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Pontes DO, Costa DDM, da Silva Pereira PP, Whiteley GS, Glasbey T, Tipple AFV. Adenosine triphosphate (ATP) sampling algorithm for monitoring the cleanliness of surgical instruments. PLoS One 2023; 18:e0284967. [PMID: 37582099 PMCID: PMC10426997 DOI: 10.1371/journal.pone.0284967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 04/13/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Timely detection of cleaning failure is critical for quality assurance within Sterilising Service Units (SSUs). Rapid Adenosine Triphosphate (ATP) testing provides a real time and quantitative indication of cellular contaminants, when used to measure surface or device cleanliness. The aim of this study was to investigate the use of an ATP algorithm and to whether it could be used as a routine quality assurance step, to monitor surgical instruments cleanliness in SSUs prior to sterilisation. METHODS Cleanliness monitoring using rapid ATP testing was undertaken in the SSUs of four hospitals located in the western (Amazonia) region of Brazil. ATP testing was conducted (Clean Trace, 3M) on 163 surgical instruments, following manual cleaning. A sampling algorithm using a duplicate swab approach was applied to indicate surgical instruments as (i) very clean, (ii) clean, (iii) equivocal or (iv) fail, based around a 'clean' cut-off of 250 Relative Light Units (RLU) and a 'very clean' <100 RLU. RESULTS The four cleanliness categories were significantly differentiated (P≤0.001). The worst performing locations (hospitals A & C) had failure rates of 39.2% and 32.4%, respectively, and were distinctly different from hospitals B & D (P≤0.001). The best performing hospitals (B & D) had failure rates of 7.7% and 2.8%, respectively. CONCLUSION The ATP testing algorithm provides a simple to use method within SSUs. The measurements are in real time, quantitative and useful for risk-based quality assurance monitoring, and the tool can be used for staff training. The four-tiered approach to the grading of surgical instrument cleanliness provides a nuanced approach for continuous quality improvement within SSU than does a simple pass/fail methodology.
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Affiliation(s)
- Daniela Oliveira Pontes
- Faculty of Nursing, Federal University of Goiás, Catalão, Brazil
- Nursing Department, Federal University of Rondônia, Porto Velho, Brazil
| | - Dayane de Melo Costa
- Faculty of Nursing, Federal University of Goiás, Catalão, Brazil
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | | | - Greg S. Whiteley
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- School of Medicine, Western Sydney University, Penrith, Australia
- Whiteley Corporation, Kewdale, Australia
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Kim YJ, Hong MY, Kang HM, Yum SK, Youn YA, Lee DG, Kang JH. Using adenosine triphosphate bioluminescence level monitoring to identify bacterial reservoirs during two consecutive Enterococcus faecium and Staphylococcus capitis nosocomial infection outbreaks at a neonatal intensive care unit. Antimicrob Resist Infect Control 2023; 12:68. [PMID: 37443079 PMCID: PMC10339505 DOI: 10.1186/s13756-023-01273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/05/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION This study aimed to assess the role of adenosine triphosphate (ATP) bioluminescence level monitoring for identifying reservoirs of the outbreak pathogen during two consecutive outbreaks caused by Enterococcus faecium and Staphylococcus capitis at a neonatal intensive care unit (NICU). The secondary aim was to evaluate the long-term sustainability of the infection control measures employed one year after the final intervention measures. METHODS Two outbreaks occurred during a 53-day period in two disconnected subunits, A and B, that share the same attending physicians. ATP bioluminescence level monitoring, environmental cultures, and hand cultures from healthcare workers (HCW) in the NICU were performed. Pulsed-field gel electrophoresis (PFGE) typing was carried out to investigate the phylogenetic relatedness of the isolated strains. RESULTS Four cases of E. faecium sepsis (patients A-8, A-7, A-9, B-8) and three cases of S. capitis sepsis (patients A-16, A-2, B-8) were diagnosed in six preterm infants over a span of 53 days. ATP levels remained high on keyboard 1 of the main station (2076 relative light unit [RLU]/100 cm2) and the keyboard of bed A-9 (4886 RLU/100 cm2). By guidance with the ATP results, environmental cultures showed that E. faecium isolated from the patients and from the main station's keyboard 1 were genotypically indistinguishable. Two different S. capitis strains caused sepsis in three patients. A total 77.8% (n = 7/9) of S. capitis cultured from HCW's hands were genotypically indistinguishable to the strains isolated from A-2 and A-16. The remaining 22.2% (n = 2/9) were genotypically indistinguishable to patient B-8. Three interventions to decrease the risk of bacterial transmission were applied, with the final intervention including a switch of all keyboards and mice in NICU-A and B to disinfectable ones. Post-intervention prospective monitoring up to one year showed a decrease in blood culture positivity (P = 0.0019) and catheter-related blood stream infection rate (P = 0.016) before and after intervention. CONCLUSION ATP monitoring is an effective tool in identifying difficult to disinfect areas in NICUs. Non-medical devices may serve as reservoirs of pathogens causing nosocomial outbreaks, and HCWs' hands contribute to bacterial transmission in NICUs.
