infection control & hospital epidemiology july 2017, vol. 38, no. 7 original article Reduction of Environmental Contamination With


Multidrug-Resistant Bacteria by Copper-Alloy Coating of Surfaces in a Highly Endemic Setting


Maria Souli, MD, PhD;1 Anastasia Antoniadou, MD, PhD;1 Ioannis Katsarolis, MD, PhD;1 Irini Mavrou, MD;2 Elisabeth Paramythiotou, MD;2 Evangelos Papadomichelakis, MD;2 Maria Drogari-Apiranthitou, MD, PhD;1 Theofano Panagea, MD, PhD;1,† Helen Giamarellou,MD, PhD;3 George Petrikkos, MD, PhD;1 Apostolos Armaganidis, MD, PhD2


objective. To evaluate the efficacy of copper-coating in reducing environmental colonization in an intensive-care unit (ICU) with multidrug-resistant-organism (MDRO) endemicity.


design. Interventional, comparative crossover trial. setting. The general ICU of Attikon University hospital in Athens, Greece. patients. Those admitted to ICU compartments A and B during the study period


methods. Before any intervention (phase 1), the optimum sampling method using 2 nylon swabs was validated. In phase 2, 6 copper-coated beds (ie, with coated upper, lower, and side rails) and accessories (ie, coated side table, intravenous [i.v.] pole stands, side-cart handles, and manual antiseptic dispenser cover) were introduced as follows: During phase 2a (September 2011 to February 2012), coated items were placed next to noncoated ones (controls) in both compartments A and B; during phase 2b (May 2012 to January 2013), all copper-coated items were placed in compartment A, and all noncoated ones (controls) in compartment B. Patients were randomly assigned to available beds. Environ- mental samples were cultured quantitatively for clinically important bacteria. Clinical and demographic data were collected from medical records.


results. Copper coating significantly reduced the percentage of colonized surfaces (55.6% vs 72.5%; P<.0001), the percentage of surfaces colonized by MDR gram-negative bacteria (13.8% vs 22.7%; P=.003) or by enterococci (4% vs 17%; P=.014), the total bioburden (2,858 vs 7,631 cfu/100cm2; P=.008), and the bioburden of gram-negative isolates, specifically (261 vs 1,266 cfu/100cm2; P=.049). This effect was more pronounced when the ratio of coated surfaces around the patient was increased (phase 2b).


conclusions. Copper-coated items in an ICU setting with endemic high antimicrobial resistance reduced environmental colonization by MDROs.


Infect Control Hosp Epidemiol 2017;38:765–771


The analysis of current scientific evidence has identified the inanimate hospital environment surrounding the patient as an important source of pathogens causing healthcare-associated infections (HAIs).1,2 Compliance with hand-hygiene guide- lines is the most essential intervention to interrupt the transmission pathways of nosocomial pathogens, but environ- mental cleaning is also very important. Nevertheless, even terminal cleaning often fails to eliminate important pathogens


from environmental reservoirs.3 Recently, additional approa- ches have been proposed such as the use of “self-disinfecting” surfaces created by coating with heavy metals.4 Laboratory studies have confirmed the bactericidal activity


of copper against a variety of key nosocomial pathogens.5,6 Copper-coated surfaces have been studied in a variety of hospital settings for their efficacy to reduce the microbial burden7–13 and the rate of specific HAIs.14–16


Affiliations: 1. 4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, University General Hospital


Attikon, Athens, Greece; 2. 2nd Department of Critical Care, National and Kapodistrian University of Athens, School of Medicine, University General Hospital Attikon, Athens, Greece; 3. 6th Department of Internal Medicine, Diagnostic and Therapeutic Center of Athens “Hygeia,” Athens, Greece. †Present affiliation: Department of Microbiology, Sismanogleio-A. Fleming General Hospital, Division A. Fleming, Athens, Greece.


PREVIOUS PRESENTATION. These data were presented in part at the 52nd Interscience Conference of Antimicrobial Agents and Chemotherapy, San Francisco, California, on September 9, 2012 (Abstracts K245 and K246).


© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2017/3807-0001. DOI: 10.1017/ice.2017.52 Received December 3, 2016; accepted March 1, 2017; electronically published May 5, 2017


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