Walaweyn, Lego, Marko.

Our target Wardi Community Hospital in Hamar Jajab, has four parts such as

BEMOC ( Basic Emergency obstatric care) includes Laboratory Departmet, (ANC) Anti
natal care department, Pharmacy Department, (OPD) Out patient Department, Under five
and Over five, Ultrasound, EPI ( Expanded Programm On Immunization)

CEMOC ( Comprehensive Emergency Obstatric Care). It has two sections such as Delivery
and (OP) Operation Threathe

21
Nutrition includes: Mother Child Nutrion Health Department (MCNH), Theraputic
Supplementary feeding Program (TSFP),Out Pateint Theraputic Programm (OTP),
Established center (SC)

Cold Chain: Temperature control

3.2 Target Population

This may set up the target population which is 60 participants of all mobile phone of
healthcare professionals and patients,

3.3 Study Population

The study population is 60 mobile phones and involved all healthcare professionals such
(Doctors, Nurses, Lab technician, Nutrititisa and pharmacy staff) and pateints stay on the
Wardi Comunity Hospital Hamar Jajab .

3.4 Study Unit

A health care worker or a patient in Wardi Communtity Hospital Hamar Jajab these are
ready to answer our questions.

3.5. Sample Size

The sample size of this study was 52 respondents which were randomly selected from the
target population, using Solvent’s formula.

Where n= sample size, N= population size, 60 and e = margin of error of 0.05.

60
=52
1+ 60 ( 0.05 ) 2

3.6. Sampling Procedure/ Technique

The sampling Techniques this study was used is sample random sampling procedure which
involves the selection of sample from a population based on the principle of randomization or
chance. Especially systematic sampling;- Its statistical method involving the selection of
elements from larger population according to a random starting point and fixed periodic
interval. The researchers select this sampling technique because it gives the opportunity to
choose the respondents who can provide accurate information or data which relates to this
study.
22
3.6.1 Sample Collection

The researchers was used a cotton swab moistened with sterile normal saline for an area of 3
cm2 of mobile phone or cover. The swab was placed in 1 ml sterile normal saline tube to
maintain the viability of microorganisms. All samples was transported from collection area
within one hour to the Medical Microbiology Laboratory.

3.6.2 Bacterial Count, Culture and Identification

A 0.1 ml of the suspension was aseptically pipette and transferred onto pre-labeled Nutrient
Agar (HiMedia, India). Colonies were counted after 48 hours of incubation at 37 ᵒC and
expressed as a colony-forming unit per milliliter (CFU/ml) of the sample analyzed. A loopful
of the suspension was streaked on Blood Agar and MacConkey Agar (HiMedia, India). The
inoculated plates were incubated at 37±0.50C for 48 hours, after which their cultural
characteristics were observed and recorded. Isolates from Blood and MacConkey agar were
sub-cultured to obtain pure isolates. The isolates were then identified by colony morphology
and characteristic growth, gram stain, and pattern of biochemical profile (catalase, oxidase,
coagulase, citrate, indole and API 20E) in accordance with the standard methods.

3.7 Research Instrument

Instrument is the general term that researchers use for a measurement device (questionnaire.).
Research tool is a set of questions designed to collect data from the target population. In this
study, Laboratory diagnosis was used as the primary collection of data, as well as
questionnaire. Questionnaire is a set of printed or written questions with a choice of answers,
devised for the purposes of a survey or statistical study. The questionnaires of this study is
developed by the researcher and they base on literature review whose congruent their
dimensions of research and research objectives through steps in order to get relevant
information on the research.

3.8. Data Gathering Procedure

Data gathering is a process of collecting information from all the relevant sources to find
answers to the research problem, test the hypothesis and evaluate the outcomes. Data
collection methods can be divided into two categories: secondary methods of data collection
and primary methods of data collection. In the case of this study data collection method was
primary data collection methods. Questionnaire method was used for data gathering. The
researchers selected this approach because it is a common device used by the researchers, the

23
questionnaire items were open, guide by the data requirement and the objective of the
questionnaire, thereby providing opportunity for respond data collection to present their own
independent opinions about the study.

3.9 Data Analysis

The process of evaluating data using analytical and logical reasoning to examine each
component of the data provided. This form of analysis is just one of the many steps that must
be completed when conducting a research. Data from various sources is gathered, reviewed,
and then analyzed to form some sort of finding or conclusion. There are a variety of specific
data analysis methods but in this study SPSS program especially version 20 was used to
analyze data.

