Peer-reviewed research papers discussing the antimicrobial properties of copper-based metals
Here is a library of published papers and conference posters covering the laboratory and clinical studies conducted on the antimicrobial characteristics of solid copper and copper alloys over the last 20 years. Some papers are accessible here as pdfs, others have links to entries in various scientific libraries where full papers can be accessed via a subscription or for a cost.
If you have a paper to suggest we include here, please contact Bryony Samuel, Communications Officer, Copper Development Association.
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J. Inkinen, R. Mäkinen, M.M. Keinänen-Toivola, K. Nordström, M. Ahonen. Letters in Applied Microbiology, Vol. 64, Issue 1, January 2017
The present study was performed in real life settings in different facilities (hospital, kindergarten, retirement home, office building) with copper and copper alloy touch surface products (floor drain lids, toilet flush buttons, door handles, light switches, closet touch surfaces, corridor hand rails, front door handles and toilet support rails) in parallel to reference products. Pure copper surfaces supported lower total bacterial counts (16 ± 45 vs 105 ± 430 CFU cm−2, n = 214, P < 0·001) and a lower occurrence of Staphylococcus aureus (2·6 vs 14%, n = 157, P < 0·01) and Gram-negatives (21 vs 34%, n = 214, P < 0·05) respectively than did reference surfaces, whereas the occurrence of enterococci (15%, n = 214, P > 0·05) was similar. The studied products could be assigned to three categories according to their bacterial loads as follows (P < 0·001): floor drain lids (300 ± 730 CFU cm−2, n = 32), small area touch surfaces (8·0 ± 7·1 to 62 ± 160 CFU cm−2, n = 90) and large area touch surfaces (1·1 ± 1·1 to 1·7 ± 2·4 CFU cm−2, n = 92). In conclusion, copper touch surface products can function as antibacterial materials to reduce the bacterial load, especially on frequently touched small surfaces.
A. Różańska, A. Chmielarczyk, D. Romaniszyn, M. Bulanda. Journal of Hospital Infection, Supplement 1, November 2016.
Background: Coagulase-negative staphylococci (CNS) are the predominant contaminant flora of the Polish hospital environment.
Aim(s)/Objective(s): The objective of the study was to evaluate the antimicrobial properties of copper and selected copper alloys, against CNS highly resistant to antibiotics, isolated from touch surfaces of Polish hospital units.
Method(s): Modification of Japanese standard – a method for testing antimicrobial properties of surfaces made of non-porous materials was used in the study. Assessment of antimicrobial properties was performed on copper alloys: CuZn37, CuSn6, CuNi12Zn24 and Cu-ETP as positive control and stainless steel as negative control. Bacterial strains used in the study were: Staphylococcus haemolyticus and Staphylococcus epidermidis – strains resistant to beta-lactam antibiotics, aminoglycosides, fluoroquinolones, clindamycin, erythromycin and trimethoprim/sulfamethoxazole vs. strains of these species forming a biofilm and, for comparison–Stapylococcus aureus.
Results: The strongest antimicrobial properties against the tested strains were found for pure copper –total elimination of bacteria from the level of 107 CFU/mL was observed after approximately 180 min. A faster total reduction of the density of bacterial suspension was also observed in case of SA comparing to CNS strains. Effectiveness comparable to that of pure copper was demonstrated for tin bronze (CuSn6).
Discussion and/or Conclusion(s): The results demonstrated that copper alloy materials exhibit strong antimicrobial properties against the study strains. It means that the use of equipment made of materials with antimicrobial properties can help to limit the spread of antibiotic resistance genes in the hospital environment. The work was carried out in the framework of the NCBiR project PBS3/ A9/32/2015.
AA Estelle, J Rutherford, MG Schmidt. Poster presented at DiMiMED, the International Conference on Disaster and Military Medicine. 15–16 November 2016, Düsseldorf, Germany
Antimicrobial copper surfaces are proven to inactivate lethal viruses and kill infectious bacteria that cause healthcare-associated infections (HAIs) responsible for substantial patient morbidity and mortality. These continuously active metal surfaces can be integrated into rapidly deployable military medical clinics and military medical treatment facilities to reduce the risk of infectious outbreaks thereby increasing productivity and improving mission effectiveness.
Shannon M. Hinsa-Leasure, Queenster Nartey, Justin Vaverka, Michael G. Schmidt. American Journal of Infection Control, 28 September 2016
Objective: To assess the ability of copper alloy surfaces to mitigate the bacterial burden associated with commonly touched surfaces in conjunction with daily and terminal cleaning in rural hospital settings.
