With all the new requirements and improved gadgets/devices popping up to help improve Infection Control (IC) efforts, it can feel daunting. We all clearly understand the urgent need for better Infection Control, but especially for smaller ambulatory environments when is it too much?
ASC’s operate like small businesses. They don’t have an entire staff dedicated to Infection Control. Half the time they don’t even have an FTP focusing on their IC needs. As a member of APIC (Association for Professionals in Infection Control and Epidemiology), I see countless forums with IC questions and best practices, in hopes for additional support! Having the comradery with other piers in the industry is incredibly helpful.
As I was skimming through the recent forums, I came across a question regarding the new AORN requirement for monitoring. The question was regarding which was the best method to use and how frequently, once, twice a year, etc. I thought the inquiry was a very good question and I came across an article in the July 2014 American Journal of Infection Control, Evaluating and Operationalizing an Environmental Auditing Program. The study compared the two most common monitoring methods available today. An alcohol-based fluorescent marking product and an aderosine-5-triphosphate bioluminescence (ATP) product.
An alcohol-based fluorescent marking product is used to mark high touched objects before cleaning occurs. It is a fluorescent marking product that dries clear on surfaces and can be removed using friction applied with a moist cloth. An auditor can use UV light to determine if the marks have been effectively removed during the cleaning process. This method is very good at providing a visual aid to coach Environmental Services (ES) staff on proper cleaning techniques. The down fall is the time constraint. It takes two trips before and after cleaning to gain the appropriate measurements of the method used.
ATP bioluminescence method refers to the quantitative measurement of organic ATP on surfaces. Surfaces are wiped using a special swab and results are quantified using a handheld measuring device. The amount of ATP, is displayed in relative light units (RLUs). This method is particularly useful in gaining quantitative results on how much bio-burden is left on a surface. This method generally seems to provide a good measure of surface disinfection but not how well a surface is actually being cleaned. It also is a much higher priced method for monitoring. Most hand held measuring devices start at around $1,200 and up, then there are additional costs for the swabs.
There are definitely some pros and cons with both methods. I suggest reading their study to learn more about their findings. However, I feel that both methods should be considered in your overall auditing program if it is allowed. Using fluorescent markers is great for continual support in your training and effectiveness in your proper cleaning efforts. But let’s say your cleaning results are always at or above 80%. One would think the surfaces should be properly disinfected. However, what if the disinfectant being used wasn’t strong enough or wet enough to properly kill any living microorganisms. You then still have an infection control risk for HAI’s. Using the ATP reader every now and then would be helpful in your overall monitoring efforts and providing added peace of mind that your cleaning efforts are in fact removing as much bio-burden as you suspected. A strong, effective and concise monitoring program is imperative in any infection control plan. These monitoring methods are a vital tool in helping keep our healthcare environments safe and infection free. This is why agencies have started cracking down on perioperative environments because the results are astounding.
The American Journal of Infection Control: July 2014, Volume 42 No 7.