Major article A pilot study into locating the bad bugs in a busy intensive care unit Greg S. Whiteley BAppSc, MSafetySc, Dip AICD a, b, *, Jessica L. Knight DipSc, BSc(Hons) c, d, e , Chris W. Derry BSc(Med)Hons, MSc(Med), PhD a , Slade O. Jensen BSc(Hons), PhD c, d, e , Karen Vickery BVSc(Hons), MSc, PhD f , Iain B. Gosbell MBBS, MD, FRACP c, d, e, g a School of Science and Health, University of Western Sydney, Richmond, NSW Australia b Whiteley Corporation Pty Ltd, North Sydney, NSW Australia c School of Medicine, University of Western Sydney, Campbelltown, NSW Australia d Ingham Institute for Applied Medical Research, Antibiotic Resistance and Mobile Elements Group, Campbelltown, NSW Australia e Molecular Medicine Research Group, Liverpool, NSW Australia f Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, North Ryde, NSW Australia g Department of Microbiology and Infectious Diseases, Sydney South West Pathology Service, Liverpool, NSW Australia Key Words: MDRO locations ATP correlation Dry surface biofilm Intensive care unit Staff work area High-touch objects Background: The persistence of multidrug-resistant organisms (MDROs) within an intensive care unit (ICU) possibly contained within dry surface biofilms, remains a perplexing confounder and is a threat to patient safety. Identification of residential locations of MDRO within the ICU is an intervention for which new scientific approaches may assist in finding potential MDRO reservoirs. Method: This study investigated a new approach to sampling using a more aggressive environmental swabbing technique of high-touch objects (HTOs) and surfaces, aided by 2 commercially available adenosine triphosphate (ATP) bioluminometers. Results: A total of 13 individual MDRO locations identified in this pilot study. The use of ATP bio- luminometers was significantly associated with the identification of 12 of the 13 individual MDRO lo- cations. The MDRO recovery and readings from the 2 ATP bioluminometers were not significantly correlated with distinct cutoffs for each ATP device, and there was no correlation between the 2 ATP devices. Conclusion: The specific MDRO locations were not limited to the immediate patient surroundings or to any specific HTO or type of surface. The use of ATP testing helped rapidly identify the soiled locations for MDRO sampling. The greatest density of positive MDRO locations was around and within the clinical staff work station. Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. Pathogenic microorganisms are a persistent risk to patient safety in modern health care settings, particularly within active intensive care units (ICUs). 1 The presence of multidrug-resistant organisms (MDROs) embedded within dry surface biofilms adds further complexity to the cleaning process. 2 A validated scientific approach to evidence-based cleaning requires a multidisciplinary understanding of all intersecting parts of the hygiene puzzle. 3 The location of MDROs within an ICU may be subject to patterns of localization and dispersion. 4 There is an expected “hot zone” of bacterial surface contamination normally focused around the bed of an infected patient. 5,6 The transfer of these MDROs away from the patient area and throughout the ICU is thought to occur largely via unwashed hands and gloved hands. 7,8 High-touch objects (HTOs) are located throughout clinical areas and can provide a likely transit point for microbes owing to the frequency of hand touches. 9 A lack of cleaning in the clinical workspace, which is distant from the direct patient surroundings, may allow biofilm develop- ment without mitigation. 10 This opens the potential for MDRO to move seamlessly between residential biofilm locations either close to or away from the patient, and then back and forth via hands onto surfaces and objects that are frequently touched within the ICU. 11 The identification of residential biofilm locations thus becomes a critical requirement in the validation of any cleaning process within health care settings and particularly in ICUs. 12 * Address correspondence to Greg S. Whiteley, BAppSc, MSafetySc, Dip AICD, PO Box 1076, North Sydney, NSW 2096, Australia. E-mail address: gsw@whiteley.com.au (G.S. Whiteley). Conflicts of interest: None to report. Contents lists available at ScienceDirect American Journal of Infection Control journal homepage: www.ajicjournal.org American Journal of Infection Control 0196-6553/$36.00 - Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2015.07.013 American Journal of Infection Control 43 (2015) 1270-5