Design: A prospective intention-to-treat trial design was used to evaluate the effectiveness of cooper alloy surfaces and respective controls to augment infection control practices under pragmatic conditions.
Setting: Half of the patient rooms in the medical-surgical suite in a 49-bed rural hospital were outfitted with copper alloy materials. The control rooms maintained traditional plastic, metal, and porcelain surfaces.
Methods:The primary outcome was a comparison of the bacterial burden harbored by 20 surfaces and components associated with control and intervention areas for 12 months. Locations were swabbed regardless of the occupancy status of the patient room. Significance was assessed using nonparametric methods employing the Mann-Whitney U test with significance assessed at P < .05.
Results: Components fabricated using copper alloys were found to have significantly lower concentrations of bacteria, at or below levels prescribed, upon completion of terminal cleaning. Vacant rooms were found to harbor significant concentrations of bacteria, whereas those fabricated from copper alloys were found to be at or below those concentrations prescribed subsequent to terminal cleaning.
Conclusions: Copper alloys can significantly decrease the burden harbored on high-touch surfaces, and thus warrant inclusion in an integrated infection control strategy for rural hospitals.
Michael G. Schmidt, Joseph J. John Jr., Katherine D. Freeman, Peter A. Sharpe, Adam A. Estelle, Harold T. Michels. American Journal of Infection Control, 9 August 2016
The recent commentary, “It is time to revise our approach to registering antimicrobial agents for health care settings” by Alvarez et al1 provides welcome recognition that antimicrobial touch surfaces, such as copper alloys, offer a promising method to augment our capacity to combat health care-associated infections (HAIs). We agree that replacing high-touch surfaces in hospitals and elsewhere with continuously active, antimicrobial copper alloys provides an important means of reducing microbial burden during intervals between routine and terminal environmental cleanings.
Harold T. Michels, Corinne A. Michels, Current Trends in Microbiology, Vol. 10 2016
Exposure to dry copper alloy surfaces, such as brass, kills a wide spectrum of microorganisms including Gram-negative and Gram-positive bacteria and fungi, and permanently inactivates several types of viruses.
A large body of published evidence reports that greater than 99.9% killing occurred within a 2-hour period when the microorganism was exposed to the copper alloy samples at room temperature and typical indoor humidity levels. Included in these studies were disease-causing bacteria such as E. coli O157:H7 as well as hospital “super-bugs” such as Methicillin- Resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococci(VRE). The results of these laboratory-based tests are reviewed here.
The mechanism(s) of action of copper alloy surface killing is still under investigation and progress on this important area of research will be described. It is important to note that mutations that provide resistance to copper alloy surface exposure have not been reported. These results suggest that copper alloy surfaces could be a powerful tool against the transmission of infectious disease in public settings, most particularly hospitals.
In a clinical trial, summarized here, the amount of live bacteria found on components made of copper alloys was compared to that found on components made from standard materials and shown to be 83% lower. Most significantly, when infection rates were tracked in these hospital rooms with the copper components and compared to rooms containing the standard components, it was found that the infection rates were reduced by a statistically significant 58%.
Thus, the widespread deployment of copper alloy components to frequently touched surfaces, such as door knobs and hand rails, has the potential to significantly reduce the rate of transmission of infections in the clinical settings and public-use spaces such as schools and transit systems.
Marin Vincent, Philippe Hartemann, Marc Engels-Deutsch. International Journal of Hygiene and Environmental Health. doi:10.1016/j.ijheh.2016.06.003
Copper has long been known to have antimicrobial activity and is used in drinking water treatment and transportation. It has been recognized by the American Environmental Protection Agency as the first metallic antimicrobial agent in 2008. With ongoing waterborne hospital-acquired infections and antibiotic resistance, research on copper as an antimicrobial agent is again very attractive.
Many studies have shown that the use of copper surface and copper particles could significantly reduce the environmental bioburden. This review highlights in its first part all the conditions described in the literature to enhance copper antimicrobial activity. Secondly, the different antimicrobial applications of copper in water treatment, hospital care units and public applications are presented. Finally, the future research needs on copper as an antimicrobial agent are discussed.
Bettina von Dessauer Maria S. Navarrete, Dona Benadof, Carmen Benavente, Michael G. Schmidt. American Journal of Infection Control. doi:10.1016/j.ajic.2016.03.053
Studies have consistently shown that copper alloyed surfaces decrease the burden of microorganisms in health care environments. This study assessed whether copper alloy surfaces decreased hospital-associated infections in pediatric intensive and intermediate care units.
