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Use of adenosine triphosphate to audit reprocessing of flexible endoscopes with an elevator mechanism
Erik Quan1, Rizwan Mahmood2, Amar Naik2
1Loyola University Chicago Stritch School of Medicine, Maywood, IL.
Background:
There have been reported outbreaks of carbapenem-resistant Enterobacteriaceae infections linked to endoscopes with elevator mechanisms. Adenosine triphosphate (ATP) testing has been used as a marker for bioburden and monitoring manual cleaning for flexible endoscopes with and without an elevator mechanism. The objective of this study was to determine whether routine ATP testing could identify areas of improvement in cleaning of endoscopes with an elevator mechanism.
Methods:
ATP testing after manual cleaning of TJF-Q180V duodenoscopes and GF-UCT180 linear echoendoscopes (Olympus America Inc, Center Valley, PA) was implemented. Samples were tested from the distal end, the elevator mechanism, and water flushed through the lumen of the biopsy channel. Data were recorded and compared by time point, test point, and reprocessing technician.
Results:
Overall failure rate was 6.99% (295 out of 4,219). The highest percentage of failed ATP tests (17.05%) was reported in the first quarter of routine testing, with an overall decrease in rates over time. The elevator mechanism and working channel lumen had higher failure rates than the distal end. Quality of manual cleaning between reprocessing technicians showed variation.
Conclusion:
ATP testing is effective in identifying residual organic material and improving quality of manual cleaning of endoscopes with an elevator mechanism. Cleaning efficacy is influenced by reprocessing technicians and location tested on the endoscope. Close attention to the working channel and elevator mechanism during manual cleaning is warranted.
Insights
Routine adenosine triphosphate (ATP) testing effectively identifies areas needing improved cleaning for duodenoscopes with elevator mechanisms. This method helps reduce bioburden and enhances patient safety by monitoring manual cleaning efficacy.
Area of Science:
- Infection Control
- Medical Device Reprocessing
- Healthcare Associated Infections
Background:
- Outbreaks of carbapenem-resistant Enterobacteriaceae infections have been linked to endoscopes with elevator mechanisms.
- Adenosine triphosphate (ATP) testing is a recognized method for assessing bioburden and monitoring manual cleaning of flexible endoscopes.
Purpose of the Study:
- To evaluate the effectiveness of routine adenosine triphosphate (ATP) testing in identifying areas for cleaning improvement in endoscopes featuring an elevator mechanism.
Main Methods:
- Adenosine triphosphate (ATP) testing was implemented post-manual cleaning for specific duodenoscopes and linear echoendoscopes.
- Samples were collected from the distal end, elevator mechanism, and biopsy channel lumen.
- Data were analyzed based on time, test location, and reprocessing technician.
Main Results:
- The overall ATP test failure rate was 6.99%, with the highest rate (17.05%) observed in the initial testing quarter.
- Failure rates decreased over time, indicating improved cleaning practices.
- The elevator mechanism and working channel lumen showed higher failure rates compared to the distal end, with notable variation in cleaning quality among technicians.
Conclusions:
- Routine ATP testing is a valuable tool for detecting residual organic material and enhancing the manual cleaning quality of endoscopes with elevator mechanisms.
- Cleaning effectiveness is influenced by the reprocessing technician and the specific location on the endoscope.
- Focused attention on the working channel and elevator mechanism during manual cleaning is crucial for infection prevention.
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