Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
Cheung MM Lily(1) Yung WP(1) Pang SY(1) Ng LK Monica(1)(2) To SH(1)(2)
Affiliation :
(1)Combined Endoscopy Unit (2)Department of Surgery
Introduction :
Visual assessment of instrument cleanliness after manual cleansing of endoscopes is unreliable, as clinical soil may persist. Adenosine Triphosphate (ATP) methods: -Provide an important quality control measure for manual cleaning process, -Ensures effective disinfection and benefits patients undergoing endoscopic procedures. This method is widely adopted in the West to allow rapid evaluation of endoscopes for bacteriologic or biologic residue, but is rarely adopted in Asia (Chan et. al, 2023).
Objectives :
1) Prevent cross contamination risk
2) Provide instant feedback before processing endoscopes
3) Prevent outbreak
4) Evaluate cleanliness of flexible endoscopes
Methodology :
By using retrospective cohort study, service test samples and water test samples of used scopes were collected after manual cleaning and tested for residual ATP. The ATP test benchmark for adequate manual cleaning was set at <200RLUs. If RLU>200 or above, the endoscope should be re-cleaned and re-tested (ANSI/AAMI ST91, 2015).
For the surface test: Using one 3M Clean-trace ATP surface test (UXC), swab at distal end of length of 10cm and/ or elevator if applicable.
For the water test: Ensure biopsy valve and suction valves are covered with small plugs, 60ml of water was injected through the suction channel, water was collected from the distal end of the endoscope to a sterile bottle, the 3M Clean-trace water collection swab was deep into the water inside the sterile bottle. These test swabs were put inside the 3M Clean-trace luminometer for measuring and result was recorded.
Result & Outcome :
During the period of January to end of November 2023, 108 of endoscopes in our Endoscopy Unit were being tested, which included 68 Oesophago-gastro-duodenoscopes (OGD), 7 Endoscopic Retrograde Cholangiopancreatography scopes (ERCP) 1 bronchoscope and 32 colonoscopes.
i) Our data shown 94% of surface test of the 108 of used endoscopes met the ATP benchmark of <200RLU. Among these 108 of tested endoscopes, 7 failed surface tests were found.
ii) Our data shown 99% of water test of the 108 used endoscopes met the ATP benchmark of <200RLU. Among these 108 of tested endoscopes, 1 failed water test was found in August period. Conclusion & Recommendation: Data shown that both surface and water tests’ results finally met 100%, though retests were needed.
Reinforcement was done to wipe the red dirty tray once before putting testing.
Using this Smart ATP testing method in manual cleaning procedure:
-can provide an important quality control measure in manual cleaning process,
-shows effectiveness of the rest of the disinfection process and ensures patient safety.
As to sustain this good EBN practice, our Endoscopy Unit would like to practice once a month. Further test may suggest by using this ATP testing method and/ or culture sampling method, samples can be collected from endoscopes after high-level disinfection (HLD), and/or after storage for 3 hours as a comparison to evaluate the degree of contamination, which is essential for the safe guard to patient (BSG, 2020).
Citation:
1)Chan SF Ada, Chan LY Henry at al. Effectiveness of Adenosine Triphosphate to monitor manual cleaning and disinfection efficacy of flexible endoscopes in Hong Kong. Journal of gastroenterology and hepatology. (2023); 7:141-147.
2)ANSI/AAMI ST91:2015 Flexible and Semi-rigid Endoscope Processing in Health Care Facilities. Arling-ton, VA: Association for the Advancement of Medical Instrumentation; 2015.
3)BSG: 2020. Guidance Decontamination of Equipment for Gastrointestinal Endoscopy.
