ATP-based assessments of recent cleaning and disinfection for high-touch surfaces in low-resource shared toilets.
Graeme Prentice-Mott, Lorna Maru, Alexandra Kossik, Evelyn Makena Mugambi, Cynthia Ombok, Raymond Odinoh, Florence Mwikali, Ruthie Rosenberg, Isaac Ngere, Jennifer Murphy, David Berendes
Author Information
Graeme Prentice-Mott: Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Lorna Maru: Washington State University Global Health Program Kenya, Nairobi, Kenya.
Alexandra Kossik: Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Evelyn Makena Mugambi: Washington State University Global Health Program Kenya, Nairobi, Kenya.
Cynthia Ombok: Washington State University Global Health Program Kenya, Nairobi, Kenya.
Raymond Odinoh: Washington State University Global Health Program Kenya, Nairobi, Kenya.
Florence Mwikali: Sanergy, Inc.
Ruthie Rosenberg: Sanergy, Inc.
Isaac Ngere: Washington State University Global Health Program Kenya, Nairobi, Kenya.
Jennifer Murphy: Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
David Berendes: Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Quality improvements and reduction of disease risk for low-resource shared sanitation facilities require cleanliness assessment approaches that are both rigorous and practical. Using Adenosine Triphosphate (ATP) bioluminescence testing, we assessed contamination on high-touch (HT) surfaces (inner door handles) at 32 shared toilet sites in Kisumu, Kenya. In public toilets, contamination was lowest after cleaning and disinfection (C&D) with 0.5% chlorine solution (adjusted difference in mean log Relative Light Units per 100cm (aDiff): -1.61; CI: -2.43, -0.59), followed by C&D with 0.1% chlorine solution (aDiff: -1.16; CI: -1.77, -0.55). ATP levels were not associated with overall observable toilet cleanliness and had poor agreement with visually assessed HT surface cleanliness. Our findings demonstrate the utility of this field-feasible method for detecting the impact of recent C&D in low-resource shared toilets, a novel setting for ATP cleanliness testing, while also highlighting the importance of using effective C&D procedures and addressing HT surfaces within cleaning protocols.
References
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