Why do some Doctors ignore Infection Control issues when experimenting with mHealth on the poor?

National Post Toronto Doctor turns his iPhone into field microscope

As for his iPhone, (Dr. Isaac) Bogoch (an Infectious Disease Specialist at Toronto General Hospital) says it takes seconds to turn it back into phone. He simply removes the ball lens and tape, and gives it a “wipe with alcohol”

This is the second time I’ve noticed such complete abandonment of good practice with regard to infection control by Doctors from leading North American Medical Schools as they experiment with ways to provide care for Patients in poorer regions of the world using their mobile phones.

It’s not a surprise that tech writers at the BBC and CNN haven’t picked up on this but it amazes me that the Editors at the American Journal of Tropical Medicine and Hygiene have let this be published in their Journal even though it doesn’t have a single mention or warnings of infection control issues or details of the cleaning procedures being used.

In case there is any doubt:

The value of documenting intestinal worms in a patients stool in a very poor region of the world is not worth risking lives.

If you are collecting stool samples and conducting fecal smears it is a good idea to be trained, to be doing it in a dedicated laboratory environment with proper waste disposal facilities and to be wearing disposable gloves, face mask, etc. The importance of this should be obvious to an Infectious Disease Specialist at the Toronto General Hospital as there are many viruses (like the Novoviruses that have closed Canadian hospitals) that can be present in fecal material that can even become aerosolized.

Even a thorough cleaning process using Alcohol (in the National Post article Dr Isaac Bogoch is quoted as suggesting that a “wipe with alcohol” will be sufficient) will not kill everything and there are certain bacterial spores, protozoa and noneveloped viruses that won’t be affected.

In regions of the world where it would be too expensive to use proper equipment for analysing stools the alcohol-based hand cleansers that are for sale are often of variable quality.

A Mobile phone that hasn’t been cleaned properly will be a fomite that will be capable of transferring infectious organisms to the next person who comes into contact with it and smooth non-porous surfaces like the glass and metal casing of an iPhone will transmit bacteria and viruses very effectively because unlike porous materials it will not absorb and trap any contagion – thus making it easier for it to be contracted via simple touch.

iPhone being used to read fecal smears

*** *** UPDATE: 22 SEPTEMBER 2015 *** ***

A catchily titled “Smartphone Device Can Quickly Diagnosis Cancer” article by Jennifer Nejman Bohonak on a fundraising page for Massachusetts General Hospital is now promoting the work of “a team led by Ralph Weissleder, MD, PhD, director of the Centre for Systems Biology at Massachusetts General Hospital, and Hakho Lee, PhD” that suggests further ways expensive iPhones can be quickly turned into clinical waste:

MassGen Hospital If you use a smartphone used as mircoscope it becomes Clinical Waste

*** *** UPDATE: 3 NOVEMBER 2016 *** ***

I like the approach that IOLight are taking with their mobile connected microscopes.

screen-shot-2016-11-03-at-08-22-36

I think the useful video overview the company has made would benefit from featuring a demo where it’s being used by two lab workers (one doing the prep work with the sample and the other staying ‘clean’ and using the iPad/Mobile):

 

*** *** UPDATE: 18 JANUARY 2017 *** ***

A paper published in Nature on “Targeted DNA sequencing and in situmutation analysis using mobile phone microscopy” suggests it’s a good idea to remote analyse images taken of tumour tissue samples using mobile phones in “resource-limited settings”. Not even a mention of any infection control challenges. HatTip: Vivek Wadhwa 

screen-shot-2017-01-18-at-00-25-03

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2 Responses to Why do some Doctors ignore Infection Control issues when experimenting with mHealth on the poor?

  1. Pingback: How can we help prevent unethical and dangerous alternative uses of mHealth tech? | mHealth Insight: the blog of 3G Doctor

  2. Infections are a serious thread! Also Bill Gates acknowledged a widespread epidemic far worse than Ebola far worse than Ebola in his lifetime as well over 50% not even mentioning hospital-acquired infections: http://locatible.com/blog/grail-hospital-infection-control-contact-seconds/

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