Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-28T00:45:20.211Z Has data issue: false hasContentIssue false
  • English
  • Français

Adenosine Triphosphate Quantification Correlates Poorly with Microbial Contamination of Duodenoscopes

Published online by Cambridge University Press:  17 April 2017

Lovisa B. Olafsdottir ,
Sharon B. Wright ,
Anne Smithey ,
Riley Heroux ,
Elizabeth B. Hirsch ,
Alice Chen ,
Benjamin Lane ,
Mandeep S. Sawhney  and
Graham M. Snyder
Lovisa B. Olafsdottir
Affiliation:
Division of Infection Control/Hospital Epidemiology, Silverman Institute of Health Care Quality & Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Sharon B. Wright
Affiliation:
Division of Infection Control/Hospital Epidemiology, Silverman Institute of Health Care Quality & Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Anne Smithey
Affiliation:
Division of Infection Control/Hospital Epidemiology, Silverman Institute of Health Care Quality & Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Riley Heroux
Affiliation:
Division of Infection Control/Hospital Epidemiology, Silverman Institute of Health Care Quality & Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Elizabeth B. Hirsch
Affiliation:
Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts Department of Pharmacy and Health Systems Sciences, Northeastern University, Boston, Massachusetts
Alice Chen
Affiliation:
Division of Infection Control/Hospital Epidemiology, Silverman Institute of Health Care Quality & Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Benjamin Lane
Affiliation:
Division of Infection Control/Hospital Epidemiology, Silverman Institute of Health Care Quality & Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Mandeep S. Sawhney
Affiliation:
Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
Graham M. Snyder*
Affiliation:
Division of Infection Control/Hospital Epidemiology, Silverman Institute of Health Care Quality & Safety, Beth Israel Deaconess Medical Center, Boston, Massachusetts Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
*
Address correspondence to Graham Snyder, Mailstop SL-435, 330 Brookline Ave, Boston, MA 02115 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

The aim of this study was to quantify the correlation between adenosine triphosphate (ATP) measurements and bacterial cultures from duodenoscopes for evaluation of contamination following high-level disinfection.

DESIGN

Duodenoscopes used for any intended endoscopic retrograde cholangiopancreatography (ERCP) procedure were included. Microbiologic and ATP data were collected concomitantly and in the same manner from ERCP duodenoscopes.

SETTING

A high-volume endoscopy unit at a tertiary referral acute-care facility.

METHODS

Duodenoscopes were sampled for ATP and bacterial contamination in a contemporaneous and highly standardized fashion using a “flush-brush-flush” method for the working channel (WC) and a dry flocked swab for the elevator mechanism (EM). Specimens were processed for any aerobic bacterial growth (colony-forming units, CFU). Growth of CFU>0 and ATP relative light unit (RLU)>0 was considered a contaminated result. Frequency of discord between among WC and EM measurements were calculated using 2×2 contingency tables. The Spearman correlation coefficient was used to calculate the relatedness of bacterial contamination and ATP as continuous measurements.

RESULTS

The Spearman correlation coefficient did not demonstrate significant relatedness between ATP and CFU for either a WC or EM site. Among 390 duodenoscope sampling events, ATP and CFU assessments of contamination were discordant in 82 of 390 WC measurements (21%) and 331 of 390 of EM measurements (84.9%). The EM was frequently and markedly positive by ATP measurement.

CONCLUSION

ATP measurements correlate poorly with a microbiologic standard assessing duodenoscope contamination, particularly for EM sampling. ATP may reflect biological material other than nonviable aerobic bacteria and may not serve as an adequate marker of bacterial contamination.

Infect Control Hosp Epidemiol 2017;38:678–684

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 6 , June 2017 , pp. 678 - 684
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: Findings from this study were presented at The Society for Healthcare Epidemiology Spring 2016 Conference in Atlanta, Georgia, on May 19, 2016 (poster no. 530).