Admitted infants were assigned sequentially to a room furnished with or without a limited number of copper alloyed surfaces. Clinical and exposure to intervention data were collected on a daily basis. To avoid counting infections present prior to admission, patients who stayed in the hospital <72 hours were excluded from analysis. Health care–associated infections (HAIs) were confirmed according to protocol definitions.
Clinical outcomes from 515 patients were considered in our analysis: 261 patients from the intervention arm of the study, and 254 from the control arm. Crude analysis showed an HAI rate of 10.6 versus 13.0 per 1,000 patient days for copper- and non–copper-exposed patients, respectively, for a crude relative risk reduction (RRR) of 0.19 (90% confidence interval, 0.46 to -0.22). Conducting clinical trials to assess interventions that may impact HAI rates is very challenging. The results here contribute to our understanding and ability to estimate the effect size that copper alloy surfaces have on HAI acquisition.
Exposure of pediatric patients to copper-surfaced objects in the closed environment of the intensive care unit resulted in decreased HAI rates when compared with noncopper exposure; however, the RRR was not statistically significant. The clinical effect size warrants further consideration of this intervention as a component of a systems-based approach to control HAIs.
S. L. Warnes and C. W. Keevil. Applied and Environmental Microbiology 2016, 10.1128/AEM.03861-15
The pandemic of hospital acquired infections caused by methicillin-resistant Staphylococcus aureus (MRSA) has declined but the evolution of strains with enhanced virulence, toxins and the increase of community-associated infections is still a threat. In previous studies, simulated droplet contamination of MRSA was killed on copper and brass surfaces within 90 minutes. However, contamination of surfaces is often via finger tips which dries rapidly and may be overlooked by cleaning regimes unlike visible droplets. In this new study a 5-log reduction of a hardy epidemic strain of MRSA (EMRSA-16) was observed following 10 minutes contact with copper and 4-log reduction observed on copper nickel and cartridge brass alloys in 15 minutes. A methicillin-sensitive strain (MSSA), from an osteomyelitis patient, was killed on copper surfaces in 15 minutes and a 4-log and 3-log reduction occurred within 20 minutes contact with copper nickel and cartridge brass, respectively. Bacterial respiration was compromised on copper surfaces and superoxide generated as part of the killing mechanism. In addition, destruction of genomic DNA occurs on copper and brass surfaces allaying concerns about horizontal gene transfer and copper resistance. Incorporation of copper alloy biocidal surfaces could help to reduce the spread of this dangerous pathogen.
Michael Hans, Salima Mathews, Frank Mücklich and Marc Solioz, Biointerphases 11, 018902 (2016); http://dx.doi.org/10.1116/1.4935853
Contact killing is a novel term describing the killing of bacteria when they come in contact with metallic copper or copper-containing alloys. In recent years, the mechanism of contact killing has received much attention and many mechanistic details are available. The authors here review some of these mechanistic aspects with a focus on the critical physicochemical properties of copper which make it antibacterial. Known mechanisms of contact killing are set in context to ionic, corrosive, and physical properties of copper. The analysis reveals that the oxidation behavior of copper, paired with the solubility properties of copper oxides, are the key factors which make metallic copper antibacterial. The concept advanced here explains the unique position of copper as an antibacterial metal. Based on our model, novel design criteria for metallic antibacterial materials may be derived.
Michael G. Schmidt PhD; Bettina von Dessauer MD; Carmen Benavente MD; Dona Benadof MD; Paulina Cifuentes RN; Alicia Elgueta RN; Claudia Duran MS; Maria S. Navarrete MD MPH. American Journal of Infection Control, Corrected proof. doi:10.1016/j.ajic.2015.09
Background: Health care associated infections result in significant patient morbidity and mortality. Although cleaning can remove pathogens present on hospital surfaces, those surfaces may be inadequately cleaned or recontaminated within minutes. Because of copper’s inherent and continuous antimicrobial properties, copper surfaces offer a solution to complement cleaning. The objective of this study was to quantitatively assess the bacterial microbial burden coincident with an assessment of the ability of antimicrobial copper to limit the microbial burden associated with 3 surfaces in a pediatric intensive care unit.
