Hygiene Monitoring : A Scientific Approach

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Hygiene Monitoring A Scientific Approach

• Beth Waite BSc (hons)
• Mercer Medical Ltd

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THIS PRESENTATION HAS BEEN VIEWED BY STANDARDS
NEW ZEALAND. ALL REFERENCES TO AS/NZS 41872003
HAVE BEEN APPROVED.To obtain copies of the
Standard please visit www.standards.co.nz
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Objectives

• Discuss hygiene monitoring
• Traditional v New methods
• Understand why this new technology is the way
  forward
• Explain how and why this fits in with
  AS/NZS41872003

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What is hygiene ?

• A condition promoting sanitary practices
• The science concerned with the prevention of
  illness and maintenance of health
• What it practically meansCLEANING
• (Gross debris removal, detergent application,
  final rinse, application
• of disinfectant hygienic surface)

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What is hygiene monitoring?

• After cleaning, surfaces appear visibly clean but
  organic residue may still remain (organic residue
  anything living or once living, eg, skin cells,
  bacteria, fungi, food residues)
• An assessment of the cleaning regime over time.
  Is it improving, deteriorating or staying the
  same?

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Why is it important?

• Hygiene monitoring is important to confirm that
• The cleaning regime is effective and working
• The surface has been cleaned effectively
• The threat of cross contamination via hand
  contact has been minimised

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Visual Assessment

• The cheapest, easiest method of hygiene
  monitoring
• First level of monitoring
• Not very thorough
• Open to personal interpretation!

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Traditional methods

• Microbiological testing

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Rapid Methods

• Assessment of ATP
• Easy, rapid method of assessing the hygiene level
  (cleanliness) of a surface
• Results available in under 1 minute allowing
  immediate corrective action
• No need for laboratory facilities
• All staff could perform the test

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ATPey??

• ATP is present in ALL living cells
• When we eat we are providing fuel for our cells
  to function. This fuel, in a cellular form, is
  called ATP
• The presence of ATP indicates either
• life (anything from microbes to man)
• nutrient source that can support life (food)
• No ATP lack of any life or food source
• No ATP means that the surface must be CLEAN

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What is ATP?

• ADENOSINE TRI-PHOSPHATE
• Fire Flies use ATP to produce LIGHT
• The enzyme used is LUCIFERIN LUCIFERASE

LUCIFERIN LUCIFERASE

ATP
The reaction is called BIOLOUMINESCENCE and is
measured in RELATIVE LIGHT UNITS (RLU)
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History of ATP

• ATP Technology.
• 1935 ATP structure established
• 1947 Firefly luminescence established
• 1960s NASA used ATP in space program
• 1970s First commercial luminometers
• 1980s ATP used as rapid method in industry
• 1990s ATP systems routinely used in food
  industry
• 2000s ATP introduced to healthcare market

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ATP Bioluminescence Technology

• CFU / ATP correlation

CFU
RLU
With pure culture of micro-organisms, without
other residues, RLU correlate well with CFU
With these typical proportions of ATP on a swab
RLU does not correlate with CFU but with
cleanliness
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Sampling for Hygiene

• Both surface and rinse water samples can be
  collected for hygiene analysis
• When surfaces are accessible (environmental
  surfaces, inside washers, hand contact sites)
  swabs can be taken directly
• When surfaces are inaccessible (inside lumens,
  shower heads) final rinse water can be obtained
• In both cases, samples will contain ATP
• where insufficient cleaning has occurred

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Swab samples

• When taking a swab sample from a surface, any
  residue present will be transferred to the swab
  bud
• It is important to swab correctly to ensure that
  a representative sample is obtained
• The result will then reflect the level of surface
  hygiene

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Swabbing Techniques
Do not touch the swab anywhere near the swab bud
Hold the swab between thumb and forefinger in
such a way that the swab can be easily rotated
Apply downward pressure
Rotate swab during sampling
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Water Samples

• Water samples taken should be the final rinse
  water
• Take a water sample that has been run through an
  endoscope lumen. A high RLU will indicate poor
  cleaning in the lumen.
• Take random water samples from shower heads to
  ensure theres been no microbial build up through
  low use

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How both tests work

• When sampling any ATP is picked up on the swab
  bud or pick-up stick
• The sample then mixes with the enzyme
• ATP present will react with the enzyme and start
  to produce light
• The light output is read on an instrument
• The instrument measures the light produced and
  converts it into a number called a Relative Light
  Unit (RLU)

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Other applications

• Audits Quantifiable monitoring allows realistic
  and achievable values to be set throughout the
  hospital
• Training tool An ideal way to demonstrate best
  practice cleaning
• Hand hygiene before and after swabbing
  demonstrates the bio-burden reduction when hands
  are cleaned thoroughly

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Compliance with AS/NZS 41872003

• There are several entries in the standard that
  would allow for ATP testing
• 2.11 Monitoring of cleaning process
• The most commonly used practice for the
  monitoring of cleaning is by visual inspection.
  However, due to the complex design of most
  instruments, visual inspection alone is not
  sufficient to establish cleaning efficiency.
  Commercially available soil tests may be used to
  verify cleaning efficiency.

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Continued...

• 2.9.2.1 Mechanical Cleaning (General)
• Routinely clean and maintain
  washer/disinfectors and ultrasonic cleaners to
  prevent colonization and formation of biofilms
  which could contaminate the instruments processed
  therein

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Continued...

• 7.7 Maintenance of sterilisers
• Cleaning and maintenance of equipment is
  essentialrisks of cross contamination are kept
  to a minimum if a clean environment is maintained
• 10.2.1 Thermal disinfection
• Effective thermal disinfection is dependent on
  the achievement of a low bio-burden

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Continued

• 11.1 General
• A clean environment will assist in the
  prevention of cross contamination. Completion of
  cleaning activities shall be documented
• Clause 7.1 General
• After cleaning, all items, including component
  parts, should be inspected for cleanliness or any
  deterioration that could effect the safety and
  functionality

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The Future

• ATP monitoring will not replace traditional
  microbiology
• Both should be utilised to obtain a complete
  picture of hygiene
• The ease of use and rapidity of ATP monitoring is
  ideal for use within the whole hospital
  environment
• Routine ATP monitoring can reduce the risk of
  cross contamination

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• The futures bright
• when you read the light !!