title: Comparison of clinically relevant benchmarks and channel sampling methods used to assess manual cleaning compliance for flexible gastrointestinal endoscopes.
abstract: BACKGROUND
  The objectives of this study were to recommend sample collection method(s) based on relative soiling in patient-used gastrointestinal (GI) endoscopes and determine whether the published benchmarks for protein, bioburden, and adenosine triphosphate (ATP) remain relevant for pump-assisted manual cleaning.
  
  
  METHODS
  Patient-used gastroscopes, duodenoscopes, and colonoscopes were sampled before and after manual cleaning and assessed for protein, bioburden, and ATP levels. The biopsy port (BP) to distal end (D) sample was collected using 20 mL of sterile reverse-osmosis water. After a 200-mL flush, the umbilical (UM) to BP portion was sampled by flushing 40 mL from the UM to the D.
  
  
  RESULTS
  The BP to D portion of the suction biopsy channel contained 83% of ATP residuals. Despite cleaning with brushing and a flushing pump, 25% of gastroscopes exceeded the ATP benchmark of 200 relative light units (RLU), whereas all duodenoscopes and colonoscopes had <200 RLU after cleaning. The protein and bioburden residuals after pump-assisted cleaning were consistently lower than existing benchmarks.
  
  
  CONCLUSIONS
  Sampling the suction biopsy channel from BP to D detected the most residuals from patient-used GI endoscopes. The protein and bioburden benchmarks for pump-assisted cleaning can be lowered, but 200 RLU is still adequate for ATP.
authors.affiliation: Department of Clinical Microbiology, Diagnostic Services of Manitoba, Winnipeg, MB, Canada; Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada; Microbiology Laboratory, St Boniface Research Centre, Winnipeg, MB, Canada. Electronic address: malfa@dsmanitoba.ca.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Alfa
authors.affiliation: Microbiology Laboratory, St Boniface Research Centre, Winnipeg, MB, Canada.
authors.forename: Nancy
authors.initials: N
authors.lastname: Olson
authors.affiliation: Microbiology Laboratory, St Boniface Research Centre, Winnipeg, MB, Canada.
authors.forename: Brenda-Lee
authors.initials: BL
authors.lastname: Murray
mesh_terms: D000255:Adenosine Triphosphate / Q000032:analysis; D019985:Benchmarking; D015169:Colony Count, Microbial; D003666:Decontamination / Q000379:methods*; D004203:Disinfection / Q000379:methods*; D020776:Endoscopes, Gastrointestinal / Q000382:microbiology*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D011506:Proteins / Q000032:analysis; D013048:Specimen Handling / Q000379:methods*
chemical_list: D011506:Proteins; D000255:Adenosine Triphosphate
keywords: ATP; Soil distribution; Validation