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Affiliation(s)
- Ye Ji Kim
- Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- Infection Control Office, Seoul St. Mary's Hospital, Seoul, Republic of Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Yeong Hong
- Infection Control Office, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Hyun Mi Kang
- Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
- Infection Control Office, Seoul St. Mary's Hospital, Seoul, Republic of Korea.
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Sook Kyung Yum
- Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Ah Youn
- Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Gun Lee
- Infection Control Office, Seoul St. Mary's Hospital, Seoul, Republic of Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Han Kang
- Department of Pediatrics, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Madureira RADS, de Oliveira AC. Cleaning of in-hospital flexible endoscopes: Limitations and challenges. Rev Lat Am Enfermagem 2022; 30:e3684. [PMID: 36287399 PMCID: PMC9580990 DOI: 10.1590/1518-8345.5969.3684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE to analyze the cleaning process of gastroscopes, colonoscopes and duodenoscopes in eight in-hospital health services. METHOD a cross-sectional study conducted with 22 endoscopes (eight gastroscopes, eight colonoscopes and six duodenoscopes), and microbiological analysis of 60 samples of air/water channels (all endoscopes) and elevator (duodenoscopes), in addition to protein testing. Descriptive statistics with calculation of frequencies and central tendency measures was used in data analysis. RESULTS the processing of 22 endoscopes was monitored with microbiological analysis for 60 channels. In the pre-cleaning procedure, in 82.3% (14/17) of the devices, gauze was used in cleaning the insertion tube. Incomplete immersion of the endoscope in detergent solution occurred in 72.3% (17/22) of the cases, and in 63.6% (14/22) there was no standardization of filling-in of the channels. Friction of the biopsy channel was not performed in 13.6% (3/22) of the devices. In the microbiological analysis, 25% (7/32) of the samples from the stored endoscopes were positive for microbial growth (from 2x101 to 9.5x104 CFU/mL), while after processing, contamination was 32% (9/28). Protein residues in the elevator channel were detected in 33% of duodenoscopes. CONCLUSION the results indicate important gaps in the stages of pre-cleaning and cleaning of endoscopes that, associated with presence of protein residues and growth of microorganisms of epidemiological importance, indicate limitations in safety of the processing procedures, which can compromise the disinfection processes and, consequently, their safe use among patients subjected to such tests.
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Bakke M. A Comprehensive Analysis of ATP Tests: Practical Use and Recent Progress in the Total Adenylate Test for the Effective Monitoring of Hygiene. J Food Prot 2022; 85:1079-1095. [PMID: 35503956 DOI: 10.4315/jfp-21-384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/26/2022] [Indexed: 11/11/2022]
Abstract
ABSTRACT Rapid hygiene monitoring tests based on the presence of ATP have been widely used in the food industry to ensure that adequate cleanliness is maintained. In this study, the practical applications and limitations of these tests and recent technological progress for facilitating more accurate control were evaluated. The presence of ATP on a surface indicates improper cleaning and the presence of contaminants, including organic debris and bacteria. Food residues are indicators of insufficient cleaning and are direct hazards because they may provide safe harbors for bacteria, provide sources of nutrients for bacterial growth, interfere with the antimicrobial activity of disinfectants, and support the formation of biofilms. Residues of allergenic foods on a surface may increase the risk of allergen cross-contact. However, ATP tests cannot detect bacteria or allergenic proteins directly. To ensure efficient use of commercially available ATP tests, in-depth knowledge is needed regarding their practical applications, methods for determining pass-fail limits, and differences in performance. Conventional ATP tests have limitations due to possible hydrolysis of ATP to ADP and AMP, which further hinders the identification of food residues. To overcome this problem, a total adenylate test was developed that could detect ATP+ADP+AMP (A3 test). The A3 test is suitable for the detection of adenylates from food residues and useful for verification of hygiene levels. The A3 test in conjunction with other methods, such as microorganism culture and food allergen tests, may be a useful strategy for identifying contamination sources and facilitating effective hygiene management. HIGHLIGHTS
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Affiliation(s)
- Mikio Bakke
- Kikkoman Biochemifa Company, Marketing & Planning Division, 2-1-1 Nishi-shinbashi, Minato-ku, Tokyo 105-0003, Japan
