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Use of ATP Readings to Predict a Successful Hygiene Intervention in the Workplace to Reduce the Spread of Viruses on Fomites


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The purpose of this study was to validate the use of adenosine triphosphate (ATP) for evaluating hygiene intervention effectiveness in reducing viral dissemination in an office environment. The bacterial virus MS-2 was used to evaluate two scenarios, one where the hand of an individual was contaminated and another where a fomite was contaminated. MS-2 was selected as a model because its shape and size are similar to many human pathogenic viruses. Two separate experiments were conducted, one in which the entrance door push plate was inoculated and the other in which the hand of one selected employee was inoculated. In both scenarios, 54 selected surfaces in the office were tested to assess the dissemination of the virus within the office. Associated surface contamination was also measured employing an ATP meter. More than half of the tested hands and surfaces in the office were contaminated with MS-2 within 4 h. Next, an intervention was conducted, and each scenario was repeated. Half of the participating employees were provided hand sanitizer, facial tissues, and disinfecting wipes, and were instructed in their use. A significant (p < 0.05) reduction was observed in the number of surfaces contaminated with virus. This reduction in viral spread was evident from the results of both viral culture and the surface ATP measurements, although there was no direct correlation between ATP measurements with respect to viral concentration. Although ATP does not measure viruses, these results demonstrate that ATP measurements could be useful for evaluating the effectiveness of hygiene interventions aimed at preventing viral spread in the workplace.
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Use of ATP Readings to Predict a Successful Hygiene Intervention
in the Workplace to Reduce the Spread of Viruses on Fomites
Laura Y. Sifuentes
Sonia L. M. Fankem
Kelly Reynolds
Akrum H. Tamimi
Charles P. Gerba
David Koenig
Received: 20 July 2016 / Accepted: 11 August 2016
ÓSpringer Science+Business Media New York 2016
Abstract The purpose of this study was to validate the use
of adenosine triphosphate (ATP) for evaluating hygiene
intervention effectiveness in reducing viral dissemination
in an office environment. The bacterial virus MS-2 was
used to evaluate two scenarios, one where the hand of an
individual was contaminated and another where a fomite
was contaminated. MS-2 was selected as a model because
its shape and size are similar to many human pathogenic
viruses. Two separate experiments were conducted, one in
which the entrance door push plate was inoculated and the
other in which the hand of one selected employee was
inoculated. In both scenarios, 54 selected surfaces in the
office were tested to assess the dissemination of the virus
within the office. Associated surface contamination was
also measured employing an ATP meter. More than half of
the tested hands and surfaces in the office were contami-
nated with MS-2 within 4 h. Next, an intervention was
conducted, and each scenario was repeated. Half of the
participating employees were provided hand sanitizer,
facial tissues, and disinfecting wipes, and were instructed
in their use. A significant (p\0.05) reduction was
observed in the number of surfaces contaminated with
virus. This reduction in viral spread was evident from the
results of both viral culture and the surface ATP mea-
surements, although there was no direct correlation
between ATP measurements with respect to viral concen-
tration. Although ATP does not measure viruses, these
results demonstrate that ATP measurements could be use-
ful for evaluating the effectiveness of hygiene interventions
aimed at preventing viral spread in the workplace.
Keywords Hygiene Adenosine triphosphate (ATP)
Viral dispersion Workplace Intervention MS-2 virus
Enteric and respiratory illnesses are readily spread among
persons working together in an office environment, and can
result in significant economic and productivity losses
(Bramley et al. 2002; Birbaum et al. 2003; Callan et al.
2005). Although implementation of hygiene interventions
may reduce the spread of viral illnesses in the workplace,
traditional methods for evaluating their effectiveness are
costly and time-consuming. Rapid methods for screening
of relative biological loads on surfaces could be helpful in
evaluating the efficacy of mitigation efforts. In this study,
the measurement of ATP was used to determine its value as
a rapid screening method for evaluation of workplace
hygiene interventions in reducing the potential for viral
Common illnesses of viral etiology, such as colds and
diarrhea, have a significant impact on health care costs and
absenteeism among office employees (Bramley et al.
2002). The increasingly globalized economy creates
greater opportunity than ever before for viral transmission,
as evidenced by the recent and emerging viral pandemics
such as those caused by H1N1 (Swine Flu), H7N9 (Avian
&Charles P. Gerba
Department of Soil, Water and Environmental Science,
College of Agriculture and Life Sciences, The WEST Center,
Kimberly-Clark Corporation, University of Arizona, 2959 W.
Calle Agua Nueva, Tucson, AZ 85721, USA
Department of and Environmental Occupational Health,
College of Public Health, University of Arizona, Tucson,
AZ 85721, USA
Kimberly-Clark Corporation, 2100 Winchester Road,
Neenah, WI 54956, USA
Food Environ Virol
DOI 10.1007/s12560-016-9256-2
Flu), and norovirus (Cauchemez et al. 2009; Morens et al.
