Use of ATP bioluminescence for assessing the cleanliness of hospital surfaces: A review of the published literature (1990—2012)
Introduction
Hospital cleanliness has been a significant concern for both patients and the public as it is taken as the indicator of the general quality of healthcare. Researchers are testing the availability of adenosine triphosphate (ATP) to represent microbial contamination in the healthcare sector. It is believed that dirty surfaces can be contaminated by microorganisms which expose patients to a risk of acquiring infections. The rate of acquiring infections from the healthcare facilities by patients is alarming. Environmentally medicated transmission of pathogens that are antibiotic resistant have been reported in most hospitals in the United States. Despite the increased exposure of patients to pathogens and microorganisms, routine housekeeping practices are reported to reduce the risks of infections; besides, disinfection when improved and the ultimate result will be reduced bacteriological environmental contamination. Also, ensuring routine disinfection can reduce transmission of vancomycin-resistant Enterococcus and other prevalent bacteria in the hospital setup.
Promoting cleanliness of the hospital environment is perceived to be one of the best strategies that reduce healthcare-related infections and colonization. Many healthcare facilities are unable to define what clean is which have made it hard to maintain cleanliness in the healthcare sector. The use of the best tools for assessing cleanliness in a hospital is necessary to ensure that the risk factors in the healthcare sector are identified for better intervention. Though specific measures of cleanliness have not been identified, thus, there is an increased risk of exposure to infection by patients as well as the public. Detection of ADP has been assumed to monitor the cleanliness of the hospital.
Purpose of the study
The study aimed to review the available literature on the topic and discuss the results of these findings concerning assessing the cleanliness of the hospital surface by the use of adenosine triphosphate.
Research question
Is the use of adenosine triphosphate a good measure for hospital cleanliness?
Are hospitals aware of what “clean” means and the standards that should be used to assess cleanliness?
Study method and sample Demographics
A review was conducted which included relevant English-language articles that were retrieved from databases. To identify the articles, key words used were ATP and bioluminescence, hospital and surfaces. Any article that had these words was reviewed for suitability of use in the study. Bibliographies of the selected articles were identified, and the articles were used to provide information about the study. A total of 31 articles were considered for use in the analysis, but only 24 articles were used because seven of identified articles lacked medical knowledge or were published before 1990 while the others appeared more than once.
Results of the Study
Measurement of ATP had a wide variation were the values ranged from 0 to 500,000. Although various authors were used, the ultimate result of the study revealed that ATP bioluminescence could not be considered as a quick and reliable method to assess hospital cleanliness. This is because it can be standardized both nationally and internationally.
Citation
Amodio, E., & Dino, C. (2014). Use of ATP bioluminescence for assessing the cleanliness of hospital surfaces: a review of the published literature (1990–2012). Journal of infection and public health, 7(2), 92-98.
The use of adenosine triphosphate bioluminescence to assess the efficacy of a modified cleaning program implemented within an intensive care setting
Problem Statement
Hospital cleanliness is determined by the level of hospital-acquired infection. Various countries have devised initiatives that can improve the standards of cleaning although the cleaning programs are not as efficient as expected. Lack of proper cleaning standards is an issue that is affecting healthcare facilities in the United States. For cleaning standard to be effective, it has to include a way of assessing the efficacy and must comply with National Specifications for Cleanliness. Healthcare systems are increasingly adopting cleaning audits aimed at assessing the efficiency of cleaning programs employed in a hospital. Use of ATP bioluminescence in the healthcare system has been limited in most countries. Even so, the Clean-Trace Clinical Hygiene Monitoring System is employed in the United Kingdom and has recently been awarded a Rapid Review Panel Recommendation. The panel was set by the Department of health with the aim of assessing all products that are meant to reduce health infections. According to the panel, the Clean-Trace ATP system is an effective measure of hospital cleanliness; hence it can be used to measure the level of cleanliness in as healthcare set-up.