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Madureira RADS, Oliveira ACD. Limpieza de endoscopios flexibles intrahospitalarios: limitaciones y desafíos. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.5969.3683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Resumen Objetivo: analizar el proceso de limpieza de gastroscopios, colonoscopios y duodenoscopios en ocho servicios de salud intrahospitalarios. Método: estudio transversal con 22 endoscopios, de los cuales ocho eran gastroscopios, ocho colonoscopios y seis duodenoscopios, y análisis microbiológico de 60 muestras de los canales de aire/agua (todos los endoscopios) y elevador (duodenoscopios), además de prueba de proteínas. En el análisis de los datos se utilizó estadística descriptiva, con cálculo de frecuencias y medidas de tendencia central. Resultados: el procesamiento de los 22 endoscopios fue monitoreado con el análisis microbiológico de 60 canales. En la prelimpieza, en el 82,3% (14/17) de los equipos se utilizó gasa para limpiar el tubo de inserción. En el 72,3% (17/22) de los casos la inmersión del endoscopio en solución detergente fue incompleta y en el 63,6% (14/22) no hubo estandarización del llenado de los canales. La fricción del canal de biopsia no se realizó en el 13,6% (3/22) de los equipos. En el análisis microbiológico, el 25% (7/32) de las muestras endoscópicas almacenadas dio positivo para crecimiento microbiano (2x101 a 9,5x104 UFC/ml), mientras que después del procesamiento, la contaminación fue del 32% (9/28). Se detectaron residuos de proteína en el canal elevador en el 33% de los duodenoscopios. Conclusión: los resultados indican que hay importantes lagunas en las etapas de prelimpieza y limpieza de los endoscopios que, junto con la presencia de residuos de proteínas y del crecimiento de microorganismos de importancia epidemiológica, indican limitaciones en la seguridad del procesamiento, que pueden comprometer los procesos de desinfección y, por ende, el uso seguro en los pacientes que se someten a esos procedimientos.
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Madureira RADS, Oliveira ACD. Limpeza de endoscópios flexíveis intra-hospitalares: limitações e desafios. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.5969.3685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Resumo Objetivo: analisar o processo de limpeza de gastroscópios, colonoscópios e duodenoscópios em oito serviços de saúde intra-hospitalar. Método: estudo transversal com 22 endoscópios, sendo oito gastroscópios, oito colonoscópios e seis duodenoscópios, e análise microbiológica de 60 amostras dos canais de ar/água (todos os endoscópios) e elevador (duodenoscópios), além de teste de proteína. Na análise dos dados, utilizou-se estatística descritiva, com cálculo de frequências e medidas de tendência central. Resultados: o processamento de 22 endoscópios foi acompanhado com análise microbiológica de 60 canais. Na pré-limpeza, em 82,3% (14/17) dos equipamentos, foi utilizada gaze na limpeza do tubo de inserção. A imersão incompleta do endoscópio em solução detergente ocorreu em 72,3% (17/22) dos casos, e em 63,6% (14/22) não havia padronização do preenchimento dos canais. A fricção do canal de biópsia não foi realizada em 13,6% (3/22) dos equipamentos. Na análise microbiológica, 25% (7/32) das amostras dos endoscópios armazenados foram positivas para crescimento microbiano (2x101 a 9,5x104 UFC/mL), enquanto após o processamento, a contaminação foi de 32% (9/28). Resíduos de proteína no canal do elevador foram detectados em 33% dos duodenoscópios. Conclusão: os resultados apontam lacunas importantes nas etapas de pré-limpeza e limpeza dos endoscópios que, associadas à presença de resíduos de proteína e ao crescimento de microrganismo de importância epidemiológica, sinalizam limitações na segurança do processamento, que podem comprometer os processos de desinfecção e consequentemente seu uso seguro entre pacientes submetidos a tais exames.
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Health Care Environmental Hygiene: New Insights and Centers for Disease Control and Prevention Guidance. Infect Dis Clin North Am 2021; 35:609-629. [PMID: 34362536 DOI: 10.1016/j.idc.2021.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Recent research has significantly clarified the impact of optimizing patient-zone environmental hygiene. New insights into the environmental microbial epidemiology of many hospital-associated pathogens, especially Clostridioides difficile, have clarified and quantified the role of ongoing occult pathogen transmission from the near-patient environment. The recent development of safe, broadly effective surface chemical disinfectants has led to new opportunities to broadly enhance environmental hygiene in all health care settings. The Centers for Disease Control and Prevention has recently developed a detailed guidance to assist all health care settings in implementing optimized programs to mitigate health care-associated pathogen transmission from the near-patient surfaces.
