Page 140 - HA Convention 2016 [Full Version]

HOSPITAL AUTHORITY CONVENTION 2016 Service Enhancement Presentations

F3.7 Clinical Safety and Quality Service I 14:30 Room 421

An Effective Tool to Assess Environmental Cleanliness — Adenosine Tri-phosphate Pilot in North District

Hospital 2015
Lee KP 1, Tam OY 1, Yung ML1, Ip SY 1, Tam OF 2, Ngai MY 2, Tang WF 2
1Infection Control Team, 2Central Nursing Division, North District Hospital, Hong Kong

Introduction

Contaminated environment serves as a reservoir for dissemination of multidrug-resistant organisms (MDROs). Bed occupied
by patient with MDRO is a well-known risk factor for acquisition of the bug for subsequent patients. Terminal disinfection
of patients’ immediate environmental is part and parcel in breaking the chain of infection. Cleaning should be monitored to
ensure the environment being thoroughly decontaminated. Ultra-violet (UV) assessment is a fundamental tool to monitor the
quality of environmental cleaning, it is an economic assessment tool with real-time visible result. Depending on the type of
UV stains, the marking can be stained on the surface permanently and is difficult to remove. False negative result may be
caused by UV mark being removed by the motions of staff or patient instead of the cleaning procedure. In order to provide
accurate and real-time feedback result to the cleaning personal, multiple site visits by auditor is necessary. Environmental
sample culture is another assessment tool of environmental cleanliness and is the gold standard to evaluate for the presence
of MDRO. However, it is labour intensive, time-consuming and organism specific. Most of the time, the discharge bed would
be occupied immediately by next patients after disinfection. The time required for culture, which usually takes two to three
days, serves as an opportunity for transmission of MDROs.

Tuesday, 3 May Objectives

(1) To ensure good quality environmental cleaning is in practice; (2) to provide cleaning personnel with instant, objective and
quantified feedback on the cleaning performance.

Methodology

By means of measuring Adenosine Tri-phosphate (ATP) on the environment surface, the presence of organic matter could be
evaluated. ATP is a distinct marker to evaluate the degree of environmental contamination: ATP of the organism reacts with
the specific enzymatic regent and generates light; the result is expressed in Relative Light Units (RLUs) which is measured by
the Luminometer. ATP assessment is a quick tool for instant quantified result for the cleaning personnel.

Results

ATP was introduced in August 2015 to evaluate the quality of environmental cleaning. Assessment of the cleaning of MDRA
patient discharged bed was one of the uses of ATP since September 2015. The pass level of ATP assessment is defined as
≤ 250 RLUs. 39 samples of the environment were cultured and compared with the data of ATP assessment. Only 4% of false
negative was noticed. The Hospital Acquired Infection (HAI) MDRA rate was significantly dropped from 0.12% to 0.03% and
the multi-drug resistant acinetobacter environmental sample culture was also significantly decreased from 9.39% to 1.13%.
The result provided the cleaning personnel with instant and objective feedback. Most of the cleaning personnel cherished the
instant recognition and feedback by the ATP tool.

Conclusion

Effective environmental decontamination is essential to eradication of MDROs. ATP is a useful quality tool for environmental
cleaning.

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