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Adenosine Triphosphate Quantification Correlates Poorly with Microbial Contamination of Duodenoscopes
Lovisa B Olafsdottir1, Sharon B Wright1, Anne Smithey1
11Division of Infection Control/Hospital Epidemiology,Silverman Institute of Health Care Quality & Safety,Beth Israel Deaconess Medical Center,Boston,Massachusetts.
Infection Control and Hospital Epidemiology
|April 18, 2017
Summary
Adenosine triphosphate (ATP) measurements poorly correlate with bacterial cultures for duodenoscope contamination assessment. ATP may detect non-bacterial biological material, questioning its use as a reliable marker for disinfection effectiveness.
Area of Science:
- Infection Control
- Medical Device Reprocessing
- Microbiology
Background:
- Duodenoscopes require rigorous disinfection due to complex design.
- Assessing residual contamination after high-level disinfection is critical for patient safety.
- Adenosine triphosphate (ATP) bioluminescence assays are used to detect biological material.
Purpose of the Study:
- To quantify the correlation between ATP measurements and bacterial cultures from duodenoscopes.
- To evaluate the effectiveness of ATP as a marker for duodenoscope contamination post-disinfection.
Main Methods:
- Duodenoscopes underwent standardized "flush-brush-flush" (working channel) and swab (elevator mechanism) sampling.
- Samples were analyzed for aerobic bacterial growth (CFU) and ATP (RLU).
- Correlation was assessed using Spearman coefficient and contingency tables.
Main Results:
- No significant correlation was found between ATP and CFU for either the working channel or elevator mechanism.
- Discordance between ATP and CFU was high: 21% for the working channel and 84.9% for the elevator mechanism.
- ATP measurements frequently indicated contamination on the elevator mechanism, but not necessarily bacterial.
Conclusions:
- ATP measurements demonstrate poor correlation with bacterial contamination standards for duodenoscopes.
- ATP may not be a suitable marker for detecting bacterial contamination on duodenoscopes.
- Elevator mechanism sampling showed significant discordance, suggesting ATP detects other biological residues.