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Whiteley GS, Glasbey TO, Fahey PP. Using a simplified ATP algorithm to improve data reliability and improve cleanliness standards for surface and medical device hygiene. Infect Dis Health 2021; 27:3-9. [PMID: 34391730 DOI: 10.1016/j.idh.2021.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/05/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND An algorithm has been improved to mitigate variability in cleanliness measurements of various surfaces using rapid Adenosine Triphosphate (ATP) testing. A cleaning intervention step (CIS) verifies the cleanability of those surfaces. METHODS ATP testing was performed on surfaces which were pre-approved as "clean" and ready for re-use. Adjacent (duplicate) ATP sampling was undertaken on 421 environmental surfaces, medical devices and other implements. The CIS was conducted on 270 surfaces using an aseptic technique and disposable cleaning wipes. RESULTS The two initial ATP results were plotted against each other with a 100 RLU threshold grading the results as clean (2x < 100RLU), dirty (2x > 100RLU) or equivocal (1x < 100RLU and 1x > 100RLU). Of the surfaces sampled, 68.5 % were clean (288/421), 13.5 % were dirty (57/421) and 18 % were equivocal (76/421). The duplicate testing demonstrated a false negative rate of 10 % (44/421) where the first swab was <100 RLU and the second swab >100 RLU. For the equivocal group, the gap between the two swabs was >100 RLU for 7.5 % of surfaces (33/421). The CIS was conducted on 270 of the surfaces tested and showed that cleaning could be improved (P=<0.001) on 88.5 % of surfaces (239/270). CONCLUSION The simplified ATP testing algorithm provides real-time discrimination between surface cleanliness levels and improved certainty over surface hygiene. The duplicate swab sampling approach mitigates uncontrolled variability in the results and the CIS provides a nuanced understanding of the measurable cleanliness of any surface.
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Affiliation(s)
- Greg S Whiteley
- School of Medicine, Western Sydney University, Australia; Whiteley Corporation, Western Sydney University, Australia.
| | - Trevor O Glasbey
- Whiteley Corporation, Western Sydney University, Australia; Macquarie University, Western Sydney University, Australia
| | - Paul P Fahey
- School of Health Sciences, Western Sydney University, Australia
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Liu J, Tian M, Song R, Li Y, Cao Z, Li Q, Liu J, Xu S, Wang J. Graphene field effect transistor for ultrasensitive label-free detection of ATP and Adenosine. BIO WEB OF CONFERENCES 2021. [DOI: 10.1051/bioconf/20213002007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Because of unique electrical and structural properties, graphene has attracted widespread attention in biosensing applications. In this paper, a single layer of graphene was grown by chemical vapor deposition (CVD). Using graphene as the electric channel, a graphene field effect transistor (G-FET) biosensor was fabricated and used to detect adenosine triphosphate (ATP) and adenosine. Compared with traditional methods, the G-FET biosensor has the advantages of higher sensitivity and better stability. The sensor showed high performance and achieved a detection limit down to 0.5 pM for both ATP and adenosine. Moreover, the G-FET biosensor showed an excellent linear electrical response to ATP concentrations in a broad range from 0.5 pM to 50 μM. The developed graphene biosensor has high sensitivity, simple operation, and fast analysis speed, which may provide a new feasible direction to detect ATP and adenosine. Healthy sexually mature male laboratory Wistar rats, weighing 180-200 gr (“FSUE “Nursery of laboratory animals “Rappolovo”) and having been placed under quarantine not less than for 14 days, were selected for the experiment.
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Mildenhall KB, Rankin SA. Implications of Adenylate Metabolism in Hygiene Assessment: A Review. J Food Prot 2020; 83:1619-1631. [PMID: 32338738 DOI: 10.4315/jfp-20-087] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/24/2020] [Indexed: 11/11/2022]
Abstract
The assessment of a hygienic state or cleanliness of contact surfaces has significant implications for food and medical industries seeking to monitor sanitation and exert improved control over a host of operations affecting human health. Methods used to make such assessments commonly involve visual inspections, standard microbial plating practices, and the application of ATP-based assays. Visual methods for inspection of hygienic states are inherently subjective and limited in efficacy by the accuracy of human senses, the degree of task-specific work experience, and various sources of human bias. Standard microbial swabbing and plating techniques are limited in that they require hours or even days of incubation to generate results, with such steps as enrichment and colony outgrowth resulting in delays that are often incompatible with manufacturing or usage schedules. Rapid in conduct and considered more objective in operation than visual or tactile inspection techniques, swabbing surfaces using ATP-based assessments are relied on as routine, even standard, methods of hygienic assessment alone or in complement with microbial and visual inspection methods. Still, current ATP methods remain indirect methods of total hygiene assessment and have limitations that must be understood and considered if such methods are to be applied judiciously, especially under increasingly strict demands for the verification of hygiene state. Here, we present current methods of ATP-based bioluminescence assays and describe the limitations of such methods when applied to general food manufacturing or health care facilities.