2013; Hall et al. 2013). Even if an employee is not absent
as a result of viral infection, the increased cost of signifi-
cantly reduced productivity can equal or exceed those of
absenteeism attributed to illness (Lamb et al. 2006).
In these relatively enclosed environments, commonly
touched surfaces, such as break room tables, photocopying
machines, door entrances, and restrooms, represent the
most likely routes for the spread of enteric and respiratory
viruses (Boone and Gerba 2007). Fomites, inanimate
objects or surfaces that serve as microbial transmission
vehicles, are contaminated by infected individuals through
either direct contact or by the settling of aerosols created
by sneezing or coughing. The viruses are then transferred
to the hands of the individuals touching these surfaces, and
are subsequently introduced to the site of infection (i.e.,
nose, mouth, or eyes). Nicas and Jones (2009) found that
adults contact these critical points of microbial entry to the
human body approximately 16 times each hour. Because
viruses can survive on fomites from a few hours to a month
(Boone and Gerba 2007), contaminated surfaces represent
an important means of infectious disease transmission.
Bacterial viruses (phages), which do not infect humans,
have been used to study the movement of viruses in indoor
environments such as day care centers, neonatal nurseries,
and home settings (Rheinbaben et al. 2000; Gerhardts et al.
2012; Lopez et al. 2013). The bacterial virus MS-2 was
used in this study to represent pathogenic virus spread in
the office environment. MS-2 infects the bacterium
Escherichia coli and is very similar in shape and size
(23 nm) to rhinovirus, norovirus (most common cause of
adult gastroenteritis), and many other enteric viruses. In
addition to studying viral transmission patterns, bacterio-
phage models are also useful in the validation of preventive
measures (Mamane-Gravetz and Linden 2004).
Availability and use of hygiene interventions have been
shown effective in the disruption of both direct contact and
surface-mediated microbial transmission in school and
hospital environments (Liu et al. 2009; Bright et al. 2010;
Bloomfield et al. 2016). Preventive measures such as hand
washing (Ryan et al. 2001;Curtis and Cairncross 2003) and
use of hand sanitizers (Sandora et al. 2005), as well as anti-
microbial wipes and cleaners (Kochar et al. 2009), have
been demonstrated to reduce gastrointestinal and respira-
tory infectious disease incidence. In addition, proper uses
of disposable surgical masks and facial tissues have been
used to reduce transmission of respiratory infections
through aerosolization. Although these measures have been
shown effective when properly implemented, there is not
currently a rapid, cost-effective means to routinely monitor
their sustained effectiveness.
Adenosine triphosphate (ATP), the universal energy
molecule found in all animal, plant, bacterial, yeast, and
mold cells, produces bioluminescence that has been sug-
gested as a potential alternative for rapid confirmation of
hygiene intervention effectiveness. ATP detection methods
have been validated for assessment of relative microbial
presence in aquatic environments (Hammes et al. 2010)
and intravenous fluids (Anderson et al. 1986), as well as on
inanimate surfaces in hospitals (Moore et al. 2010; Aikin
et al. 2011) and food preparation areas (Aycicek et al.
2006). ATP is thus used as a general indicator of cleanli-
ness of a surface. Simple, hand held, ATP meters are now
available that allow for testing of fomites with results
available in 15 s (Hygienia 2016). This creates an oppor-
tunity for rapid screening of fomites with minimum cost
and time.
This study describes the effectiveness of a workplace
hygiene intervention in preventing the spread of a bacterial
virus in an office environment as a model for removal of a
pathogenic virus. ATP measurements were then compared
to viral load after the implementation of the hygiene
intervention to determine if the general cleanliness of a
surface could be correlated with the removal of viral
pathogens. This could provide an alternative monitoring
tool for the simple and rapid confirmation of the effec-
tiveness of a hygiene intervention on reducing the spread of
viruses in the workplace.
Materials and Methods
Study Approach
MS-2 was used to evaluate two scenarios, one where the
hand of one selected employee was contaminated and
another where a fomite, the entrance door push plate, was
contaminated. Samples from 54 selected surfaces were
sampled in the office setting at the beginning of the day and
at 4 and 7 h after inoculation to assess the dissemination of
the virus within the office. The samples were subsequently
tested using traditional viral culture and ATP detection
methods to assess the spread of the virus through the office
environment from each of the two starting points. Each
experiment was repeated after the employees were
instructed on the use of provided hygiene interventions
including facial tissues, disinfecting wipes, and hand san-
itizer, as well as hand-washing techniques using basic (not
labeled as anti-microbial) hand soap.
Office Description
This study was conducted in an office setting with
approximately 80 full-time employees. The office is loca-
ted on the second floor of a three-story building, with three
stairway accesses and one elevator access to the floor. The
Food Environ Virol
main entry door to the floor is located near the elevator,
such that persons exiting the elevator enter through the
main door. The entire office shares a common kitchen area
(break room) equipped with a microwave oven, a sink area,
a coffee machine, and a refrigerator. Other features include
several individual offices with doors located along the
perimeter of the floor, a central area divided into cubicles,
and seven locations containing shared photocopy
machines. A floor plan of the office can be seen in Fig. 1.
