Infection prevention and control
The growing evidence base for copper is
stimulating further trials, and will no doubt
continue to be the driver for further installations
using strategically targeted deployment of copper on high-touch surfaces
Official economic assessment
in France In France, following questions being asked in the country’s parliament, there is an official economic assessment in progress, and in Poland the first hospital tender to include antimicrobial copper products was made by Independent Public Clinical Hospital No. 4, the largest hospital in Lublin.
Industry stewardship Support with procuring efficacious products is offered in the form of an industry stewardship scheme. The Antimicrobial Copper brand and Cu+ mark are used by leading manufacturers of hospital equipment, furniture, and fittings, to indicate that their products are made from antimicrobial copper in a stewardship scheme established by the Copper Alliance, a global network of non- profit organisations. The use of the ‘Antimicrobial Copper’ brand and Cu+ mark by an organisation
indicates that it has been granted permission to do so based upon adherence to strict usage rules. These rules guide that organisation’s understanding of the underlying technology, and the way that the organisation promotes, advises on, and deploys it, in line with existing research, regulatory, and legislative requirements. Generally speaking, Cu+ approved alloys
contain greater than 60% copper. The range of approved alloys includes a palette of colours – from copper’s familiar red tones, to the rich browns of bronzes, and gold of brasses, right through to the silver of copper-nickels, some of which closely resemble stainless steel.
Growing range of products A growing number of companies are offering antimicrobial copper products, the latest being the world’s largest door hardware manufacturer, Ingersoll Rand, and the market is seeing a substantial rise in suppliers of antimicrobial copper medical equipment in Asia. All approved products are gathered in an online directory (
www.antimicrobialcopper.org).
Looking to the future The growing evidence base for copper is stimulating further trials, and will no doubt continue to be the driver for further installations using strategically targeted deployment of copper on high-touch surfaces, particularly in sensitive areas such as ICUs. The sourcing of products in the UK
looks set to become more streamlined, as NHS Supply Chain has issued a prior information notice on a range of decontamination products for its catalogue, to include antimicrobial copper components. This should provide a one- stop shop for a suite of products. The YHEC business case model now
provides a tool for hospital chief finance officers to estimate the return on investment of such an intervention. However, the decision-making process leading to an antimicrobial copper installation can be anything but straightforward. As YHEC’s Dr Taylor said of the
economic assessment: “This is not a typical health economics evaluation, as there are confounding factors regarding the responsibility for budgetary spend in hospitals. This is an engineering solution needing capital budget (typically held by estates and facilities departments), but with an impact on infection prevention, cost of care, and clinical outcomes. It therefore requires a high degree of understanding, and collaboration at senior decision-making levels.” Installing antimicrobial copper in a
hospital environment to augment infection control routines is a challenge, then, but clearly not insurmountable for ‘Copper Champions’.
References 1 Salgado CD, Sepkowitz KA, John JF et al. [Reply to Harbarth et al]. Infect Control Hosp Epidemiol 2013; 34 (9): 997-9.
2 Michels HT, Noyce JO, Keevil CW. Effects of temperature and humidity on the efficacy of methicillin-resistant Staphylococcus aureus challenged antimicrobial materials containing silver and copper. Lett Appl Microbiol 2009; 49 (2): 191-5.
3 Warnes SL, Keevil CW. Mechanism of copper surface toxicity in vancomycin- resistant enterococci following wet or dry surface contact. Appl Environ Microbiol 2011; 77 (17): 6049-59.
4 Casey AL, Adams D, Karpanen TJ et al. Role of copper in reducing hospital environment contamination. J Hosp Infect 2009; 74 (1): 72-7.
5 Schmidt MG, Attaway HH, Sharpe PA. Sustained reduction of microbial burden on common hospital surfaces through introduction of copper. J Clin Microbiol 2012; 50 (7): 2217-23.
6 Salgado CD, Sepkowitz KA, John JF et al. Copper surfaces reduce the rate of
healthcare-acquired infections in the intensive care unit. Infect Control Hosp Epidemiol 2013; 34 (5): 479-86.
7 Schmidt MG, Attaway HH III, Fairey SE. Copper continuously limits the concentration of bacteria resident on bed rails within the intensive care unit. Infect Control Hosp Epidemiol 2013; 34 (5): 530-3.
8 Mulvey D, Redding P, Robertson C et al. Finding a benchmark for monitoring hospital cleanliness. J Hosp Infect 2011; 77 (1): 25-30.
9 Taylor M, Chaplin S; York Health Economics Consortium, York, UK. The economic assessment of an environmental intervention: Discrete deployment of copper for infection control in ICUs. Antimicrobial Resistance and Infection Control 2013; 2 (Suppl 1): 368.
Angela Vessey
Angela Vessey, director of the Copper Development Association in the UK, studied Physiology (BSc) at Bedford College, University of London, and Applied Immunology (MSc) at Brunel University. Her early career was in medical
research in the Immunology Division of the National Institute for Medical Research. She joined the Copper Development Association – a non-profit trade association – in 1996, and became director in 2001. In 2005 she initiated the
Antimicrobial Copper programme in the UK to exploit the benefits of copper for preventing the spread of infection, while in 2007 she instigated a partnership with University Hospitals Birmingham to deliver a clinical trial to investigate copper’s efficacy in a clinical environment. In 2010 she was appointed European
Manager for a geographically-expanded Antimicrobial Copper programme to disseminate information, and to work with industry to make efficacious products available for healthcare facilities.
Health Estate Journal September 2013
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