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Those protein detection tests that use sa- line and a clean or sterile collection device (swab, brush or squeegee) to obtain the sample are free of interfering substances (feature #6); they are, when performed correctly, also accurate (feature #4) and robust (feature # 7).


automated cleaning equipment. They should also monitor the performance of all automated equipment (i.e., washer/ disinfectors and ultrasonic cleaners) as a part of their department’s quality systems. In addition, all delicate instruments that are not processed in an automated washer should be tested for residual soils on ex- ternal and internal surfaces after manual cleaning is performed.

It’s not unusual for ATP detection test- ing and protein detection testing to be confused with one another. Unlike ATP testing, which loses its detectability over time, protein detection remains constant because protein is present on the device until it is removed.

Qualit y co ntrol

Quality control measures assure SPPs that the processes and procedures they follow are effective (doing what they are intended to do, which is to thoroughly clean reusable medical devices). Cleaning verifi cation adds measurable, document- able control and consistency to the repro- cessing function.

SPPs should verify that their instru- ments are clean after going through any

Optimal tests for optimal patient safety As the CSI collects evidence at the crime scene, so must the SPP collect and docu- ment evidence to verify that instruments are clean. Commercial residual soil tests are available for use in the SPD. In addi- tion to visual inspection, they provide a more objective and sensitive approach to verifying if there is residual bioburden. But there are differences among them. ATP, a common testing method, has limitations, it is not rapid; it requires the purchase of additional equipment; and it may not be accurate. The hemoglobin test is very sensitive to blood but not to other proteins. Protein detection tests can be a better choice than ATP and hemoglobin tests because they detect protein, which is the most widely encountered soil; they are easy to perform; and they give rapid results. In addition, protein detec- tion tests don’t require the purchase of additional equipment and are free from interfering substances, which eliminates

the need for re-cleaning. The tests you select to use should be part of an overall quality system that adds control and consistency to your reprocessing func- tions, so that you can reduce infection risk and help assure better outcomes for your patients. HPN

References: 1. Retrieved from

2. Association for the Advancement of Medical Instrumentation (2017) ANSI/AAMI ST79: 2017 Comprehensive guide to steam sterilization and sterility assurance in health care facilities. Annex D. Arlington, VA: Author

3. Swenson, D., (2014). Instrument inspection. Communiquè. September/October, p. 30. Retrieved from https://www.iahc-

4. Omidbakhsh, N., Ahmadpour, F., and Kenny, N., (2014). How reliable are ATP bioluminescence meters in assessing decontami- nation environmental surfaces in healthcare settings? plosONE 9(6), e99951

Delores O’Connell is a Clinical Education Specialist for STERIS Corporation (Mentor, OH), responsible for supporting professional education needs to achieve best practices in sterile pro- cessing and infection pre- vention for surgical and endoscopy environments. O’Connell is a member of the Association for Profession- als in Infection Control and Epidemiology (APIC), International Associa- tion of Healthcare Central Service Materiel Management (IAHCSMM), Association of Perioperative Registered Nurses (AORN), and Society of Gastroenterology Nurses and Associates (SGNA).

Visit the Self-Study Series archives at for CEUs validated by IAHCSMM and CBSPD.

Recent CEUs: Worth the risk assessment! Is that really clean?

SPD: Win-Win means collaboration, teamwork with Infection Preventionist The Surgical Instrument Protection Team Quality assurance for low-temperature sterilizers TCO in the SPD: Forethought can lead to more economical equipment ownership and operation Reprocessing in the ambulatory surgery center setting Water quality for device reprocessing Processing fl exible endoscopes: AORN’s updated evidence-based guidelines Standards, sterilization and quality control Measuring the effi cacy of manual endoscope cleaning Rinsing: the most misunderstood step in reprocessing

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