The adenosine triphosphate test is a rapid and reliable audit tool to assess manual cleaning adequacy of flexible endoscope channels Ranekka Dean, MPA RN CIC June 17, 2015 APIC Greater NY Chapter 13 – Journal Club

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4 SUMMARY This study investigated if the accepted benchmark for Adenosine Triphosphate (ATP) monitoring was achievable in a busy endoscopy clinic following manufacturer’s manual cleaning instructions This study also evaluated the manual cleaning benchmarks of protein and bioburden levels for flexible endoscope channels

RELEVANCE Most healthcare facilities use manual cleaning for reprocessing of endoscopes Manual cleaning is prone to human error Recent reports links outbreaks of multiresistant organisms to inadequate cleaning Need for rapid audit tool for ongoing quality monitoring of manual cleaning 5

OBJECTIVE To verify if the ATP benchmark of <200 Relative Light Units (RLUs) is achieved following the manufacturer’s manual cleaning process for flexible endoscopes 6

SAMPLE 10 patient-used endoscopes tested post-patient use prior to manual cleaning 20 patient used endoscopes tested after manual cleaning 10 unused endoscopes manually cleaned, received HLD Presentation Title Goes Here7

METHODS All channels/lumens from patient-used endoscopes were sampled after manual cleaning and tested for residual ATP  ATP benchmark set at <200 RLUs  Protein benchmark set at <6.4ug/cm 2  Bioburden <4-log 10 cfu/cm 2 Presentation Title Goes Here8

VARIABLES Dependent (DV)  RLU (protein & bio burden) measurement Independent (IV)  Reprocessing methods: manual cleaning (& HLD) 9

ANALYSIS 2-tailed T-test To detect differences in means (pre-post manual cleaning) Presentation Title Goes Here10

MAJOR FINDINGS 96% (115/120) channels from the scopes met the ATP benchmark of <200 RLUs 5 (25%) channels exceeded ATP benchmark (elevator guide-wire channels) 10% of unused elevator guide wire channels had ATP levels >200 RLUs All 120 manually cleaned channels (suction biopsy, air-water, auxiliary) had compliant levels of protein and bio burden 11

DISCUSSION/CONCLUSIONS Adequate manual cleaning was achieved in 96% of lumens tested Elevator guide-wire channel is the most difficult to clean (high RLU post cleaning) & high levels of organic and bio burden levels after patient use Bedside wipe and channel flushing very effective for lower levels ATP tests not capable of reliably detecting low levels of microorganisms (best used after manual cleaning as an audit tool) Observational audits indicated good compliance with manufacturer’s recommendations 12

Evaluation Strengths Exploratory Analysis methods appropriate for stated objectives Results supported discussion Acknowledged limitations Weaknesses/Limitations Inability to confirm that the bedside flush was done all endoscope channels tested Inability to confirm flush volume per elevator guide wire channel Not all scopes processed underwent ATP testing Non-experimental (acknowledged) – findings by chance? Relatively small sample size Limited generalizability

EVALUATION Level III – non-experimental (no manipulation of IV, includes comparative data) study Grade – B, reasonably consistent results and recommendations, gateway for further studies Things to consider: –Acceptable level of cleaning compliance –Frequency of monitoring cleaning process Other suggestions? 14

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