RokStories Antimicrobial Copper Gaining Popularity in Battle Against HAIs
By P.J. Heller
When it comes to preventing hospital-acquired infections, antimicrobial copper may be the new gold standard.

"Stunning," declares Todd Linden, president and chief executive officer at Grinnell Regional Medical Center in describing the benefits of using copper alloy materials in the Iowa hospital. "I’m a believer. Absolutely.

"With the continued rise of hospital-acquired infections, it’s clear that standard hand-washing regimens and daily cleaning and terminal cleaning just isn’t getting the job done alone," Linden says. "I think more and more hospitals are going to be looking at this [antimicrobial copper] as a part of their overall infection control plans."

Alan Swain, assistant vice president of general services at The Cancer Treatment Centers of America (CTCA) in Arizona, agrees.

"We felt that any opportunity where we could provide a safer environment for our patients, let’s look at doing that," Swain says.

Although primarily touted for touch surfaces — such as drawer pulls, door handles, over-bed tray tables, sinks and faucets, bed rails, light switches and IV poles — the benefits of bacteria-killing copper is now also finding its way into textiles, exercise equipment, keyboards, stethoscopes, blood pressure cuffs and drinking fountains.

There are an estimated 200 facilities in more than 35 states that have installed antimicrobial copper products. Most of the installations are in hospitals; other sites include fitness centers, educational facilities, laboratories, mass transit centers, restaurants and residences.

"I just think there are going to be more and more applications coming as time goes on," Linden predicts.

Such a development would likely be a boon for both medical facilities and their patients. The Centers for Disease Controls says that in 2011, an estimated 722,000 patients in acute care hospitals contracted healthcare-associated infections (HAIs); about 75,000 of those patients died during their hospitalization.

"On any given day, approximately one in 25 U.S. patients has at least one infection contracted during the course of their hospital care . . ." the CDC says.

What that shows, the agency says, is the need for improved infection control in the nation’s healthcare facilities.

Some facilities have embraced copper as a way to help prevent hospital-acquired infections. They point to studies -- as well as thousands of years of copper history -- that show the efficacy of the metal.

Linden, for example, read about clinical trials at the Medical University of South Carolina (MUSC), the Ralph H. Johnson Veterans Administration Medical Center, also in South Carolina, and Memorial Sloan Kettering Cancer Center in New York City. The trials, funded by the Department of Defense, involved replacing stainless steel, aluminum and plastic touch surfaces with antimicrobial copper alloys in ICU rooms. The nearly one-year study was led by Dr. Michael Schmidt, professor and vice chair of the microbiology and immunology department at MUSC.

The study found that the use of copper resulted in a 97 percent reduction of bacteria that cause HAIs and that HAIs were reduced by more than half.

"Our study demonstrated that placing a copper alloy surface onto six common, highly touched objects in ICU rooms reduced the risk of HAI by more than half at all study sites," the study said. "We believe that HAI reduction was due to the continuous antimicrobial effect of copper on environmental pathogens. We previously reported that copper surfaces reduced burden by 83 percent, compared with standard surfaces in patient rooms."

That led Grinnell Regional Medical Center, a 49-bed facility serving a six-county area of roughly 40,000 people in east central Iowa, to partner with Grinnell College to study the possible benefits of copper. Half of the 26 rooms in the surgical area were outfitted with 16 copper-touch surfaces while the other half were left as is.

Random sampling was conducted over an 18-month period.

"We did have the same kind of stunning results that Dr. Schmidt had in his study," Linden reports. "We had about 90 percent less bacteria in the rooms that had copper versus the non-copper rooms. Pretty stunning results."

The study also included unoccupied rooms with and without copper.

"After a patient left and we did a terminal cleaning in that room, we studied unoccupied copper rooms versus unoccupied non-copper rooms," Linden says. "The thing that was pretty remarkable was how quickly in rooms without copper the bacteria repopulated after the terminal cleaning . . . There was no difference between the unoccupied copper rooms and the occupied copper rooms in terms of the elimination of bacteria."

Shannon Hinsa-Leasure, an associate professor of biology at Grinnell College who led the trial, said the study was "the first to demonstrate that copper alloy surfaces maintain reduced bacterial numbers in unoccupied and occupied patient rooms.

"This is key to protecting newly admitted patients from contracting infections through commonly touched surfaces, even when they are considered clean, and is integral to an effective infection-control strategy," she says.

According to the Copper Development Association, a New York-based non-profit trade group, antimicrobial copper kills 99.9 percent of bacteria -- MRSA, Vancomycin-Resistant Enterococcus faecalis (VRE), Staphylococcus aureus, Enterobacter aerogenes, Pseudomonas aeruginosa, and E. coli O157:H7 -- within two hours.

Ed Harrick, director of surgical services at Pullman Regional Hospital in eastern Washington, says he thinks that two-hour time frame is a conservative number.

