770 infection control & hospital epidemiology july 2017, vol. 38, no. 7
It is also possible, however, that the introduction of copper on some ICU surfacesmay indeed have had a “halo effect,” decreasing themicrobial burden in nearby noncopper surfaces. The results of our study agree with the existing literature,
which has demonstrated that copper-coated surfaces reduce bacterial load by 60%–70% and levels of vegetative bacteria by approximately 1- to 2-log10 cfu and that, unlike standard disinfection, a reduced bioburden was maintained for hours after standard cleaning.23 In a randomized trial by Salgado et al,14 copper coating reduced the rate of HAIs and/or coloni- zation by MRSA or VRE, but the effect on infection or coloni- zation by MDR gram-negative bacteria was not addressed. Furthermore, in previous studies, the total microbial burden was reported (including nonpathogenic bacteria) without speciation of bacterial colonies.7–10 More recently, in a non- randomized study in a neonatal ICU, the reduction of HAIs by the introduction of copper items was not statistically sig- nificant.15 However, the broad deployment of copper-composite hard surfaces and linens in a new hospital wing in Norfolk, Virginia, was associated with fewer HAIs, including C. difficile infections, in a population of acute-care patients.16 Our study has several limitations. First, this is a single-
institution study, so the results may not be applicable to other institutions with different infection control practices and MDRO profiles orwith lower acquisition rates. Also, this study was not designed to detect a reduction in the rate of patient colonization or in the incidence of HAIs. There was no randomization to coated and uncoated beds; however, there were no statistically significant differences in a variety of clinical and demographic characteristics between the 2 groups of patients, including the comparable high rate of colonization with MDRO (89%). Finally, a cost-effectiveness analysis was not performed, but others have calculated that the time to recover the cost of copper installation in their ICU was <2 months.23 Our study has several strengths, as well. This is the first study
acknowledgment
We acknowledge the technical contributions of Dimitra Katsala, Panagiota Adamou, and Zoe Chryssouli. Financial support: This study was supported by a grant from the Hellenic
Copper Development Institute. Potential conflicts of interest: M.S. has received a research grant from Achaogen. G.P. and A.A. received a grant from the Hellenic Copper Develop- ment Institute for this study. I.K. is currently an employee of Gilead Sciences Hellas. H.G. has received a research grant from Pfizer. All other authors have no conflicts to report relevant to this article.
Address correspondence to Maria Souli, 4th Department of Internal Med-
icine, University General Hospital Attikon, 1 Rimini Str. 124 62 Chaidari, Athens, Greece (
msouli@med.uoa.gr).
supplementary material
To view supplementary material for this article, please visit https:/
doi.org/10.1017/ice.2017.52
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bacteria.The long duration of the study (17months of intervention phase) provided evidence in favor of the persisting antimicrobial effect of copper coating over time. Regular measurements of compliance with hand hygiene and cleaning protocols throughout the study eliminated the influence of these variables on the results. Finally, 2 different types of arrangements of copper-coated surfaces were compared in a crossover design. In conclusion, the introduction of copper-coated surfaces
in a setting with endemic high antimicrobial resistance reduced the microbial burden, and the percentage of colonized surfaces surrounding the patient. The overall effect was more pronounced as the percentage of coated items increased.
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http://www.epa.gov/pesticides/factsheets/copper-alloy- products.htm. Published 2008. Accessed November 26, 2016.
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