3.10 Limitation of the study

As it is a cross-sectional study, the study did not address the effect of period variations. The
small sample size makes it difficult to understand the actual practice of health professionals
and to perform further multivariable analysis to identify the effect of specific factors on
mobile phone contamination.

24
 CHAPTER FOUR

RESULTS AND DISCUSIONS

4.0 Introduction
This chapter presents the results of the study and comprised of different sections. The first
section is made up of the demographic characteristics of participants while the rest of the
sections reports the study findings in line with the objectives of the study.

4.1 Socio-Demographic characteristics of participants

Table 4.1.1 Age of the respondents

Age of the respondents Frequency Percent
18-25 years 25 48%
26-33 years 18 35%
34-41 years 6 11%
42 and above years 3 6%
Total 52 100%

Age of the respondents

11%
6%

48%

35%

18-25 years 26-33 years

34-41 years 42 and above years
Figure 4.1.1 Age of the respondents
Table: 4.1.1, shows48% of respondents were aged (Between 18-25) which indicates the
majority of respondents, while 35% of respondents were between (26-33) also the
respondents, while 11% of the respondents were between (34-41), and 6% of the respondents

25
(42 above), this revealed the most of the respondents were between 18-25 and have ability to
complete their education.

Table 4.1.2 Gender of the respondents

Gender of the respondents Frequency Percent
Male 20 38%
Female 32 62%
Total 52 100%

Gender of the respondents

38% Male
Female

62%

Figure 4.1.2 Gender of the respondents

Table 4.1.2 shows 32(62%) of the respondents were female while 20(38%) of the
respondents were male. Therefore, there is big difference or majority of the respondents.

26
Table 4.1.3 Educational Level of the respondents
Educational Level of the respondents Frequency Percent
Secondary 5 10%
Bacherol degree 35 67%
Master degree 8 15%
PhD 4 8%
Total 52 100%

Educational Level of the respondents

15% 8% 10%

67%

Secondary Bacherol degree Master degree PhD

Figure 4.1.3 Educational Level of the respondents

Table 4.1.3Shows the level of education of the respondents it indicates that 67% of the
respondents were Bacherol degree of education which is the majority of the respondents and

27
15% were Master degree level, while PhD Level and secondary level were 8% and 10%
respectively.

Table 4.1.4 Occupation of the respondents

Occupation of the respondents Frequency Percent
Medical Doctor 16 31%
Nurse 11 21%
Pharmacy staff 6 12%
Laboratory staff 9 17%
Nutrition staff 10 19%
Total 52 100%

Occupation of the respondents

19%
31% Medical
Doctor
17% Nurse
Pharmacy
staff
12% 21% Laboratory
staff

Figure 4.1.4 Occupation of the respondents

Table 4.1.4 Shows the work status of the respondents, it indicates that 31% of the
respondents were Medical Doctor which is the majority of the respondents while 21% and

28
19% were nurse and Nutrition staff, laboratory staff and pharmacy staff were 17% and 12%
respectively.

4.2 Characteristics of Cell phone

Table 4.2.1 have you own a cell phone

Have you own a Mobile Phone Frequency Percent
Yes 49 94%
No 3 6%
Total 52 100%

Have you own a Mobile Phone

6%

Ye
s

94%

Figure 4.2.1 Have you own a cell phone

29
Table 4.2.1Indicates that majority of respondent said have own a mobile phoen were 49(94
%), while the respondents said have no own which is 3(6%), this clearly indicates that most
of the respondents have a mobile phone or cell phone.

Table 4.2.2 Type of cell phone do you use

Type of cell phone do you use Frequency Percent
Smartphone 40 77%
keypad phone 12 23%
Total 52 100%

Type of cell phone do you use

23%

Smartphone
Keypadphone

77%

Figure 4.2.2 Type of cell phone do you use

Table 4.2.2Shows the type of cell phone that use of the respondents, it indicates that
(40)77% of the respondents were used Smartphones which is the majority of the respondents
while (12) 23% of the reapondents were used Keypad phones.

