Less haste, more speed: Robust risk-benefit analysis needed

Rapid response to BMJ letter Doctors taking a pulse using their mobile phone can spread MRSA by our CEO.

The authors of a recent small study on the contamination risk associated with mobile phone usage in a clinical environment[1] should be congratulated for their contribution to the broader topic of appropriate use of mobile devices in healthcare. More studies like this are needed to develop a comprehensive understanding of the use of this technology, the risks involved, the mitigating actions that can be taken, and the costs associated.  This should then be balanced with the benefits that greater adoption of wireless technology can bring to the health system as a whole, with the ultimate goal of developing evidence-based, practical guidelines for its safe and proper use.

Developing such guidelines is no simple task. Bacterial contamination represents just one risk type associated with wireless device use in healthcare[2]. Wireless devices are multifunction devices amongst a plethora of high and low technology alternatives (PCs, pagers, landlines phones, wristwatches, books, paper and pen etc.) and should therefore be considered in this context.

However we agree with recent calls that guidelines should be developed as a matter of urgency. Our 2010 survey showed that over 80% of UK doctors own and use a mobile phone at work[3], and recent research has shown that between 9-25% of mobile communication devices used in hospitals are contaminated with pathogenic bacteria[4]. Further studies have shown variable knowledge and understanding of infection control protocols[5], and that 90% of healthcare professionals have never cleaned their mobile phone[6].

It would therefore seem appropriate for any such guidelines to advise healthcare professionals on how to decontaminate their wireless device, and at what frequency, especially as many devices fulfil a dual role supporting professional use at work and personal use at home. Existing literature suggests the efficacy of alcohol based solution over ultraviolet irradiation[4]. By logical extension, the use of hands free technology may be advantageous as this reduces the number of touches and the proximity of the device to the face. Further, devices that incorporate fewer switches or keys as part of their design (i.e. touchscreen technology) may prove easier to clean, while anti-microbial cases and covers may be prudent accessories.

Finally, for those readers that caught sight of the original article via the byline of “Unhelpful apps”, we recently published a report [7] that serves as a primer for those interested in producing or using health apps and how to mitigate the associated risks.

1. Morris TC, Moore LSP, Shaunak S. Doctors taking a pulse using their mobile phone can spread MRSA. BMJ 2012;344:e412
2. Visvanathan A, Gibb AP, Brady RR. Increasing clinical presence of mobile communication technology: avoiding the pitfalls. Telemed J E Health 2011;17:656-61.
3. Nolan T. A smarter way to practise. BMJ 2011;342:d1124.
4. Brady RR, Verran J, Damani NN, Gibb AP. Review of mobile communication devices as potential reservoirs of nosocomial pathogens. J. Hosp. Infect. 2009; 71:295-300.
5. Brady RR, McDermott C, Cameron F, Graham C, Gibb AP. UK healthcare workers’ knowledge of meticillin-resistant Staphylococcus aureus practice guidelines; a questionnaire study. J. Hosp. Infect. 2009;73:264-70.
6. Ulger F, Esen S, Dilek A, Yanik K, Gunaydin M, Leblebicioglu H. Are we aware how contaminated our mobile phones with nosocomial pathogens? Ann. Clin. Microbiol. Antimicrob. 2009;8:7.
7. d4. The regulation of health apps: a practical guide. http://www.d4.org.uk/research/ January 2012.

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