Journal
JOURNAL OF HOSPITAL INFECTION
Volume 106, Issue 2, Pages 348-356Publisher
W B SAUNDERS CO LTD
DOI: 10.1016/j.jhin.2020.07.038
Keywords
Triple adenylate nucleotides; Adenosine triphosphate; Bacterial contamination; Duodenoscopes; Reprocessing
Funding
- Ratchadaphiseksomphot Endowment Fund
- Ratchadaphiseksomphot Endowment Fund, Chulalongkorn University
- Kikkoman Biochemifa Company, Tokyo, Japan
- Gastroenterological Association of Thailand
- Center of Excellence for Innovation and Endoscopy in Gastrointestinal Oncology, Faculty of Medicine, Chulalongkorn University
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Background: Adenosine triphosphate (ATP) test based on one nucleotide has been applied as point-of-care testing (POCT) for bacterial contamination in the medical and food industries. Hypothetically, testing three adenylate nucleotides (A3) may provide better detection of duodenoscope bacterial contamination than ATP test. Aim: To evaluate performance characteristics and optimal cut-off value of A3 and ATP tests in predicting bacterial contamination of duodenoscopes. Methods: Four hundred duodenoscope samples obtained after 100 endoscopic retrograde cholangiopancreatography procedures were randomized into group A (A3 test) or B (ATP test). Samples were collected from the elevator at the four-step cleaning process of duodenoscope. We defined the new cut-off value of the test for reaching 100% negative predictive value (NPV) from our receiver operating characteristic (ROC). Findings: Using the cultures from the four-step cleaning process as the reference, the areas under ROC (AUROC) were 0.83 and 0.84 for group A (N = 200) and group B (N = 200), respectively. Using the cultures from post-high-level disinfection (HLD) as the reference, the AUROC were 0.35 and 0.74 for group A (N = 50) and group B (N = 50), respectively. We investigated ATP as a POCT after HLD with a new cut-off value of 40 RLU. However, this threshold did not allow detection of low numbers of bacteria. Conclusion: A3 and ATP tests provide good performances in predicting bacterial contamination of duodenoscopes for the four-step cleaning process. The ATP <40 RLU is helpful as a POCT after HLD; however, the limitation of this cut-off value is its inability to detect low numbers of bacteria. (C) 2020 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
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