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\begin{document}

\title{Nasal carriage of Staphylococcus aureus and presence of genetically
identical strains on the mobile phones carried by healthcare providers
in the intensive care unit.}



\author[1]{Nevcivan Guldas}%
\author[2]{Ayse  Nur  Sari}%
\author[3]{Zeynep GULAY}%
\affil[1]{Dokuz Eylul University Faculty of Medicine}%
\affil[2]{Dokuz Eylul Universitesi}%
\affil[3]{Dokuz Eylul University School of Medicine}%


\vspace{-1em}



  
  \date{May 26, 2024}


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\selectlanguage{english}
\begin{abstract}
Aims of the study: Staphylococcus aureus colonized in the nose of
healthcare providers is an important risk factor for the development of
hospital-acquired staphylococcal infections. Cross-contamination of this
bacterium between the hands of healthcare providers and the surfaces is
known. In this study, we aimed to evaluate the clonal relationship
between eight Staphylococcus aureus strains isolated from the nose of
healthcare providers and five Staphylococcus aureus strains isolated
from mobile phones carried by healthcare providers. Methods: The clonal
relationship between the strains and molecular epidemiological status
were investigated by the pulsed-field gel electrophoresis method.
Results: The first and third strains are isolated from the mobile phone
and the nose of a healthcare provider working in the intensive care unit
were the same. The second and fourth strains were isolated from the
mobile phone and nose of another healthcare provider working in the
intensive care unit were the same. The fifth strain, which was found to
be the same as the second and fourth strains, was isolated from the
mobile phone of another healthcare provider working in the intensive
care unit. No similarity was observed between the other strains.
Conclusion: Our findings indicate that Staphylococcus aureus strains
colonized in the nose of healthcare providers are also transmitted to
other surfaces and that the hospital environment and co-used devices
pose a risk for spread. For this reason, training of healthcare
providers on the infection control procedure, hand hygiene,
environmental disinfection and regular cleaning of mobile phones are
important components in order to prevent hospital-acquired infections.%
\end{abstract}%



\sloppy


\textbf{INTRODUCTION}

\emph{Staphylococcus aureus,} one of the most commonly isolated agents
in both community and hospital-acquired infections
worldwide\textsuperscript{1}\textsubscript{.} One of the important risk
factors for the development of hospital-acquired staphylococcal
infections is\emph{S. aureus} , which is colonized in the noses of
healthcare providers \textsuperscript{2}. This bacterium can be
transmitted to the mobile phones used by healthcare providers through
their hands\textsuperscript{3, 4}.

The relationship between \emph{S. aureus} colonized in the noses of
healthcare providers and \emph{S. aureus} detected in their mobile
phones is still unclear. The question of ``Are mobile phones randomly
contaminated with \emph{S. aureus} or contaminated with \emph{S.
aureus}colonized in the noses of healthcare providers?'' is waiting to
be answered.

The aim of this study was to evaluate the clonal relationship
between\emph{S. aureus} strains isolated from the noses of healthcare
providers working in the internal medicine intensive care unit (IMICU)
and the operating room, and \emph{S. aureus} strains isolated from the
mobile phones of IMICU workers.

\textbf{METHODS}

During the period from December 2014-January 2015, 96 mobile phones of
healthcare providers in IMICU, anesthesia intensive care unit (AICU) and
operating room of our hospital were sampled for bacterial contamination.
On the other hand, during the same period we investigated nasal \emph{S.
aureus} colonization of same healthcare providers. The samples were
screened for bacterial pathogens by standart bacteriological procedures.
The methicillin sensitivity of the identified \emph{S. aureus} isolates
were tested. Eight methicillin-sensitive \emph{S.aureus (MSSA)} strains
isolated from the noses of the healthcare providers and five
\emph{MSSA}strains isolated from their mobile phones were included in
this study. The section from which the strains were isolated,
occupational group and sample distribution are presented in

Table I.

The clonal relationship between the strains and molecular
epidemiological status were investigated by the pulsed-field gel
electrophoresis (PFGE) method. The bacterial DNA was obtained from each
strain by the acromopeptidase method. The DNA macrorestriction analysis
was performed according to the protocol prepared by the Scottish MRSA
Reference Laboratory with the \emph{Sma} I restriction method suggested
by Bannerman et al. \textsuperscript{5} The Chef DR III (Biorad) device
was used for PFGE, and EMRSA 2 and EMRSA 6 strains were included in the
study with the aim of making a comparison. After electrophoresis, the
gel was stained with ethidium bromide (0.5 \selectlanguage{greek}µ\selectlanguage{english}g/ml), and DNA bands were
observed. The clonal relationship between the strains was evaluated
according to the criteria described by Tenover et al. from the DNA band
patterns formed in the gel after
PFGE\textsuperscript{6}\textsubscript{.}

\textbf{RESULTS}

In the evaluation of the strains with the PFGE analysis, the 1st and 3
rd strains, and the 2 nd, 4 th and 5 th strains were identical. The 1st
strain was isolated from the mobile phone of a healthcare provider
working in the IMICU, and the 3 rd strain was isolated from the nose of
the same worker. Similarly, the 2 nd strain was isolated from the mobile
phone of a healthcare provider working in the IMICU, and the 4 th strain
was isolated from the nose of the same worker. The 5 th strain, which
was observed to be identical with the 2 nd and 4 th strains, was
isolated from the mobile phone of another healthcare provider working in
the IMICU. No similarity was observed between other strains ( Figure 1)
.

