Since ATP cleanliness monitoring was introduced over fve years ago a number of departments and services at Southport and Ormskirk Hospital NHS Trust have chosen
Hygiena International’s fast and easy to use system.
“We were initially using ATP to monitor the cleanliness of commodes,” Andrew Chalmers, the trust’s consultant nurse and deputy director of infection prevention and control, told Hospital Matters: “It’s also used by domestic services after an infection clean. More recently an ATP system has been purchased by the ITU to verify their cleaning procedures. “We’ve been using ATP for more than fve years. Initially we were using a system that we found to be relatively expensive and moved to Hygiena International’s solution,” explained Andrew. “ATP was initially introduced to the
trust by Martin Kiernan, when he was the trust’s consultant nurse and deputy DIPC.
“We’re always working to drive down all types of infection and realise that something that might look clean could have organic material on it that could harbour infection. ATP identifes this and
therefore helps to improve infection control. “If you look at the directions and links from NHS England regarding MRSA and C.diff, you’ll fnd the use of ATP is one of the recommendations.”
Andrew said: “One of the primary things we look at with ATP is commodes as they are used by multiple people and can easily be contaminated. Nursing staff clean the commodes following each patient use. Tey are also cleaned by the domestic services’ action team when they clean the sluice area and any equipment that’s in there.
“Infection prevention and control carry out weekly ATP tests on commodes and other items of equipment. If there’s a ‘failure’ we inform the staff, who re-clean the failed equipment and later
in the week return and re-test it.” Andrew explained: “When we studied the results following the introduction of ATP testing, we found that we had a lot of ‘fails’ on the commodes. So we concentrated on the quality of cleaning. We introduced wipes that help with cleaning, together with associated training. “It’s affected the method of cleaning. With HCAs and nurses we teach the ‘S’ pattern of cleaning. It’s important to use the correct cleaning method and correct contact time for the disinfectant being used. “We’ve also moved over to commodes manufactured by Kirton, as we found that they have smoother surfaces that are easier to clean. “Staff appreciate the value of the ATP monitoring and take it personally if we ‘fail’ a commode,” said Andrew. “Using the ATP swabs
has introduced a degree of competition.” Describing a couple of further instances, Andrew recalled: “One time we were checking equipment, a blood monitor, and ‘zing’ we had a really high fgure. I’d spotted a very small amount of blood and swabbed it with the ATP. 
“Also, with a peer group, I’ve swabbed their hands, got them to wash them, then swabbed them again, and they see that the reading is much lower. I tell them that if their hands score higher
than a certain fgure it’s as if it’s a commode ‘fail’. “It’s also used to ensure hand hygiene compliance. We’ve occasionally used it as part of the mandatory or induction training. “When you have a number - like the ATP machine gives you - it’s more objective than subjective. You can’t argue with it.” Andrew explained: “We also use Hygiena ATP monitoring when we may have had an incidence of VRE, for example. After a clean, the area might look clean but a number of spot ATP tests might show that the area is, in fact, not clean.
“In ITU we’ve found that the quality of some of the equipment surfaces is the issue. Instead of being smooth it has ripples or bumps, which are difcult to clean consistently. Te ATP swab
picks up the organic material and tells you that you need to concentrate on those areas. So staff have to clean this equipment more diligently.” Describing the changeover to Hygiena,
Andrew said: “At the time we needed a replacement, Hygiena’s product was comparably cheaper than the system we were using. Bill Spencer, Hygiena’s product specialist, gives
absolutely great support. “For example, we once ran out of ATP swabs and Bill was here very quickly with a supply. If we’ve had an issue with a machine, Bill’s here with a replacement. Te support from Hygiena is really very good.”