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Affiliation(s)
- Kristen B Mildenhall
- Department of Food Science, University of Wisconsin-Madison, Madison, Wisconsin 53528, USA (ORCID: https://orcid.org/0000-0001-6784-6770 [S.A.R.])
| | - Scott A Rankin
- Department of Food Science, University of Wisconsin-Madison, Madison, Wisconsin 53528, USA (ORCID: https://orcid.org/0000-0001-6784-6770 [S.A.R.])
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Sanna T, Dallolio L, Raggi A, Mazzetti M, Lorusso G, Zanni A, Farruggia P, Leoni E. ATP bioluminescence assay for evaluating cleaning practices in operating theatres: applicability and limitations. BMC Infect Dis 2018; 18:583. [PMID: 30453892 PMCID: PMC6245901 DOI: 10.1186/s12879-018-3505-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 11/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background Environmental cleaning practice plays an important role in reducing microbial contamination in hospital surfaces and contributes to prevent Healthcare Associated Infections. Adenosine Triphosphate (ATP) bioluminescence assay is a commonly used method for assessing environmental cleanliness on healthcare surfaces. This study tested the feasibility of using ATP-bioluminescence assay for evaluating the efficiency of cleaning procedures in the operating theatre settings, comparing the ATP-bioluminescence test with the traditional culture method. Methods The surfaces of 10 operating rooms of two public hospitals (140 samples in total) were examined “at rest”, in two moments of the same daily session: before the first scheduled operation (Pre), and before the second, after a clean environment was re-established (Post). Surface contamination was assessed using the cultural method to detect Total Viable Counts (TVC36°C) and ATP-bioluminescence assay (RLU). Results The examined surfaces presented very low TVCs (geometric means: 1.8 CFU/plate; IC95%: 1.6–2.0), always compliant with the relative reference standards. No statistical correlation was found between ATP values and TVCs. However, considering the results in terms of general evaluation of hygienic quality of surfaces, the two methods were consistent in identifying the most contaminated areas (Hospital A > Hospital B; Pre > Post; most contaminated surfaces: scialytic lamp). Furthermore, the ATP mean values showed a progressive increase from surfaces with TVC = 0 to surfaces with TVC > 15 CFU/plate. Conclusions Although not an alternative to cultural methods, the ATP-bioluminescence-assay can be a useful tool to measure the efficiency of cleaning procedures also in environments with very low microbial counts. Each health facility should identify appropriate reference values, depending on the devices used and on the basis of the analysis of the data collected through spatial and temporal sampling series. By providing a rapid feedback, the ATP-assay helps to increase the awareness of operators and allows immediate action to be taken in critical situations.
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Affiliation(s)
- Tiziana Sanna
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, via S. Giacomo 12, 40126, Bologna, Italy
| | - Laura Dallolio
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, via S. Giacomo 12, 40126, Bologna, Italy.