MS-2 Virus
MS-2 (ATCC 15597-B1) was obtained from the American
Type Culture Collection (ATCC Manassas, VA). MS-2
virus was prepared as previously described with minor
modifications (Rusin et al. 2002). The agar overlay tech-
nique was used to isolate and enumerate phage MS-2.
Dilutions of sample suspension (1 mL) followed by log-
phase host culture (1 mL) were added to melted top agar
tubes. The inoculated top agar tubes were mixed and
poured over a TSA plate, and then the solidified agar
overlay was inverted and incubated at 37 °C for 24 h.
Phage plaques were counted, and the concentration of
phage isolated per 100 cm
was calculated for each fomite
ATP Detection
ATP bioluminescence was measured in relative light units
(RLU) using a SystemSURE
ATP meter (Hygiena,
Camarillio, CA) according to the manufacturer’s recom-
mended protocol. An adjacent 100 cm
to where the phage
sample was collected was swabbed with the swabs pro-
vided by the manufacturer for use with the device.
Surface Inoculation
An area of approximately 50 cm
on an office entrance
door push plate and the hand of one of employee were
inoculated with 6 910
plaque forming units (PFU)
of MS-2 bacterial virus. This was done before the arrival
of any of the employees to ensure they were unaware of
the inoculation. This level of phage was used to make it
easily traceable through the facility and not necessarily to
reflect an actual viral load from an infected person.
However, this level is not out of reality as persons
infected with adenovirus, rotavirus, and norovirus may
have 10
virus particles per gram of feces (Maier
et al. 2009). Thus, 10
would represent only 0.01–0.001
grams of fecal material.
Sample Collection
Samples from 54 selected fomites and the hands of 42
participating employees were collected for viral assays
using sterile cotton transport swabs containing a buffer
to neutralize any residual disinfectant used on the sur-
face or hand (3 M Corporation, St. Paul, MN). Fomites
sampled included desk tops, table tops, refrigerator door
handles, microwave oven door handles, coffee pot han-
dles, and vending machine buttons. (Reynolds et al.
2016). Fomite samples for ATP detection were also
collected from adjacent surface areas using swabs rec-
ommended by the manufacturer for use with the Sys-
ATP meter (Hygiena, Camarillio, CA).
Each swab was aseptically removed from its transport
container, swabbed over an area of approximately
100 cm
for each surface, and carefully returned to its
transport container.
Fig. 1 Office floor plan
Food Environ Virol
The Healthy Workplace Project Intervention
Individual offices and communal areas were provided with
a series of intervention products intended to reduce the
spread of virus. The hygiene intervention was evaluated by
conducting the same inoculation and sampling protocol
before and after its implementation. The following prod-
ucts were provided for each individual office of these
individuals who agreed to participate in the intervention: a
bactericidal hand sanitizer (KIMTECH Moisturizing
Instant Hand Sanitizer, Kimberly-Clark Professional,
Roswell, GA), virucidal and bactericidal surface disin-
fecting wipes (SCOTT
Disinfectant Wipes, Kimberly-
Clark Professional, Roswell, GA), and facial tissue
Tissue, Kimberly-Clark Corporation, Nee-
nah, WI). Of the 80 persons in the office, 42 agreed to take
part in the intervention study.
Restrooms were stocked with basic hand soap (not anti-
bacterial) and paper towels. The communal areas were
provided with a bactericidal hand sanitizer with stands/
dispensers (KLEENEX
Moisturizing Instant Hand Sani-
tizer, Kimberly-Clark Global Sales, Roswell, GA). The
break room was provided with food safe bactericidal san-
itizing wipes (KIMTECH PREP* Surface Sanitizer Wipes,
Kimberly-Clark Professional, Roswell, GA), and the con-
ference rooms were equipped with a bactericidal hand
sanitizer (KIMTECH* Moisturizing Instant Hand Sanitizer,
Kimberly-Clark Professional, Roswell, GA), virucidal and
bactericidal surface disinfecting wipes (SCOTT
fectant Wipes, Kimberly-Clark Professional, Roswell,
GA), and facial tissue (KLEENEX
Tissue, Kimberly-
Clark, Neenah, WI).
Employees were instructed on the implementation of the
Healthy Workplace Project. They were advised to sanitize
hands when entering and leaving the office, as well as
before and after shaking hands, after touching communal
surfaces, and after touching the nose or face. In addition,
they were provided with tissues to wipe or blow their
noses, and instructed to wash their hands for 15 s with soap
and dry with a clean paper towel after using the restroom
and before eating food. Employees were advised to use
disinfecting wipes to clean desk areas (keyboard, mouse,
and phone) at the beginning of each day and to wipe down
the conference room table before starting a meeting; and to
use sanitizing wipes to clean frequently touched items in
the break room such as refrigerator handles, microwave
handles and buttons, coffee pot handles, vending machine
buttons, and tables.
