How to better monitor and clean irregular surfaces in operating rooms: Insights gained by using both ATP luminescence and RODAC assays

• Published in: American journal of infection control Vol. 46; no. 8; pp. 906 - 912
• Main Authors: Ellis, Olivia, Godwin, Hilary, David, Maren, Morse, Dan J., Humphries, Romney, Uslan, Daniel Z.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2018
• Subjects: ATP; Bioburden; Healthcare-associated infections; Infection prevention; Operating room; RODAC; Surgical site infections; RODAC; Bioburden; Surgical site infections; Operating room; Healthcare-associated infections; Infection prevention; ATP
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2018.03.024

•We present a study assessing cleaning of different surface types in an OR using an ATP assay.•We found that irregularly shaped surfaces are less likely to pass cleaning standards.•We recommend that disposable covers be used on irregularly shaped high-touch surfaces in ORs. A major limitation to developing evidence-based approaches to infection prevention is the paucity of real-time, quantitative methods for monitoring the cleanliness of environmental surfaces in clinical settings. One solution that has been proposed is adenosine triphosphate (ATP) bioluminescence assays, but this method does not provide information about the source of the ATP. To address this gap, we conducted a study in which ATP bioluminescence was coupled with traditional RODAC sampling and matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry to assess which organisms were viable and present. Using this mixed assessment approach, we evaluated cleaning of 5 different types of high-touch surfaces (overhead lights, door handles, anesthesia keyboards, mattresses, and side tables) in operating rooms. Whether surfaces tested cleaner after turnaround than they did before turnaround depended on the surface type. Before and after cleaning, flat, covered surfaces (mattresses and side tables) were more likely to pass as “clean” by ATP assay than uncovered, irregularly shaped surfaces (overhead lights, door handles, and anesthesia keyboards). Irregularly shaped surfaces were more likely to pass by RODAC assay than by ATP assay after cleaning. Our results suggest that irregularly shaped surfaces in operating rooms may require enhanced covering, cleaning, and monitoring protocols compared to more regularly shaped surfaces.