\textbf{DISCUSSION}

Bacterial contamination of healthcare providers' mobile phones is an
extensively studied subject \textsuperscript{7}. However, the
relationship between nasal colonization and mobile phone contamination
is not well understood. In this study, we conducted PFGE to investigate
the closeness between \emph{S.aureus} strains isolated from the noses
and mobile phones of healthcare providers. We found that out \emph{S.
aureus} strains isolated from the mobile phones of two healthcare
providers and \emph{S. aureus} strains isolated from their noses were
genetically identical. This shows that bacteria colonized in the nose
contaminate mobile phones. Kanayama et al. showed that \emph{S.
aureus}strains isolated from the mobile phones of nurses and \emph{S.
aureus}strains detected in their hands were genetically identical and
mentioned the cross-contamination between mobile phones and
hands\textsuperscript{8}. Furthermore, it was found out in our study
that the strain isolated from the nose and mobile phone of a healthcare
provider and the strain detected on the mobile phone of another
healthcare provider were identical, which shows that \emph{S.aureus}
strains colonized in the noses of healthcare providers can be
transmitted to other surfaces through hands, and that the hospital
environment and the shared devices pose a risk for spread. Similarly,
\emph{S. aureus}strains, which were also genetically identical in the
study of Kanayama et al. were observed in many mobile phones and the
hands of people using them, indicating that these strains spread to
large areas within the hospital through the hands of healthcare
providers using contaminated mobile phones
\textsuperscript{8}\textsubscript{.}

In the study of Chang et al. which examines the bacterial contamination
of mobile phones of healthcare providers working in the operating room
and compares this with the hand and nose colonization of the same
healthcare providers, it was found out that the rate of mobile phone
contamination was 98\%, and also the bacteria in the mobile phones,
hands, and noses of the healthcare providers were identical at the rate
of 94.3 \% \textsuperscript{9} \textsubscript{.}

In their study, Brady et al. demonstrated the relationship between
nasal\emph{S. aureus} carriage of healthcare providers and the \emph{S.
aureus} contamination of the mobile phones used by patients and
emphasized the risk of cross-contamination \textsuperscript{10}. Shi et
al. reported the cross-contamination of \emph{S. aureus} on the surfaces
which healthcare providers contacted with their hands in a large city
hospital \textsuperscript{11}.

In many studies conducted, it was reported that nasal \emph{S.
aureus}carriage was detected at a high rate in healthcare providers.
Chang et al. detected that \emph{S. aureus} nasal carriage in 19,9 \% of
healthcare providers \textsuperscript{9}. According to other studies in
the literature, this rate was reported to be 30 \% in a study conducted
in Argentina, 12 \% in a study conducted in Ethiopia, and 26 \% in a
study conducted in India \textsuperscript{12-14}\textsubscript{.}

The findings of our study indicate that mobile phones used by healthcare
providers may be reservoirs for potential pathogens in nasal
colonization. The most common potential pathogen \emph{S. aureus} is
encountered in surgical site infections, pneumonia, septicemia and
instrument-related infections. The identification of the relationship
between \emph{S. aureus} strains isolated from these infections and
\emph{S. aureus} strains isolated from the noses and mobile phones of
healthcare providers will be useful in determining the ways of infection
transmission.

\textbf{CONCLUSION}

In the light of these findings, it is important that mobile phone use
should be regulated and cleanliness should not be neglected in areas
with a high risk of infection in the hospital. Hand hygiene is one of
the basic factors in the prevention of hospital
infections\textsuperscript{15.} Hand hygiene must be definitely ensured
after the use of a mobile phone and before contact with the patient. In
addition to appropriate hand hygiene, it is important to determine the
healthcare providers with \emph{S. aureus} nasal carriage, to treat the
carriage and to pay attention to the use of shared devices to prevent
hospital-acquired infections.

\textbf{AUTHOR CONTRIBUTIONS :}

All authors were involved in the conception or design of the study, data
analysis and interpretation, drafting, critical revision and approval of
article.

\textbf{Table I:} Isolated section, occupational group and sample
distribution of the strains\selectlanguage{english}
\begin{longtable}[]{@{}lllll@{}}
\toprule
Strain No & Sample used in isolation & Section & Occupational group &
PFGE Pattern\tabularnewline
\midrule
\endhead
1 & Mobile phone & IMICU\textsuperscript{A} & Doctor 1 &
A\tabularnewline
2 & Mobile phone & IMICU & Doctor 2 & B\tabularnewline
3 & Nose & IMICU & Doctor 1 & A\tabularnewline
4 & Nose & IMICU & Doctor 2 & B\tabularnewline
5 & Mobile phone & IMICU & Doctor 3 & B\tabularnewline
6 & Mobile phone & IMICU & Allied Health Personnel 1 & C\tabularnewline
7 & Mobile phone & IMICU & Nurse 1 & D\tabularnewline
8 & Nose & IMICU & Doctor 4 & E\tabularnewline
9 & Nose & IMICU & Allied Health Personnel 2 & F\tabularnewline
10 & Nose & Operating Room & Allied Health Personnel 3 &
G\tabularnewline
11 & Nose & IMICU & Doctor 5 & H\tabularnewline
12 & Nose & Operating Room & Allied Health Personnel 4 &
I\tabularnewline
13 & Nose & IMICU & Allied Health Personnel 5 & J\tabularnewline
\bottomrule
\end{longtable}

\textsuperscript{A}Internal medicine intensive care unit

\textbf{Figure 1:} PFGE band patterns of strains (Batches 1-13: strains
isolated from the noses and mobile phones of healthcare workers, K1:
EMRSA 2, K2: EMRSA 6)\selectlanguage{english}
\begin{figure}[H]
\begin{center}
\includegraphics[width=0.70\columnwidth]{figures/image1/image1}

\end{center}
\end{figure}

\textbf{REFERENCES}

\begin{enumerate}
\tightlist
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