Adenosine triphosphate bioluminescence for bacteriologic surveillance and reprocessing strategies for minimizing risk of infection transmission by duodenoscopes.
OBJECTIVE
Recent outbreaks of duodenoscope-transmitted infections underscore the importance of adequate endoscope reprocessing. Adenosine triphosphate (ATP) bioluminescence testing allows rapid evaluation of endoscopes for bacteriologic/biologic residue. In this prospective study we evaluate the utility of ATP in bacteriologic surveillance and the effects of endoscopy staff education and dual cycles of cleaning and high-level disinfection (HLD) on endoscope reprocessing.


METHODS
ATP bioluminescence was measured after precleaning, manual cleaning, and HLD on rinsates from suction-biopsy channels of all endoscopes and elevator channels of duodenoscopes/linear echoendoscopes after use. ATP bioluminescence was remeasured in duodenoscopes (1) after re-education and competency testing of endoscopy staff and subsequently (2) after 2 cycles of precleaning and manual cleaning and single cycle of HLD or (3) after 2 cycles of precleaning, manual cleaning, and HLD.


RESULTS
The ideal ATP bioluminescence benchmark of <200 relative light units (RLUs) after manual cleaning was achieved from suction-biopsy channel rinsates of all endoscopes, but 9 of 10 duodenoscope elevator channel rinsates failed to meet this benchmark. Re-education reduced RLUs in duodenoscope elevator channel rinsates after precleaning (23,218.0 vs 1340.5 RLUs, P < .01) and HLD (177.0 vs 12.0 RLUs, P < .01). After 2 cycles of manual cleaning/HLD, duodenoscope elevator channel RLUs achieved levels similar to sterile water, with corresponding negative cultures.


CONCLUSIONS
ATP testing offers a rapid, inexpensive alternative for detection of endoscope microbial residue. Re-education of endoscopy staff and 2 cycles of cleaning and HLD decreased elevator channel RLUs to levels similar to sterile water and may therefore minimize the risk of transmission of infections by duodenoscopes.
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
Saurabh
S
Sethi
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
Robert J
RJ
Huang
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
Monique T
MT
Barakat
Department of Microbiology, Stanford University School of Medicine, Stanford, California, USA.
Niaz
N
Banaei
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
Shai
S
Friedland
Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
Subhas
S
Banerjee
D000255:Adenosine Triphosphate / Q000032:analysis*; D003428:Cross Infection / Q000517:prevention & control*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D004203:Disinfection / Q000379:methods*; D020698:Duodenoscopes / Q000382:microbiology*; D016099:Endoscopy, Gastrointestinal; D004866:Equipment Contamination / Q000517:prevention & control*; D017743:Equipment Reuse; D006801:Humans; D008163:Luminescent Measurements; D011361:Professional Competence
D000255:Adenosine Triphosphate