Statistical Analysis
Adenosine triphosphate (ATP) measurements taken before
and after the intervention were compared with results from
the viral culture analysis to identify any statistical corre-
lations. The statistical analysis was performed using
2010 (Microsoft Corporation, Red-
mond, WA). The data were plotted to determine whether it
followed a normal distribution model. The log-transformed
data (log
) were normally distributed, which allowed us to
perform the Analysis of Variance (ANOVA) with the
assumption of normal distribution. In order to answer
specific questions, multiple ANOVA tests were conducted
on the data to test different hypotheses. Completely ran-
domized designs were used to perform the ANOVA, with a
rejection region of 5 % using the Fdistribution.
In order to evaluate the effectiveness of a hygiene inter-
vention for the reduction of MS-2 in an office setting, 54
samples were collected from commonly touched surfaces
for two baseline experiments and two interventions. Cor-
relations between the viral data and ATP measurements
were used to evaluate ATP as a rapid indicator of the
success of the intervention. No bacterial viruses were
detected on the fomites before the beginning of the study
(i.e., no background virus was recovered). MS-2 was
observed to spread throughout the office setting rapidly,
within 4 h, to a variety of fomites. Before implementation
of The Healthy Workplace Project, MS-2 virus had spread
to approximately 56 % of the fomites sampled within 4 h
after inoculation of one employee’s hand (Fig. 2), and
increased to 63 % at 7 h after inoculation.
Implementation of The Healthy Workplace Project
resulted in a reduction of MS-2 on fomites. The virus was
detected on 9 % of the fomites after 4 h and 30 % after 7 h
(Fig. 2). After 7 h, the number of contaminated fomites
and hands increased, but was still half as much that was
observed on the surfaces before the intervention (Fig. 3).
When the door push plate was contaminated, there were
Fig. 2 Percent positive of MS-2 occurrence on surfaces before and
after intervention
Food Environ Virol
70 % fewer fomites contaminated after 4 h during the
intervention portion of the study. Thus, there was a sig-
nificant overall reduction in virus occurrence on both hand
and fomite surfaces after implementation of The Healthy
Workplace Project.
A statistically significant difference was observed
between MS-2 concentrations with no intervention and
intervention experiments on fomites at the 4 h sampling
time (p\0.005). Using the ANOVA test with a 5 %
rejection region, the differences between pre-intervention
concentrations of MS-2 and those observed after a 7-h
workday remained marginally significant (p=0 054).
Combined data from both the 4 and 7 h time points
demonstrated that the impact of the intervention was highly
significant for reducing the exposure to MS-2 (Fig. 2). The
number of sites with an ATP reading of greater than 2 RLU
was 45 % before the intervention and 15 % after the
intervention. This difference was shown to be statistically
significant (p\0.005). Thus, ATP readings were useful in
determining the success of the hygiene intervention as they
demonstrated a significant reduction of virus on the sam-
pled fomites after the intervention.
Discussion and Conclusions
ATP bioluminescence is a general measurement of bio-
logical contamination. It does not directly monitor viruses,
but indicates a mixture of biological forms, such as human
cellular materials, bacteria, and plant and fungal cells.
Materials like epithelium from the upper respiratory tract
mucus membranes, saliva, and associated material from the
coughs and sneezes of persons with viral or bacterial
infections can also contribute to ATP measurements
(Shaughnessy et al. 2013).While there are limits to the use
of ATP measurements in assessing the impact of cleaning
practices (Green et al. 1999), recent studies have demon-
strated its potential usefulness for validating the effec-
tiveness of cleaning practices in schools (Shaughnessy
et al. 2013) and hospitals (Boyce et al. 2009a,b).
The rapid spread of virus throughout the office after a
high-touch surface (office door bar) or the hand of one
employee was inoculated illustrates how a contaminated
surface can result in viral transmission in the workplace.
Shared facilities (e.g., break room, copy machine), where
transfer of viruses from infected to uninfected persons is
most likely to occur, were readily contaminated. The viral
culture results show statistically significant reductions in
the spread of virus (MS-2) from either a contaminated hand
or fomite throughout an office environment after imple-
mentation of hygiene interventions. This was accomplished
with only 52 % of the occupants of the building partici-
pating in the intervention, demonstrating that a significant
reduction in virus spread can occur without everyone in the
office following the intervention protocol. In addition, this
improvement occurred after the intervention protocol was
in place for only 3 days before the virus was seeded onto
the hands/push plate. The seeding of the door handle or
hand of an employee made no significant difference in the
spread of the virus throughout the facility or the success of
the intervention (Reynolds et al. 2016). ATP measurements
correlated significantly with reduced viral recovery and
showed statistically significant differences in measure-
ments taken before and after an intervention. This suggests
that although ATP readings do not specifically predict the
occurrence or degree of reduction in microbial contami-
nation, the method can be useful for monitoring the success
of health interventions in the workplace in terms of the
reduction in the spread of a virus.
Despite the described limitations of ATP measurement
as a method for monitoring microbial contamination, the
resultsofthisstudyclearly demonstrate that workplace
hygiene interventions can result in a significant reduction
of viral contamination, and ATP can be used to monitor
performance rapidly. It also illustrates that a general
measure of cleanliness with a quantitative tool can be
related to the spread of viruses in indoor environments
and can be used as an aid to assess of potential inter-
ventions .