30
 Table 4.2.3 Time do you spent on using cell phone during working hours
Time do you spent on using cell phone during working hours Frequency Percent
Less than an hour 29 56%
1-5 hours 17 33%
6-10 hours 6 11%
Total 52 100%

Time do you spent on using cell phone during working hours

Time do you spent on using cell phone during working hours

6-10 hours 11%

1-5 hours 33%

ss than an hour 56%

0% 10% 20% 30% 40% 50% 60%

Figure 4.2.3 Time do you spent on using cell phone during working hours

Table 4.2.3 Shows time they spent on using mobile phone during working hours of the
respondents. , it indicates that (29)56% of the respondents were using on mobile phone less
than an hour during work which is the majority of the respondents while (17) 33% of the

31
respondents were used mobile one or five hours during work and (6) 11% of the
respondents were used mobile phone six or ten hours.

Table 4.2.4 Use of Mobile Phone at work

Use of Mobile Phone at work Frequency Percent
Yes 44 85%
No 8 15%
Total 52 100%

Use of Mobile Phone at work

15%

85%

Figure 4.2.4 Use of Mobile Phone at work

Table 4.2.4 shows Use of mobile phone at work. It indicates that respondent said use of
mobile phone phone at work were 44(85 %), while of the respondents said no use of mobile
phone which is 8(15%), this clearly indicates that most of the respondents using of mobile
phone or cell phone at work.

32
Table 4.2.5 General Reasons for Mobile Phone use at work
General Reasons for Mobile Phone use at work Frequency Percent
Medical Purpose 25 48%
Personal Only Use 22 42%
Social media 4 8%
Entertainment 1 2%
Total 52 100%

General Reasons for Mobile phone use at work

8% 2%

48%
42%

Medical Purpose Personal Only Use

Social media Entertainment
Figure 4.2.5 General Reasons for Mobile phone use at work
Table 4.2.5 Shows general reasons for cell phone use during work, the most of the
respondents 25(48%) were use medical purpose, 22(42%) were use for personal only,
4(8%)were use for social media and 1(2%) were use for entertainment . The researcher
indicates the majority of the respondents were used for medical purpose.

33
Table 4.2.6 Clinical reasons for use of Mobile Phone at work
Clinical reasons for use of Mobile Phone at work Frequency Percent
Communication with patient families 20 39%
Communication with colleagues 13 25%
Light source 2 4%
Reference tool 9 17%
Others 8 15%
Total 52 100%

Clinical reasons for use of Mobile Phone at work

15%

Communication with patient

families
39%
Communication with colleagues
17%
Light source

Reference tool
4%
Others

25%
Figure 4.2.6 Clinical reasons for use of Mobile Phone at work
Table. 4.2.6Shows clinical reasons for cell phone use during work, the majority of the
respondents 20(39%) were use communication with patient families, 13(25%) were use for
communication with colleagues, 9(17%) were use for reference tool while 2(4%) and
8(15)were use for light source and others . The researcher indicates the most of the
respondents were used for communication with patient families.

34
4.3 according to respondents of cell phone cleaning method, frequently share mobile
phone other health care workers, daily hand washing habits

Table 4.3.1 cell phone cleaning method

Cell phone cleaning method Frequency Percent

Rubbing with the clothes you are wearing 14 27%
Using a handkerchief/ tissue paper 22 42%
Using wet antibacterial tissue 14 27%
Others 2 4%
Total 52 100%

Cell phone cleaning method

4% Rubbing with the

clothes you are wearing
27%
27%
Using a handkerchief/
tissue paper

Using wet antibacterial

tissue
42%
Others

Figure 4.3.1 Cell phone cleaning method

Table. 4.3.1Shows cell phone cleaning method, the majority of the respondents 22(42%)
were use tissue paper or handerchief, while 14(27%) and 14(27%) were use rubbing with
clothes wearing and wet antibacterial tissue, 2(4%) were use others . The researcher indicates
the most of the respondents were used for handerchief/ tissue paper.

35
Table 4.3.2 Mobile Phone Cleaning period
Mobile Phone Cleaning period Frequency Percent
Daily 33 64%
Weekly 11 21%
Monthly 8 15%
Total 52 100%

Mobile Phone Cleaning period

70%
64%
60%

50%

40%

30%
21%
20% 15%
10%

0%
Daily Weekly Monthly
Figure 4.3.2 Mobile Phone Cleaning period
Table 4.3.2respondents were asked which period for cleaning their cell phone, majority of
the respondents 33(64%) said daily, 11(21%) said weekly, while monthly said 8(15%)
respectively.