Methods: A pragmatic trial was conducted enrolling 1,012 patients from 2 high acuity care units within a 249-bed tertiary care pediatric hospital over 12 months. The microbial burden was determined from 3 frequently encountered surfaces, regardless of room occupancy, twice monthly, from 16 rooms, 8 outfitted normally and 8 outfitted with antimicrobial copper.
Results: Copper surfaces were found to be equivalently antimicrobial in pediatric settings to activities reported for adult medical intensive care units. The log10 reduction to the microbial burden from antimicrobial copper surfaced bed rails was 1.996 (99%). Surprisingly, introduction of copper objects to 8 study rooms was found to suppress the microbial burden recovered from objects assessed in control
rooms by log10 of 1.863 (73%).
Conclusion: Copper surfaces warrant serious consideration when contemplating the introduction of no-touch disinfection technologies for reducing burden to limit acquisition of HAIs.
Warnes SL, Little ZR, Keevil CW. 2015. Human coronavirus 229E remains infectious on common touch surface materials. mBio 6(6):e01697-15. doi:10.1128/mBio.01697-15.
The evolution of new and reemerging historic virulent strains of respiratory viruses from animal reservoirs is a significant threat to human health. Inefficient human-to-human transmission of zoonotic strains may initially limit the spread of transmission, but an infection may be contracted by touching contaminated surfaces. Enveloped viruses are often susceptible to environmental stresses, but the human coronaviruses responsible for severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) have recently caused increasing concern of contact transmission during outbreaks. We report here that pathogenic human coronavirus 229E remained infectious in a human lung cell culture model following at least 5 days of persistence on a range of common nonbiocidal surface materials, including polytetrafluoroethylene (Teflon; PTFE), polyvinyl chloride (PVC), ceramic tiles, glass, silicone rubber, and stainless steel. We have shown previously that noroviruses are destroyed on copper alloy surfaces. In this new study, human coronavirus 229E was rapidly inactivated on a range of copper alloys (within a few minutes for simulated fingertip contamination) and Cu/Zn brasses were very effective at lower copper concentration. Exposure to copper destroyed the viral genomes and irreversibly affected virus morphology, including disintegration of envelope and dispersal of surface spikes. Cu(I) and Cu(II) moieties were responsible for the inactivation, which was enhanced by reactive oxygen species generation on alloy surfaces, resulting in even faster inactivation than was seen with nonenveloped viruses on copper. Consequently, copper alloy surfaces could be employed in communal areas and at any mass gatherings to help reduce transmission of respiratory viruses from contaminated surfaces and protect the public health.
Michels, H.T. 2015. Health Environments Research & Design Journal. 1–16.
Bacteria die on copper alloy surfaces in both the laboratory and the hospital rooms. Infection rates were lowered in those hospital rooms containing copper components. Thus, based on the presented information, the placement of copper alloy components, in the built environment, may have the potential to reduce not only hospital-acquired infections but also patient treatment costs.
Koseoglu Eser O, Ergin A, Hascelik G, Current Microbiology, 5 June 2015
The emergence and spread of antibiotic resistance demanded novel approaches for the prevention of nosocomial infections, and metallic copper surfaces have been suggested as an alternative for the control of multidrug-resistant (MDR) bacteria in surfaces in the hospital environment.
This study aimed to evaluate the antimicrobial activity of copper material for invasive MDR nosocomial pathogens isolated over time, in comparison to stainless steel. Clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) (n:4), OXA-23 and OXA-58 positive, MDR Acinetobacter baumannii (n:6) and Pseudomonas aeruginosa (n:4) were evaluated.
The antimicrobial activity of coupons containing 99 % copper and a brass alloy containing 63 % copper was assessed against stainless steel. All the materials demonstrated statistically significant differences within each other for the logarithmic reduction of microorganisms. Among the three materials, the highest reduction of microorganisms was seen in 99 % copper and the least in stainless steel.
The result was statistically significant especially for 0, 2, and 4 h (P = 0.05). 99 % copper showed a bactericidal effect at less than 1 h for MRSA and at 2 h for P. aeruginosa. 63 % copper showed a bactericidal effect at 24 h for P. aeruginosa strains only. Stainless steel surfaces exhibited a bacteriostatic effect after 6 h for P. aeruginosa strains only.
99 % copper reduced the number of bacteria used significantly, produced a bactericidal effect and was more effective than 63 % copper.
The use of metallic copper material could aid in reducing the concentration of bacteria, especially for invasive nosocomial pathogens on hard surfaces in the hospital environment.
C. S. Manuel, M. D. Moore and L.A. