INFECTION CONTROL
kitchen, areas which are frequently implicated in the spread of infectious intestinal disease. Operating theatre sites had lower ATP results but 61% of sites would be considered unacceptable.14 In his presentation at HIS, Prof Griffith highlighted the vast differences between wards assessed using visual means, ATP testing, and microbiological means – in one study, 91% of ward sites were reported to be ‘visually clean’, 10% were ‘ATP clean’ and 45% were ‘microbiologically clean’.14 Concluding, he summarised that there is a need to manage cleaning, by improving systems and culture, and emphasised that it is important to assess surface cleanliness. There are a range of methods available, depending on what information is required, but ATP offers a number of advantages.
Monitoring cleanliness with ATP Dennis Andersen, Andersen Control Aps, Denmark, provided an insight into monitoring hospital cleanliness with standardised ATP measurements, highlighting a new Danish standard that combines visual control with a quantitative measuring method for assessing non-visible contamination and transmission risk.
The EN/DS 2451-10 standard is the only normative standard in the world
for cleaning in the healthcare sector and provides official guidance on the use of ATP testing. With this standard, it is possible to establish cleanliness levels for surfaces and to obtain recommendations for processes to achieve established hygiene levels. The standard includes a biological inspection method, ATP, as well as microbiological inspection. The guidelines outline stated hygiene levels for critical risk points, expressed in femtomole units. Dennis Andersen explained that ‘femtomole’ is often converted into RLU. The conversion factor depends on the measurement equipment. However, the SystemSURE Plus luminometer from Hygiena has a conversion factor of one femtomol ATP to one RLU – using a luminometer where the scale of RLU corresponds to the amount of femtomol eliminates the need for conversion. Five hygiene levels are outlined in the
standard. Level five includes care/treatment areas and production areas requiring a particularly high degree of cleanliness. Level four and three are primarily patient- related areas, while there are no patients present in the two lowest levels (one and two). If a result of between 25 and 50 femtomol is obtained at a hygiene level five location, further observation is required. A result over 50 femtomol requires
intervention. If a result of between 50 and 100 femtomol is obtained at a hygiene level four and three location, this requires further observation – while a result over 100 femtomol requires intervention. Speaking to The Clinical Services
Journal, after the HIS symposium, Martin Easter commented that the UK should follow the example of Denmark. Other organisations, such as the CDC in the US, also incorporate ATP technology as part of their tool kit for evaluating environmental cleaning. “A great deal of pioneering work has been carried out in the UK and there is increasing adoption of the technology, but we should now be implementing a standardised approach like the Danes.” He added that, despite the recent acknowledgement by infection control experts that the patient environment is a reservoir for pathogenic bacteria, there is a lack of understanding of the importance and benefits of hospital cleaning in the UK. “Some infection control specialists want to try to measure specific pathogens in the environment which is like trying to detect a needle in a haystack (or an ant on a tennis court), but these bacteria get there in traces of body fluids which also protect and nourish the bacteria so they can survive for long periods,” Martin Easter continued.
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www.lte-scientific.co.uk Please visit us on Stand 12B07 APRIL 2015 THE CLINICAL SERVICES JOURNAL 23
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