Infection prevention and control


Silver-coloured antimicrobial copper door furniture at Homerton University Hospital, London.


reduce bioburden, in between cleans, without further intervention from staff. No special cleaning or training is required, and copper alloys such as brass, bronze, and copper-nickel, are resilient and hard- wearing – ideal for a long life in a challenging hospital environment. Being solid, there is also no surface coating that might wear away and result in reduced efficiency as time passes, and any dents or scratches in the material will also offer continuous antimicrobial efficacy. The question is then one of economy:


howmuch does it actually cost to augment existing infection control practices with antimicrobial copper, and what long-term financial benefits does it offer?


‘Unique study’ Health economics evaluations are typically applied to medication or surgery costs, but a unique study by York Health Economics Consortium (YHEC) investigated the economic benefits of antimicrobial copper as an engineering and design approach to infection control. The study compared expenditure on


copper and standard components with improvements in patient outcomes (fewer infections, shorter stays, and cost savings) and other tangible benefits drawn from the US clinical trial, and similar trials reporting from around the world. This investigation allowed the derivation of a spreadsheet-based model using the best current, published information, which was presented at theWHO International Conference on Prevention and Infection Control in Geneva in June this year.9


Payback in under two months Using UK data, and a conservative infection rate reduction of 20%, the model predicts that the cost of replacing the six key frequently-touched surfaces in a 20-bed ICU with antimicrobial copper equivalents will be recouped in less than two months, based on fewer infections, and the resulting shorter lengths of stay. It also calculates a (positive) impact on bed days and quality-adjusted life years offered by antimicrobial copper.


68 Health Estate Journal September 2013


An antimicrobial copper-equipped ward at the Children’s Hospital Roberto del Rio, Santiago, in Chile.


Dr Matthew Taylor, YHEC’s director,


and one of the paper’s authors, explains: “After the initial two months, ongoing cost savings will accrue from the reduction in blocked beds and better-directed staff resources.”


‘Latest from the lab’ While research has progressed from in vitro to in situ studies, lab work is ongoing, testing copper’s efficacy against different organisms, and elucidating the mechanism by which it exerts its effect. Professor Keevil’s group has concluded


that copper exerts its rapid effect via multiple pathways, with different pathways being more important for Gram-negative or Gram-positive bacteria, and similarly for wet or dry contamination incidents. During the process, DNA is totally degraded, and this prevents the transfer of genetic material via plasmids – a means of transferring antibiotic resistance between different bacteria. Professor Keevil demonstrated that this transfer took place on stainless steel, but not on copper. “We know that many human pathogens


survive for long periods in the hospital environment and can lead to infection,


expensive treatment, blocked beds, and death,” Professor Keevil explains. “What we have shown in this work is the potential for strategically placed antimicrobial copper touch surfaces to not only break the chain of contamination, but also to actively reduce the risk of antibiotic resistance developing at the same time. Provided that adequate cleaning continues in critical environments, copper can be employed as an important additional tool in the fight against pathogens.”


Adoption Even before the link between reduced bioburden and reduced infections was reported, installations were taking place in hospitals around the world, including Trafford General Hospital, Homerton University Hospital, and Craigavon Area Hospital in the UK; Nicosia General Hospital in Cyprus; Niederberg Hospital in Germany, and Tokuda Hospital Sofia in Bulgaria. Since the publication of the US trial paper, several US medical facilities have specified antimicrobial copper, and medical facilities in China and Japan – including Hua Dong Hospital in Shanghai, and Ochiai Fever Clinic in Chiba – are also using antimicrobial copper surfaces as an adjunct to existing hygiene protocols. In all of these installations there has


tended to be one ‘Copper Champion’ who – based on a combination of evidence and professional judgement – has driven through the inclusion of copper as part of either a new build, or planned refurbishment.Wards chosen for upgrade to antimicrobial copper have been those where the most vulnerable patients are cared for, such as neonatal and adult intensive care units. In some countries, the development of


An antimicrobial copper-equipped room at Tokuda Hospital Sofia, in Bulgaria.


hospital specifications for copper is under way. In Chile, where revenue from the nationalised copper mines contributes significantly to government funding, copper has been specified for a programme of new builds this year. The suite of products includes dressings trolleys, beds, IV drip poles, door furniture, taps, and overbed tables.


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