title: Analytical performance issues: comparison of ATP bioluminescence and aerobic bacterial count for evaluating surface cleanliness in an Italian hospital.
abstract: Contaminated hospital surfaces have been demonstrated to be an important environmental reservoir of microorganisms that can increase the risk of nosocomial infection in exposed patients. As a consequence, cleaning and disinfecting hospital environments play an important role among strategies for preventing healthcare-associated colonization and infections. The aim of the present study was to evaluate whether adenosine triphosphate (ATP) presence, measured by bioluminescence methods, can predict microbiological contamination of hospital surfaces. The study was carried out between September and December 2012 at the University Hospital "P. Giaccone" of Palermo. A total of 193 randomly selected surfaces (tables, lockers, furnishings) were sampled and analyzed in order to assess ATP levels (expressed as relative light units or RLU) and aerobic colony count (ACC) or presence of S. aureus. ACC had median values of 1.85 cfu/cm(2)(interquartile range = 4.16) whereas ATP median was 44.6 RLU/cm(2)(interquartile range = 92.3). Overall, 85 (44.0%) surfaces exceeded the established microbial benchmark: 73 (37.8%) exceeded the 2.5 cfu/cm(2)ACC standard, 5 (2.6%) surfaces were positive for S. aureus and 7 (3.6%) showed both the presence of S. aureus and an ACC of more than 2.5 cfu/cm(2). ACC and bioluminescence showed significant differences in the different surface sites (p < 0.001). A significant correlation was found between ACC and RLU values (p-value < 0.001; R(2)= 0.29) and increasing RLU values were significantly associated with a higher risk of failing the benchmark (p < 0.001). Our data suggest that bioluminescence could help in measuring hygienic quality of hospital surfaces using a quick and sensitive test that can be an useful proxy of microbial contamination; however, further analysis will be necessary to assess the cost-efficacy of this methodology before requiring incorporation in hospital procedures.
authors.affiliation: a Department of Sciences for Health Promotion, "G. D'Alessandro" , University of Palermo , Palermo , Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Amodio
authors.forename: Lucia
authors.initials: L
authors.lastname: Cannova
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: Villafrate
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Merendino
authors.forename: Luigi
authors.initials: L
authors.lastname: Aprea
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Calamusa
mesh_terms: D000255:Adenosine Triphosphate / Q000032:analysis*; D058491:Bacterial Load; D004784:Environmental Monitoring / Q000379:methods*; D006761:Hospitals; D007558:Italy; D008163:Luminescent Measurements; D016273:Occupational Exposure / Q000032:analysis*; D013499:Surface Properties
chemical_list: D000255:Adenosine Triphosphate