Examining the results of some recent ATP spot checks, Andrew highlighted a complex piece of equipment - a specialised turning bed - on which the mattress, that looked clean, had a reading of
619, when the ‘caution’ score begins at 50 and the ‘fail’ score 150. And the same bed’s cot side had a reading of 179. “Te complexity of the piece of equipment increases the need for high quality cleaning,” said Andrew. “Such analysis of the ATP spot checks highlights problematic pieces of equipment, from an infection control point of view, and demonstrated the need for off-site  specialised cleaning for the turning bed. “We took some regular swabs of the environment which were plated up on Agar plates. At the same time we swabbed different areas with ATP swabs which gave an instant result. “Based on this, ITU have purchased their own Hygiena SystemSURE hand unit to swab and test whenever they want to test.” Andrew explained: “Te results of our spot checks are recorded on a monthly report which is circulated to all the departments and wards. “We have a hygiene committee that discusses various issues that arise. Domestic services
decided that they would like to use an Hygiena system of their own. Tey’re in use at both of the trust’s hospitals - in Southport and Ormskirk. “Hygiena’s system is also used in the medical
equipment library on items such air mattresses and infusion pumps. Tese are cleaned and randomly selected and monitored with the ATP system for an instant result. Te department’s
manager was an infection control nurse and wanted to use the ATP system in the medical library.” Andrew said: “Hygiena’s ATP system is used in medical equipment, ITU, IP&C, domestic
services, planned care and in catering. We’re now looking at using it is in theatres.” Val Hume, team leader domestic services, explained: “Using ATP has made staff more aware
of the need for quality cleaning. If the result comes out high they are upset, as they are proud of their work. “We now only get the odd high reading, and that’s often due to it being a new member of
staff. But they appreciate the value of the test. It reinforces the need for quality cleaning. Once they’re shown the results they never get a high result again. “It’s great beneft is that it’s an instant measure of cleanliness.
“ATP gives you a clean hospital,” said Val. “When you’re doing a deep clean the staff know they are going to be tested but they do everything to a very high standard now. ATP has helped us
to achieve that. “Te domestic services team leaders do the ATP monitoring and the staff competences. We also do a number of random tests each week in different departments “In ITU domestic services are responsible for the bed, sink, locker, chair and the high touch points,” explained Val. “Te departments were a bit shocked when we introduced ATP monitoring, but it did wake them up. We often swab the easy bits to miss, the silly bits.” 
Describing the typical cleaning undertaken by domestic services, Val said: “Te task team goes in on a weekly basis to all areas.

“In the morning they do all the drip stands, commodes, hoists, wheelchairs, etc. In the afternoon they do all the scrubbing off, steaming of toilets, bathrooms, treatment rooms, kitchens, steam cleaned, floor cloth and the upside-down clean of tables and chairs. “ATP makes them competitive. Tey all want to score fve or below. And ideally zero.” Andrew explained: “Te results of the ATP
monitoring are incorporated into the weekly infection prevention and control performance report, which is circulated trust-wide. It includes a breakdown of the results of commode cleanliness, amongst a range if other items, area by area. “Tis adds a competitive edge and drives the staff to achieve a low score.

“It’s there to encourage people, to make them aware. If they’re doing a good job, it’s a low number and the staff are delighted. “If we have an area of concern with a particular infection or organism - we use ATP as part of the investigation. “Te beneft is that with ATP we can react immediately to the results on site and put any necessary interventions into immediate effect. Tat
way we’re safeguarding patients, which is what it’s
all about.
Andrew added: “Low numbers mean it’s a safe environment for patients to be in. And with Hygiena International’s SystemSURE we get an instant check of environmental hygiene for about
£1.50.” Bill Spencer, an experienced clinical microbiologist a product specialist and sales coordinator with Hygiena International, explained: “You can’t control the quality of cleaning efciently without measuring it. Poor cleaning costs money and the ramifcations can be expensive. Typically, each hospital acquired infection costs a hospital £10,000. “Martin Kiernan, who introduced the system to Southport and Ormskirk Hospital NHS Trust, was very pro ATP and Andrew Chalmers and the team have extended its use. “Tey are very proactive and keen to embrace technology that gives objective measurement of cleaning performance, safeguarding patients’ welfare and ensuring value for money of cleaning implementation. “While Southport and Ormskirk use their own
system to record and circulate results, Hygiena’s SureTrend is an easy to use software application that enables healthcare management to monitor environment hygiene whenever and wherever.
“With SureTrend users can track cleaning verifcation results, quickly identify problem areas, compare multiple facilities or departments and generate reports for management and record keeping. Te easy to use interface and pre-set reports allow managers to start analysing data immediately.”