特多酶及會(huì)議物料設(shè)計(jì)

MarcoBommarito簡(jiǎn)介康奈爾大學(xué)物理化學(xué)博士，哈佛大學(xué)應(yīng)用科學(xué)博士后，有超過20年從事醫(yī)院感染控制相關(guān)技術(shù)的研發(fā)和臨床驗(yàn)證工作的經(jīng)驗(yàn)。主持過與多家美國(guó)中心醫(yī)院合作的臨床科研驗(yàn)證項(xiàng)目，包括過氧化氫等離子生物指示劑的臨床驗(yàn)證，器械清洗質(zhì)量檢測(cè)驗(yàn)證，ATP在醫(yī)院感染控制領(lǐng)域適用性驗(yàn)證等。MARCO在醫(yī)院感染控制技術(shù)的相關(guān)領(lǐng)域發(fā)表的研究文獻(xiàn)超過30篇，多篇文獻(xiàn)由世界頂尖的Science期刊發(fā)表。特別是在ATP技術(shù)方面，Marco是將ATP引入醫(yī)院感染控制領(lǐng)域應(yīng)用的奠基人之一，是美國(guó)ATP技術(shù)的資深專家。MonitoringthePatient’sEnvironmentusingATPMarcoBommaritoWhyisthepatientenvironmentimportantWhycanATPbeusedasapatientenvironmenthygienemonitoringtoolHowtouseATPasamonitoringtoolWhatarethecriticalissuesyoushouldfocusonwhenusingATPasamonitoringtoolObjectivesWhyisthepatientenvironmentimportant

InfectedPatientEnvironmentSusceptiblePatientWhyistheEnvironmentImportant–ChainofTransmissionXHandHygieneXXEnvironmentalHygieneTransmissionofhealthcareassociatedpathogensWhyistheEnvironmentImportant–PathogenPersistenceHealthcareassociatedpathogenscansurviveonenvironmentalsurfacesforlongperiodsoftimeThereisasignificantlyincreasedriskofacquiringaninfectionifthepriorroomoccupanthadaninfection.WhyistheEnvironmentImportant–IncreasedInfectionRiskWhyistheEnvironmentImportant–CleaningInterventionscanReducetheAcquisitionofPathogensWhyistheEnvironmentImportant–CleaningInterventionscanReducetheAcquisitionofPathogensDisinfectant:SelectionandProperUseIdentificationofsurfacesanditemstobecleaned/disinfectedPPE:SelectionandUseClean/DisinfectSurfacesanditemsusingcorrecttechniquesIdentifyandreportbreachesinInfectionPreventionFollowInfectionPreventionPracticesProperHandHygieneMonitoringeffectivenessofcleaning/providefeedbackDevelopclearpoliciesandproceduresEffectiveeducationprogramRuthCarrico,Ph.D.CleanSpaces,HealthyPatientsNancyHavill,CIC,Hosp.ofSt.Raphael,CT.APIC2012CleanSpacesHealthyPatientsStrategytoManagePatientRisk-HospitalHygieneBundleWhycanATPbeusedasapatientenvironmenthygienemonitoringtool

MethodsforMonitoringtheEnvironmentCenterforDiseasesControlandPrevention:ImportantGuidelinesandPositionPapersthatDiscusstheuseofATPMonitoringtoAssessCleaningQualityWhatisATP?ATPispresentinALLlivingcellsMicrobesPlantsAnimalsBodilyFluidsATPstoresenergyinthephosphatebonds.EnergyisreleasedwhenthephosphatebondsarebrokenAdenosinePhosphatesAdenosineTri-PhosphateDetectingATPFire-flyLuciferaseharnessesthisenergytoproduceLightIncells,ATPlosesoneormorephosphatestoreleaseenergySimpleRelationshipincreaseinorganismsandotherorganicresiduesincreaseinATPlevelsincreaseinlight(RLU)3TMClean-TraceTMHygieneManagementSystem3?Clean-Trace?NGiLuminometer

3?Clean-Trace?ATPWaterTest

3?Clean-Trace?ATPSurfaceTest3?Clean-Trace?OnlineSoftwareCurrentProductLineup:Applications:MonitoringcleanlinessofenvironmentalsurfacesMonitoringwashanddisinfectionofsurgicalinstrumentsMonitoringmanualcleaningofendoscopesandotherlumenedinstrumentsDetectionofATPinaComplexSampleMatrixSimulatedacomplexsamplematrixusingcommerciallyavailableATS(ArtificialTestSoilavailablefromHealthmark)loadedwithvaryingamountsofATP.Determinedtheanalyticallimitofdetectiontobe1.1femtomoles/swabInstrumentBackground=19RLUsLOD=1.1fmoles/swab1femtomole=10-15molesDetectionofWholeBloodTenfolddilutionsofwholebloodDeterminedtheanalyticallimitofdetectiontobelessthan1x10-7dilutedwholeblood(between5-50RBCs/swab)AnalyzedseveraldifferentmodelorganismsoverawiderangeofconcentrationsTherearevariationsinATPanismtypeObservedalinearcorrelationbetweenRLUsandbacteriaconcentrationonalog-logplot(aboveLimitofDetectionLOD)ApproximateLODis1000-10,000CFUs/swabdependingonthetypeoforganismDetectionofBacterialCellsHowtouseATPasamonitoringtool

