Assessment of post-manual cleaning adenosine triphosphate tests to prevent the use of contaminated duodenoscopes and linear echoendoscopes: the DETECT study

We investigated whether use of post-manual cleaning adenosine triphosphate (ATP) tests lowers the number of duodenoscopes and linear echoendoscopes (DLE) contaminated with gut flora. In this single-centre before-and-after study, DLEs were ATP tested post-cleaning. During the control period participants were blinded for ATP results: ATP-positive DLEs were not recleaned. During the intervention period ATP-positive DLEs were recleaned. DLEs underwent microbiological sampling after High Level Disinfection (HLD) with participants blinded for culture results. Using fifteen endoscopes of five different DLE types, nine-hundred-nine procedures were included (52% duodenoscopes, 48% linear echoendoscopes). During the intervention period the absolute rate of contamination with gut flora was higher (16% vs 21%). Main analysis showed that contamination was less likely to occur in the intervention period (OR 0.32; 95%CI 0.12-0.85). Secondary analysis showed that this effect was based on one particular duodenoscope type (estimated probability 39%; 95%CI 18%-64% vs 9%; 95%CI 2%-21%), while no effect was seen in the other four DLE types. In detail, of the four duodenoscopes of this type two had lower contamination rates (69% vs 39% and 36% vs 10%). During the control period, both these duodenoscopes had multiple episodes with ongoing contamination with the same microorganism which ended weeks before the start of the intervention period, i.e. they were not terminated by ATP testing. Post-manual cleaning ATP tests do not reduce post-HLD gut flora contamination rates of DLE. Hence, post-cleaning ATP tests are not suited as a means for quality control of endoscope reprocessing.