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Adenosine triphosphate bioluminescence in intensive care units: Be careful with its use

2016; Elsevier BV; Volume: 44; Issue: 6 Linguagem: Inglês

10.1016/j.ajic.2015.12.045

1527-3296

Vincenzo Russotto, Andrea Cortegiani, Santi Maurizio Raineri, Cesare Gregoretti, Antonino Giarratano,

Biosensors and Analytical Detection

We read with interest the article by Whiteley et al1Whiteley G.S. Knight J.L. Derry C.W. Jensen S.O. Vickery K. Gosbell I.B. A pilot study into locating the bad bugs in a busy intensive care unit.Am J Infect Control. 2015; 43: 1270-1275Abstract Full Text Full Text PDF Scopus (11) Google Scholar investigating the use of adenosine triphosphate (ATP) bioluminescence for location of multidrug-resistant organisms (MDROs) in an intensive care unit (ICU). We agree with the authors that inanimate surfaces and equipment contamination, either in the patient zone or in the health care area, may significantly contribute to cross-transmission of pathogens, including MDROs.2Carling P. Methods for assessing the adequacy of practice and improving room disinfection.Am J Infect Control. 2013; 41: S20-5Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar Indeed, we recently performed a review of the available evidence of bacterial contamination of high-touch objects (HTOs) in the ICU, with a contamination rate as high as 60%-80% of samples in most studies.3Russotto V. Cortegiani A. Raineri S.M. Giarratano A. Bacterial contamination of inanimate surfaces and equipment in the intensive care unit.J Intensive Care. 2015; 3: 1-8Crossref Scopus (166) Google Scholar However, we have some concerns about the use of ATP bioluminescence as a method to identify the locations of MDROs in the ICU. In 2010, the Centers for Disease Control and Prevention developed a toolkit providing guidance for programs aiming to improve environmental hygiene. In this document, ATP bioluminescence was included among methods for objective assessment of HTOs' cleanliness and improvement of hygiene practices.4Guh A. Carling P. Environmental Evaluation Workgroup.Options for evaluating environmental cleaning.http://www.cdc.gov/HAI/pdfs/toolkits/Environ-Cleaning-Eval-Toolkit12-2-2010.pdfDate: 2010Google Scholar In our opinion, and according to available recommendations, a culture method should be adopted instead, when the aim is the identification of MDROs locations.5Dancer S.J. Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination.Clin Microbiol Rev. 2014; 27: 665-690Crossref PubMed Scopus (355) Google Scholar, 6Galvin S. Dolan A. Cahill O. Daniels S. Humphreys H. Microbial monitoring of the hospital environment: why and how?.J Hosp Infect. 2012; 82: 143-151Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar Another questionable point is the search for a correlation between values of ATP bioluminescence readings and MDRO contamination. Very low values of relative light units (RLUs) have been associated with low aerobic colonic counts.7Aycicek H. Oguz U. Karci K. Comparison of results of ATP bioluminescence and traditional hygiene swabbing methods for the determination of surface cleanliness at a hospital kitchen.Int J Hyg Environ Health. 2006; 209: 203-206Crossref PubMed Scopus (118) Google Scholar However, this is not always true, and MDROs have been detected also in sampled surfaces with low RLUs, as also observed in this study.1Whiteley G.S. Knight J.L. Derry C.W. Jensen S.O. Vickery K. Gosbell I.B. A pilot study into locating the bad bugs in a busy intensive care unit.Am J Infect Control. 2015; 43: 1270-1275Abstract Full Text Full Text PDF Scopus (11) Google Scholar, 2Carling P. Methods for assessing the adequacy of practice and improving room disinfection.Am J Infect Control. 2013; 41: S20-5Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar Very high RLU values may indicate a viable bioburden, organic debris (including dead bacteria), or a combination of both, and a relationship between RLU values and risk of MDRO detection cannot be established with reliability.2Carling P. Methods for assessing the adequacy of practice and improving room disinfection.Am J Infect Control. 2013; 41: S20-5Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar For these reasons, previous authors recommended to identify benchmark values corresponding to what, in a given setting, may be considered clean, and to use the ATP bioluminescence to monitor an intervention which would reduce the bioburden under a predefined level.4Guh A. Carling P. Environmental Evaluation Workgroup.Options for evaluating environmental cleaning.http://www.cdc.gov/HAI/pdfs/toolkits/Environ-Cleaning-Eval-Toolkit12-2-2010.pdfDate: 2010Google Scholar, 8Boyce J.M. Havill N.L. Dumigan D.G. Golebiewski M. Balogun O. Rizvani R. Monitoring the effectiveness of hospital cleaning practices by use of an adenosine triphosphate bioluminescence assay.Infect Control. 2009; 30: 678-684Google Scholar In other words, ATP bioluminescence is not a reliable method for identification and surveillance of potentially contaminated HTOs but rather a tool to assess the efficacy of a cleaning procedure or other infection control measures.2Carling P. Methods for assessing the adequacy of practice and improving room disinfection.Am J Infect Control. 2013; 41: S20-5Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar We appreciate the authors' interests in investigating the contamination of HTOs in the ICU and we thank them for providing another occasion to remind us: clean your hands! Response to Russotto et alAmerican Journal of Infection ControlVol. 44Issue 6PreviewWe welcome the comments regarding our recent article.1 The study showed a number of interesting findings that built on our earlier article2 where we proposed a new, synergistic approach to monitoring cleanliness within health care settings. The use of rapid adenosine triphosphate (ATP) testing is a single component of the monitoring approach we trialed. Full-Text PDF