{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T01:54:23Z","timestamp":1780624463927,"version":"3.54.1"},"reference-count":25,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T00:00:00Z","timestamp":1692057600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","award":["88882.306482\/2018-01"],"award-info":[{"award-number":["88882.306482\/2018-01"]}],"id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Timely detection of cleaning failure is critical for quality assurance within Sterilising Service Units (SSUs). Rapid Adenosine Triphosphate (ATP) testing provides a real time and quantitative indication of cellular contaminants, when used to measure surface or device cleanliness. The aim of this study was to investigate the use of an ATP algorithm and to whether it could be used as a routine quality assurance step, to monitor surgical instruments cleanliness in SSUs prior to sterilisation.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Cleanliness monitoring using rapid ATP testing was undertaken in the SSUs of four hospitals located in the western (Amazonia) region of Brazil. ATP testing was conducted (Clean Trace, 3M) on 163 surgical instruments, following manual cleaning. A sampling algorithm using a duplicate swab approach was applied to indicate surgical instruments as (i) very clean, (ii) clean, (iii) equivocal or (iv) fail, based around a \u2018clean\u2019 cut-off of 250 Relative Light Units (RLU) and a \u2018very clean\u2019 &lt;100 RLU.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The four cleanliness categories were significantly differentiated (P\u22640.001). The worst performing locations (hospitals A &amp; C) had failure rates of 39.2% and 32.4%, respectively, and were distinctly different from hospitals B &amp; D (P\u22640.001). The best performing hospitals (B &amp; D) had failure rates of 7.7% and 2.8%, respectively.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The ATP testing algorithm provides a simple to use method within SSUs. The measurements are in real time, quantitative and useful for risk-based quality assurance monitoring, and the tool can be used for staff training. The four-tiered approach to the grading of surgical instrument cleanliness provides a nuanced approach for continuous quality improvement within SSU than does a simple pass\/fail methodology.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0284967","type":"journal-article","created":{"date-parts":[[2023,8,15]],"date-time":"2023-08-15T17:27:38Z","timestamp":1692120458000},"page":"e0284967","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Adenosine triphosphate (ATP) sampling algorithm for monitoring the cleanliness of surgical instruments"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7280-0638","authenticated-orcid":true,"given":"Daniela Oliveira","family":"Pontes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dayane de Melo","family":"Costa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8900-6801","authenticated-orcid":true,"given":"Priscilla Perez","family":"da Silva Pereira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greg S.","family":"Whiteley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor","family":"Glasbey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0812-2243","authenticated-orcid":true,"given":"Anaclara Ferreira Veiga","family":"Tipple","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,8,15]]},"reference":[{"key":"pone.0284967.ref001","doi-asserted-by":"crossref","first-page":"352","DOI":"10.3390\/healthcare9030352","article-title":"ATP Bioluminiescence for assessing the efficacy of the manual cleaning procedure during reprocessing of reusable surgical instruments","volume":"9","author":"MD Masia","year":"2021","journal-title":"Healthcare"},{"key":"pone.0284967.ref002","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.jhin.2014.08.007","article-title":"Infections and exposures: Reported incidents associated with unsuccessful decontamination of reusable surgical instruments","volume":"88","author":"P.M. 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