When cleanliness matters, knowledge is power

In these times, it has become more evident than ever that cleanliness leads to curbing the spread of infection in any setting.

A study* published on the “Use of ATP Readings to Predict a Successful Hygiene Intervention in the Workplace to Reduce the Spread of Viruses on Fomites” provides an insight on how using ATP can assist in this validating cleanliness.

The purpose of the study was to validate the use of adenosine triphosphate (ATP) for evaluating hygiene intervention effectiveness in reducing viral dissemination in an office environment.

Although ATP does not measure viruses, the results demonstrated that ATP measurements could be useful for evaluating the effectiveness of hygiene interventions aimed at preventing viral spread in the workplace.

Rapid methods for screening of relative biological loads on surfaces could be helpful in evaluating the efficacy of mitigation efforts. In the study, the measurement of ATP was used to determine its value as a rapid screening method for evaluation of workplace hygiene interventions in reducing the potential for viral spread.

Commonly touched surfaces, such as door handles, light switches, keyboards, lift buttons and surfaces in bathrooms represent likely routes for the spread of infection. Fomites, inanimate objects, or surfaces that serve as microbial transmission vehicles, are contaminated by infected individuals through either direct contact or by the settling of aerosols created by sneezing or coughing. The viruses are then transferred to the hands of the individuals touching these surfaces and are subsequently introduced to the site of infection (i.e., nose, mouth, or eyes). Because viruses can survive on fomites from a few hours to several days or weeks, contaminated surfaces represent an important means of infectious disease transmission.

ATP, the universal energy molecule found in all animal, plant, bacterial, yeast, and mould cells, produces bioluminescence that has been suggested as a potential alternative for rapid confirmation of hygiene intervention effectiveness. ATP detection methods have been validated for assessment of relative microbial presence in aquatic environments (Hammes et al. 2010) and intravenous fluids (Anderson et al. 1986), as well as on inanimate surfaces in hospitals (Moore et al. 2010; Aikin et al. 2011) and food preparation areas (Aycicek et al. 2006). ATP is thus used as a general indicator of cleanliness of a surface.

ATP measurements were compared to viral load after the implementation of the hygiene intervention to determine if the general cleanliness of a surface could be correlated with the removal of viral pathogens. This could provide an alternative monitoring tool for the simple and rapid confirmation of the effectiveness of a hygiene intervention on reducing the spread of viruses in a setting.

The number of sites with an ATP reading of greater than 2 RLU was 45% before the intervention and 15% after the intervention. This difference was shown to be statistically significant (p<0.005). Thus, ATP readings were useful in determining the success of the hygiene intervention as they demonstrated a significant reduction of virus on the sampled fomites after the intervention.

Materials like epithelium from the upper respiratory tract mucus membranes, saliva, and associated material from the coughs and sneezes of persons with viral or bacterial infections can also contribute to ATP measurements (Shaughnessy et al. 2013). While there are limits to the use of ATP measurements in assessing the impact of cleaning practices (Green et al. 1999), recent studies have demonstrated its potential usefulness for validating the effectiveness of cleaning practices in schools (Shaughnessy et al. 2013) and hospitals (Boyce et al. 2009a, b). ATP measurements correlated significantly with reduced viral recovery and showed statistically significant differences in measurements taken before and after an intervention. This suggests that although ATP readings do not specifically predict the occurrence or degree of reduction in microbial contamination, the method can be useful for monitoring the success of health interventions in the workplace in terms of the reduction in the spread of a virus.

Despite the limitations of ATP measurement as a method for monitoring microbial contamination, the results of the study clearly demonstrated that workplace hygiene interventions can result in a significant reduction of viral contamination, and ATP can be used to monitor performance rapidly. It also illustrated that a general measure of cleanliness with a quantitative tool can be related to the spread of viruses in indoor environments and can be used as an aid to assess potential interventions.

Hygiena is leading the world in ATP Rapid Testing. Data submitted to the AOAC demonstrates the latest EnSURE™ Touch system to have a high level of sensitivity with a limit of detection of 1.28 femtomoles of ATP and high degree of consistency and accuracy.

Anaeron is proud to be working directly with Australian Healthcare as well as service providers into healthcare on minimising the risk of infection through ATP Rapid Testing with Hygiena Luminometers and Swabs.

Authors — Use of ATP Readings to Predict a Successful Hygiene Intervention in the Workplace to Reduce the Spread of Viruses on Fomites: Laura Y. Sifuentes¹, Sonia L. M. Fankem¹, Kelly Reynolds^1,2, Akrum H. Tamimi¹, Charles P. Gerba¹, David Koenig³
1 Department of Soil, Water and Environmental Science, College of Agriculture and Life Sciences, The WEST Center, Kimberly-Clark Corporation, University of Arizona, 2959 W. Calle Agua Nueva, Tucson, AZ 85721, USA; 2 Department of and Environmental Occupational Health, College of Public Health, University of Arizona, Tucson, AZ 85721, USA; 3 Kimberly-Clark Corporation, 2100 Winchester Road, Neenah, WI 54956, USA.

References

Hammes, F., Goldschmidt, F., Vital, F., Wang, Y., & Egli, T. (2010). Measurement and interpretation of microbial adenosine triphosphate (ATP) in aquatic environments. Water Research, 44, 3915–3923.

Anderson, R. L., Highsmith, A. K., & Holland, B. W. (1986). Comparison of the standard pour plate procedure and the ATP and limulus amebocyte lysate procedures for the detection of microbial contamination in intravenous fluids. Journal of Clinical Microbiology, 23, 465–468.

Moore, G., Smyth, D., Singleton, J., & Wilson, P. (2010). The use of adenosine triphosphate bioluminescence to assess the efficacy of a modified cleaning program implemented within an intensive care setting. American Journal of Infection Control, 38, 617–622.

Aycicek, H., Oguz, U., & Karci, K. (2006). Comparison of results of ATP bioluminescence and traditional hygiene swabbing methods for the determination of surface cleanliness at a hospital kitchen. International Journal of Hygiene and Environmental Health, 209, 203–206.

Shaughnessy, R. J., Cole, E. C., Moschandreas, D., & Haverinen-Shaughnessy, U. (2013). ATP as a marker for surface contamination of biological origin in schools and as a potential approach to the measurement of cleaning effectiveness. Journal of Environmental Health, 10, 336–346.

Green, T. A., Russell, S. M., & Fletcher, D. L. (1999). Effect of chemical cleaning agents and commercial sanitizers on ATP bioluminescence measurements. Journal of Food Protection, 62, 86–90.

Boyce, J. M., Havell, H. L., Dumigan, D. G., Golebiewski, M., Balogun, O., & Rizvani, R. (2009b). Monitoring the effectiveness of hospital cleaning practices by use of an adenosine triphosphate bioluminescence assay. Infection Control and Hospital Epidemiology, 30, 678–684.