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Food Environ Virol
... These studies demonstrate that NAHA can be used as a marker for mold cell biomass under the proper conditions. ATP Application ATP testing by luminous reaction as a hygienic tool has been used in the food & beverage industry (9)(10)(11)(12) , medical facilities (13)(14)(15)(16)(17) , offices (18) , industrial water treatment plants (19,20) , manufacturing (21,22) and schools (23,24) . ATP has been used to evaluate bacteria (9-11, 13-17, 19-22, 24) , mold (7,9,12,21,25) , and even viruses (18) under a surrogate basis. ...
... ATP Application ATP testing by luminous reaction as a hygienic tool has been used in the food & beverage industry (9)(10)(11)(12) , medical facilities (13)(14)(15)(16)(17) , offices (18) , industrial water treatment plants (19,20) , manufacturing (21,22) and schools (23,24) . ATP has been used to evaluate bacteria (9-11, 13-17, 19-22, 24) , mold (7,9,12,21,25) , and even viruses (18) under a surrogate basis. In one study (21) it was found to have a lower detection limit than culturing of bacteria and fungi. ...
... Because viruses are associated with living cells (viruses need them to replicate) ATP is an overall generic marker of biological contamination, and it allows one to monitor potential viral contamination (from viral infections) indirectly (24) . One study with M-2 phage (virus) (18) found this surrogate approach (ATP) successful. Similarly, the Mycometer provides a way of monitoring biological load. ...
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ATP and Mycometer instrument theory and operational aspects to test surrogates for cleaning efficiency for COVID 19.
... Sanitarian Control and Hygiene Monitoring in Public Places ATP control in evaluating the effectiveness of hygiene interventions aimed at preventing viral spreading in the workplaces [4] 54 selected office surfaces for the analysis of MS2 bacterial virus spreading inside enclosed spaces ATP measurements confirmed the spreading and contamination of a half of the tested hands and surfaces in the offices by the virus MS-2 within 4 h. ...
... This method of analysis's application to detect the presence of various microorganisms is interesting and diverse, and it should be noted in the field of sanitary control of various objects. Here, ATP sensing is used to analyze various surfaces in hospitals and places intended for short-term stay of patients [4,5,9,10,14,15], surfaces of instruments used for examination and treatments of patients [7,8,11,12], and also as tools and places for slicing and cooking of food products [19,20], where sanitation is important for human health. The express analysis in real time and sensitivity of the bioluminescent determination of ATP, as well as the amount of total information obtained, make it possible to assess the degree of contamination by microbial cells from different points of examination, identify the main sites of cell pollutions and monitor the effectiveness of methods and reagents used for sanitary treatment. ...
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Bioluminescent analysis of adenosine triphosphate (ATP) concentrations is now acquiring new applications in the form of objects and processes in which it can be effectively used for sensing. A quick analysis of biological objects and systems for which the level of ATP concentrations is one of the main parameters, and a forecast of the development of various situations in such biosystems under industrial production conditions or the ecological state of the environment, confirmed by various results of analytical control of other parameters, turns out to be simple and effective. Sanitary control, quality control of purified water, microbial analysis in the food industry, maintenance of drugs and estimation of their quality, and monitoring of the metabolic state of biocatalysts used in various biotechnological processes are between the main trends of recent applications of bioluminescent ATP-assay. Additionally, the new areas of ATP sensing are developed, and the following topics are their creation of synthetic microbial consortia, their introduction as new biocatalysts to biodegradation of pesticides, suppression of methane accumulation in model urban land fields, control of dangerous development of biocorrosive processes, design of chemical-biocatalytic hybrid processes, creation of effective antimicrobial dressing and protective tissue materials, etc. These aspects are the subject of this review.
... 14 MS2 bacteriophage, a culturable indicator of fecal contamination in environmental waters, is used to model transfer and survival dynamics of viruses on environmental surfaces but is uncommonly detected on environmental surfaces without prior inoculation. 16 crAssphage is frequently detected in human feces and on environmental surfaces, 12-15 but current methods for detecting crAssphage are PCR-based and cannot assess virus viability. ...
... 17 In 1 study, levels of MS2 bacteriophage, a fecal indicator virus, and ATP in the workplace were significantly reduced after cleaning surfaces and hands; although, a direct correlation was not found. 16 ATP testing has the most value when it is used to evaluate how well a surface is cleaned or to quantify improvements in cleaning practices over time. 17 Audit and feedback systems using ATP have enhanced the efficacy of cleaning high-touch surfaces in health care settings and their implementation has been associated with reduced numbers of health care associated infections in hospitals and LTC facilities. ...