Although different tests can measure the level of cleanliness of a healthcare setting, few of the systems can differentiate between microbial and non-microbial ATP; therefore, tests that cannot differentiate between them also cannot be considered in microbiologic tests. Most of the implemented systems of measuring infections in most countries cannot be used in microbiologic tests because they cannot differentiate microbial and non-microbial ATP. Thus, this study was conducted to establish efficient studies.
Purpose of the Study
The study was aimed to assess the use of adenosine triphosphate bioluminescence and whether it could differentiate between microbial and non-microbial ATP.
Research question
Is the use of ATP bioluminescence effective in improving hospital cleanliness?
Are existing programs of testing cleanliness effective?
Study method and sample Demographics
The study used a team of trained hygiene techniques to clean near-patient furniture and hospital equipment twice a day for 40days. They cleaned using ultra microfiber cloth for 40 weeks and later the surfaces were selected and sampled using 3M Clean-Trace Clinical Hygiene Monitoring system to test the difference.
Results of the Study
The findings of the study revealed the efficiency of ATP bioluminescence as a means to improve hospital cleanliness. Also, benchmark values were reported to be effective in assessing the efficacy of a program.
Citation
Moore, G., Smyth, D., Singleton, J., & Wilson, P. (2010). The use of adenosine triphosphate bioluminescence to assess the efficacy of a modified cleaning program implemented within an intensive care setting. American journal of infection control, 38(8), 617-622.
Multisite evaluation of environmental cleanliness of high-touch surfaces in intensive care unit patient rooms
Problem Statement
Environment surfaces in intensive care unit are prone to infections by pathogens due to frequent touch by hands. Previous studies have revealed an increased risk of acquiring pathogens when patients occupy a room that was previously occupied by patients with multi-resistant pathogens. Cleaning and disinfection of such rooms have been reported to reduce the risk of infections for patients sharing the same rooms. ICU patients have been at risk of infections because patients receiving care from such rooms are critical and with a high rate of transmitting infections. Healthcare professionals are required to conduct thorough cleaning and disinfection of such rooms before a new patient is admitted. This is done to reduce the chances of infection by pathogens for individuals who work in those rooms as well as patients who use those rooms later.
Previous studies have revealed a close association between the risk of pathogens and patients using ICU rooms. These rooms have been assumed to provide an environment with increased touch surfaces. Various methods are used for cleaning and disinfecting the rooms, but most of them are not tested for efficacy. Identification of the areas with increased risk of infection is the first key to coming up with relevant strategies for control and prevention of pathogens. Some areas have increased risks due to frequent hand touch. Bacteria count in any environment determines the risk of infection associated with that environment. Several systems are employed in the monitoring of the environment that is contaminated. The use of ATP in the assessment of cleanliness and direct feedback are some of the ways that can be used to identify the riskiest areas in the ICU; thus they create the importance of cleaning and disinfection of the surfaces.
Purpose of the study
The study aimed to determine the baseline contamination levels before discharge cleaning and disinfection and after the patient is discharged. It also wanted to determine the relevance of educational intervention and rapid cleanliness techniques can be effective.
Research question
What is the level of baseline contamination before and after the patient is discharged?
How effective is educational intervention and rapid cleanliness in ICU?
Study method and sample Demographics
A prospective study was conducted which involved assessment of high-touch surfaces in the 50 provided ICU rooms. Evaluation of how an efficient discharge cleaning and disinfection regimen was done using ATP levels. The selection of the rooms was based on the sample selected and convenience.
Results of the Study
A high level of contamination was reported before and after discharge, and educational feedback that incorporates the rapid feedback of ATP measurement was found to be effective in increasing effectiveness of cleaning and disinfection regimes.
Citation
Hopman, J., Donskey, C. J., Boszczowski, I., & Alfa, M. J. (2018). Multisite evaluation of environmental cleanliness of high-touch surfaces in intensive care unit patient rooms. American journal of infection control.