36
Table 4.3.3Use daily handwashing habits
Use daily handwashing habits Frequency Percent
1-10 times 28 54%
11-20 times 13 25%
More than 20 times 11 21%
Total 52 100%
Figure 4.3.3 Use of daily handwashing habits

Use of daily handwashing habits

54%

25% 21%

1-10 times 11-20 times More than 20 times

Table 4.3.3 respondents were asked How much do you Use daily handwashing habits? The
majority of the respondents 28(54%) said 1-10 times, 13(25%) said 11-20 times, while more
than 20 times said 11(21%) respectively.

37
Table 4.3.4 Share your cell phone with other health care worker
Share your cell phone with other health care worker Frequency Percent
Yes 30 58%
No 22 42%
Total 52 100%

Share your cell phone with other health care worker

42%

58%

Yes No
Figure 4.3.4 Share your cell phone with other health care worker

Table 4.3.4respondents were asked Share your cell phone with other healthcare worker and
majority of the respondents said share cell phone with other healthcare worker which are
30(58%), while 22(42%) said No . Therefore, indicates most of the respondents share cell
phones with other heathcare worker.

Table 4.3.5 Ever disinfected your cell phone

Ever disinfected your cell phone Frequency Percent

38
 Yes 30 58%
No 22 42%
Total 52 100%

Have you ever disinfected your cell phone

42%

58%

Yes No
Figure 4.3.5 Ever disinfected your cell phone

Table 4.3.5 respondents were asked have you ever disinfected your cell phone? and majority
of the respondents said Yes disinfected cell phone which are 30(58%), while 22(42%) said
No. respectively

Table 4.3.6 laboratory staff are mostly at risk to mobile phone contamination
laboratory staff are mostly at risk to mobile phone contamination Frequency Percent
Yes 39 75%
No 13 25%

39
 Total 52 100%

laboratory staff are mostly at risk to mobile phone contamination

75%

25%

Yes No
Figure 4.3.6 laboratory staff are mostly at risk to mobile phone contamination
Table 4.3.6 respondents were asked do you think laboratory staff are mostly at risk to mobile
phone contamination? and majority of the respondents said Yes lab staff are mostly at risk to
mobile phone contamination which are 39(75%), while 13(25%) said No. so that it indicates
the most respondents said Yes. Therefore laboratory staff are mostly at risk to mobile phones.

4.4 Microbial growth, washinghands, Personal hygiene, spread infection, endanger

health, transmission

Table 4.4.1 Aware of microbial growth on mobile phone

Aware of microbial growth on mobile phone Frequency Percent
Yes 34 65%

40
 No 18 35%
Total 52 100%

Aware of microbial growth on mobile phone

35%

65%

Yes No
Figure 4.4.1 Aware of microbial growth on mobile phone

Table 4.4.1respondents were asked do you aware of microbial growth on mobile phone? and
majority of the respondents said Yes aware of microbial growth on mobile phone which are
34(65%), while 18(35%) said No. so that it indicates the most respondents said Yes.
Therefore they awre of microbial growth on mobile phone.

Table 4.4.2 Wash hand after phone use before touching patient
Wash hand after phone use before touching patient Frequency Percent
Never 9 17%
Occasionally 17 33%
Always 21 40%
Do not recall 5 10%
Total 52 100%

41
 Wash hand after phone use before touching patient
10%
17%
40%

33%

Always Occasionally Never Do not recall

Figure 4.4.2 Wah hand after phone use befor touching patient
Table 4.4.2respondents were asked do you wash your hands before touching a patients after
touching your phone? , and majority of the respondents 21(40%) said always, while 17(33%)
said occasionally, 9(17%) said Never, and 5(10%) said do not recall.

Table 4.4.3 Believe mobile phone role in spread of infections

Believe mobile phone role in spread of infections Frequency Percent
Yes 40 77%
No 12 23%
Total 52 100%
Figure 4.4.3 Believe mobile phone role in spread of infections

42
 Believe mobile phone role in spread of infections

23%

77%

Yes No
Table 4.4.3 respondents were asked the question do you believe mobile phone role in spread
of infection? The majoritry of the respondents 40(77%) said yes believe mobile phone in
spread of infection while 12(23%) said No.

Table 4.4.4 Personal hygiene for reduction of microbial growth

Personal hygiene for reduction of microbial growth Frequency Percent
Yes 43 83%
No 9 17%
Total 52 100%
Figure 4.4.4 Personal hygiene for reduction of microbial growth

43
 Personal hygiene for reduction of microbial growth

17%

Yes
No

83%

Table 4.4.4 respondents were asked the question do you believe personal hygiene for
reduction of microbial growth? The majoritry of the respondents 43(83%) said Yes believe
personal hygiene reduction of microbial growth while 9(17%) said No.