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Background Norovirus and C. difficile are associated with diarrheal illnesses and deaths in long-term care (LTC) facilities and can be transmitted by contaminated environmental surfaces. Hygienic monitoring tools such as adenosine triphosphate (ATP) bioluminescence and indicators of fecal contamination can help to identify LTC facility surfaces with cleaning deficiencies. Methods High-touch surfaces in 11 LTC facilities were swabbed and tested for contamination by norovirus, a fecal indicator virus, crAssphage, and ATP which detects organic debris. High levels of contamination were defined as log ATP relative light unit values or crAssphage log genomic copy values in the 75th percentile of values obtained from each facility. Results Over 90% of surfaces tested positive for crAssphage or gave failing ATP scores. Norovirus contamination was not detected. Handrails, equipment controls, and patient beds were 4 times more likely than other surfaces or locations to have high levels of crAssphage. Patient bed handrails and tables and chairs in patient lounges had high levels of both ATP and crAssphage. Conclusions Surfaces with high levels of ATP and crAssphage were identified. Quantifying levels of contamination longitudinally and before and after cleaning might enhance infection prevention and control procedures for reducing diarrheal illnesses in LTC facilities.
... ch-based cleaning products. Preferred products include those with 'No Wipe' usages, which means that little or no residue remains after the manufacturer's recommended contact time (APHC, 2020). The effectiveness of cleaning and disinfection practices can be assessed using a technique to detect Adenosine Triphosphate (ATP) as a biological indicator (Sifuentes et. al., 2016;Sanna et al., 2018; see section 4.1.2). ...
... As such, rapid methods for screening of relative biological loads on surfaces can be useful in evaluating the efficacy of mitigation efforts. A rapid assay to test for the presence of microbiological contamination and verify large-scale disinfection of surfaces is the ATP test (Sifuentes et al., 2016). This test can be used as a rapid screening method to evaluate workplace hygiene interventions in reducing the potential for viral spread. ...
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The Aviation Public Health Initiative is a joint program of the Harvard School of Public Health and Kennedy School of Government, sponsored for Airlines for America (A4A) member organisations, manufacturers, and airport operators. The intent of the report is to underscore the importance of follwiing the science of SARS-CoV-2 in order to save lives, reinvogorate our economy, and help lead the country and the world in efforts to overcome the COVID-19 crisis.
... However, the authors failed to detect SARS-CoV-2 RNA in any surface sampled [22]. Our results are in agreement with a previous work focused on RNA from bacteriophages [34]. In that study, the ATP measurement was not related to the viral nucleic acid contamination. ...
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Understanding transmission routes of SARS-CoV-2 is crucial to establish effective interventions in healthcare institutions. Although the role of surface contamination in SARS-CoV-2 transmission has been controversial, fomites have been proposed as a contributing factor. Longitudinal studies about SARS-CoV-2 surface contamination in hospitals with different infrastructure (presence or absence of negative pressure systems) are needed to improve our understanding of their effectiveness on patient healthcare and to advance our knowledge about the viral spread. We performed a one-year longitudinal study to evaluate surface contamination with SARS-CoV-2 RNA in reference hospitals. These hospitals have to admit all COVID-19 patients from public health services that require hospitalization. Surfaces samples were molecular tested for SARS-CoV-2 RNA presence considering three factors: the dirtiness by measuring organic material, the circulation of a high transmissibility variant, and the presence or absence of negative pressure systems in hospitalized patients' rooms. Our results show that: (i) There is no correlation between the amount of organic material dirtiness and SARS-CoV-2 RNA detected on surfaces; (ii) SARS-CoV-2 high transmissible Gamma variant introduction significantly increased surface contamination; (iii) the hospital with negative pressure systems was associated with lower levels of SARS-CoV-2 surface contamination and, iv) most environmental samples recovered from contaminated surfaces were assigned as non-infectious. This study provides data gathered for one year about the surface contamination with SARS-CoV-2 RNA sampling hospital settings. Our results suggest that spatial dynamics of SARS-CoV-2 RNA contamination varies according with the type of SARS-CoV-2 genetic variant and the presence of negative pressure systems. In addition, we showed that there is no correlation between the amount of organic material dirtiness and the quantity of viral RNA detected in hospital settings. Our findings suggest that SARS CoV-2 RNA surface contamination monitoring might be useful for the understanding of SARS-CoV-2 dissemination with impact on hospital management and public health policies. This is of special relevance for the Latin-American region where ICU rooms with negative pressure are insufficient.
... UltraSnap ATP detection device and SystemSURE Plus Luminometer were used to perform the tests. It is usually used to measure the biological contamination in surface within 15 s [8]. Several studies demonstrated its efficiency during cleaning practices in hospitals [9] and schools [10]. ...
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The coronavirus disease 2019 (COVID-19) poses significant risks to health in the workplace for employees in the manufacturing sector of Bangladesh. A variety of preventive steps are being taken by many food industries to sustain their production during this period by ensuring food safety. In response to the current outbreak, early identification, preparedness for the growing threat, and employee well-being are of utmost importance. Food health is also a concern in this regard, as workers in the food industry remain close to food and packages. The risk of spreading the virus within the industry can be held to a minimum with timely action and concerted efforts. A study was carried out in one baking industry of Bangladesh to investigate their regular activities during the pandemic period. Until the writing of this report, there were no cases of COVID-19 among employees. Thus this case study shows how one baking industry in Bangladesh prepares and responds to the COVID 19 outbreak.
