copper as a self-disinfecting surface 775
with copper-coated surfaces or clinical outcomes (ie, reduc- tion of HAIs) have rarely assessed whether residual microbes had intrinsic or acquired resistance to copper. Survival on copper surfaces has been described and appears to be the consequence of endospore formation, survival on patches of dirt, or a special ability to endure a dry metallic copper sur- face.23 The frequency and importance of reduced susceptibility to copper among healthcare-associated pathogens remains poorly defined but likely will not be clinically significant. Fifth, the cost of purchasing, installing, and maintaining copper- coated surfaces has not been delineated. Sixth, the durability of copper-coated surfaces has been poorly described. Finally, no cost-effective analysis of the use of copper-coated surfaces has been published. In conclusion, the use of copper-coated surfaces to provide
continuous room disinfection is promising, but additional carefully designed and appropriately powered studies are required before this technology should be routinely adopted to prevent HAIs.
acknowledgments
Potential conflicts of interest: J.A.O. is a consultant to Gama Healthcare. D.J.W. and W.A.R. are consultants for PDI Healthcare. Financial support: J.A.O.would like to acknowledge support fromtheNational
Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare-Associated Infection and Antimicrobial Resistance at Imperial College London in partnership with Public Health England (PHE), and the Imperial College Healthcare Trust NIHR Biomedical Research Centre (BRC). Address correspondence to David J. Weber, MD, MPH, 2163 Bioinfor- matics, CB #7030, Chapel Hill, NC, 27599-7030 (
dweber@unch.unc.edu).
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