"Even though the Copper Development Association says that it kills 99.9 percent of bacteria within two hours, the reality is within about 5 to10 minutes, if you take it on a Petri dish and look at how fast C. diff (Clostridium difficile) die in a copper medium, it’s within about 5 to 10 minutes. If you leave it in just a regular Petri dish, it will live 7, 10, 14 days. So it’s just kind of like a little booby trap sitting there for someone to come along and touch and get on their hands," he says.

"That’s why were on the copper path," Harrick says about Pullman installing copper at touch points — among them faucet handles, push buttons, and drawer and IV handles — as well as some surfaces throughout the hospital.

"Our housekeeping is really good, they’re very competent," he says. "But how long would it be before they wiped off a faucet handle, or a push button or a drawer handle. The point is, who knows. Some of the (1,300) handles I took off weren’t as clean as you would have thought they were. So we’re trying to decrease the possibility of picking up bio burdens between your hand washing."

The Copper Development Association notes that the use of antimicrobial copper doesn’t lessen the need for hospitals to maintain their standard infection control procedures.

"Antimicrobial copper surfaces are a supplement to and not a substitute for standard infection control practices," the organization says. "Just like other antimicrobial products, they have been shown to reduce microbial contamination, but do not necessarily prevent cross contamination; users must continue to follow all current infection control practices."

Linden agrees, saying he believe that copper "is going to be another arrow in our quiver of fighting hospital-acquired infections."

The results of the Grinnell study have prompted Linden to retrofit the rest of the rooms at the hospital with copper.

"I really can’t put patients in non-copper rooms given how much cleaner the copper rooms are," he says.

Grinnell’s emergency room also is being equipped with copper touch surfaces and the fitness center is being outfitted with copper exercise equipment.

Another recently published study at Sentara Leigh Hospital in Norfolk, Va., reported similar success with copper. The 10-month clinical trial reported that copper touch surfaces and copper infused linens reduced some infections by as much as 83 percent.

"We’ve just about reached the limit of human processes to control infections in hospitals and Sentara Leigh was already performing pretty well," said Dr. Gene Burke, vice president and executive medical director for clinical effectiveness with Sentara Healthcare.

"We owe it to our patients to try new approaches and this clinical trial indicates that copper-infused products are an effective addition to a robust infection prevention program," Burke said in a statement released by the hospital.

The trial was so effective that Sentara now plans to retrofit all of its 12 hospitals in Virginia and North Carolina. Plans also call for copper-infused linens in all patient rooms.

Swain of the CTCA in Goodyear, Ariz., is another believer in the benefits of copper. The facility, about 25 miles from Phoenix, is one of five CTCA for-profit hospitals serving cancer patients throughout the U.S.

Although no specific trials were carried out there, Swain says the impetus for installing copper was because "our patients are highly immune compromised and we felt that [retrofitting with copper products] would be in the best interests of our patients."

Swain had antimicrobial copper installed in patient rooms. Included were doorknobs, cabinet handles and knobs and towel racks in restrooms.

"We did install it and we did it with our patients in mind,’ he says. "That’s the biggest takeaway of why we did it."

While copper is more expensive than other materials for hospitals, officials say the additional cost is worth it, both to patients and the hospitals themselves, the latter which can face stiff penalties under Medicare quality and safety incentive programs. One advantage of copper cited by the CDA is that the antibacterial efficacy of copper metals won't wear away. "They are solid through-and-through and are effective even when scratched. They offer long-term protection; whereas, antimicrobial coatings are fragile, and can deteriorate or and wear off after time," the organization says.

"Although there is an increased cost for installing copper alloy products compared to stainless steel or porcelain, the lives saved and costs reduced by decreasing the number of healthcare-associated infections far exceed the initial input," says Grinnell College’s Hinsa-Leasure in a hospital news release.

Linden estimates the cost of copper is about 15 percent more than stainless steel.

"But we‘re not talking about expensive products," he notes. "A door handle, knobs on furniture, the sink handles, the toilet flusher, they’re not expensive to begin with. So 15 percent more for copper is really not a barrier.

"When you figure that the average increased cost for a patient once they get a hospital-acquired infection is $43,000 to their hospital stay, the ROI actually is pretty dramatic for utilizing copper-touch surfaces and that’s why were seeking to deploy it throughout our medical center," he says.

"We know it’s the right thing to do," Harrick adds. "If copper can be the little helper behind the scenes, behind the housekeepers, behind everything else, if it helps one patient in the lifetime that I’m here, then it’s all worth it for that one patient."

Swain concurs, adding that while more costly, the benefits that antimicrobial copper bring to patients is well worth the cost.

"Anytime you can provide a higher level of care to the patient, healthcare organizations owe that to them," Swain says. "It’s just a matter of if they have that in their budget to withstand that price differential."

"It’s not just about here," Harrick adds. "It‘s about helping patients worldwide."

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