| | - Alessandra Raggi
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, via S. Giacomo 12, 40126, Bologna, Italy
| | - Magda Mazzetti
- Unit of Hygiene, Control of Healthcare Associated Infections, Bologna Local Health Authority, "Bellaria" Hospital, via Altura 3, 40139, Bologna, Italy
| | - Giovanni Lorusso
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, via S. Giacomo 12, 40126, Bologna, Italy
| | - Angela Zanni
- Unit of Hygiene and Quality of Residencial Services, Bologna Local Health Authority, "Bellaria" Hospital, via Altura 3, 40139, Bologna, Italy
| | - Patrizia Farruggia
- Unit of Hygiene and Quality of Residencial Services, Bologna Local Health Authority, "Bellaria" Hospital, via Altura 3, 40139, Bologna, Italy
| | - Erica Leoni
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, via S. Giacomo 12, 40126, Bologna, Italy
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A new sampling algorithm demonstrates that ultrasound equipment cleanliness can be improved. Am J Infect Control 2018; 46:887-892. [PMID: 29551202 DOI: 10.1016/j.ajic.2018.01.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/12/2018] [Accepted: 01/12/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Australia has established guidelines on cleaning for reusable ultrasound probes and accompanying equipment. This is a preliminary study investigating cleanliness standards of patient-ready ultrasound equipment in 5 separate health care facilities within a major city. METHODS The cleanliness was assessed using rapid adenosine triphosphate (ATP) testing used with a sampling algorithm which mitigates variability normally associated with ATP testing. Each surface was initially sampled in duplicate for relative light units (RLUs) and checked for compliance with literature recommended levels of cleanliness (<100 RLUs). Triplicate sampling was undertaken where necessary. A cleaning intervention step (CIS) followed using a disposable detergent wipe, and the surface was retested for ATP. RESULTS There were 253 surfaces tested from the 5 health care facilities with 26% (66/253) demonstrating either equivocal or apparent lack of cleanliness. The CIS was conducted on 148 surfaces and demonstrated that for >91% (135/148) of surfaces, the cleaning standards could be improved significantly (P > .001). For 6% (9/148) of devices and surfaces, the CIS needed to be repeated at least once to achieve the intended level of cleanliness (<25 RLUs). CONCLUSIONS This study indicates that ATP testing is an effective, real-time, quality assurance tool for cleanliness monitoring of ultrasound probes and associated equipment.
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Kenters N, Gottlieb T, Hopman J, Mehtar S, Schweizer ML, Tartari E, Huijskens EGW, Voss A. An international survey of cleaning and disinfection practices in the healthcare environment. J Hosp Infect 2018; 100:236-241. [PMID: 29772262 DOI: 10.1016/j.jhin.2018.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 05/09/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Antimicrobial resistance has become an urgent global health priority. Basic hygiene practices and cleaning and disinfection of the hospital environment are key in preventing pathogen cross-transmission. AIM To our knowledge no studies have assessed the worldwide differences in cleaning and disinfection practices in healthcare facilities. The electronic survey described here was developed in order to evaluate differences in healthcare facility cleaning practices around the world. METHODS The International Society of Antimicrobial Chemotherapy (ISAC, formerly ISC), Infection Prevention and Control work group developed a survey with 30 multiple-choice questions. The questions were designed to assess the current cleaning practices in healthcare settings around the world. FINDINGS A total of 110 healthcare professionals, representing 23 countries, participated in the online survey. In 96% of the facilities a written cleaning policy was present. Training of cleaning staff occurred in 70% of the facilities at the start of employment. Cleaning practices and monitoring of these practices varied. CONCLUSIONS The survey enabled assessment and recognition of widely differing global practices in approaches to environmental cleaning and disinfection. Development of guideline recommendations for cleaning and disinfection could improve practices and set minimum standards worldwide.
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Affiliation(s)
- N Kenters
- Department of Infection Prevention and Control, Albert Schweitzer Hospital, Dordrecht, The Netherlands; Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands.
| | - T Gottlieb
- Department of Microbiology and Infectious Diseases, Concord Hospital, Sydney, Australia
| | - J Hopman
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
| | - S Mehtar
- Unit of Infection Prevention and Control, Stellenbosch University, Cape Town, South Africa
| | - M L Schweizer
- Department of Epidemiology, College of Public Health, Department of Internal Medicine, Iowa, USA
| | - E Tartari
- Infection Control Programme and WHO Collaborating Centre of Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - E G W Huijskens
- Department of Infection Prevention and Control, Albert Schweitzer Hospital, Dordrecht, The Netherlands; Department of Medical Microbiology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - A Voss
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands; Department of Medical Microbiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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Affiliation(s)
- Philip C Carling
- Department of Infectious Diseases, Carney Hospital, 2100 Dorchester Avenue, Boston, MA 02124, USA.
