This study aimed to assess the feasibility of monitoring the quality of endoscope reprocessing using an adenosine triphosphate (ATP) based bioluminescence system. 60 samples of eight gastroscopes that were routinely used in a major university hospital in Germany were examined. The endoscopes were evaluated using both the ATP system and microbial cultures at various stages of the reprocessing process. Reprocessing of the endoscopes consisted of the following steps: bedside flushing, manual pre-cleaning, cleaning and disinfection in the automated endoscope reprocessor (AER). Manual pre-cleaning was performed with conventional reusable brushes and the pH-neutral cleaner Bodedex® forte. After the bedside flush, the mean ATP level was 19,437 relative light units (RLU), which decreased to 667 RLU after manual cleaning and further reduced to 227 RLU after automated endoscope reprocessing (AER). Similarly, the mean total viable count (TVC) per endoscope was reduced from 15.3 colony-forming units (CFU)/10 ml after manual cleaning to 5.7 CFU/10 ml after AER. These results indicated that certain reprocessing cycles were inadequate in effectively cleaning the endoscopes. The ATP measurement appears to be a valid technique that allows for immediate corrective action, such as repeating the manual cleaning if ATP results exceed the established cutoff of 200 RLU.

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