Table 4.4.5 Aware of microorganisms can endanger health

Aware of microorganisms can endanger health Frequency Percent
Yes 45 86%
No 7 14%
Total 52 100%
Figure 4.4.5aware of microorganisms can endanger health

44
 aware of microorganisms can endanger health
No
14%

Yes
86%

Table 4.4.5 respondents were asked the question do you aware of microorganisms can
endanger health? The majoritry of the respondents 45(86%) said Yes aware of
microorganisms can endanger health while 7(14%) said No.

Table 4.4.6 constant holding cell phones breeding place for microbes makes
Constant holding cell phones breeding place for microbes Frequency Percent
makes
Yes 45 86%
No 7 14%
Total 52 100%

45
 contant holding cell phones breeding place for microbes makes
14%

86%

Yes No
Figure 4.4.6 contant holding makes cell phones breeding place for microbes

Table 4.4.6 respondents were asked the question If you contant holding makes cell phones
breeding place for microbes? The most of the respondents 45(86%) said Yes while 7(14%)
said No.

Table 4.4.7 Possible microbial contamination source

Possible microbial contamination source Frequency Percent
Human skin or hands 23 44%
Dust 9 18%
Environment 10 19%
Transmission from contaminated material 10 19%

46
 Total 52 100%
Figure 4.4.7 Possible microbail contamination source

Possible microbail contamination source

19%

44%
Human skin or hands

Dust

19% Environment

Transmission from
contaminated material
18%

Table 4.4.7 respondents were asked do you What are possible microbail contamination
source?, and majority of the respondents 23(44%) said Human skin or hands, while 10(19%)
said environment and transmission contaminted material, 9(18%) said Dust.

Table 4.4.8 Mobile Phone decontamination daily after finished work

Mobile Phone decontamination daily after finished work Frequency Percent
Yes 28 54%
No 24 46%
Total 52 100%
Figure 4.4.8 Mobile Phone decontamination dialy after finished work

47
 Mobile Phone decontamination dialy after finished work

46%
54%

Yes No
Table 4.4.8 respondents were asked the question Do you decontaminate your phone daily
after finished of work? The highest number of the respondents 28(54%) said Yes while
24(46%) said No.

Table 4.4.9 Perception on degree of contamination at work

Perception on degree of contamination at work Frequency Percent
Not contaminated 18 35%
Moderately contaminated 29 55%
Highly contaminated 5 10%
Total 52 100%

48
Figure 4.4.9Perception on degree of contamination at work

Perception on degree of contamination at work

10%
35%

55%

Not contaminated Moderately contaminated Highly contaminated

Table 4.4.9 respondents were asked the question From your perspective what degree of
contamination of your phone occurs at work? The majoritry of the respondents 29(55%) said
Moderate contaminated while 18(35%) said not contaminated and 5(10%) said highly
contaminated.

4.5 Bacterial contamination of mobile phones surfaces

The mobile phones of staff of the Wardi Community Hospital were assessed for the presence
of bacterial contamination using Petri Dish plates. Of the 60 mobile phones assessed, 52 of
the phones were contaminated by bacteria giving a percentage of 87%. The mean colony per
mobile phone was 4.915 (range-0-10.4) colony forming units per cm 2. There was no

49
significant difference between average colony counts on the mobile phones of Healthcare
professionals.

A total of 52 bacterial isolates were identified from mobile phones of staff at the WCH. They
comprised of Gram positive bacteria (65%) and Gram negative (35%).

Table 4.5.1 total of 52 bacterial isolates were identified from mobile phones of staff at
the WCH
Bacterial identified Number of bacterial Percentage (%)
Gram positive 34 65%
Gram negative 18 35%
Total 52 100%

Among the Gram negative bacteria isolates, Pseudomonas species and Non-coliform bacteria
constituted close (77%) while 23% was coliforms bacteria. Majority of the Pseudomonas
species and Non-coliform bacteria isolates were found on the mobile phone of Females and
coliforms bacteria was identified on the mobile phones of Males.

