Matt Morrison
Matt Morrison

Virtually all industries and organizations are now extremely focused on protecting the health of building users by implementing hygienic cleaning methods that target high-contact surfaces such as doorknobs, handles, bed tables, handrails, and more.

But one of the first was the long-term care industry.  

Some of the earliest cases of COVID-19 sweeping the country were in nursing homes, long-term facilities, rest homes and the like. Furthermore, by May 2020, two months into the pandemic, the Centers for Disease Control and Prevention (CDC) was already sending out directives to long-term care facilities, encouraging them to put more focus on enhanced cleaning and disinfecting to protect residents and staff from the virus.

However, what possibly has been overlooked is the need to test surfaces after they have been cleaned to ensure the effectiveness of the cleaning process.  

At one time, the only scientific way to accomplish this was to test a surface by what is called swabbing and plating, which requires swabbing a surface to collect a sample and then swabbing the sample onto a Petri dish plate.  Once this was completed, administrators, housekeepers, and other cleaning professionals could expect test results in about two to four days.  If those surfaces proved to be contaminated, then we would know they must be cleaned and disinfected once again.

However, two to four days is far too long when it comes to evaluating cleaning and disinfecting effectiveness, and this was true even before the pandemic. In a long-term care facility, waiting those two to four days could mean several people might come down with the disease before the test results are returned.  Today, fortunately, we have newer technologies that can produce results in less than 15 seconds.

What is needed are ATP rapid monitoring systems. These systems are about the size of a large television remote control.  Prices can vary, but what long-term care administrators and housekeepers need to know is that they are must-have devices.  We must be able to clean effectively – and then prove it.  This was true during the pandemic and even more true going forward.

Because they are so essential, we need to understand a bit more about how these systems work, how to use them, cautions and related information.  

What is ATP?

Adenosine triphosphate (ATP) bioluminescence measurement systems are used in many industries including foodservice, healthcare, and in recent years, the professional cleaning industry. They measure relative light units (RLUs) on a surface. The higher the RLU, the higher the ATP.  

When used in professional cleaning, these systems help determine the cleanliness of a surface, providing very rapid results.  A high ATP reading suggests that a surface may have a high level of microbial contamination.  A low level would indicate just the opposite, that the surface is relatively clean, with few contaminants that might harm human health. 

What is a low and what is a high ATP reading?

The measuring systems can vary based on the manufacturer; however, each manufacturer should provide a guide indicating what the readings mean.  For example, at least one popular system provides the following readings:

  • 0-10 is pass, meaning the surface is clean and safe.
  • 11-30 is caution, the surface should be recleaned.
  • 31 or above is fail, the surface is likely contaminated. 

Does the ATP monitor tell what contaminants are on a surface?

No.  Use the readings as a warning sign that contaminants could be on a surface.  This is especially true if the reading is high.

Are ATP readings always correct?

Not always. After a surface has been cleaned, if chemical residue is left on the surface, the results could be skewed.  There is also the possibility that the swab is touched or becomes contaminated before or during use.  

Is there a way to get the most precise ATP reading?

Yes.  Many administrators and housekeepers just swab one area of a surface. Instead, swab several areas of the same surface. For instance, if we are swabbing the top of a bedside table, swab five different areas of the table top in the immediate area.  Add the results together and divide by five.  Now you will have an average ATP reading for the entire tabletop.

Are there conditions that can impact an ATP reading?

Temperature can affect test results. If a surface is cold or hot, it can skew the reading. Room temperature should be about 70 degrees Fahrenheit.  Also, if the surface is in direct sunlight that could impact the reading.

What if we reclean a surface and it still gets a high ATP reading?

This most likely means that the cleaning tools or solutions used are not proving effective.  In most cases, the problem is the tools.  Many times, when using a cleaning cloth or a mop, it is the cloth, mop, or mop water that is contaminated.  As they are used, they spread containments. This can even happen if the cloth or mops have been washed.  For this reason, many medical facilities now use what ISSA, the worldwide cleaning association, calls spray-and-vac cleaning systems, better known as no-touch cleaning systems. These systems spray, rinse, and then vacuum surfaces, eliminating cleaning cloths and mops entirely.  They have proven far more effective at removing pathogens.  

The end of cautions

We need to address another issue and that is in a post-COVID world, cautions aren’t acceptable — either an ATP test gets a pass reading or a fail reading.  In a long-term care location, the reason for this is simple: we just can’t take the chance.  Cleaning surfaces properly, using the right tools and cleaning solutions, should result in a low ATP reading, and that is what long-term care administrators and housekeepers must always look for.

Matt Morrison is communications manager for Kaivac, manufacturers of cleaning systems and products designed to eliminate the spread of infection.  He can be reached at [email protected].

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.