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The Perennial Problem of Variability In Adenosine Triphosphate (ATP) Tests for Hygiene Monitoring Within Healthcare Settings

Published online by Cambridge University Press:  03 March 2015

Greg S. Whiteley*
Affiliation:
University of Western Sydney, School of Science and Health, Richmond, NSW, Australia Whiteley Corporation, North Sydney, NSW, Australia
Chris Derry
Affiliation:
University of Western Sydney, School of Science and Health, Richmond, NSW, Australia WHO Collaborating Centre for Environmental Health Development, Richmond, NSW, Australia
Trevor Glasbey
Affiliation:
Whiteley Corporation, North Sydney, NSW, Australia
Paul Fahey
Affiliation:
University of Western Sydney, School of Science and Health, Richmond, NSW, Australia
*
Address correspondence to Greg S. Whiteley, M Safety Sc, P.O. Box 1076, North Sydney, NSW 2059, Australia (gregswhiteley@aol.com).

Abstract

OBJECTIVE

To investigate the reliability of commercial ATP bioluminometers and to document precision and variability measurements using known and quantitated standard materials.

METHODS

Four commercially branded ATP bioluminometers and their consumables were subjected to a series of controlled studies with quantitated materials in multiple repetitions of dilution series. The individual dilutions were applied directly to ATP swabs. To assess precision and reproducibility, each dilution step was tested in triplicate or quadruplicate and the RLU reading from each test point was recorded. Results across the multiple dilution series were normalized using the coefficient of variation.

RESULTS

The results for pure ATP and bacterial ATP from suspensions of Staphylococcus epidermidis and Pseudomonas aeruginosa are presented graphically. The data indicate that precision and reproducibility are poor across all brands tested. Standard deviation was as high as 50% of the mean for all brands, and in the field users are not provided any indication of this level of imprecision.

CONCLUSIONS

The variability of commercial ATP bioluminometers and their consumables is unacceptably high with the current technical configuration. The advantage of speed of response is undermined by instrument imprecision expressed in the numerical scale of relative light units (RLU).

Infect Control Hosp Epidemiol 2015;00(0):1–6

Type
Original Articles
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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References

