The Role of Antimicrobial Copper Surfaces in Reducing Healthcare-associated Infections
Just six key components were selected and re-engineered to take a copper or copper alloy surface. This included the bed rails, visitor chair arms and nurse call-buttons. After upgrade, reduction in contamination levels on these items was verified to be 97 % (see Figure 2) – confirming the results from Selly Oak. Finally, after three and a half years, the interim result reported at the 1st WHO International Conference on Prevention and Infection Control (ICPIC) indicated a reduction in HCAIs of 40 % for patients in the copper rooms compared with those in the non-copper rooms. For patients in a copper room with all six copper items present throughout their stay, the reduction was nearly 70 %.21
Future Activities
Up until now, all research and applications appear to show great potential regarding the effectiveness of antimicrobial copper alloys against bacteria and other pathogenic organisms.
Further to the scientific and clinical research results, manufacturers have also shown great interest in producing objects that are used frequently in high nosocomial potential areas (e.g. ICU, medical wards, etc.). However, implementation outside hospital areas, where microbial flora are at high levels, also worries public health planners.
In Laval, France, the brand new Center Inter-Generational Multi Accueil (CIGMA)22
– a nursery for 35 infants and a 60-bed care home
for dependent elderly people – has deployed copper alloys on all handrails and door handles. In Tokyo, Japan, the Mejiro Daycare Center for Children fitted copper sinks and handrails, as well as other touch surfaces.23
In Athens, Greece, a large private elementary school with 2,500 students changed all the handrails, door handles and push plates to those made from copper alloy (Cu 64 %, Zn 36 %). The first results showed 90–100 % less contamination than on standard, non-copper surfaces.24
In another application area, transport, the Santiago Metro system in Chile has installed copper alloy handrails at one new station.25 Subsequently, the Metro has signed contracts to fit brass handrails on two new lines under construction – some 30 stations.
Economics
The total cost of copper or copper alloy objects is a combination of raw material and manufacturing time. Many copper alloys are still used widely in industry because they can be fabricated into complex parts easily and quickly (e.g. taps and lock mechanisms). This means that copper alloy components will become cost-effective when product volumes are economic even if prototypes carry a premium.
Furthermore, because these components are generally straightforward to install, they will be more cost-effective than many high-tech propositions. Installing during a typical refurbishment project, when such common equipment would be refitted anyway, requires few special skills and is therefore broadly cost neutral. These items will also likely have a 30-year minimum lifetime.
1. Deane RS, Mills EL, Hamel AJ, Antimicrobial action of copper in respiratory therapy apparatus, Chest, 1970;58(4):373–7
2. Kuhn PJ, Doorknobs: a source of nosocomial infection?, Diagnostic Medicine, 1983;62–3.
3. WHO, Report on the Burden of Endemic Healthcare- Associated Infection Worldwide, 2011.
4. European Centre for Disease Prevention and Control (ECDC),
Figure 1: Intensive Care Unit at Sloane Kettering Memorial Hospital, One of the Three Hospitals in the Multicentre US Clinical Trial, with Copper Components Installed
Figure 2: Comparative Bacterial Load on Copper and Standard Key Touch Surfaces in US Trial21 Rooms, over 197 Weeks’ Sampling)
(for all
7,000 6,000 5,000 4,000 3,000 2,000 1,000 0
6,517 4,851
2,818 962 374 Bedrail 691 677 226 Call button Chair arm Tray table
Standard components (plastic, stainless steel, wood, chrome, laminate)
CFU = colony-forming units, IV = intravenous.
Due to the antimicrobial efficacy, the cost of replacing and installing copper alloy components cannot be compared to the cost of objects made from other types of material (stainless steel, plastic, etc.). Rather, it is the value of the benefit of copper that should be assessed. Targeted installation of copper clearly results in a decrease in environmental bioburden. Now the link has been established between this and infection rates: Dr Schmidt's conservative assessment indicates a 40 % reduction in ICU-acquired infections, with the potential for a 70 % reduction. This should lead to a reduction in care costs, better bed availability and an improvement in patient outcomes. When, as should result, we are able to decrease antibiotics usage, we have a further a benefit of incalculable value. In times when multi-resistant bacteria are increasing and antibiotics could have run their course, the antimicrobial copper era may have dawned. n
Annual Epidemiological Report, 2008.
5. Klevens RM, Edwards JR, Richards CL Jr, et al., Estimating health care-associated infections and deaths in U.S. hospitals, 2002, Public Health Rep, 2007;122:160–6.
6. EPIC, Guidelines for preventing healthcare-associated infections, J Hosp Infect, 2001;47(Suppl.):S1.
7. Noyce JO, Michels H, Keevil CW, Use of copper cast alloys to
control Escherichia coli O157 cross-contamination during food processing, Appl Environ Microbiol, 2006:72;4239–44.
8. Michels HT, Noyce JO, Keevil CW, Effects of temperature and humidity on the efficacy of methicillin-resistant Staphylococcus aureus challenged antimicrobial materials containing silver and copper, Lett Appl Microbiol, 2009;49(2):191–5.
955 305 326 Monitor Copper components 132 IV pole
EUROPEAN INFECTIOUS DISEASE
127
CFU/100cm2
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