Assessing the effectiveness of surface cleaning methods in intravitreal injection procedure rooms

To assess cleaning effectiveness of room surfaces in an office-based intravitreal injection practice by using adenosine triphosphate (ATP) luminometry.

Prospective, comparative case series.

A total of 792 intravitreal injection room surfaces were sampled (396 before cleaning, 396 after cleaning) using 3 cleaning methods.

Three cleaning methods were evaluated: baseline terminal cleaning, directed terminal cleaning, and enhanced terminal cleaning. For each method, residual ATP bioburden (relative light units [RLUs]/sample) was sampled from 9 high-touch injection room surfaces before and after terminal cleaning using the 3M Clean-Trace ATP System (3M Inc, St. Paul, MN). Surface ATP RLUs were used to compare cleaning methods and against an ATP benchmark of fewer than 250 RLU. Differences between cleaning methods were compared by using paired t tests with Bonferroni correction for 3 comparisons.

Surface ATP RLU levels.

In baseline terminal cleaning and directed terminal cleaning, the median ATP level of all surfaces exceeded threshold when sampled after terminal cleaning (391 RLU and 264 RLU, respectively), and levels were increased significantly at the completion of the injection clinic and before terminal cleaning (780 RLU and 626 RLU, respectively; P < 0.003). In enhanced terminal cleaning, the median ATP level was below threshold after terminal cleaning (71 RLU), was unchanged at the completion of injection clinic and before terminal cleaning (63 RLU; P = 0.27), and was significantly lower than after the baseline terminal and directed terminal cleaning methods (P < 0.003).

An easily adopted enhanced terminal cleaning program reduced surface ATP bioburden in intravitreal injection rooms to less than clean benchmarks used in nonophthalmologic healthcare settings.