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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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Zeneli A, Petrini M, Foca F, Bernabini M, Ronconi S, Montalti S, Pancisi E, Soldati V, Golinucci M, Frassineti GL, Altini M. Microbiological evaluation of environmental cleanliness in haematopoietic cell transplant patient rooms: implementing JACIE standards. J Hosp Infect 2019; 104:276-282. [PMID: 31785318 DOI: 10.1016/j.jhin.2019.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Environmental hygiene is one of the most important strategies to prevent hospital-acquired infections by reducing pathogens in haematopoietic cell transplant (HCT) patient rooms. This study was designed in response to JACIE requirements for microbiological monitoring, and aimed to assess environmental hygiene in protective isolation rooms. METHODS Environmental cleanliness was assessed by measuring microbial loads in at-rest and operational conditions sampled from target surfaces, and in passive and active air from rooms occupied by patients with different grades of neutropenia. The study also evaluated whether microbial loads were influenced by isolation precautions. RESULTS The failure rate of cleanliness on target surfaces in at-rest conditions was 0% compared with 37% for surfaces and 13% for passive and active air samples in operational conditions. Differences in failure rates were observed in the rooms of patients with different levels of neutropenia (P=0.036 for surfaces, 0.028% for passive air). No relationship was found between infections and microbial loads. CONCLUSIONS Microbiological assessment integrated with an enhanced monitoring programme for hospital hygiene provides invaluable information to drive infection control policies in HCT patients. These results highlight the need to set and validate strict standards for the assessment of cleanliness in a clinical setting.
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Affiliation(s)
- A Zeneli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - M Petrini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy.
| | - F Foca
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - M Bernabini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - S Ronconi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - S Montalti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - E Pancisi
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - V Soldati
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - M Golinucci
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - G L Frassineti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - M Altini
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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3
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Oliveira JB, Teixeira MA, Paiva LFD, Oliveira RFD, Mendonça ARDA, Brito MJAD. In Vitro and In Vivo Antimicrobial Activity of Cymbopogon citratus (DC.) Stapf. Against Staphylococcus spp. Isolated from Newborn Babies in an Intensive Care Unit. Microb Drug Resist 2019; 25:1490-1496. [PMID: 31369340 DOI: 10.1089/mdr.2018.0047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Phytotherapy is an emerging topic of health research, with particular focus on studying the efficiency of essential oils as antimicrobials. In this study, we investigated the in vitro and in vivo susceptibility of Staphylococcus strains isolated from newborns to Cymbopogon citratus oil. The in vitro susceptibility of the microorganisms to C. citratus essential oil was compared with the activities of standard antibiotics administered to newborns using disk diffusion and microdilution methods. For in vivo assessment, 30 Wistar rats were wounded and subjected to infection of Staphylococcus aureus strain DRJ080, followed by treatment with the antibiotic vancomycin, C. citratus, or carbopol polymer gel (control) for 11 days. S. aureus accounted for 23.36% of the 107 Staphylococcus sp. strains isolated. Both vancomycin and the essential oil of C. citratus inhibited the growth of all microorganisms in vitro. The minimum inhibitory and bactericidal concentrations for the C. citratus oil were 0.625 mg/mL in all strains tested. The oil had the same therapeutic effectiveness as vancomycin against S. aureus DRJ080 in rats. Thus, Staphylococcus strains of newborns are sensitive to C. citratus oil, both in vitro and in vivo, demonstrating its potential as an antibiotic alternative.
