sine triphosphate (ATP).
ATP is an organic chemical that provides energy for many different
processes in cells. It's also a substrate for enzymes and is an impor-
tant part of RNA synthesis. The presence of ATP, above a certain
threshold, is an indicator that potentially pathogenic material still
remains in the scope.
There are many options available for performing cleaning verifica-
tion. Some kits may test for one or more of protein, hemoglobin and
carbohydrates. This test is usually performed by flushing sterile water
through a channel or swabbing a surface of a scope with a test strip to
determine the presence of organic material.
ATP kits include collection materials and a bioluminescence reader,
which measures the amount of ATP present using relative light units
(RLUs). Cleaning verification tests are usually set to read as pass/fail,
although some ATP tests report the results in RLUs, which should be
clarified for a threshold of pass/fail by the manufacturer. It's important
to note that after manual cleaning and before high-level disinfection,
there may be some organic material present. The cleaning verification
tests determine whether the amount of organic material has been
reduced enough to make high-level disinfection effective and render the
endoscope safe for patient use.
There is a wide variance of cost among the different tests available.
Work with your infection preventionist to determine which test, or
combination of tests, would be best for your facility; it's important to
investigate which form of testing can be done correctly and consis-
tently, with results that are easy to interpret. You should also develop
policies and procedures for managing scopes that have failed a single
cleaning verification test and those that fail multiple tests. These
scopes may be damaged and harboring debris that is impossible to
remove. They must be cleaned and disinfected, according to the OEM
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