Table 4.5.2 Gram negative bacteria isolates

Gram negative bacteria isolates Number of GN Bacteria Percentage (%)
Pseudomonas species 6 33%
Non-coliform bacteria 8 44%
coliforms bacteria 4 23%
Total 18 100%
Of the 34 Gram positive bacteria isolates, the most frequently encountered were
Staphylococcus aureus 29% and coagulase negative Staphylococcus (CoNs) representing
23% of Gram positive bacteria isolates, followed by Micrococcus species with 12% while 9%
was Bacillus species.

Table 4.5.3 Gram positive bacteria isolates

Gram positive bacteria isolates Number of GP Bacteria Percentage (%)
Staphylococcus aureus 10 29%
Staphylococcus epidermidis 9 27%
Bacillus species 3 9%
Micrococcus species 4 12%
CoNs 8 23%
Total 34 100%
Staphylococcus aureus was the common Gram positive bacteria isolate identified on the
mobile phones of respondents. The Staphylococcus aureus47.1% isolate identified was found

50
on the mobile phones of Males while majority of the CoNs,Bacillus species andMicrococcus
species were found on the mobile phones of Females with 35.3%, 17.6% and 11.8%
respectively.

Table 4.5.4 Gram positive bacteria according to Gender Female and male
Gram positive bacteria according by gender Female Frequency Percent
S.aurus 2 11.8%
S.Epidermis 4 23.5%
CoNs 6 35.3%
Basillus Species 3 17.6%
Micrococcus species 2 11.8%
Total 17 100%

Table 4.5.5 Gram positive bacteria according by gender Male

Gram positive bacteria according by gender Male Frequency Percent
S.aurus 8 47.1
S.Epidermis 5 29.4
CoNs 2 11.8
Micrococcus species 2 11.8
Total 17 100%
Overall the commonest bacteria isolate identified on the mobile phone of healthcare staff in
the WCH of Hamar-Jajab District in this study were Staphylococcus aureus, Staphylococcus
epidermidis, CoNs while non-pathogenic bacteria (Micrococcus sp and Bacillus sp) isolated
made up 27% of bacteria.

Table 4.5.6 the commonest bacteria isolate identified on the mobile phone of healthcare
staff
Commonest bacteria isolate Frequency Percent
Staphylococcus aureus 10 38%
Staphylococcus epidermidis 9 35%
non-pathogenic bacteria(Micrococcus sp and Bacillus 7 27%
sp)
Total 26 100%

Table 4.5.7 Frequency of bacteria isolated from personal mobile phones

Microorganisms Mobile Phone N(52) Percentage (%)
Staphylococcus aureus 10 19%
Staphylococcus epidermidis 9 17%

51
 Pseudomonas species 6 12%
CoNS 8 15%
Bacillus species 3 6%
Non-coliform bacteria 8 15%
Micrococcus species 4 8%
Coliform bacteria 4 8%
Total 52 100%

Figure 4.5.7Frequency of bacteria isolated from personal mobile phoness

Frequency of bacteria isolated from personal mobile phoness

Coliform bacteria
Bacillus species
Micrococcus species
Pseudomonas species
CoNS
Non-coliform bacteria
S.epidermidis
S. aureus
0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20%

Figure 4.5.7Both Gram-positive and Gram-negative bacteria were isolated from mobile
phones covers swab (Patient and HCW) samples. The most common isolates wereS. aureus
(19%) while S.epidermidis (17%) and CoNS (15%), as shown inTable 4.5.7

CHAPTER FIVE

CONCLUSIONS AND RECOMMENDATIONS

5.0 introduction
This chapter discussedthe conclusions arising from the study and recommendations in chapter
four, which could improve the study of bacterial contamination of mobile phone among
healthcare professionals.

52
5.1 Conclusions
The study included 52 mobile phones belonging to HCW and Patients (32 females and 20
males) work in Wardi Community Hospital. The mobile phone was first held with the aid of
sterile gloves. The new mobiles were excludedfrom research. Each participant’s mobile
phone was swabbed aseptically by rotating damp cotton swabs withsterile demineralised
water over three sites over all exposed outer surfaces of the mobile phones. The samples were
transported immediately to the microbiological laboratory for culture and identification of
microorganism. Swabs were streaked onto blood agar, McConkey agar and Nutrient agar ,
after that the plates incubated at 37°Cfor 48 hrs. Isolated microorganisms were identified
using gram stain, morphology, catalase, and coagulase reaction.

Statistical analysis was performed using SPSS (version 20).Descriptive statistics.The main
methods of data collection was questionnaire and laboratory diagnosis during research.