EnvironmentalHygienePass/FailThreshold–250RLUsThemendedPass/Failvalueisderivedfrombestpracticestandards.Thevalueof250RLUsisbasedonpublishedclinicaldataandhasalsobeenusedinsuccessfulATPmonitoringprograms:Boyce,J.M.etal.2012.MonitoringtheEffectivenessofHospitalCleaningPracticesbyUseofanAdenosineTriphosphateBioluminescenceAssay.InfectControlHospEpidemiol.Vol.30,No.7pp.678-84.Eckstein,B.C.etal.2007.ReductionofClostridiumdifficileandycinresistantEnterococcuscontaminationofenvironmentalsurfacesafteraninterventiontoimprovecleaningmethods.BMCInfectDis.Vol.21.No.7p.61.TheNYULangoneMedicalCenterStory.CleanSpacesHealthyPatientshttp:///sucessful-collaborations/nyu-langone-story/.EnvironmentalHygienePass/FailATPValueOtherClinicalDataReferencesSupportingATPasaMonitoringToolforEnvironmentalHygiene-BoyceJM,HavillNL,DumiganDG,GolebiewskiM,BalogunO,RizvaniR.MonitoringtheeffectivenessofHospitalcleaningpracticesbyuseofanadenosinetriphosphatebioluminescenceassay.InfectControlHospEpidemiol.2009;30:678-684.-BoyceJM,HavillNL,LipkaA,HavillH,RizvaniR.Variationsinhospitaldailycleaningpractices.InfectControlHospEpidemiol.2010;31:99–101.-CooperRA,GriffithCJ,MalikRE,ObeeP,LookerN.MonitoringtheeffectivenessofcleaninginfourBritishhospitals.AmJInfectControl.2007;35:338–341.-GriffithCJ,CooperRA,GilmoreJ,DaviesC,LewisM.Anevaluationofhospitalcleaningregimensandstandards.JHospInfect.2000:45:19–28.-GriffithCJ,ObeeP,CooperRA,BurtonNF,LewisM.TheeffectivenessofexistingandmodifiedcleaningregimensinaWelshhospital.JHospInfect.2007;66:352259.-LewisT,GriffithC,GalloM,WeinbrenM.AmodifiedATPbenchmarkforevaluationthecleaningofsomeHospitalenvironmentalsurfaces.JHospInfect.2008:69:156–163.-MooreG,SmythD,SingletonJ,JacksonR,BellinganG,SingerM,ShawS,JamesE,GantV,WilsonP.TheuseofATPbioluminescencetoassesstheefficacyofmodifiedcleaningprogrammes:ApotentialproblemencounteredwithintheICUsetting[poster].AssociationforProfessionalsinInfectionContol&Epidemiology2009.-SherlockO,O’ConnellN,CreamerE,HumphreysH.Isitreallyclean?Anevaluationoftheefficacyoffourmethodsfordetermininghospitalcleanliness.JHospInfect.2009;72:140–146.-TheHealthcareAssociatedInfections(HCAI)TechnologyInnovationProgramme:ShowcaseHospitalsReportsNo.2:The3M?Clean-Trace?ClinicalHygieneMonitoringSystem.Chester,UK:NHSPurchasingandSupplyAgency;2009.EndoscopeManualCleaningPass/FailThreshold–200RLUsThePass/FailthresholdsfortheSuction/Biopsychannel,theEGWchannelandtheoutsidedistalendofflexibleendoscopesweredeterminedinsimulated-usestudiesandthenverifiedasachievableinaclinicalsettingfollowingthemanufacturer’smanualcleaninginstructions:EndoscopeManualCleaningPass/FailATPValueSurgicalInstrumentsAutomatedWasher/DisinfectorPass/FailATPValueSurgicalInstrumentsWasher/DisinfectorPass/FailThreshold–150RLUsBasedonclinicalfieldstudies,3MmendsaPass/Failthresholdvalueof150RLUsforthewasher-disinfectorstepClinicalfieldstudydatasupportinguseofATPasamonitoringtoolforhospitalhygieneOperatingroomscanbeupto10xdirtierthatpatientrooms!‘Highdirt’pointsarenotnecessarily‘hightouch’points.Dirtlevelsvarieddependingon:testobjecttype,roomtype,hospitaltype.Surfacesthatcarriedahigheramountofcontaminationbeforeterminalcleaning,werealsohigheraftercleaning.LevelsofATP,colonyformingunits,andproteinsappeartotrendsimilarlybeforeandafterterminalcleaning.Differencesinsoilcompositionbylocationinahospitalcouldbeaveryimportantfactor,andrequiresfurtherstudy.MonitoringthePatientEnvironment:KeyInsightsfromClinicalFieldStudiesusingATPMonitoringATPMonitoringtoUnderstandCleaningEffectivenessPatientRoomsOperatingRoomsInoperatingrooms,beforeterminalcleaning,TDCscoresvariedwidelyfromahighof62%toalowof14%.Afterterminalcleaning,theobservedscoresimprovebutstillvaryconsiderably:82%-22%.Inpatientrooms,beforecleaning,scoresrangefrom64%to27%.Aftercleaning,therangeis91%-52%.Wenotethatatgivensites(1,2,3)terminalcleaninginoperatingroomsresultsinNOimprovements.ThestudydemonstratesthatATPmonitoringcanbeveryusefulindeterminingquantitativelytheeffectivenessofterminalcleaning.Theabilitytoquantifycontaminationinthemannerexemplifiedbythisstudyisfoundationaltoaprocessimprovementprogramforthehospital’senvironmentalservices.“HighDirt”surfacesarenotnecessarily“HighTouch”surfacesHigherATPContaminationBeforeCleaning,ResultsinHigherContaminationLevelsAfterCleaning250=PassSurfacesthatcarriedahigheramountofdirtbeforeterminalcleaning,werealsohigheraftercleaning.Thereappearstobeonlya“fixed’amountofdirtthatcanberemovedinonecleaning(~0.3logs).Adeepercleanmayrequiremultiplecleanings.LevelsofATP,colonyformingunits,andproteinsappeartotrendinasimilarmannerbeforeandafterterminalcleaning.HigherCFUs/swabinpatientroomsthanoperatingrooms,butlowerATPinpatientroomsthanoperatingrooms.Differencesinsoilcompositionbylocationinahospitalcouldbeaveryimportantfactor,andrequiresfurtherstudy.Directimplicationsonhoweffectivelyonecancleanagivensurface.BeforeandAfterTerminalCleaningComparisonforDifferentMonitoringMarkersThesedatasupportthepremisethatATPbioluminescencecouldserveasanegativescreenforthepresenceofbacteria:surfacesthatarecleanedtolevelsbelow200RLUshaveaveryhighlikelihoodofresultinginnegativemicrobialcultures.Forthedatasetshownhere,theprobabilitythatareadingfromatestpointlowerthan200RLUswouldalsoresultinanegativemicrobialculturewas99%witha95%confidenceintervalof93.8%-99.9%.ComparingMonitoringResultsfromATPandMicrobialCulturesOtherInvestigatorsResultsSupportingtheRelationshipbetweenATPMonitoringandMicrobialCulturesOtherInvestigatorsResultsSupportingtheRelationshipbetweenATPMonitoringandMicrobialCulturesDifferentamountsofsoilarepresentby:hospital,testpointandtypeofroom.“Whocleanswhat?”andmoreimportantly“Whoshouldcleanwhat?”appeartobeextremelyimportantquestionstoachievethebestcleaninge.ATPmonitoringcanprovidequantitativedatatohelpanswerthesequestions.InadditiontoprovidingatoolforbettertrainingoftheEVSstaff,ATPmonitoringcouldbeusedindecidinghowtomoreeffectivelydirectresourcestoroomtypesthataredifficulttoclean.Thesignificantdifferencesseenbytestpointindicatethathightouchpointsarenotnecessarilyhighdirtpoints.ATPmonitoringcouldallowmorefocustobeplacedoncleaninghighdirtpointsbecauseitcanidentifythesesurfacesdirectly.Monitoringthepatient’senvironmentwithATPiscarriedoutwithpost-cleaningdata.Comparisonspre-andpost-cleancanbeveryinstructivebutarenotnecessary.Additionally,pass-failthresholdvaluesdonothavetobedeterminedforeachtestobjectusingacomparisonofpre-andpost-cleandata,butaresetusingeitherpublishedvaluesorthroughbenchmarkingwithpost-cleandata.Attheroomlevel,ATPcontaminationtrendswellwithotherrelevantmarkersofcleanliness(bacteria,blood,proteinresidues).FluorescenceandATParecomplementarymonitoringtools:fluorescenceprovidesevidenceforthephysicalcleaningofasurface(hasthatsurfacebeenwipedadequately),whereasATPprovidesaquantitativeassessmentofcleanliness(whatsurfacesarecleanandhowcleanarethesesurfaces).Monitoringthepatient’senvironmentmaybebestplishedusingatieredapproach:visual,fluorescence,ATP.ATPPatientEnvironmentMonitoring-ConsiderationsClinicalfieldstudydatasupportingusingATPtomonitordecontaminationofsurgicalinstrumentsSurgicalInstrumentMonitoringtheWashandDisinfectionProcessATPmonitoringdemonstratedtheeffectivenessofthemanualwashprocess,wasabletodetectskipsincleaningprocedures,andconfirmedtheoverallefficacyofthewasher-disinfectorequipmenttoremovesoil.VisiblycleaninstrumentscanresultinhighRLUvalues,andinstrumentswithhigherlevelsofATPaftermanualcleaningalsoshowhigherlevelsofATPafterautomatedwash/disinfection.UsingATPtomonitormanualcleaningandtheautomatedwash/disinfectionprocessClinicalfieldstudiesandmethoddevelopmentHowtouseATPmonitoringforqualitycontrolofthesurgicalinstrumentsdecontaminationprocessUnderstandingtheeffectivenessofcleaninganddisinfectionforgenerallaparoscopicinstrumentsATPandproteincomparisonConclusionsOutlineMonitoringtheSPDWashandDisinfectionProcessInitialhospitaltrialsdemonstrateapplicabilityoftheATPsystemasacleanmonitorinCS/SPD.Datawasrepeatablewithinsiteandappearedconsistentsite-to-site.Monitoringdemonstratedtheeffectivenessofthemanualwashprocess(>2logreductioninaverageRLUvaluefrominitial),wasabletodetectskipsincleaningprocedures,andconfirmedtheoverallefficacyofthewasher-disinfectorequipmenttoremovesoil(~2logreductioninaverageRLUfrommanualwash).VisiblycleaninstrumentscanresultinhighRLUvalues(10,000-50,000RLUs).InstrumentswithhighlevelsofmeasurableATP(Log(RLUs)>3.0)aftermanualwashing,alsoresultinhigherlevelsofmeasurableATPafterautomatedwashanddisinfection.Methodologymaybeusefulincomparingsitetositeperformancewithinasinglehealthcaresystemoramongstvarioushospitals.Monitoringeachstepintheprocessaidsidentifyingwhereaproblemmaybeoccurring.MonitoringtheSPDWashandDisinfectionProcess(SitetoSiteComparison)EstablishingActionLimitsforATPMonitoringofSurgicalInstrumentstoEnableQualityControlInstrumentSamplingandDataCollectionCreateStatisticalControlChartfromDataSetUsingLogTransformedDatasetActionLimitChartsATPMonitoringResultsforGeneralSurgicalInstrumentsandInstrumentsthatCannotbeProcessedinanAutomatedWashDisinfectorDemonstratedthatqualitycontrolusingthismethodologybasedonATPmonitoringisfeasible.Thedecontaminationprocesswasobservedattwotimepointsthreemonthsapart.Themanualcleaningstepoftheprocessshowedactionlimitsthatwerestatisticallythesame.Theautomatedwashanddisinfectioncycleactionlimitsweredifferent.Actionlimitsforinstrumentsthatcannotbeprocessedinanautomatedwasheranddisinfectoraresignificantlyhigher.UsingATPMonitoringtoVerifytheCleanlinessofLaparoscopicInstruments-ExteriorandInteriorLumenSurfacesExterioraswellasinnerlumensurfacesoflaparoscopicinstrumentswerealsotestedaftersonicationandautomatedwashanddisinfection.Ingeneral,theseinstrumentsshowedconsiderablyhigherlevelsofcontaminationascomparedtogeneralinstrumentationateachstepinthereprocessingprocedure.ThesedatashowsthatitispossibletouseATPassaystoeffectivelymonitorthecleanlinessofsurgicalinstrumentsthroughoutdecontaminationprocess.ATPmonitoringprovidesreal-time,quantitativedatathatisactionableinavarietyofwaysthatmaybehelpfultotheCSclinician:Stopand“quarantine”instrumenttrayorloadReprocessinstrumenttrayorentireloadVerifywash-disinfectorproperoperationAuditandadjustprocessparametersCheckactivityofcleanersandreplenishorreplaceRetrainoperatorsonmanualandautomatedoperationsWesuggestamethodtoestablishactionlimitsthatcanservetodefineaqualitycontrolprocesstomonitorandimprovetheprocessofdecontamination.ATPbasedmonitoringcomplementsproteinbasedmonitoringandcanhelptoethelimitsofvisualinspection.ConclusionsClinicalfieldstudydatasupportingusingatptoMonitormanualcleaningofflexiblegiendoscopesFlexibleGIEndoscopesMonitoringtheManualCleaningProcessATPcanbeusedtoeffectivelyassesscleanlinessoftheexteriorsurfacesandtheinteriorlumensofflexibleendoscopesusingacombinationofthesurfacetestandthewatertest,respectively.ThelevelsofATPmeasuredtrendwithcombinedloadsofproteinandmicrobialsoils.TheClean-Tracesystemishighlysensitivetothepresenceofmicroscopicblood.Wehaveobserveddifferencesinlevelsofsoilpresentbasedonthetypeofscopeandprocedure.WehaveobservedsignificantsitetositedifferencesintheeffectivenessofthemanualcleaningprocessMonitoringtheManualCleaningStepImportanceStudyDesignandLimitationsSamplingProtocolATPDetectionBackgroundResultsConclusionsOutlineSpauldingClassifications:

DisinfectionBasedonUseLevelDefinitionProcedureEfficacyExampleCriticalDevicesObjectswhichentersteriletissueorvascularsystemSterilizationKillallorganisms,includingsporesSurgicalinstrumentsSemi-CriticalDevicesObjectswhichtouchmucousmembranesornon-intactskinMinimumHigh-LevelDisinfectionKillallvegetativeorganisms,sporesnotkilledRespiratorytherapyandanesthesiaequipment,someendoscopes,laryngoscopebladescystoscopes,etc.NoncriticalDevicesObjectswhichtouchonlyintactskinMinimumLow-levelDisinfectionorCleaningRemovalofpathogenicorganismsStethoscopes,B/Pcuffs,patientroomequipment,crutchesSpaulding,E.FlexibleEndoscopesareConsideredSemi-CriticalDevices……butCriticalDevicesarealsoUsedinEndoscopyProceduresLaparoscopicinstrumentsBiopsyforcepsSnaresOthercuttinginstrumentsImportanceoftheManualCleaningProcess“Thefirstandmostimportantstepinthepreventionoftransmissionofinfectionbyanendoscopeismanualcleaningoftheendoscopewithdetergentsolutionandbrushes.”“Theefficacyofcleaninganddisinfectionispersonneldependent,hence,trainingandqualitycontrolarecriticalforreliableinfectioncontrol.”“Failuretoadheretoestablishedreprocessingguidelinesaccountsformost,ifnotall,ofthereportedcasesofbacterialandviraltransmissions.”InfectionControlduringGIEndoscopy.ASGEStandardofPracticeCommitteeGastrointestinalEndoscopy.2008.Vol.67.No.6pp.781-790,824-828Manualcleaningofendoscopesisnecessaryimmediatelyafterremovingtheendoscopefromthepatientandpriortoautomatedormanualdisinfection.ThisisthefirstandmostimportantstepinremovingThemicrobialburdenfromanendoscope.Retaineddebrismayinactivateorinterferewiththecapabilityoftheactiveingredientofthechemicalsolutiontoeffectivelykilland/orinactivatemicroorganisms.StandardsofInfectionControlinReprocessingofFlexibleGastrointestinalEndoscopes.2009ReprocessingaFlexibleEndoscopeisaComplicatedProcess3/38StepshavedocumentedQA(8%)QualityControlforSteamSterilizationofSurgicalInstruments17/44StepshavedocumentedQA(39%)Evenwithwrittenpolicies&proceduresinplaceandemployeesaffirmingtheimportanceofthosesteps,directobservationrevealedthatall12stepsofthemanualcleaningprocesswereperformedforonly1outof69endoscopes(1.4%)

