IMPLEMENTATION OF THE ATP BIOLUMINESCENCE TEST AS A MONITORING TOOL FOR CLEANING PROCEDURES IN A CLINICAL COMPOUNDING UNIT OF A HOSPITAL PHARMACY SERVICE
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European Statement
Production and Compounding
Author(s)
A. Sousa; B. Martins; J. Gonçalves
ULSGE, Unidade Local de Saúde Gaia e Espinho, Vila Nova de Gaia, Portugal
ana.luisa.sousa@ulsge.min-saude.pt
Why was it done?
The quality and effectiveness of surface cleaning in the Clinical Compounding Unit (CCU) directly impacts the quality and safety of compounded medications. As a routine task, cleaning is often undervalued, and its effectiveness uncertain. The need for a reliable, real-time monitoring method led to the implementation of ATP testing, ensuring cleaning processes are effective and reproducible. Standard operating procedures, work instructions, and audit tools were developed to support its integration, based on the hospital-wide protocol.
High ATP levels indicate poor cleaning performance and increased microbiological risk, enabling immediate corrective action before any clinical compounding takes place.
What was done?
The ‘Hospital Cleaning Verification Procedure – ATP Bioluminescence Method’, developed by the Local Unit for Infection Prevention and Control and Antimicrobial Resistance (UL-PPCIRA), was adapted and implemented in the CCU of the Hospital Pharmacy Service.
The test is simple and can be performed by any trained healthcare professional. It involves swabbing a surface, followed by luminometric reading. The light intensity from the enzymatic bioluminescent reaction correlates with the amount of ATP, indicating organic contamination.
How was it done?
Key challenges included the time needed for staff training and initial resistance to procedural changes, with some perceiving the tests as personal performance evaluations. These were addressed through training sessions and awareness efforts focused on promoting a culture of quality and collective responsibility. At the end of the year, the test results will be presented to the team during a training session, as part of the annual training programme.
What has been achieved?
Monthly internal testing and bimonthly external audits by UL-PPCIRA are conducted, with approximately 120 tests/year. Non-compliant results lead to immediate cleaning repetition. So far, 17% of tests exceeded acceptable ATP levels. The goal is to reduce this to 10% by year-end. The project has actively engaged a multidisciplinary team of pharmacists, pharmacy technicians, and support staff in improving service quality and patient safety through shared responsibility.
What next?
The aim is to maintain a dynamic, continuously improving process and expand ATP testing to other areas: Cytotoxic Preparation Unit, Repackaging Area, and eventually the entire Pharmacy Service. Future goals include identifying contamination sources to complement ATP testing, further enhancing process control.