 The work status of the respondents, it indicates that 31% of the respondents were
Medical Doctor which is the majority of the respondents while 21% and 19% were
nurse and Nutrition staff, laboratory staff and pharmacy staff were 17% and 12%
 The type of cell phone that use of the respondents, it indicates that 77% of the
respondents were used Smartphones.
 Time they spent on using mobile phone during working hours of the respondents. , it
indicates that 56% of the respondents were using on mobile phone less than an hour
during work.
 Use of mobile phone at work. It indicates that 85 % of respondent said yes
 General reasons for cell phone use during work, the majority of the respondents 48%
were use medical purpose and 42% were used for personal only.
 Clinical reasons for cell phone use during work, the majority of the respondents 39%
were use communication with patient families.
 Cell phone cleaning method, the majority of the respondents 42% were use tissue
paper or handerchief.
 Period for cleaning their cell phone, majority of the respondents 64% said daily.
 Use daily handwashing habits majority of the respondents 54% said 1-10 times
 Share your cell phone with other healthcare worker and majority of the respondents
58% said Yes.
 Have you ever distinfected your cell phone? and majority of the respondents said Yes
which are 58%.

53
 You think laboratory staff are mostly at risk to mobile phone contamination and
majority of the respondents 75% said yes.
 You aware of microbial growth on mobile phone and majority of the respondents 65%
said yes.
 Washing your hands before touching a patients after touching your phone and
majority of the respondents 40% said always, while 33% said occasionally.
 You believe mobile phone role in spread of infection. The majoritry of the
respondents 77% said yes.
 You believe personal hygiene for reduction of microbial growth. The majoritry of the
respondents 83% said yes.
 You aware of microorganisms can endanger health? The majoritry of the respondents
86% said Yes.
 Possible microbail contamination source. The majority of the respondents 44% said
Human skin or hands.
 Decontaminate your phone daily after finished of work. The majoritry of the
respondents 54% said Yes.
 From your perspective what degree of contamination of your phone occurs at work.
The majoritry of the respondents 55% said Moderate contaminated.
 The most common isolates were S. aureus (19%) while S.epidermidis (17%) and
CoNS (15%), as shown in Figure 4.5.7
 This study highlights mobile phones as a potential threat in infection control practices
and could exaggerate rate of healthcare - associated infections.
 Mobile phones were found to carry these bacteria because count of these bacteria
increases in high temperature and our phones are ideal breeding sites for these
microbes as they are kept warm and snug in our pockets and handbags.
 Also, there are no guidelines for the care, cleaning and restriction of mobile phones in
our health care settings.
 Hence, in a country like ours, mobile phones of HCWs play an important role in
transmission of infection to patients, which can increase the burden of heath care.
 In conclusion, it can be said that hand hygiene is greatly overlooked and under-
emphasized in health care settings.
 Simple measures such as increasing hand hygiene and regular decontamination of
mobile phones with alcohol disinfectant wipes may reduce the risk of cross-
contamination caused by these devices.

54
5.2 Recommendations
The following recommendations were made base on the findings of the study. The
recommendations are categorized into the following:

5.2.1 Recommendations for Practice

The conclusion that most healthcare professionals in the department wash their hands after
touching their cell phones during work and supportive of bans on the use of mobile phones at
work, it was be crucial for hospital authorities ability to strengthen hand hygiene practices
among healthcare staff.

This can be done through the provision of reliable and easily accessible hand washing
materials such as hand washing stands and hand sanitizers for use among staff during
working periods. Healthcare staff should also adhere strictly to hand hygiene practices during
work and should be constantly given refresher trainings through the in-service training units
on the need for hand hygiene in preventing transmission of healthcare associated infections
through mobile phone use.

5.2.2 Recommendation for policy

There is the need for hospital authorities to institute control measures as regards mobile
phone use during working periods. Hospital authorities should thus develop institutional
policies on mobile phone use during work.

5.2.3 Recommendation for research

There is the need for large scale research involving different units of the hospital to determine
the level of mobile phone use among healthcare professionls and the extent of contamination
of mobile phones with bacteria agents.