... Laura et al. reported that ATP measurement does not represent the viral load on surfaces. 9 These results suggest that the ATP assay merely has a role in the assessment of surface contamination. ...
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Rapid hygiene monitoring tests based on the presence of ATP have been widely used in the food industry to ensure that adequate cleanliness is maintained. In this study, the practical applications and limitations of these tests and recent technological progress for facilitating more accurate control were evaluated. The presence of ATP on a surface indicates improper cleaning and the presence of contaminants, including organic debris and bacteria. Food residues are indicators of insufficient cleaning and are direct hazards because they may provide safe harbors for bacteria, provide sources of nutrients for bacterial growth, interfere with the antimicrobial activity of disinfectants, and support the formation of biofilms. Residues of allergenic foods on a surface may increase the risk of allergen cross-contact. However, ATP tests cannot detect bacteria or allergenic proteins directly. To ensure efficient use of commercially available ATP tests, in-depth knowledge is needed regarding their practical applications, methods for determining pass-fail limits, and differences in performance. Conventional ATP tests have limitations due to possible hydrolysis of ATP to ADP and AMP, which further hinders the identification of food residues. To overcome this problem, a total adenylate test was developed that could detect ATP+ADP+AMP (A3 test). The A3 test is suitable for the detection of adenylates from food residues and useful for verification of hygiene levels. The A3 test in conjunction with other methods, such as microorganism culture and food allergen tests, may be a useful strategy for identifying contamination sources and facilitating effective hygiene management. Highlights:
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Although recognized as the leading cause of epidemic acute gastroenteritis across all age groups, norovirus has remained poorly characterized with respect to its endemic disease incidence. Use of different methods, including attributable proportion extrapolation, population-based surveillance, and indirect modeling, in several recent studies has considerably improved norovirus disease incidence estimates for the United States. Norovirus causes an average of 570-800 deaths, 56,000-71,000 hospitalizations, 400,000 emergency department visits, 1.7-1.9 million outpatient visits, and 19-21 million total illnesses per year. Persons >65 years of age are at greatest risk for norovirus-associated death, and children <5 years of age have the highest rates of norovirus-associated medical care visits. Endemic norovirus disease occurs year round but exhibits a pronounced winter peak and increases by ≤50% during years in which pandemic strains emerge. These findings support continued development and targeting of appropriate interventions, including vaccines, for norovirus disease.
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Fomites can serve as routes of transmission for both enteric and respiratory pathogens. The present study examined the effect of low and high relative humidity on fomite-to-finger transfer efficiency of five model organisms from several common inanimate surfaces (fomites). Nine fomites representing porous and nonporous surfaces of different compositions were studied. Escherichia coli, Staphylococcus aureus, Bacillus thuringiensis, MS2 coliphage, and poliovirus 1 were placed on fomites in 10-μl drops and allowed to dry for 30 min under low (15% to 32%) or high (40% to 65%) relative humidity. Fomite-to-finger transfers were performed using 1.0 kg/cm2 of pressure for 10 s. Transfer efficiencies were greater under high relative humidity for both porous and nonporous surfaces. Most organisms on average had greater transfer efficiencies under high relative humidity than under low relative humidity. Nonporous surfaces had a greater transfer efficiency (up to 57%) than porous surfaces (<6.8%) under low relative humidity, as well as under high relative humidity (nonporous, up to 79.5%; porous, <13.4%). Transfer efficiency also varied with fomite material and organism type. The data generated can be used in quantitative microbial risk assessment models to assess the risk of infection from fomite-transmitted human pathogens and the relative levels of exposure to different types of fomites and microorganisms.
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In the Robert Frost poem "The Road Not Taken," a traveler recalls a time when his forest path forked and wonders where he would have ended up had he chosen the other path. Some viruses encounter analogous evolutionary divergence points, and they may not all take linear paths to inevitable outcomes. For instance, a novel avian influenza A (H7N9) virus has emerged in China.(1) Because all known pandemic and other human, mammalian, and poultry influenza A viruses have descended from wild-bird viruses, it seems logical that any avian influenza A virus that becomes pandemic must have serially acquired signature mutations . . .
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To address the need for a quantitative approach to the measurement of cleaning effectiveness, related to biologically derived surface contamination, three commercially available adenosine triphosphate (ATP) test systems were used to collect multiple samples measured in relative light units (RLUs) from 27 elementary schools in the southwestern United States before and after a standardized cleaning protocol. The database consisted of 6480 ATP measurements from four critical surfaces (student desktops, cafeteria tabletops, and restroom sinks and stall doors). Data was assessed according to ranges of ATP values before and after cleaning. Results showed the potential for such data to provide the basis for a standardized approach to the measurement of cleaning effectiveness, based on detection and quantification of pollutant loads of biological origin, across critical surfaces in school building environments. It is anticipated that verification of this data in school buildings across different geographic and climatic regions will lead to the establishment of "acceptable" ranges of ATP values that can be used as a practice-based approach to improving cleaning practices and contributing to healthier school environments.
