gms | German Medical Science

German Congress of Orthopedic and Trauma Surgery (DKOU 2018)

23.10. - 26.10.2018, Berlin

An ATP based evaluation method for the cleaning and disinfection of complex surgical devices

Meeting Abstract

  • presenting/speaker Robin Otchwemah - Institut für Hygiene, Kliniken Köln, Köln, Germany
  • Thomas Hempen - Cleanpart healthcare GmbH, Köln, Germany
  • Sabine Messler - Labor im Sommerhof, Köln, Germany
  • Thorsten Tjardes - Uni Witten/Herdecke, Krankenhaus Köln Merheim, Köln, Germany
  • Sven Shafizadeh - Uni Witten/Herdecke, Krankenhaus Köln Merheim, Köln, Germany
  • Frauke Mattner - Institut für Hygiene, Kliniken Köln, Köln, Germany

Deutscher Kongress für Orthopädie und Unfallchirurgie (DKOU 2018). Berlin, 23.-26.10.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocST22-1335

doi: 10.3205/18dkou097, urn:nbn:de:0183-18dkou0977

Published: November 6, 2018

© 2018 Otchwemah et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives: Effective cleaning and disinfection (C&D) of surgical instruments are an important part of infection prevention in surgery. Proper preparation is particularly difficult, if cannulated tools are involved, as in anterior cruciate ligament (LCA) replacement surgery. Several outbreaks due to problems in the reprocessing of instruments have been described.In our study we monitored the C&D of surgical instruments for LCA replacement, using an adenosine triphosphate (ATP) based detection system for organic residuals, which has not been used for this purpose before.

Methods: A LCA replacement surgeon, an infection control specialist and an employee of the central sterile service department (CSSD) chose tools and sampling points of LCA replacement surgery sets, which were frequently used and difficult to clean and disinfect. Besides the cannels of the 4.5 mm drill, the drill hand piece, the chucks for drill and K-wires and the screwdriver hand piece, the inside of the tendon fixation clamp were tested.

During a standardised, validated process, which was developed in accordance with the KRINKO and BfArM recommendations for preparation of medical devices, a member of CSSD staff performed the ATP test after mechanical C&D. The SystemSURE Plus Cleaning Verification System by Hygiena®, which uses a bioluminescence reaction for ATP detection, was applied. Following the manufacturer's recommendations, five relative light units (RLU) were considered as threshold for proper reprocessing. Values in brackets are standard deviations.

Results and conclusion: Between December 2016 and March 2017 the six selected tools of 50 LCA replacement surgery sets were analysed after C&D. In two cases the drill hand piece was not tested, which leads to a total number of 298 analysed tools. Sixty-six instruments showed values above 5 RLU (22.7%). The 4.5 mm drill accounted for 31 of 66 cases (47.0%; total mean for all 4.5 mm drills: 11.6 RLU (±9.6); median 9.0 RLU), the drill hand piece for 8 (12.1 %; mean: 6.5 RLU (±13.6); median: 2.0 RLU), the screwdriver hand piece for 4 (6.0%; mean 1.5 RLU (±3.3); median 1.0 RLU), the drill chuck for 10 (15.2%, mean: 3.8 RLU (±5.8); mean 2.0 RLU), the K-wire chuck for 9 (13.6%; mean: 43.6 RLU (±222.0); median 1.0 RLU) and the clamp for 4 (6.0%; mean 1.9 RLU (±3.9); median 1.0 RLU) cases. If RLU were above 5, instruments were reprocessed again until RLU were below 5 before their reuse.

Although the clinical relevance of the ATP-test and its most significant threshold are unclear, the method seems to allow identification of instruments, whose reprocessing might be problematic, even with a validated process. Thus, generally high RLU values (mean and median), as in the 4.5 mm drills, may suggest single use in future, whereas individual high RLU values, like in the K-wire chucks (high mean only), may advise special adjustments of the reprocessing workflow.