CORRInsights®: What Orthopaedic Operating Room Surfaces Are Contaminated With Bioburden? A Study Using the ATP Bioluminescence Assay

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In their prospective diagnostic study, Drs. Richard and Bowen used adenosine triphosphate (ATP) bioluminescence to measure cleanliness in the orthopaedic operating room (OR). Having originated in the food service industry, this novel method to measure cleanliness is finding its way into the healthcare setting [1, 2, 8]. ATP hydrolysis (ATP → ADP + Pi + energy) is found in all living organisms, including bacteria, which makes ATP bioluminescence monitoring a practical technique to measure localized bioburden on contaminated surfaces. This topic is important because bioburden present on surfaces in the OR can potentially lead to postoperative infections [5]. I am not aware of any previous studies that evaluated the use of ATP bioluminescence as a measurement of cleanliness in orthopaedic ORs.
In their study, Drs. Richard and Burden demonstrated that multiple OR surfaces are not as clean as we would anticipate. In fact, the authors contend that if one were to compare the results of their study to the criteria set forth by the restaurant industry, surfaces such as the OR light handles, patient positioners, and the right side of the OR table headboard would not pass restaurant standards. Decreasing the risk of postoperative infections is a major focus of all hospitals and surgeons [7]. For example, the Surgical Care Improvement Project and the American Academy of Orthopaedic Surgeons both emphasize the importance of minimizing nosocomial orthopaedic infections [4, 10].
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