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15
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Whiteley G, Glasbey T, Fahey P. A suggested sampling algorithm for use with ATP testing in cleanliness measurement. Infect Dis Health 2016. [DOI: 10.1016/j.idh.2016.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Ho YH, Wang LS, Jiang HL, Chang CH, Hsieh CJ, Chang DC, Tu HY, Chiu TY, Chao HJ, Tseng CC. Use of a Sampling Area-Adjusted Adenosine Triphosphate Bioluminescence Assay Based on Digital Image Quantification to Assess the Cleanliness of Hospital Surfaces. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13060576. [PMID: 27294944 PMCID: PMC4924033 DOI: 10.3390/ijerph13060576] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 05/24/2016] [Accepted: 06/07/2016] [Indexed: 11/25/2022]
Abstract
Contaminated surfaces play an important role in the transmission of pathogens. We sought to establish a criterion that could indicate "cleanliness" using a sampling area-adjusted adenosine triphosphate (ATP) assay. In the first phase of the study, target surfaces were selected for swab sampling before and after daily cleaning; then, an aerobic colony count (ACC) plate assay of bacteria and antibiotic-resistant bacteria was conducted. ATP swabs were also tested, and the ATP readings were reported as relative light units (RLUs). The results of the ACC and ATP assays were adjusted according to the sampling area. During the second phase of the study, a new cleaning process employing sodium dichloroisocyanurate (NaDCC) was implemented for comparison. Using the criterion of 2.5 colony-forming units (CFU)/cm², 45% of the sampled sites were successfully cleaned during phase one of the study. During phase two, the pass rates of the surface samples (64%) were significantly improved, except under stringent (5 RLU/cm²) and lax (500 RLU) ATP criteria. Using receiver-operating characteristic curve analysis, the best cut-off point for an area-adjusted ATP level was 7.34 RLU/cm², which corresponded to culture-assay levels of <2.5 CFU/cm². An area adjustment of the ATP assay improved the degree of correlation with the ACC-assay results from weak to moderate.
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Affiliation(s)
- Yu-Huai Ho
- Division of Infection Diseases, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University; Hualien 97004, Taiwan.
| | - Lih-Shinn Wang
- Division of Infection Diseases, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University; Hualien 97004, Taiwan.
| | - Hui-Li Jiang
- Unit of Infection Control and Management, Buddhist Tzu Chi General Hospital, Hualien 97004, Taiwan.
| | - Chih-Hui Chang
- Department and Graduate Institute of Public Health, Tzu Chi University, Hualien 97004, Taiwan.
| | - Chia-Jung Hsieh
- Department and Graduate Institute of Public Health, Tzu Chi University, Hualien 97004, Taiwan.
| | - Dan-Chi Chang
- Department and Graduate Institute of Public Health, Tzu Chi University, Hualien 97004, Taiwan.
| | - Hsin-Yu Tu
- Department and Graduate Institute of Public Health, Tzu Chi University, Hualien 97004, Taiwan.
| | - Tan-Yun Chiu
- Department and Graduate Institute of Public Health, Tzu Chi University, Hualien 97004, Taiwan.
| | - Huei-Jen Chao
- Department of Laboratory Medicine, Buddhist Tzu Chi General Hospital, Hualien 97004, Taiwan.
| | - Chun-Chieh Tseng
- Department and Graduate Institute of Public Health, Tzu Chi University, Hualien 97004, Taiwan.
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Whiteley GS, Knight JL, Derry CW, Jensen SO, Vickery K, Gosbell IB. Response to Russotto et al. Am J Infect Control 2016; 44:733-4. [PMID: 27020083 DOI: 10.1016/j.ajic.2016.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 01/20/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Greg S Whiteley
- School of Science and Health, University of Western Sydney, Richmond, NSW, Australia; Whiteley Corporation Pty Ltd, North Sydney, NSW, Australia.
| | - Jessica L Knight
- School of Medicine, University of Western Sydney, Campbelltown, NSW, Australia; Antibiotic Resistance and Mobile Elements Group, Molecular Medicine Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Chris W Derry
- School of Science and Health, University of Western Sydney, Richmond, NSW, Australia
| | - Slade O Jensen
- School of Medicine, University of Western Sydney, Campbelltown, NSW, Australia; Antibiotic Resistance and Mobile Elements Group, Molecular Medicine Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Karen Vickery
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Iain B Gosbell
- School of Medicine, University of Western Sydney, Campbelltown, NSW, Australia; Antibiotic Resistance and Mobile Elements Group, Molecular Medicine Research Group, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia; Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service, Liverpool, NSW, Australia
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Hall L, Farrington A, Mitchell BG, Barnett AG, Halton K, Allen M, Page K, Gardner A, Havers S, Bailey E, Dancer SJ, Riley TV, Gericke CA, Paterson DL, Graves N. Researching effective approaches to cleaning in hospitals: protocol of the REACH study, a multi-site stepped-wedge randomised trial. Implement Sci 2016; 11:44. [PMID: 27009342 PMCID: PMC4806497 DOI: 10.1186/s13012-016-0406-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 03/12/2016] [Indexed: 12/02/2022] Open
Abstract
