On November 11th, 2021, Infection Control Today published an article titled "Not Blinded by the Light: Assessing ATP's Disinfection Potential." This article resonated with me for several reasons. I have had some hesitance with jumping on the ATP bandwagon. Over the years, when meeting with sales representatives, I had one question that no one was ever able to answer: "how many relative light units (RLU) was too much"? The answer was that there was no answer. RLU recommendations change from manufacturer to manufacturer with their proprietary model. The RLU reading is generally a recommendation or a benchmark to live within for the product you are using. The answer I wanted to hear was a quantitative number that defined risk to the sterilization process. In other words, X=a greater chance of something not being sterilized. To my knowledge, X does not exist when it comes to ATP results.
Without getting into the issues with bioluminescence, please read the article listed above; I have a few other concerns about using ATP within the sterile processing department. First, let me state, the goal in sterile processing is to reprocess instrumentation to a clean state and not a sterile condition, at least not at first. Otherwise, we would not need to sterilize the instruments. Microorganisms exist on all of the surfaces in the sterile processing department, so should ATP. Cross-contamination is a genuine concern when designing your testing process. False positives can affect your process outcomes negatively. Wrong data inputs will give you poor outputs. I will call those results false positives. Another concern would be what I will call a false negative, a test result coming back within the recommended parameters of the product you are using because of a lack of controlled measures. A typical sales pitch is to test instrumentation that had either been hand washed or processed via a washer/decontaminator. My first question is, how do I know which instruments to test? Do I test all or just a select few? Of the select few, because nobody can test all, how do I know which instruments were most contaminated to apply the greatest challenge to the test? If I tested instruments that weren't used during the surgery but sent back to the sterile processing department's decontamination area, how does that affect the results and my cleaning approach? Testing protocols must be very tight and consistently reproducible to have valid results.
There is a lot to think about when you design your process. I see better use of ATP within the sterile processing department in the testing of your environment. Improving the cleanliness of the surroundings within the sterile processing department should reduce some cross-contamination, along with good hand washing, less bioload increases the probability of achieving sterility. I find it as a more reproducible process. Another approach for the use of ATP is with competency testing of the staff. Using ATP before and after a cleaning process, you can verify the reduction in RLUs; utilizing the manufacturer's IFU; you can establish if a staff member is competent with the method you are using.
No matter what, we need to establish good qualitative and quantitative quality assurance programs in our sterile processing departments. There are many products on the market along with ATP to help us in this endeavor. I recommend partnering with your Infection Control department to determine what is the best fit for your department.
At Evolved Sterile Processing, our consultants have a greater focus on sterile processing. With our decades of experience, we will help you develop better processes and educational resources for your staff.
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