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Santos-Junior AG, Ferreira AM, Frota OP, Rigotti MA, Barcelos LDS, Lopes de Sousa AF, de Andrade D, Guerra OG, R Furlan MC. Effectiveness of Surface Cleaning and Disinfection in a Brazilian Healthcare Facility. Open Nurs J 2018; 12:36-44. [PMID: 29643951 PMCID: PMC5876921 DOI: 10.2174/1874434601812010036] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/24/2018] [Accepted: 02/22/2018] [Indexed: 11/22/2022] Open
Abstract
Background Failures in the processes of cleaning and disinfecting health service surfaces may result in the spread and transfer of pathogens that are often associated with healthcare-related infections and outbreaks. Aims To assess the effectiveness of environmental surface cleaning and disinfection in a hospital clinic. Method The study was conducted in a nursing ward with 45 beds. A total of 80 samples from five high-touch surfaces were evaluated before and after cleaning and disinfection, using the following methods: visual inspection, adenosine triphosphate bioluminescence assay, aerobic colony count, Staphylococcus aureus colony count, and evaluation of resistance to methicillin. The data analysis used nonparametric comparative and correlative tests to observe any differences in the pre- and post- cleaning and disinfection results for the surfaces assessed. Results Effective cleaning and disinfection had a significant effect on only two surfaces when measured for the presence of adenosine triphosphate, the inner bathroom door handle (p=0.007) and the toilet bowl (p=0.01). When evaluated for Staphylococcus aureus colony count, the toilet flush handle also demonstrated a significant effect (p=0.04). Conclusion The effectiveness of cleaning and disinfection of the surfaces tested was not satisfactory. An educational intervention is recommended for the cleaning and disinfection staff and the nursing team at the healthcare facility. Relevance to Clinical Practice The data in the study revealed that daily hospital cleaning and disinfection in the sampled sites are not sufficient in medical and surgical wards. Hospital cleanliness must be reevaluated from the point of view of materials, such as an adequate supply of clean cloths, in addition to establishing more precise cleanliness protocols and accurate monitoring systems.
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Affiliation(s)
| | - Adriano M Ferreira
- Course of Nursing, Federal University of Mato Grosso do Sul, Coxim, Brazil
| | - Oleci P Frota
- School of Medicine, Program of Health and Development in the Center-West Region and Master's Degree Program in Nursing, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | - Marcelo A Rigotti
- Course of Nursing, Federal University of Mato Grosso do Sul, Campo Grande, Brazil
| | | | | | - Denise de Andrade
- Course of Nursing, Federal University of Mato Grosso do Sul, Três Lagoas, Brazil
| | - Odanir G Guerra
- Course of Nursing, Federal University of Mato Grosso do Sul, Três Lagoas, Brazil
| | - Mara C R Furlan
- Course of Nursing, Federal University of Mato Grosso do Sul, Três Lagoas, Brazil
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Ferreira AM, de Andrade D, Rigotti MA, de Almeida MTG, Guerra OG, dos Santos Junior AG. Assessment of disinfection of hospital surfaces using different monitoring methods. Rev Lat Am Enfermagem 2017; 23:466-74. [PMID: 26312634 PMCID: PMC4547070 DOI: 10.1590/0104-1169.0094.2577] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 01/15/2015] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE: to assess the efficiency of cleaning/disinfection of surfaces of an Intensive
Care Unit. METHOD: descriptive-exploratory study with quantitative approach conducted over the
course of four weeks. Visual inspection, bioluminescence adenosine triphosphate
and microbiological indicators were used to indicate cleanliness/disinfection.
Five surfaces (bed rails, bedside tables, infusion pumps, nurses' counter, and
medical prescription table) were assessed before and after the use of rubbing
alcohol at 70% (w/v), totaling 160 samples for each method. Non-parametric tests
were used considering statistically significant differences at p<0.05. RESULTS: after the cleaning/disinfection process, 87.5, 79.4 and 87.5% of the surfaces
were considered clean using the visual inspection, bioluminescence adenosine
triphosphate and microbiological analyses, respectively. A statistically
significant decrease was observed in the disapproval rates after the cleaning
process considering the three assessment methods; the visual inspection was the
least reliable. CONCLUSION: the cleaning/disinfection method was efficient in reducing microbial load and
organic matter of surfaces, however, these findings require further study to
clarify aspects related to the efficiency of friction, its frequency, and whether
or not there is association with other inputs to achieve improved results of the
cleaning/disinfection process.
