Use of adenosine triphosphate to audit reprocessing of flexible endoscopes with an elevator mechanism

Am J Infect Control. 2018 Nov;46(11):1272-1277. doi: 10.1016/j.ajic.2018.04.224. Epub 2018 May 21.


Background: There have been reported outbreaks of carbapenem-resistant Enterobacteriaceae infections linked to endoscopes with elevator mechanisms. Adenosine triphosphate (ATP) testing has been used as a marker for bioburden and monitoring manual cleaning for flexible endoscopes with and without an elevator mechanism. The objective of this study was to determine whether routine ATP testing could identify areas of improvement in cleaning of endoscopes with an elevator mechanism.

Methods: ATP testing after manual cleaning of TJF-Q180V duodenoscopes and GF-UCT180 linear echoendoscopes (Olympus America Inc, Center Valley, PA) was implemented. Samples were tested from the distal end, the elevator mechanism, and water flushed through the lumen of the biopsy channel. Data were recorded and compared by time point, test point, and reprocessing technician.

Results: Overall failure rate was 6.99% (295 out of 4,219). The highest percentage of failed ATP tests (17.05%) was reported in the first quarter of routine testing, with an overall decrease in rates over time. The elevator mechanism and working channel lumen had higher failure rates than the distal end. Quality of manual cleaning between reprocessing technicians showed variation.

Conclusion: ATP testing is effective in identifying residual organic material and improving quality of manual cleaning of endoscopes with an elevator mechanism. Cleaning efficacy is influenced by reprocessing technicians and location tested on the endoscope. Close attention to the working channel and elevator mechanism during manual cleaning is warranted.

Keywords: Duodenoscopes; infection; quality control; water test.

MeSH terms

  • Adenosine Triphosphate / chemistry*
  • Disinfection / standards*
  • Endoscopes / microbiology*
  • Equipment Contamination*
  • Humans
  • Infection Control / methods
  • Microbiological Techniques*
  • Quality Assurance, Health Care


  • Adenosine Triphosphate