WhenanECRdevicewasusedforcleaningthecomplianceincreasedto86of114endoscopes(75.4%)ObservedActivity StepsCompleted(%)(N=69)Leaktestperformedinclearwater 77Disassembleendoscopecompletely 100Brushallendoscopechannelsandcomponents 43Immerseendoscopecompletelyindetergent 99Immersecomponentscompletelyindetergent 99Flushendoscopewithdetergent 99Rinseendoscopewithwater 96Purgeendoscopewithair 84Loadandcompleteautomatedcycleforhigh-leveldisinfection 100Flushendoscopewithalcohol 86Useforcedairtodryendoscope 45Wipedownexternalsurfacesbeforehangingtodry 90Ofstead,CoriL.,Wetzler,Harry,P,AlyceaSnyder,RebeccaA.HortonEndoscopeReprocessingMethods:AProspectiveStudyontheImpactofHumanFactorsandAutomation.2010GasteroenterologyNursing.Vol33,No.4,pp.304-311ManualCleaningisPronetoErrorConsequencestoPatientSafety“Flexibleendoscopereprocessinghasbeenshowntohaveanarrowmarginofsafety.Anyslightdeviationfromthemendedreprocessingprotocolcanleadtothesurvivalofmicroorganismsandanincreasedriskofinfection.”

Alfa,M.J.,etal.(2006).AmericanJournalofInfectionControl,34(9),561-570.StudyDesignandLimitationsClinicalfieldstudyat5sites(2West,2Midwest,1East)Totalendoscopestested(immediatelyaftermanualcleaning):129colonoscopes116gastroscopes30duodenoscopesSampleswereharvestedbyflushingtheSuction-BiopsychannelwithsterilewaterSampleswereanalyzedfortotalATPcontaminationusingacommerciallyavailablesystem(3MClean-Trace)Atonesite,sampleswerealsomeasuredfortotalproteincontentviaacommerciallyavailableBCAAssay(PierceBiochemical)MeasuredATPcontaminationonlyinSuction-BiopsyChannel(andexteriordistalendofendoscope)Allscopestestedwerefromthesamemanufacturer(Olympus)ReprocessingtechniciansknewscopeswerebeingtestedDidnottrackandrecordfailuresduringreprocessingAtotalofonly30duodenoscopesweretestedDonotknowtheageandphysicalconditionofeachdeviceSamplingProtocolHarvestingtheSampleSuctionBiopsyChannelSamplingwiththeATPWaterTestMeasuringATPlevelinRelativeLightUnits(RLUs)40mLofsterilewaterwasflushedthroughthesuction-biopsychanneloftheendoscopeusingasyringeatthesuctionconnectionontheuniversalheadofthescope.Thesamplewascollectedintoasterileconicaltubeorurinecup,andtestedimmediatelywithacommerciallyavailableATPwatertestThetotalamountofATPcontaminationwasquantifiedinRelativeLightUnits(RLUs)usingacommerciallyavailablehand-heldluminometerATPBioluminescenceTechnologyCommercializedtomonitorcleanlinessFoodSafetyapplicationforpast30yearsMonitorsCleanlinessofEnvironmentalSurfaces,SurgicalInstruments,FlexibleEndoscopesUniversalMarker–presentinalllivingcellsATPbioluminescencemeasurementsarereal-time(15sec.)Quantitative–providesnumericalassessmentofefficacyofcleaning1femtomole=10-15molesAnalyticalPerformanceoftheATPAssay–DetectingATP,Blood,andBacteriaATP:Theassayanalyticallimitofdetectionis1femtomoleofATP/swabWholeblood:Theanalyticallimitofdetectionis1x10-8dilutedwholeblood(approximately50RBCs/swab)Bacteria:Sensitivityvariesdependingonthemodelorganism.TheassayismostsensitivetoG(-)bacteriawherethelowestdetectableconcentrationscanbeapproximately1,000CFUs/swab.ForsomeG(+)bacteriathelowestdetectableamountcanbe10,000CFUs/swab.200RLUsMulti-SiteResultsforATPMonitoringoftheManualCleaningProcessLowerRLUvaluesindicatelowercontaminationlevels.ThesolidlinesindicatetheaverageRLUlevel.Thedashedlinesshowthe1sintervalsManualcleaningofcolonoscopesresultedinsignificantlylowerRLUlevelsthangastroscopesandduodenoscopes.200RLUsisaproposedpass-failthresholdvaluereportedintheclinicalliterature[M.J.Alfa,I.Fatima,N.Olson;Theadenosinetriphosphatetestisarapidandreliableaudittooltoassessmanualcleaningadequacyofflexibleendoscopechannels;Am.J.Infect.ControlandM.J.Alfa,I.Fatima,N.Olson;Validationofadenosinetriphosphatetoauditmanualcleaningofflexibleendoscopechannels;Am.J.Infect.Control(Botharticlesinpress,availableonline)].ComparisonbyTypeofScopeOne-wayANOVAp-value<0.0005.Allpairwisep-valuesarelessthan0.05ManualcleaningofcolonoscopesresultedinsignificantlylowerRLUlevelsthangastroscopesandduodenoscopes.Weobservedfailureratesinthemanualcleaningsteptobehighestforduodenoscopes(30%failurerate,10/30)andgastroscopes(24%,28/116)andlowestforcolonoscopes(3%,4/129).30RLUs145RLUs86RLUs101001000200ComparisonbySite:ColonoscopesOne-wayANOVAp-value<0.0005.Site1and3hadstatisticallysignificantlowerlevelsofATPcontaminationcomparedtosite2,4and5.Thevariabilitywasalsodependentonthesite.18RLUs58RLUs15RLUs10100100020069RLUs30RLUsComparisonbySite:GastroscopesOne-wayANOVAp-value=0.002.Site1hadstatisticallysignificanthigherlevelsofATPcontaminationcomparedtotheremainingsites.Performanceamongstsiteswasmore“uniform”thaninthecaseofcolonoscopes208RLUs97RLUs32RLUs10100100020060RLUs65RLUsComparisonbySite:DuodenoscopesOne-wayANOVAp-value=0.037.Only30scopesmeasuredat3sites.Site1hadstatisticallysignificantlowerlevelsofATPcontaminationcomparedtotheremainingsites.LevelsofATPcontaminationfoundforthistypeofscopesissignificant(30%failurerate)93RLUs281RLUs1001000200138RLUsMonitoringCleanlinessofEndoscopes–ComparingATPandProteinLevelsATPandproteinlevelstrendinthesamedirectionandarecorrelated.AftermanualcleaningweobserveaneffectivelyhighersensitivityintheATPassaycomparedtoproteinresults.BeforeManualCleaningPropermanualcleaningofflexibleendoscopesiscriticallyimportantinthedisinfectionoftheseinstruments.Themanualcleaningprocessforflexibleendoscopesisverycomplicatedandfraughtwithopportunitiesforerrors.Thereareveryfewqualityandcompliancecontrolscurrentlyrequiredoradopted.MeasuringATPcontaminationisameansofeffectivelyassessingcleanlinessofflexibleendoscopes.Wehaveobserveddifferencesinlevelsofsoilpresentbasedonthetypeofscopeandthereprocessingsiteandasignificantnumberofcleaningfailureswereobserved.Giventheimportanceofthemanualcleaningsteptoultimatelyachieveproperhighleveldisinfection,theseresultssuggeststhatmoreattentionmayneedtobeplacedonmanuallycleaningupperGIendoscopes.ConclusionsWhatarethecriticalissuesyoushouldfocusonwhenusingATPasamonitoringtool

HowdoDifferentSystemsComparewithRespecttoAccuracyandRepeatability?The3MClean-TraceSystemisValidatedOverall,the3MClean-TracesystemhasthebestLODanddynamicrangeforrelevantenvironmentalorganisms3MClean-Trace1×10