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Published on Sunday, 05 February 2012 19:11

ATP Testing

Based on the most recent statistical information released on hospital acquired infections (HAIs), (AHA, 2010), which are based on a data analysis from the Healthcare Cost and Utilization Project (HCUP) performed in 2007, there is obviously a problem with the ability of healthcare organizations to identify, contain or rectify HAIs (Lucado et al, 2010). The HCUP statistics indicate the following:

• •Over 42,000 adult patients acquired infections during their hospital stay in 2007.
• •Hospital patients with infections due to medical care had an average length of stay 19.2 days longer than patients without infections.
• •A patient with one of these infections cost nearly $43,000 more to treat than non-infected patients.

Additionally, the burden of Healthcare-Associated Infections in the United States:

• •1.7 million infections in hospitals
• •Most (1.3 million) were outside of ICUs
• •9.3 infections per 1,000 patient days
• •4.5 per 100 admissions
• •99,000 deaths associated with infections
• •36,000 – pneumonia
• •31,000 – bloodstream infections

These statistics are staggering. What factors contribute to these outcomes? Why do HAIs continue to be so prevalent in an environment that is supposed to be one of the most sterile in American culture? One supposition is that healthcare personnel are not aware of the mediums of transport of HAIs and/or they are not aware of the presence of infection causing bacteria. Current methods of infection reduction such as washing hands go a long way to reducing the spread of infection but there are other issues that must also be addressed such as 1) Cleaning practices that are not sufficient or have gaps in quality. 2) Personnel that are charged with cleaning have no way to measure the effectiveness of their cleaning practices, 3) Human error or neglect in the proposed or recommended cleaning methodology of exposure areas such as medical devices, instrumentation and touch surfaces.

There are new studies coming out that present different methodologies and devices that aid in the reduction of HAIs each having efficacy results of their individual solutions. Adenosine Triphosphate (ATP) testing is no different. The use of ATP bioluminescence has been proposed as a means to improve the management of hospital cleaning. Benchmark values of what is considered clean or acceptable levels of clean can allow healthcare departments to monitor the efficiency of existing cleaning programs (Moore, Smyth, Singleton & Wilson, 2010).

ATP testing works because Adenosine Triphosphate is present in all types of organic material (i.e. food, bacteria, bodily fluids, unique proteins, allergens and even skin), and the ability to detect it through an ATP bioluminometer indicates the amount of microbial and non-microbial contamination in a given test area. This is accomplished by a luminescent chemical reaction, very much like the chemical reaction that takes place in the tail of a firefly that creates light.

The light is produced by the oxidation of a pigment called luciferin. Generally, the reaction rate of this type of combination is very slow, but when a catalyst is introduced into the equation the reaction is almost instantaneous. The catalyst of this reaction is “luciferase” (an oxidative enzyme used in bioluminescent reactions), which is mediated by the presence of a cofactor, which in this case is ATP. So, essentially when luciferase and ATP combine, the chemical reaction produces a bioluminescence (Light), which can be measured by means of relative light units (RLUs) and quantified, which is the entire premise of ATP testing.

As organic material comes into contact with surfaces via a touch or body fluid from an operation or a runny nose etc., it leaves ATP. The amount of ATP on a surface is a direct indication of the amount of organic matter that is there. Organic matter can harbor all types of microbiological contaminants such as pathogenic bacteria, mold, yeast and viruses. Therefore, the presence of high ATP levels is a good indicator of poor hygiene or poor cleaning practices and adversely, low ATP levels indicates good hygiene or good cleaning practices.

Many times, especially in healthcare, a surface may appear to be clean and may very well have been cleaned but contaminants may still be on a surface. It is very difficult to manage something that one cannot see with the naked eye or something that cannot or has not been measured in some form (like ATP). ATP testing provides real-time, quantitative data that allows the users to monitor potential hazards in a number of ways:

• •Check the activity of cleaners
• •Audit and adjust cleaning process parameters
• •Retrain operators on manual and automated processes
• •Verify washer and disinfector proper operations
• •Reprocess individual instruments or potentially an entire tray
• •Quarantine unacceptably cleaned instruments or carts

The list goes on for the justification of this process. ATP based monitoring enhances the cleanliness efforts of healthcare professionals and initiatives and provides an excellent tool to help overcome the limitations of simple visual inspections.

References:

• •American Hospital Association (2010), Statistical Brief On Hospital Acquired Infections. Retrieved on May 16, 2011 (Click for Link)
• •Lucado, J. et al (2010) Adult hospital stays with infections due to medical care, 2007. HCUP Statistical Brief [Healthcare Cost and Utilization Project/Agency for Healthcare Research and Quality] #94
• •Moore, G., Smyth, D., Singleton, J., and Wilson, P. (2010), The use of Adenosine Triphosphate Bioluminescence to assess the efficacy of a modified cleaning program implemented within an intensive care setting. Association for Professionals in Infection Control and Epidemiology. Elsevier Publishing