The Perennial Problem of Variability In Adenosine Triphosphate (ATP) Tests for Hygiene Monitoring Within Healthcare Settings

Whiteley, Greg S.; Derry, Chris; Glasbey, Trevor; Fahey, Paul

doi:10.1017/ice.2015.32

Cited by 24 publications

(28 citation statements)

References 34 publications

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“…Notably, except in a few studies [ 7 , 9 ], the threshold of the ATP-assay results used to indicate cleanliness was not calibrated according to the sampling area. The RLU value that is obtained using the ATP assay is a relative unit that has not been quantified against known standards [ 10 ]. Similar to culture level values, the measured ATP levels should be proportional to the sampling area, and if the ATP readings are obtained without calibration of the sampling area, the values will be difficult to interpret and the correlation with ACC assay–based values will decrease.…”

Section: Introductionmentioning

confidence: 99%

Use of a Sampling Area-Adjusted Adenosine Triphosphate Bioluminescence Assay Based on Digital Image Quantification to Assess the Cleanliness of Hospital Surfaces

Wang

Jiang

et al. 2016

IJERPH

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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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Section: Introductionmentioning

confidence: 99%

Use of a Sampling Area-Adjusted Adenosine Triphosphate Bioluminescence Assay Based on Digital Image Quantification to Assess the Cleanliness of Hospital Surfaces

Wang

Jiang

et al. 2016

IJERPH

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“…Based on the work of Reed et al a Cv of 0.4 suggests that any two measures from the identical surface could differ by a factor of 1.5 or more in nearly half of all trials and differ by a factor of 2 or more in 1 in every 5 trials [23]. In such cases, a reading of 50 RLU and 100 RLU could be generated from the same surface cleanliness and still represent the same result [24,25]. While a Cv of 0.4 was relatively infrequent, our proposed algorithm is conservative and based on the possible two-fold difference in RLU measures.…”

Section: Methods the Atp Testing Algorithmmentioning

confidence: 99%

“…Controlled experiments have demonstrated that a Cv of 0.4 is a frequent occurrence [24]. In studies using a single sampling point, where the Cv is above 0.4, there is a 20% chance that any reading could be wrong by a factor of two [25].…”

Section: Variability and Imprecision With Atp Testingmentioning

confidence: 99%

A suggested sampling algorithm for use with ATP testing in cleanliness measurement

Whiteley

Glasbey

Fahey

2016

Infection, Disease & Health

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Introduction: Rapid Adenosine Triphosphate (ATP) testing is becoming a commonly used method to measure cleanliness on reusable medical devices and healthcare environmental surfaces. Unfortunately, ATP testing devices suffer from inherent variability from a number of sources including imprecision in ATP measurement. Method: This paper proposes a new sampling algorithm which reduces the impact of inherent variability and thus improves decision making when using ATP testing. Conclusion: This algorithm can be applied across a variety of applications to provide more reliable data on measurable cleanliness standards for both medical devices and environmental surfaces. Formal trials using the new ATP sampling algorithm are required.

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“…We will routinely assess bio-burden on a selection of high touch surfaces using adenosine tri-phosphate (ATP) luminosity following cleaning in three of the 11 hospitals, using a validated sampling process [ 27 ].…”

Section: Methodsmentioning

confidence: 99%

Researching effective approaches to cleaning in hospitals: protocol of the REACH study, a multi-site stepped-wedge randomised trial

et al. 2015

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BackgroundThe 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/designThe 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.DiscussionEvidence 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 registrationAustralia New Zealand Clinical Trial Registry ACTRN12615000325505

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The Perennial Problem of Variability In Adenosine Triphosphate (ATP) Tests for Hygiene Monitoring Within Healthcare Settings

Abstract: The variability of commercial ATP bioluminometers and their consumables is unacceptably high with the current technical configuration. The advantage of speed of response is undermined by instrument imprecision expressed in the numerical scale of relative light units (RLU).

Cited by 24 publications

References 34 publications

Use of a Sampling Area-Adjusted Adenosine Triphosphate Bioluminescence Assay Based on Digital Image Quantification to Assess the Cleanliness of Hospital Surfaces

Use of a Sampling Area-Adjusted Adenosine Triphosphate Bioluminescence Assay Based on Digital Image Quantification to Assess the Cleanliness of Hospital Surfaces

A suggested sampling algorithm for use with ATP testing in cleanliness measurement

Researching effective approaches to cleaning in hospitals: protocol of the REACH study, a multi-site stepped-wedge randomised trial

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