Healthcare-associated Infections
The Role of Antimicrobial Copper Surfaces in Reducing Healthcare-associated Infections
Panos A Efstathiou Orthopedic Surgeon and Secretary General, Hellenic College of Orthopedic Surgeons
Abstract
Recent work investigating the antimicrobial characteristics of copper has led to a re-evaluation of the role of this essential metal in healthcare. While ancient civilisations used copper for its health benefits it seems its usefulness has been forgotten. The requirement for evidence-based interventions for infection control has been the driver behind recent scientific assessments of the benefits of copper. Ten years of laboratory research has led to clinical trials confirming a very significant and continuous reduction in environmental bioburden in a number of healthcare settings globally. The newest and most comprehensive clinical research has now reported an impressive 40 % reduction in healthcare-associated infections in intensive care units (ICUs) where copper was incorporated in key touch surfaces. The deployment of copper touch surfaces should be considered as an additional infection control measure to reduce care costs and improve bed availability and patient outcomes.
Keywords Antimicrobial, copper, environment, HCAI, ICU, infection rate, nosocomial infections, public health
Disclosure: Panos Efstathiou provides consultancy on the antimicrobial properties of copper to the Hellenic Copper Development Institute. Acknowledgements: The author thanks Evangelia Kouskouni, Katerina Karageorgou, Agapi Vilaeti, Zaharoula Manolidou, Maria Tseroni and Joanna Agrafa for their expert advice on the Greek studies. Received: 8 July 2011 Accepted: 1 August 2011 Citation: European Infectious Disease, 2011;5(2):125–8 Correspondence: Panos A Efstathiou, Artis 17, Amarousio PC 15125, Greece. E:
panosefstathiou@usa.net
Support: The publication of this article was funded by the Copper Development Association.
Historical Context
That copper has beneficial effects for humans has been known for at least 4,000 years. The use of copper for drinking water containers to ensure potability and the application of the powdered metal to wounds for disinfection, are reported in ancient Egypt. The Aztecs used copper to treat various skin diseases. Hippocrates, the father of medicine (460–380 BCE), recommended the use of copper for leg ulcers related to varicose veins. In France, during the three cholera epidemics around 1850, it was observed that workers in copper foundries were not affected by the disease.
More recently, in 1970, the American College of Chest Physicians published on the 'antibacterial action of copper'. They showed that the use of copper in large reservoir nebulisers for respiratory therapy resulted in the contents remaining sterile.1
More pertinently, in 1983,
a hospital study in Pennsylvania showed copper's effectiveness in lowering the Escherichia Coli count on brass door knobs.2
The Healthcare-associated Infection Problem During the subsequent decades, the major concern within the medical community has been healthcare-associated infections (HCAIs), or 'nosocomial' infections. This year's report from the World Health Organization (WHO) notes how difficult it is to gather reliable and comparable HCAI evidence globally, or even nationally. But they are able to conclude that hundreds of millions of patients are affected by them around the world.3
© TOUCH BRIEFINGS 2011
The measures taken towards reducing microbe transportation through frequently touched surfaces started in the last decade with the WHO 'Clean Care is Safer Care' campaign. In many national healthcare systems, specific guidelines were given to healthcare professionals in order to raise awareness and help combat nosocomial infections.
In 2001 in the UK, the 'EPIC Project: Developing National Evidence-based Guidelines for Preventing Healthcare associated Infections' among other good practices, points out touch surfaces as one of the major components of microbial concentration and transfer.6
125
Only receiving public attention when a family member suffers or when there are outbreaks, HCAIs are a very real endemic, ongoing problem and one that no institution or country can claim to have solved, despite many efforts. The statistics are harrowing. The European Centre for Disease Prevention and Control (ECDC) indicated HCAI levels in Europe as 7.1 % in 2008.4
This equates to
over four million patients being affected each year. The estimated incidence rate in the US was 4.5 % in 2002, corresponding to 1.7 million affected patients.5
Infections in intensive care units (ICUs) can be as high as 51 %, most of these being healthcare associated. Furthermore, the longer patients stay in an ICU, the more at risk they become of acquiring an infection.3
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92