In recent years, the Infection Prevention Department of hospitals and the individual cleaning units have been busy drawing up cleaning protocols and procedures. The audit to evaluate whether the environment is clean and safe is mostly performed by visual inspections, which is subjective and imprecise, or the time consuming microbial tests. Can ATP testing be a better aid in objectively determining the degree of contamination of the healthcare environment?
We live in a time where clean hospital environments become increasingly critical. Audits are an important part of the cleaning protocols to determine if the environment is safe for patients and personnel. This mainly focuses on usefulness of certain processes, the time investment and the outcome of these investments. ATP can play a role in this because this is an objective methodology to visual observation and faster in generating results compared to microbial tests.
What is ATP testing?
ATP stands for adenosine tri-phosphate. ATP is a substance found in organic pollution and micro-organisms. ATP testing is performed using one luminometer (measuring device) and a sample. This sample is collected using a special cotton swab and creates a reaction when it comes into contact with luciferin / luciferase. When these substances react with the ATP present, it releasing light. The light signal is measured by the luminometer. The amount of light will be displayed in RLU (relative light units). The more light, the more pollution.
ATP has been used in the food industry for years to measure the degree of contamination. ATP is not a quantitative method for actually counting microorganisms, because there is also ATP measured from other non-living cells. Such as from food scraps, the imprint of hands or skin flakes. But for hygiene measurements this is not a big objection because of this non-living cells may no longer be present after cleaning. After all, they form one breeding ground for micro-organisms and are therefore undesirable. The big advantage of measuring ATP is that you have a result within 30 seconds and therefore quickly know whether a surface is heavily contaminated or not. You can then quickly feedback this with the relevant department.
ATP testing in healthcare environment
Environmental management in healthcare facilities is essential for preventing hospital outbreaks. ATP testing can be used in hospital environments to check compliance with the established cleaning procedure. Healthcare facilities should start by mapping their entire facility into multiple areas, or hygienic zones, based on the microbial risk. Once the full environment has been mapped and considered, managers should work with their team to determine the most relevant test points and a testing cadence that makes sense for their specific processes, such as the isolation room floor, mattress, bathroom sink, pillows shown, shower handle and ventilation holes.
ATP testing should focus on two values. The first is to check if there are no outliers in the values. In the case of outliers, it may be that the hospital environment or care-technical aid is not cleaned in the correct way, the surface is damaged or it has been in use on a patient for a long time. If the values are structurally above the norm, something could be wrong with the current cleaning methods in general. ATP testing gives a general picture of the cleaning in recent periods and not necessarily of the last cleaning.
The seconds focus is on the values remain below the set standard. If ATP testing is started, the aim is that all values are below set standard. This is achieved if everyone cleans in a good way with it right cleaning tools and at the right time. If the hospital environment or care-technical aid shows a high ATP value after cleaning, this is possible be decided to clean again to see if the ATP value decreases.
If the ATP value decreases further to one after the second time cleaned, the baseline will have been very high. This can have different causes. For example, if care-technical aid cannot be cleaned after use and is used again for the next patient; the ATP value will only increase further. Or a care-technical aid is used for a very long time in a patient without having to be cleaned once in between.
ATP testing creates value for healthcare
Measuring the ATP value of the healthcare environment and aids is a good way to measure whether it has been properly cleaned. If a value will be high, this can be two have causes. The environment has not been properly cleaned after use with a patient or the environment was not properly cleaned at an earlier stage. In addition to checking compliance with the established cleaning procedure, ATP testing could also be used very well to see if the regular cleaning services are in order. The type of department and the limit value that is set. After all, different requirements apply to different locations.
While there are a number of adequately sensitive ATP monitoring systems, it’s important to evaluate each option to find the system that provides stable and consistent results, including across time and temperature changes. The most important first step in choosing to use an ATP testing device is understanding how the technology will integrate into a larger environmental monitoring programme.
In concrete terms, it is important to measure again at the same time for subsequent measurements. Spread the measurements as much as possible over the entire department, so not all sanitary points in one bathroom, or everything in one room. This prevents the measurements from being determined by one patient or by one cleaner.
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