How to choose and implement ATP testing?
When selecting an ATP test kit for healthcare applications, several key factors should be considered. First, the test kit should have AOAC or equivalent international recognition from an independent laboratory. Second, the swabbing device must be effective and capable of delivering reproducible results. Finally, it is essential to evaluate the reagent's effectiveness and the genetic stability of the enzymes (luciferase) used in the test. When using ATP testing, several considerations should be kept in mind. First, sampling techniques must adhere to the manufacturer's instructions to ensure reproducibility. Second, one should assess the potential impact of chemical or disinfectant residues on surfaces, as these may influence test outcomes. Temperature during testing is also crucial, as it affects enzyme activity. Lastly, the timing of the testing procedure should be strictly controlled to remain within the effective period.
The CDC recommends that in healthcare environments, the acceptable ATP level is <100 RLU for general care areas. Some studies suggest that healthcare facilities should set criteria for critical areas, such as ICUs, at <50 RLU, while high-touch areas may fall within the range of 100–150 RLU. Alert and action levels can be customized by individual healthcare facilities based on these reference numbers.
Currently, ATP testing is included in the cleaning efficiency criteria for reusable medical devices, including instruments and endoscopes. According to ISO 15883-5:2024, in addition to visual examination and quantitative protein detection, one more quantitative analytical test method should be included for type testing of all invasive instruments. Acceptable quantitative tests include total organic carbon (TOC), carbohydrates, hemoglobin, ATP, and endotoxin. The acceptable protein level is <3 µg/cm², with an alert level set at >3 µg/cm² and an action level at >6.4 µg/cm². For the ATP test, the acceptable level is <10 femtomoles (fmol)/cm².
Published studies of ATP tests include checking cleaning and washing performance on critical environmental surfaces, hospital kitchen environments, surgical instruments, dental instruments, endoscopes, bedpans, and hand hygiene. ATP testing is a widely used and well-established measurement tool that provides effective and real-time monitoring of cleanliness and hygiene. Healthcare facilities can effectively incorporate it for routine monitoring and improvement of environmental cleanliness, hand hygiene, and the washing effectiveness of reusable medical devices.
