Olivia Ellis1, Hilary Godwin2, Maren David3, Dan J Morse3, Romney Humphries4, Daniel Z Uslan5. 1. UCLA Fielding School of Public Health, Department of Environmental Health Sciences, Los Angeles, CA. 2. UCLA Fielding School of Public Health, Department of Environmental Health Sciences, Los Angeles, CA; Institute of the Environment and Sustainability, University of California, Los Angeles, CA. 3. 3M Infection Prevention, St. Paul, MN. 4. Department of Pathology & Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA; Accelerate Diagnostics, Tucson, AZ. 5. UCLA Fielding School of Public Health, Department of Environmental Health Sciences, Los Angeles, CA; Division of Infectious Disease, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA. Electronic address: duslan@mednet.ucla.edu.
Abstract
BACKGROUND: 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. MATERIALS/ METHODS: 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. RESULTS: 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. CONCLUSION: Our results suggest that irregularly shaped surfaces in operating rooms may require enhanced covering, cleaning, and monitoring protocols compared to more regularly shaped surfaces.
BACKGROUND: 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. MATERIALS/ METHODS: 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. RESULTS: 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. CONCLUSION: Our results suggest that irregularly shaped surfaces in operating rooms may require enhanced covering, cleaning, and monitoring protocols compared to more regularly shaped surfaces.