Due to their complex design, flexible endoscopes are notoriously difficult to clean after use. Biological material that escapes the initial cleaning process can prevent the sterilization or disinfection process from working as intended. Residual material may contain multidrug-resistant bacteria or pathogens that can infect new patients. Cleaning endoscopes therefore requires rigorous quality assurance to ensure patient safety.
Visual inspections have traditionally been the primary method used to monitor cleaning, but for obvious reasons, this approach does not work particularly well for the interior of long, narrow lumens. A more objective method is needed to ensure patient safety. Microbiological analyses may be the first thing that comes to mind, but the downside is that they are difficult to perform in practice and take a long time. The discussion about alternatives has therefore centered on finding new rapid methods. ATP has proven to be the most effective method (you can read more about what ATP and how ATP works here).
ATP limit
Hygiene Diagnostics offers an ATP for rapid and quantitative cleaning verification of flexible endoscopes. Routine ATP measurements ATP immediate feedback. You know immediately whether additional cleaning is needed based on recommended threshold values before the endoscope proceeds to the next step in the process. The threshold values are typically divided into different levels according to the following table (see 3M’s guidelines):
| ATP level | Results |
|---|---|
| 0–100 RLU | Approved |
| 101–199 RLU | Borderline case (pass with conditions) |
| >= 200 RLU | Not approved |
How to Perform ATP on an Endoscope
ATP is easy to perform and requires minimal training (see video). Begin your cleaning inspection by using an ATP and follow these steps:
- Wipe down the surface of the distal end.
- Wipe down the entire pipe and a 10-centimeter section of it.
- Put the swab back into the test tube and activate ATP.
- Use ATP-meter Clean-Trace ATP-meter follow the instructions for it.
- The next step is to take a rinse water sample. Follow the instructions below for the 3M connection kit, as shown in Figures 1–6. The sterile kit and endoscope holder can be purchased from Hygiene Diagnostics.
Figure 1. Attach the endoscope holder with the adapter and specimen cup
Figure 2. Connect the distal end of the endoscope to the adapter.
Figure 3. Connect the silicone tube included in the kit to the umbilical end of the endoscope. Close the suction valve opening and the biopsy port with the silicone plugs.
Figure 4. Fill a 60-ml sterile syringe with 40 ml of sterile water and 20 ml of air.
Figure 5. Connect the syringe to the silicone tube at the umbilical end. Inject water followed by air to ensure that no fluid remains in the tube.
Figure 6. Close the lid of the sample cup to avoid the risk of contamination.
Take a water sample using ATP Clean-Trace ATP . Follow the instructions for ATP.
Here's what you need for ATP of endoscopes
The following supplies are needed for ATP of endoscopes (for more information, please visit our online store):
- Clean-Trace™ LM1 ATP-meter
- Clean-Trace™ ATP for Surfaces
- Clean-Trace™ ATP Water Test
- Clean-Trace™ LM1 sterile connection set (consisting of a connection tube, two plugs for the biopsy port and valve opening, and a sterile adapter for the endoscope holder)
- Clean-Trace™ Endoscope Holder
- Sterile syringe, 100 ml
- Sterile sample cup
- Sterile water