Background The Researching Effective Approaches to Cleaning in Hospitals (REACH) study will generate evidence about the effectiveness and cost-effectiveness of a novel cleaning initiative that aims to improve the environmental cleanliness of hospitals. The initiative is an environmental cleaning bundle, with five interdependent, evidence-based components (training, technique, product, audit and communication) implemented with environmental services staff to enhance hospital cleaning practices. Methods/design The REACH study will use a stepped-wedge randomised controlled design to test the study intervention, an environmental cleaning bundle, in 11 Australian hospitals. All trial hospitals will receive the intervention and act as their own control, with analysis undertaken of the change within each hospital based on data collected in the control and intervention periods. Each site will be randomised to one of the 11 intervention timings with staggered commencement dates in 2016 and an intervention period between 20 and 50 weeks. All sites complete the trial at the same time in 2017. The inclusion criteria allow for a purposive sample of both public and private hospitals that have higher-risk patient populations for healthcare-associated infections (HAIs). The primary outcome (objective one) is the monthly number of Staphylococcus aureus bacteraemias (SABs), Clostridium difficile infections (CDIs) and vancomycin resistant enterococci (VRE) infections, per 10,000 bed days. Secondary outcomes for objective one include the thoroughness of hospital cleaning assessed using fluorescent marker technology, the bio-burden of frequent touch surfaces post cleaning and changes in staff knowledge and attitudes about environmental cleaning. A cost-effectiveness analysis will determine the second key outcome (objective two): the incremental cost-effectiveness ratio from implementation of the cleaning bundle. The study uses the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) framework to support the tailored implementation of the environmental cleaning bundle in each hospital. Discussion Evidence from the REACH trial will contribute to future policy and practice guidelines about hospital environmental cleaning. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in hospitals. Trial registration Australia New Zealand Clinical Trial Registry ACTRN12615000325505
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Affiliation(s)
- Lisa Hall
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Alison Farrington
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia.
| | - Brett G Mitchell
- Faculty of Nursing and Health, Avondale College, 185 Fox Valley Road, Wahroonga, NSW, 2076, Australia
| | - Adrian G Barnett
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Kate Halton
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Michelle Allen
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Katie Page
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Anne Gardner
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, PO Box 256, Dickson, ACT, 2062, Australia
| | - Sally Havers
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Emily Bailey
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
| | - Stephanie J Dancer
- Department of Microbiology, Hairmyres Hospital, Eaglesham Rd, East Kilbride, G75 8RG, UK
| | - Thomas V Riley
- School of Pathology and Laboratory Medicine, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
| | - Christian A Gericke
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia.,School of Public Health, University of Queensland, Herston, QLD, 4006, Australia
| | - David L Paterson
- Wesley Medical Research, Wesley Hospital, PO Box 499, Toowong, QLD, 4066, Australia.,University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital, Herston, QLD, 4029, Australia
| | - Nicholas Graves
- Institute of Health and Biomedical Innovation, Queensland University of Technology, GPO Box 2434, Brisbane, QLD, 4001, Australia
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Reply to Roady. Infect Control Hosp Epidemiol 2016; 36:1368. [PMID: 26477600 DOI: 10.1017/ice.2015.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Whiteley GS, Knight JL, Derry CW, Jensen SO, Vickery K, Gosbell IB. A pilot study into locating the bad bugs in a busy intensive care unit. Am J Infect Control 2015; 43:1270-5. [PMID: 26654232 DOI: 10.1016/j.ajic.2015.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 07/03/2015] [Accepted: 07/07/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND The persistence of multidrug-resistant organisms (MDROs) within an intensive care unit (ICU) possibly contained within dry surface biofilms, remains a perplexing confounder and is a threat to patient safety. Identification of residential locations of MDRO within the ICU is an intervention for which new scientific approaches may assist in finding potential MDRO reservoirs. METHOD This study investigated a new approach to sampling using a more aggressive environmental swabbing technique of high-touch objects (HTOs) and surfaces, aided by 2 commercially available adenosine triphosphate (ATP) bioluminometers. RESULTS A total of 13 individual MDRO locations identified in this pilot study. The use of ATP bioluminometers was significantly associated with the identification of 12 of the 13 individual MDRO locations. The MDRO recovery and readings from the 2 ATP bioluminometers were not significantly correlated with distinct cutoffs for each ATP device, and there was no correlation between the 2 ATP devices. CONCLUSION The specific MDRO locations were not limited to the immediate patient surroundings or to any specific HTO or type of surface. The use of ATP testing helped rapidly identify the soiled locations for MDRO sampling. The greatest density of positive MDRO locations was around and within the clinical staff work station.
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The Role of ATP Luminometers in Infection Control. Infect Control Hosp Epidemiol 2015; 36:1367. [PMID: 26387800 DOI: 10.1017/ice.2015.209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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