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ATP bioluminescence is being applied in hospitals to measure surface contamination. We compared commercial luminometers for detecting the number Staphylococcus aureus associated with surfaces. The data showed that the ATP bioluminescence methods tested were not robust enough to generate quantitative data on bacterial numbers, especially at low concentrations.
process of asset pricing, which has developed dramatically in the last few years due to advances in financial theory and econometrics. This book covers the science of asset pricing by concentrating on the most widely used modelling technique called: Linear Factor Modelling. Linear Factor Models covers an important area for Quantitative Analysts/Investment Managers who are developing Quantitative Investment Strategies. Linear factor models (LFM) are part of modern investment processes that include asset valuation, portfolio theory and applications, linear factor models and applications, dynamic asset allocation strategies, portfolio performance measurement, risk management, international perspectives, and the use of derivatives. The book develops the building blocks for one of the most important theories of asset pricing - Linear Factor Modelling. Within this framework, we can include other asset pricing theories such as the Capital Asset Pricing Model (CAPM), arbitrage pricing theory and various pricing formulae for derivatives and option prices. As a bare minimum, the reader of this book must have a working knowledge of basic calculus, simple optimisation and elementary statistics. In particular, the reader must be comfortable with the algebraic manipulation of means, variances (and covariances) of linear combination(s) of random variables. Some topics may require a greater mathematical sophistication.
This chapter provides an introduction to the book that focus on environmental microbiology. The book defines the important microorganisms that are involved in environmental microbiology, the nature of the different possible environments in which they are situated, the methodologies used to monitor microorganisms and their activities, and the possible effects of microorganisms on human activities. The book addresses the new challenges of modern environmental microbiology, in which pathogens and bioremediation remain fundamental to the field. However, in both cases, the subject areas have been greatly enhanced through the application of molecular genetics and biotechnological tools. Another important area that has been included is that of molecular ecology, which involves investigating diversity in the environment and mining and exploiting that diversity for new natural products and activities. Thus, this book can be used in teaching environmental microbiology as well as a general reference book for practitioners in the field of environmental microbiology.
Viral illnesses like gastroenteritis and the common cold create a substantial burden in the workplace due to reduced productivity, increased absenteeism, and increased health care costs. Behaviors in the workplace contribute to the spread of human viruses via direct contact between hands, contaminated surfaces and the mouth, eyes, and/or nose. This study assessed whether implementation of the Healthy Workplace Project (HWP) (providing hand sanitizers, disinfecting wipes, facial tissues, and use instructions) would reduce viral loads in an office setting of approximately 80 employees after seeding fomites and the hands of volunteer participants with an MS-2 phage tracer. The HWP significantly reduced viable phage detected on participants' hands, communal fomites, and personal fomites (p<0.010) in office environments and presents a cost-effective method for reducing the health and economic burden associated with viral illnesses in the workplace.
Objectives: In response to increasing concerns about respiratory illness in military recruits, a simple handwashing program was developed and evaluated at a large Navy training center.Methods: Clinical records from 1996 through 1998 were reviewed to determine weekly rates of respiratory illness before and after program implementation (1,089,800 person-weeks reviewed). A supplemental survey was given to a sample of recruits to assess self-reported respiratory illness and compliance with the handwashing program.Results: A 45% reduction in total outpatient visits for respiratory illness was observed after implementation of the handwashing program. No change was noted in hospitalization rates for respiratory illness, which remained low during the observation period. Survey data supported clinical observations, as frequent handwashers self-reported fewer respiratory illness episodes when compared to infrequent handwashers. Surveys also revealed challenges with handwashing compliance.Conclusions: Implementation of a handwashing program in this population of healthy young adults was associated with a marked reduction in outpatient visits for respiratory illness. Despite its success, maintenance of the handwashing program has been challenging in the time-constrained setting of military training.
Gastro-intestinal infections are widespread in the community and have considerable economic consequences. In this study, we followed chains of infection from a public toilet scenario, looking at infection risks by correlating the transmission of bacteria, fungi and viruses to our current knowledge of infectious doses. Transmission of Escherichia coli, Bacillus atrophaeus spores, Candida albicans and bacteriophage MS2 from hands to surfaces was examined in a transmission model, that is toilet brush, door handle to water tap. The load of viable pathogens was significantly reduced during transfer from hands to objects. Nevertheless, it was shown that pathogens were successfully transferred to other people in contagious doses by contact with contaminated surfaces. Our results suggest that infection risks are mainly dependent on current infectious doses of pathogens. For enteritic viruses or bacteria, for example Norovirus or EHEC, only a few particles or cells are sufficient for infection in public lavatories, thus bearing a high risk of infection for other persons. However, there seems to be only a low probability of becoming infected with pathogens that have a high infectious dose whilst sharing the same bathroom. The transmission model for micro-organisms enables a risk assessment of gastro-intestinal infections on the basis of a practical approach.