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Affiliation(s)
| | - Denise de Andrade
- Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, BR
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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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Rigotti MA, Ferreira AM, Nogueira MCL, Almeida MTGD, Guerra OG, Andrade DD. EVALUATION OF THREE SURFACE FRICTION TECHNIQUES FOR THE REMOVAL OF ORGANIC MATTER. TEXTO & CONTEXTO ENFERMAGEM 2015. [DOI: 10.1590/0104-0707201500003690014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT The objective of this study was to assess the effectiveness of three surface friction techniques for the removal of organic material. A quantitative, descriptive and exploratory study was developed to evaluate the presence or not of organic material before and after the cleaning and disinfection process of surfaces of bedside tables of patients hospitalized at an Intensive Care Unit. Three friction techniques were executed in the one-way, two-way and centrifugal sense, individually, three times on each table, during alternate weeks. For each patient unit and friction technique, a single table and three sides of cloth were used, moistened with 70% (w/v) alcohol. The organic matter was detected through the presence of adenosine triphosphate by bioluminescence, using 3M(tm) Clean-Trace(tm) ATP Systems. For each technique, 13 samples were collected before and 13 after the cleaning/disinfection process, totaling 78 samples of adenosine triphosphate by bioluminescence. No statistically significant difference was found among the removal techniques of organic matter. This study demonstrated that none of the three surface friction methods was better than the other to remove organic matter. Nevertheless, further research is needed in which other cleaning/disinfection indicators and surfaces are considered.
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8
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Oliveira ACD, Viana REH. [Adenosine triphosphate bioluminescence to evaluate the effectiveness of surface cleaning: an integrative review]. Rev Bras Enferm 2014; 67:987-93. [PMID: 25590891 DOI: 10.1590/0034-7167.2014670618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 11/01/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To identify indications and controversies in the literature of the use of ATP bioluminescence to evaluate the effectiveness of surface cleaning in healthcare facilities. METHOD Integrative literature review between 2000 and 2012 in the following databases: MEDLINE, LILACS, Science Direct, SCOPUS and Isi Web of Knowledge. RESULTS were selected for this review 15 articles. The ATP bioluminescence was considered an important educational resource and complementary method to visual inspection and microbiological evaluation of the effectiveness of cleaning. The impossibility to indicate surface contamination by microorganisms, interference by chemicals and the difficulty of interpreting the results constitute the main controversies in the use of ATP in health services. CONCLUSION Although this is an important resource in the evaluation of surface cleaning, more studies are necessary for effective incorporation of the method in health services.
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Affiliation(s)
- Adriana Cristina de Oliveira
- Departamento de Enfermagem Básica, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Roberta El Hariri Viana
- Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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Harper M, Amodio E, Cannova L, Villafrate MR, Merendino AM, Aprea L, Calamusa G. Analytical performance issues: comparison of ATP bioluminescence and aerobic bacterial count for evaluating surface cleanliness in an Italian hospital. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2014; 11:D23-D27. [PMID: 24369935 PMCID: PMC7196686 DOI: 10.1080/15459624.2013.852281] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Contaminated hospital surfaces have been demonstrated to be an important environmental reservoir of microorganisms that can increase the risk of nosocomial infection in exposed patients. As a consequence, cleaning and disinfecting hospital environments play an important role among strategies for preventing healthcare-associated colonization and infections. The aim of the present study was to evaluate whether adenosine triphosphate (ATP) presence, measured by bioluminescence methods, can predict microbiological contamination of hospital surfaces. The study was carried out between September and December 2012 at the University Hospital "P. Giaccone" of Palermo. A total of 193 randomly selected surfaces (tables, lockers, furnishings) were sampled and analyzed in order to assess ATP levels (expressed as relative light units or RLU) and aerobic colony count (ACC) or presence of S. aureus. ACC had median values of 1.85 cfu/cm(2)(interquartile range = 4.16) whereas ATP median was 44.6 RLU/cm(2)(interquartile range = 92.3). Overall, 85 (44.0%) surfaces exceeded the established microbial benchmark: 73 (37.8%) exceeded the 2.5 cfu/cm(2)ACC standard, 5 (2.6%) surfaces were positive for S. aureus and 7 (3.6%) showed both the presence of S. aureus and an ACC of more than 2.5 cfu/cm(2). ACC and bioluminescence showed significant differences in the different surface sites (p < 0.001). A significant correlation was found between ACC and RLU values (p-value < 0.001; R(2)= 0.29) and increasing RLU values were significantly associated with a higher risk of failing the benchmark (p < 0.001). Our data suggest that bioluminescence could help in measuring hygienic quality of hospital surfaces using a quick and sensitive test that can be an useful proxy of microbial contamination; however, further analysis will be necessary to assess the cost-efficacy of this methodology before requiring incorporation in hospital procedures.
