Healthcare Derived Smart Watches and Mobile Phones are Contaminated Niches to Multidrug Resistant and Highly Virulent Microbes

Figures & data

Table 1 Demographic Profile and the Mobile Phone Utilization and Cleaning Practices of Participants

Study ID	ER_14	ER_27	ER_41	ER_54
Age bracket (years)*	26–55	< 25 years	26–55	26–55
Gender	Male	Female	Female	Female
Staff category	Nurse	Physician	Physician	Unspecified*
Use of digital device during the work shift	Yes	Yes	Yes	Yes
Digital devices used during the work shift	Mobile phone only	Smart watch and mobile phone	Smart watch and mobile phone	Smart watch and mobile phone
Use of digital device is considered essential for work purposes	Yes	Yes	Yes	Yes
Last time digital devices were cleaned	> 24 hours but within the last one week	> 1 hour but within last 24 hours	> 24 hours but within the last one week	No response
Preferred method for cleaning the digital devices	Alcohol swab/disinfectant spray	Dry cloth/ non-disinfectant wipe	Alcohol swab/disinfectant spray	No response
Use of digital devices in the toilet	Yes	Yes	No	Yes
Mobile phones can harbour microbes	Yes	Yes	Yes	Yes

Note: *Respondent did not indicate.

Table 2 Distribution of Bacteria Identified by Culture-Based Methods on Swabs Obtained from the Devices and Hands of Healthcare Workers

Study ID	Microorganisms Identified on Bacterial Culture
	Hand Swab	Smart Watch	Mobile Phone
ER_14	Aerococcus viridans Staphylococcus epidermidis Staphylococcus hominis	Staphylococcus epidermidis	Staphylococcus epidermidis
ER_27	Staphylococcus hominis	Micrococcus luteus	Staphylococcus epidermidis Staphylococcus hominis
ER_41	Staphylococcus hominis	Staphylococcus epidermidis	Staphylococcus hominis
ER_54	Staphylococcus hominis Enterococcus faecalis	Staphylococcus hominis Staphylococcus cohnii	Staphylococcus hominis

Notes: S. hominis and S. epidermidis isolates were resistant to: benzylpenicillin, oxacillin, erythromycin, fusidic acid, tetracycline, trimethoprim/sulfamethoxazole. E. faecalis was resistant to: gentamicin, erythromycin, tetracycline.

Table 3 Abundance of Microbial Diversity and Number of Genes Related to Antibiotic Resistance and Virulent Factors for Each Participant

Study ID	Occupation	Diversity of Microorganisms and Number of ARG & VFG
		Bacteria		Fungi		Protists		Viruses		Phages		ARG		VFG
		MP	SW	MP	SW	MP	SW	MP	SW	MP	SW	MP	SW	MP	SW
ER-14	Nurse	63	17	7	3	3	0	2	1	39	9	40	36	149	143
ER-27	Physician	72	17	5	3	0	0	0	0	26	9	41	36	153	145
ER-41	Physician	13	11	3	3	0	0	0	0	86	17	37	36	143	145
ER-54	Unspecified	87	114	4	6	2	0	1	2	78	82	49	64	156	185
Total		235	159	19	15	5	0	3	3	229	117	167	172	601	618

Abbreviations: MP, mobile phones; SW, smart watches; ARG, antibiotic resistance genes; VFG, virulent factor genes.

Figure 1 Boxplot showing the distribution of bacterial strains identified on smartwatches and mobile phones.

Figure 2 Phylum profile of bacteria specifically detected on mobile phones or smart watches.

Figure 3 Comparison of bacteria present on smart watches and mobile phones.

Notes: (A) Highest bacterial hits found on smart watches compared to the same bacteria found on mobile phones. (B) Highest bacterial hits found on mobile phones compared to the same bacteria found on smart watches.

Figure 4 Distribution of bacteriophages retrieved with the most hits.

Table 4 Multidrug Resistance Efflux Pumps Genes Omnipresent on All Smart Watches and Mobile Phones with Reported Corresponding Efflux Pump Phenotypes

Multidrug Resistant Efflux Pump Genes Detected on Metagenomic Profiling			Corresponding Efflux Pump Phenotype
Fusion Protein	Inner Membrane Transporter	Outer Membrane Channel
amrA	amrB	oprM	AmrAB-oprM
mexA	mexB	oprM	MexAB-oprM
mexC	mexD	oprJ	MexCD-oprJ
mexE	mexF	oprN	MexEF-oprN
(MexG) mexH	mexI	opmD	MexGHI-opmD
mexJ	NA	opmH	MexJK-opmH
mexM	mexN	oprM	MexMN-oprM
mexP	mexQ	opmE	MexPQ-opmE
triA, triB	triC	opmH	TriABC-opmH

Table 5 Regulatory Genes for Efflux Pumps Present on Smart Watches and Mobile Phones of Healthcare Workers

Efflux Pump Regulator Genes (Metagenomic Profiling)	MDR Efflux Pumps Resistance-Nodulation-Cell Division (RND)	Drug Class Conferred Resistance
Repressor nalC (PA3721) and nalD (PA3574)	MexAB-oprM	Aminoglycosides; amphenicols; β-lactams (except imipenem); fluoroquinolones; macrolides; novobiocin; sulphonamides; tetracyclines; thiolactomycin; tigecycline; trimethoprim
Repressor-of-efflux-complex nfxB	MexCD-oprJ	Chloramphenicol; fluoroquinolones; macrolides; zwitterionic cephalosporins; tetracyclines; trimethoprim
Suppressor-of-MexT mexS	MexEF-oprN	Chloramphenicol; fluoroquinolones; tetracycline; trimethoprim
Sensor-protein soxR	MexGHI-opmD	Vanadium, norfloxacin, and acriflavin
Repressor-of-mexJK mexL	MexJK-opmH	Triclosan
Repressor-of-efflux-complex phoP*	MexPQ-opmE	Disinfecting agents and intercalating dyes, phenicol antibiotic, diaminopyrimidine antibiotic, carbapenem, tetracycline antibiotic, acridine dye, macrolide antibiotic

Note: *rhe Repressor-of-efflux-complex phoP was found uniquely in 50% of smart watches and absent from mobile phones.