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 APPENDEX A: QUESTIONNAIRE
Title: Study of bacterial contamination on mobile phone among healthcare professional in
Wardi Community Hospital Hamar Jajab-Mogadishu-Somalia

We are student of Salaam University, faculty of health science, department of medical

laboratory science so we was be graduating at this year 2020 and preparing for dissertation
(graduating book). Therefore, we want to participate in this questionnaire about study of
bacterial contamination on mobile phone among healthcare professional in Wardi
Community Hospital Hamar Jajab, Mogadishu-Somalia
Kindly tick (√) on the blank space in each category

Socio-demographic characteristics
1) Age of the respondents
a) 18-25 Years
b) 26-33 years
c) 34-40 years
d) 41 and above years
2) Gender of the respondents
a) Male
b) Female
3) Educational level of the respondents
a) Seconady high School
b) Bacherol degree
c) Master degree
d) PhD
4) Occupational level of the respondents
a) Medical Doctor
b) Nurse
c) Pharmacy Staff
d) Laboratory staff
e) Others
Characteristics of cell phone repondents according to cell phone, cell phone usage
period, cell phone type and cell phone keeping area
5) Do you own a cell phone?
a) Yes
b) No
6) What Type of cell phone did you use?
a) Smartphone
b) Keypad phone
7) How much time do you spent on using cell phone during working hours?
a) Less than an hour
b) 1-5 hours

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 c) 6-10 hours
d) More than 10 hours
8) Do you use your mobile phone at work?
a) Yes
b) No
9) What do you use phone for?
a) Personal use only
b) As professional referrence tool
c) As a clinical instrument for pateint care
d) For purposes of social media
e) Clinical and personal use
f) Entertainment
10) If you use your phone for clinical purposes, tick the most appropriate common clinical
use of your phone.
a) Communication with families
b) Communicating with collegues
c) Use as a time piece for vitals
d) Use as light source
e) Reference tool
f) Others(specify)__________________
Respondents according to cell phone cleaning method, cell phone cleaning period, and
daily hand washing habits, Usage of antibacterial hand washing soap, frequently share
mobile phone habit, and sneezing habits while scrolling through mobile phone
11) Which method do you use to clean your cell phone?
a) By rubbing with the clothes you are wearing
b) Using a handkerchief/ tissue paper
c) Using wet antibacterial tissue
d) Others
12) How often do you clean your cell phone?
a) Daily
b) Weekly
c) Monthly
13) How much do you Use daily handwashing habits?
a) 1-10 times
b) 11-20 times
c) More than 20 times
14) Do you share your a cell phone with other health care worker?
a) Yes
b) No
15) Have you ever disinfected your cell phone?
a) Yes
b) No
16) Do you think that laboratory staff are mostly at risk to mobile phone contamination?
a) Yes
b) No

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Respondents according to aware of microbial growth on a mobile phone, personal
hygiene for reduction of microbial growth and aware of that these microorganisms can
endanger health.
17) Do you aware of microbial growth on a mobile phone?
a) Yes
b) No
18) Do you wash your hands before touching a patient after touching your phone?
a) Never
b) Occasionally
c) Always
d) Do not recall
19) Do you believe mobile phone role in spread of infections?
a) Yes
b) No
20) Do you believe personal hygiene for reduction of microbial growth?
a) Yes
b) No
21) Do you aware of microorganisms can endanger health?
a) Yes
b) No
22) If you contant holding makes cell phones breeding place for microbes
a) Yes
b) No
23) What are possible microbail contamination source?
a) Human skin or hands
b) Dust
c) Environment
d) Transmission from contaminated material
24) Do you decontaminate your phone daily after finished of work?
a) Yes
b) No
25) From your perspective what degree of contamination of your phone occurs at work?
a) Not contaminted
b) Moderately contimanited
c) Highly contimated

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 Appendix B: WORK PLAN
Activities February March April MAy June July August

Topic selection

Writing proposal

Data collection

Data analysis
and research
report writing

Final Thesis
submission

Thesis defense

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APPENDIX C: BUDGET PLAN

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No Item Quantity Price Amount

1 Stationary

A4 paper 1 box $4.5 $4.5

Total stationary $4.5

2
Computer facility and printing
Printing facility $ 21
Internet facility 3 months %15 $45
Photocopy cost 402 pages 805,000sh.so $33.5
Total facility cost $104

3
Communication cost
Telephone expenses ---------- ----------- $20

Transportation expenses ---------- ------------ $30

Total communication cost $50

Total budget cost $154

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APPENDIX D: AUTHORITY LETTERS

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APPENDIX E: SOMALI MAP

71
APPENDIX F: MOGADISHU MAP

72
 APPENDIX G: IMAGES

Petri dish labeling Petri dish incubation

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 Swab Cover mobile phone
Petri dish labeling

74