Multicenter Evaluation of ATP-Based Cleaning Standards for Flexible Endoscopes: Establishing Recommended Thresholds for Primary Cleaning

Abstract

This multicenter study aimed to evaluate the effectiveness of primary cleaning of flexible endoscopes using ATP (adenosine triphosphate) bioluminescence testing and to establish recommended ATP thresholds for different endoscope types. Data were collected from 18facilitiesusingstandardizedprotocolsforATPandmicrobialtesting. While microbial counts were generally low, no significant correlation was observed between ATP values and colony-forming units (CFU). Based on the 95th percentile of ATP values, recommended thresholds were proposed for upper GI, lower GI, and duodenoscopes. These findings support the use of ATP testing as a practical tool for cleaning validation and highlight the need for differentiated standards by scope type.