title: The adenosine triphosphate test is a rapid and reliable audit tool to assess manual cleaning adequacy of flexible endoscope channels.
abstract: BACKGROUND
  The study objective was to verify that the adenosine triphosphate (ATP) benchmark of <200 relative light units (RLUs) was achievable in a busy endoscopy clinic that followed the manufacturer's manual cleaning instructions.
  
  
  METHODS
  All channels from patient-used colonoscopes (20) and duodenoscopes (20) in a tertiary care hospital endoscopy clinic were sampled after manual cleaning and tested for residual ATP. The ATP test benchmark for adequate manual cleaning was set at <200 RLUs. The benchmark for protein was <6.4 μg/cm(2), and, for bioburden, it was <4-log10 colony-forming units/cm(2).
  
  
  RESULTS
  Our data demonstrated that 96% (115/120) of channels from 20 colonoscopes and 20 duodenoscopes evaluated met the ATP benchmark of <200 RLUs. The 5 channels that exceeded 200 RLUs were all elevator guide-wire channels. All 120 of the manually cleaned endoscopes tested had protein and bioburden levels that were compliant with accepted benchmarks for manual cleaning for suction-biopsy, air-water, and auxiliary water channels.
  
  
  CONCLUSIONS
  Our data confirmed that, by following the endoscope manufacturer's manual cleaning recommendations, 96% of channels in gastrointestinal endoscopes would have <200 RLUs for the ATP test kit evaluated and would meet the accepted clean benchmarks for protein and bioburden.
authors.affiliation: Clinical Microbiology Diagnostic Services of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada. malfa@dsmanitoba.ca
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Alfa
authors.forename: Iram
authors.initials: I
authors.lastname: Fatima
authors.forename: Nancy
authors.initials: N
authors.lastname: Olson
mesh_terms: D000255:Adenosine Triphosphate / Q000032:analysis*; D019723:Endoscopes / Q000382:microbiology*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D011785:Quality Assurance, Health Care / Q000379:methods*; D013194:Staining and Labeling / Q000379:methods*; D062606:Tertiary Care Centers; D013997:Time Factors
chemical_list: D000255:Adenosine Triphosphate