Q: We just started using ATP in endoscope reprocessing. Is it normal to see a number of failures when using ATP?
A: It is not unusual to see failing results when beginning a cleaning monitoring program with any type of cleaning indicator. A failing ATP result is signaling where to focus additional efforts to achieve effective cleaning practices. Initially every endoscope should be tested multiple times to achieve a baseline assessment of the effectiveness of the current cleaning process, followed by taking steps to improve the process and decrease failure rates.
Q: Some of our endoscopes always pass the ATP test, but others don’t. What’s happening?
A: It is somewhat typical to discover that a particular endoscope type has higher average ATP values. Upper GI flexible endoscopes (e.g., gastroscopes and duodenoscopes) have been shown in clinical studies to be more contaminated than lower GI flexible endoscopes1,2 (e.g., colonoscopes). Upper GI endoscopes are also more difficult to clean.
Another common finding is that specific scopes (i.e., a particular serial no.) routinely result in higher ATP values after cleaning. When multiple rounds of manual cleaning are required to obtain a passing ATP result, this can be a sign that this particular scope may be damaged and need servicing. ATP is an effective means to help identify endoscopes nearing “end of life” or needing repair.
Q: How are the Pass/Fail numbers determined?
A: The pass/fail thresholds for ATP testing are not arbitrary. They are based on validation with results provided in published clinical studies3,4.
Q: We do a manual clean then process in the AER. We were told to do our ATP check before AER processing. Wouldn’t that provide a false record of how clean our scopes are since they haven’t been through AER yet?
A: Clean and disinfected/sterilized are not the same thing. ATP is a cleaning verification method, used to verify that the cleaning process was effective for removal of clinical soil and that the appropriate level of cleanliness was achieved prior to sterilization or disinfection. ATP testing is not an appropriate tool for measuring disinfection or sterilization, and therefore should not be used to measure the success of the high-level disinfection (HLD) process. Ensuring that an endoscope is clean enough prior to HLD is critical – after all, HLD can’t be effective if the endoscope isn’t clean going in.
Have more questions? 3M is happy to answer any further questions about ATP cleaning verification monitoring – you can contact your local representative, call the 3M Health Care Helpline 1-800-228-3957 or visit go.3M.com/cleantrace.
- Ofstead CL, et al. Assessing residual contamination and damage inside flexible endoscopes over time. 2016. Am J of Infect Control. 44: 1675-7.
- Ofstead CL, et al. Longitudinal assessment of reprocessing effectiveness for colonoscopes and gastroscopes. 2017. Am J of Infect Control. 45: e26-e33.
- Alfa MJ, Fatima I, Olson N. Validation of adenosine triphosphate to audit manual cleaning of flexible endoscope channels. 2013. Am J Infect Control. 41: 245-8.
- Alfa MH, Fatima I, Olson N. The adenosine triphosphate test is a rapid and reliable audit tool to assess manual cleaning adequacy of flexible endoscope channels. 2013. Am J Infect Control. 41: 249-53.