1. Griffith, CJ, Cooper, RA, Gilmore, J, Davies, C, Lewis, M. An evaluation of hospital cleaning regimes and standards. J Hosp Infect 2000;45:1928.Google Scholar
2. Aitken, ZA, Wilson, M, Pratten, J. Evaluation of ATP bioluminescence assays for potential use in a hospital setting. Infect Control Hosp Epidemiol 2011;32:507509.Google Scholar
3. Sciortino, CV, Giles, RA. Validation and comparison of three adenosine triphosphate luminometers for monitoring hospital surface sanitization: a rosetta stone for adenosine triphosphate testing. Am J Infect Control 2012;40:e233239.Google Scholar
4. Smith, PW, Beam, E, Sayles, H, Rupp, ME, Cavalieri, RJ, Gibbs, S, Hewlett, A. Impact of adenosine triphosphate detection and feedback on hospital room cleaning. Infect Control Hosp Epidemiol 2014;35:564569.CrossRefGoogle ScholarPubMed
5. Carling, PC, Huang, SS. Improving healthcare environmental cleaning and disinfection: current and evolving issues. Infect Control Hosp Epidemiol 2013;34:507513.Google Scholar
6. Mitchell, BG, Wilson, F, Dancer, SJ, McGregor, A. Methods to evaluate environmental cleanliness in healthcare facilities. Healthcare Infect 2013;18:2230.Google Scholar
7. Loveday, H, Wilson, JA, Pratt, RJ, Golsorkhi, M, Tingle, A, Bak, A, Browne, J, Prieto, J, Wilcox, M. EPIC 3 National Evidence Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. J Hosp Infect 2014;86:Suppl 1.Google Scholar
8. Gibbs, SG, Sayles, H, Chaika, O, Hewlett, A, Colbert, EM, Smith, PW. Evaluation of the relationship between ATP bioluminescence assay and the presence of organisms associated with healthcare-associated infections. Healthcare Infect 2014;19:101107.Google Scholar
9. Malik, DJ. Assessment of infection risk from environmental contamination using rapid ATP surface measurements. Am J Infect Control 2013;41:469479.Google Scholar
10. Whiteley, GS, Derry, C, Glasbey, T. Reliability testing for portable adenosine triphosphate bioluminometers. Infect Control Hosp Epidemiol 2013;34:538540.Google Scholar
11. Shama, G, Malik, DJ. The uses and abuses of rapid bioluminescence-based ATP assays. International J Hyg Environ Health 2013;216:115125.Google Scholar
12. Whiteley, GS, Derry, C, Glasbey, T. The comparative performance of three brands of portable ATP-bioluminometer intended for use in hospital infection control. Healthcare Infect 2012;17:9197.Google Scholar
13. Cooper, RA, Griffith, CJ, Malik, RE, Obee, P, Looker, N. Monitoring the effectiveness of cleaning in four British hospitals. J Hosp Infect 2007;35:338341.Google ScholarPubMed
14. Lewis, T, Griffith, C, Galo, M, Weinbren, M. A modified ATP benchmark for evaluating the cleaning of some hospital environmental surfaces. J Hosp Infect 2008;69:156163.Google Scholar
15. Mulvey, D, Redding, P, Robertson, C, Woodall, C, Kingsmore, P, Bedwell, D, Dancer, SJ. Finding a benchmark for monitoring hospital cleanliness. J Hosp Infect 2011;77:2530.Google Scholar
16. Boyce, JM, Havill, NL, Lipka, A, Havill, H, Rizvani, BS. Variations in hospital daily cleaning practices. Infect Control Hosp Epidemiol 2010;31:99101.Google Scholar
17. Moore, G, Smyth, D, Singleton, J, Wilson, P. The use of adenosine triphosphate bioluminescence to assess the efficacy of a modified cleaning program implemented within an intensive care setting. Am J Infect Control 2010;38:617622.Google Scholar
18. Anderson, RE, Young, V, Stewart, M, Robertson, C, Dancer, SJ. Cleanliness audit of clinical surfaces and equipment: who cleans what? J Hosp Infect 2011;78:178181.Google Scholar
19. Smith, PW, Gibbs, S, Sayles, H, Hewlett, A, Rupp, ME, Iwen, PC. Observations on hospital room contamination testing. Healthcare Infect 2013;18:1013.Google Scholar
20. Smith, PW, Sayles, H, Hewlett, , Cavalieri, RJ, Gibbs, SG, Rupp, ME. A study of three methods for assessment of hospital environmental cleaning. Healthcare Infect 2013;18:8085.Google Scholar
21. Lautenback, E, Woeltje, KF, Malani, PN. Practical Healthcare Epidemiology, 3rd ed. Chicago, IL: University of Chicago Press; 2010.CrossRefGoogle Scholar
22. Martin, P, Pierce, R. Practical Statistics for the Health Sciences. South Melbourne: Thomas Nelson, 1994.Google Scholar
23. Whiteley, GS, Derry, C, Glasbey, T. Sampling plans for use of rapid adenosine triphosphate (ATP) monitoring must overcome variability or suffer statistical invalidity. Infect Control Hosp Epidemiol 2015;36:236237.Google Scholar
24. Deva, AK, Adams, WP, Vickery, KA. The role of bacterial biofilms in device associated infections. Plast Recon Surg 2013;132:13191328.Google Scholar
25. Lautenbach, E, Perencevich, EN. Introduction: addressing the emergence and impact of multidrug resistant Gram-negative organisms: a critical focus for the next decade. Infect Control Hosp Epidemiol 2014;35:333335.Google Scholar
26. Wood, RJ, Durham, TM. Reproducibility of serological titers. J Clinical Microbiol 1980;11:541545.Google Scholar
27. Reed, GF, Lynn, F, Meade, BD. Use of coefficient of variation in assessing variability of quantitative assays. Clinical Diagnostic Lab Immunology 2002;9:12351239.Google Scholar
28. Wood, RJ. Alternative ways of estimating serological titer reproducibility. J Clinical Microbiol 1981;13:760768.CrossRefGoogle ScholarPubMed
29. Malik, DJ, Shama, G. Estimating bacterial surface contamination by means of ATP determinations: 20 pence short of a pound. J Hosp Infect 2012;80:354356.Google Scholar
30. Rastogi, S, Shah, R, Perlman, J, Bhutada, A, Grossman, S, Pagala, M, Lazzaro, M. Pattern of bacterial colonisation in a new neonatal intensive care unit and its association with infections in infants. Am J Infect Control 2012;40:512515.Google Scholar
31. Moore, G, Muzlay, M, Wilson, P. The type, level and distribution of microorganisms within the ward environment: a zonal analysis of an intensive care unit and a gastrointestinal surgical ward. Infect Control Hosp Epidemiol 2013;34:500506.CrossRefGoogle Scholar
32. Vickery, K, Deva, A, Jacombs, A, Allan, J, Valente, P, Gosbell, IB. Presence of biofilm containing viable multi-resistant organisms despite terminal cleaning on clinical surfaces in an intensive care unit. J Hosp Infect 2012;80:5255.CrossRefGoogle Scholar
33. Galvin, S, Dolan, A, Cahill, O, Daniels, S, Humphreys, H. Microbial monitoring of the hospital environment: why and how? J Hosp Infect 2012;82:143151.Google Scholar
34. Whiteley, GS, Derry, C, Glasbey, T. Failure analysis in the identification of synergies between cleaning monitoring methods. Am J Infect Control 2015;43:147153.Google Scholar