The use of adenosine triphosphate bioluminescence to assess the efficacy of a modified cleaning program implemented within an intensive care setting

Background: A total environmental cleaning system based on microfiber technology was implemented within 2 intensive care units (ICUs). The efficacy of this modified cleaning program was assessed using adenosine triphosphate (ATP) bioluminescence. Methods: A team of trained hygiene technicians cleaned all near-patient furniture and equipment twice a day using ultramicrofiber cloths. Every week for 40 weeks, 10 surfaces within a randomly selected bed area were sampled using the 3M Clean-Trace Clinical Hygiene Monitoring System (3M Health Care Ltd, Loughborough, United Kingdom). The ability of the modified cleaning program to reduce surface contamination to "acceptable" levels was measured against previously proposed benchmark ATP values. Results: In comparison with normal cleaning procedures routinely carried out by the nurses, the modified cleaning program significantly reduced (P < .001) the ATP readings obtained from surfaces within the near-patient environment. In both ICUs, 95% of surfaces sampled after modified cleaning had relative light unit values of <500 and were deemed "clean." Almost 90% of the surfaces could also be "passed" using the more stringent benchmark value of 250 relative light units. However, regardless of benchmark value used, the majority of surfaces sampled could also be considered adequately clean prior to them being cleaned by the hygiene technicians. Conclusion: The use of ATP bioluminescence has been proposed as a means to improve the management of hospital cleaning. Use of benchmark values can help continually monitor the efficacy of existing cleaning programs. However, when evaluating novel or new cleaning practices, baseline cleanliness (ie, the level of cleanliness routinely achieved using normal cleaning procedures) must also be taken into consideration, or the efficacy of modified cleaning will be overestimated.