774 infection control & hospital epidemiology july 2017, vol. 38, no. 7


table 1. Results of Selected Clinical Trials of Copper-Coated Versus Control Surfaces to Reduce Healthcare-Associated Infections Author, Year Setting


Study Design


Von Dessauer, 2016


Sifri, 2016 PICU, PIMCU Quasi-experimental


Acute-care units


Salgado, 2013 ICU


Quasi-experimental (ie, before and after)


RCT


Microbes All HAI


MDRO, C. difficile


All HAI pathogens, MRSA, VRE


Coated Surfaces


Bed rails, bed rail levers, IV poles, sink handles, nurses’ work station


Countertops (eg, sink), overbed table, bed rails plus Cu- impregnated linens


6 items: bed rails, overbed table, IV poles, arms visitor’s chair, plus 2 of nurses’ call button, computer mouse, bezel touchscreen monitor, computer palm rest


Outcomes (Cu vs Control)


Assessment of HH


Compliance HAI (RR, 0.81; P=NS) Yes


HAI (RR, 0.22; P=.023) C. difficile (RR, .017; P=.48)


MDRO (RR, 0.32 P=NS)


HAI (RR, 0.42; P=.013) MRSA or VRE colonization (RR, 0.36; P=.063)


No No Not mentioned Yes


Assessment of EVS Cleaning


No No


Other HAI Preventive Initiatives


Not mentioned Yes


NOTE. Cu, copper; HH, hand hygiene; EVS, environmental service; HAI, healthcare-associated; RR, relative risk; PICU, pediatric intensive care unit; PIMCU, pediatric intermediate care unit; IV, intravenous; NS, not significant; MRSA, methicillin-resistant Staphylococcus aureus; VRE, vancomycin-resistant Enterococcus spp; RCT, randomized clinical trial.


table 2. Advantages and Limitations in the Use of Copper as a Self-Disinfecting Surface in Hospital Rooms


Potential Advantages ∙ Demonstrated in vitro microbicidal effectiveness including sporicidal activity ∙ Demonstrated ability to reduce the level and frequency of bacterial contamination on copper-coated surfaces in patient rooms ∙ Adverse reactions to contact with copper-coated surfaces very uncommon ∙ Provides continuous disinfection of copper-coated surfaces (ie, unlike ultraviolet devices and hydrogen peroxide systems, its use is not limited to terminal disinfection)


Potential Limitations and Deficiencies in the Scientific Literature ∙ Unclear how many and which surfaces must be coated ∙ Likelihood and frequency of development of reduced susceptibility to copper in healthcare-associated pathogens not well studied ∙ Only limited data that use of copper-coated surfaces will reduce healthcare-associated infections. Further, existing clinical trials have potential design flaws (ie, none assessed environmental cleaning effectiveness)


∙ Available in vitro studies and clinical trials have evaluated a variety of types of copper coatings (ie, no agreement best method to use) ∙ Cost of purchasing copper-coated surfaces not described in the scientific literature ∙ Durability of copper-coated surfaces in patient rooms poorly described ∙ Cost-effectiveness of using copper-coated surfaces to reduce healthcare-associated pathogens not available


blinding.” An additional clinical trial has been published in the Spanish literature; it reported no differences in the frequency of nosocomial infections as well as no difference in the rates of ventilator-associated pneumonia, catheter-associated urinary tract infections, or central line-associated bloodstream infec- tions.32 However, this study was limited by its failure to achieve its intended sample size. The use of copper-coated surfaces to decrease contamina-


tion of hospital-room surfaces to decrease HAIs has several potential advantages over current technologies, but it also has several limitations, and several scientific questions remain unanswered (Table 2). Copper-coated surfaces have demon- strated the ability to inactivate many key pathogens associated with HAIs. Multiple studies have demonstrated that copper- coated surfaces can reduce the level of contamination on room surfaces by 1- to 2-log10. Importantly, unlike the “no-touch” methods that use UV devices or hydrogen peroxide systems (which currently can only be used for terminal disinfection),


copper-coated surface provide continuous disinfection. To date, clinical trials have reported only rare adverse reactions related to contact with a copper-coated surface. However, currently available studies still leave many ques-


tions regarding the routine use of copper-coated surfaces in hospital rooms. First, it is unclear how many and which surfaces must be coated to achieve a reduction in HAIs. Second, the types of copper-coating that have been studied vary, and widely accepted standard for such surfaces do not exist. Third, only a limited number of clinical trials have been published that have assessed whether copper-coated surfaces reduce the incidence of HAIs, and among published studies, copper-coated surfaces have not uniformly been shown to


reduce HAIs. Furthermore, the published studies have design flaws including failure to use a randomized design and failure to account for all possible confounding variables (eg, hand- hygiene compliance and cleaning effectiveness). Fourth, current studies investigating microbial reductions associated


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