References

REFERENCES

1. Carbonne, A, Thiolet, JM, Fournier, S, et al. Control of a multi-hospital outbreak of KPC-producing Klebsiella pneumoniae type 2 in France, September to October 2009. Euro Surveill 2010:15.Google ScholarPubMed
2. Aumeran, C, Poincloux, L, Souweine, B, et al. Multidrug-resistant Klebsiella pneumoniae outbreak after endoscopic retrograde cholangiopancreatography. Endoscopy 2010;42:895–899.CrossRefGoogle ScholarPubMed
3. Spach, DH, Silverstein, FE, Stamm, WE. Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med 1993;118:117–128.CrossRefGoogle ScholarPubMed
4. Epstein, L, Hunter, JC, Arwady, MA, et al. New Delhi metallo-β-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes. JAMA 2014;312:1447–1455.CrossRefGoogle Scholar
5. Rutala, WA, Weber, DJ. ERCP scopes: What can we do to prevent infections? Infect Control Hosp Epidemiol 2015;36:643–648.CrossRefGoogle ScholarPubMed
6. Rutala, WA, Weber, DJ. Outbreaks of carbapenem-resistant Enterobacteriaceae infections associated with duodenoscopes: What can we do to prevent infections? Am J Infect Control 2016;44:e47–e51.CrossRefGoogle ScholarPubMed
7. Petersen, BT, Chennat, J, Cohen, J, et al. Multisociety guideline on reprocessing flexible GI endoscopes: 2011. Infect Control Hosp Epidemiol 2011;32:527–537.CrossRefGoogle ScholarPubMed
8. Beilenhoff, U, Neumann, CS, Rey, JF, et al. ESGE-ESGENA guideline for quality assurance in reprocessing: microbiological surveillance testing in endoscopy. Endoscopy 2007;39:175–181.CrossRefGoogle ScholarPubMed
9. Interim protocol for healthcare facilities regarding surveillance for bacterial contamination of duodenoscopes after reprocessing. Centers for Disease Control and Prevention website. http://www.cdc.gov/hai/organisms/cre/cre-duodenoscope-surveillance-protocol.html. Published 2015. Accessed June 3, 2016.Google Scholar
10. Turner, DE, Daugherity, EK, Altier, C, Maurer, KJ. Efficacy and limitations of an ATP-based monitoring system. J Am Assoc Lab Anim Sci 2010;49:190–195.Google ScholarPubMed
11. Amodio, E, Dino, C. Use of ATP bioluminescence for assessing the cleanliness of hospital surfaces: a review of the published literature (1990–2012). J Infect Public Health 2014;7:92–98.CrossRefGoogle ScholarPubMed
12. Leon, MB, Albrecht, JA. Comparison of adenosine triphosphate (ATP) bioluminescence and aerobic plate counts (APC) on plastic cutting boards. Journal of Foodservice 2007;18:145–152.CrossRefGoogle Scholar
13. Poulis, JA, de Pijper, M, Mossel, DA, Dekkers, PP. Assessment of cleaning and disinfection in the food industry with the rapid ATP-bioluminescence technique combined with the tissue fluid contamination test and a conventional microbiological method. Int J Food Microbiol 1993;20:109–116.CrossRefGoogle Scholar
14. Batailler, P, Saviuc, P, Picot-Gueraud, R, Bosson, JL, Mallaret, MR. Usefulness of adenosinetriphosphate bioluminescence assay (ATPmetry) for monitoring the reprocessing of endoscopes. Infect Control Hosp Epidemiol 2015;36:1437–1443.CrossRefGoogle ScholarPubMed
15. Hansen, D, Benner, D, Hilgenhoner, M, Leisebein, T, Brauksiepe, A, Popp, W. ATP measurement as method to monitor the quality of reprocessing flexible endoscopes. Ger Med Sci 2004;2:Doc04.Google ScholarPubMed
16. Ofstead, CL, Wetzler, HP, Doyle, EM, et al. Persistent contamination on colonoscopes and gastroscopes detected by biologic cultures and rapid indicators despite reprocessing performed in accordance with guidelines. Am J Infect Control 2015;43:794–801.CrossRefGoogle ScholarPubMed
17. Alfa, MJ, Olson, N, Murray, BL. Comparison of clinically relevant benchmarks and channel sampling methods used to assess manual cleaning compliance for flexible gastrointestinal endoscopes. Am J Infect Control 2014;42:e1–e5.CrossRefGoogle ScholarPubMed
18. Alfa, MJ, Fatima, I, Olson, N. The adenosine triphosphate test is a rapid and reliable audit tool to assess manual cleaning adequacy of flexible endoscope channels. Am J Infect Control 2013;41:249–253.CrossRefGoogle ScholarPubMed
19. Fushimi, R, Takashina, M, Yoshikawa, H, et al. Comparison of adenosine triphosphate, microbiological load, and residual protein as indicators for assessing the cleanliness of flexible gastrointestinal endoscopes. Am J Infect Control 2013;41:161–164.CrossRefGoogle ScholarPubMed
20. Fernando, G, Collignon, P, Beckingham, W. ATP bioluminescence to validate the decontamination process of gastrointestinal endoscopes. Healthcare Infection 2014;19:59–64.CrossRefGoogle Scholar
21. Obee, PC, Griffith, CJ, Cooper, RA, Cooke, RP, Bennion, NE, Lewis, M. Real-time monitoring in managing the decontamination of flexible gastrointestinal endoscopes. Am J Infect Control 2005;33:202–206.CrossRefGoogle ScholarPubMed
22. Clinicaltrials.gov. Duodenoscope Disinfect Study. https://clinicaltrials.gov/ct2/show/NCT02611648?term=NCT02611648&rank=1. Published 2015. Accessed August 3, 2016.Google Scholar
23. Dawson, BT. Basic and Clinical Biostatistics, 4th ed. New York: Lange Medical Books/McGraw-Hill; 2004. Pp. 306–311.Google Scholar
24. Alfa, MJ, Fatima, I, Olson, N. Validation of adenosine triphosphate to audit manual cleaning of flexible endoscope channels. Am J Infect Control 2013;41:245–248.CrossRefGoogle ScholarPubMed
25. Aiken, ZA, Wilson, M, Pratten, J. Evaluation of ATP bioluminescence assays for potential use in a hospital setting. Infect Control Hosp Epidemiol 2011;32:507–509.CrossRefGoogle ScholarPubMed
26. Pajkos, A, Vickery, K, Cossart, Y. Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and decontamination? J Hosp Infect 2004;58:224–229.CrossRefGoogle Scholar
27. Omidbakhsh, N, Ahmadpour, F, Kenny, N. How reliable are ATP bioluminescence meters in assessing decontamination of environmental surfaces in healthcare settings? PLoS One 2014;9:e99951.CrossRefGoogle ScholarPubMed
28. Frequently asked questions (FAQs) on the interim duodenoscope surveillance protocol. Centers for Disease Control and Prevention website. https://www.cdc.gov/hai/organisms/cre/cre-duodenoscope-surveillance-protocol-faqs.html. Published 2015. Accessed February 6, 2017.Google Scholar