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Affiliation(s)
| | - Emanuele Amodio
- Department of Sciences for Health Promotion, “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Lucia Cannova
- Department of Sciences for Health Promotion, “G. D’Alessandro”, University of Palermo, Palermo, Italy
- Sanitary Management of the Azienda Ospedaliera Universitaria, “P. Giaccone” of Palermo, Palermo, Italy
| | - Maria Rosaria Villafrate
- Department of Sciences for Health Promotion, “G. D’Alessandro”, University of Palermo, Palermo, Italy
- Sanitary Management of the Azienda Ospedaliera Universitaria, “P. Giaccone” of Palermo, Palermo, Italy
| | - Anna Maria Merendino
- Department of Sciences for Health Promotion, “G. D’Alessandro”, University of Palermo, Palermo, Italy
- Sanitary Management of the Azienda Ospedaliera Universitaria, “P. Giaccone” of Palermo, Palermo, Italy
| | - Luigi Aprea
- Department of Sciences for Health Promotion, “G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Giuseppe Calamusa
- Department of Sciences for Health Promotion, “G. D’Alessandro”, University of Palermo, Palermo, Italy
- Sanitary Management of the Azienda Ospedaliera Universitaria, “P. Giaccone” of Palermo, Palermo, Italy
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Amodio E, Dino C. Use of ATP bioluminescence for assessing the cleanliness of hospital surfaces: a review of the published literature (1990-2012). J Infect Public Health 2013; 7:92-8. [PMID: 24231159 DOI: 10.1016/j.jiph.2013.09.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/26/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022] Open
Abstract
Hospital cleanliness tends to be considered by patients and the public as an important indicator of the general quality of healthcare. Tests for detecting the presence of adenosine triphosphate (ATP) as a proxy of microbial contamination are increasing in popularity, and several studies have been conducted on this topic in the last few decades. The aim of the present study was to review the published literature on this topic and summarize and discuss the available results. The review focused on relevant English-language articles that were identified through searches of two databases [PubMed and Scopus (1990-2012)] by using the keywords "ATP", "bioluminescence", "hospital", and "surfaces". Twelve articles were included and analyzed. ATP measurements showed a wide variation, with values ranging from 0 to >500,000 relative light units (RLU)/s before cleaning and from 3 to 500,000RLU/s after cleaning. ATP benchmarks used by authors ranged from 100 to 500RLU/s. The percentage of surfaces exceeding the chosen cut-off limit showed a failure rate varying from 21.2% to 93.1% before cleaning and from 5.3% to 96.5% after cleaning. Although the use of ATP bioluminescence can be considered a quick and objective method for assessing hospital cleanliness, it appears to be still poorly standardized at both the national and international level.
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Affiliation(s)
- Emanuele Amodio
- Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Italy.
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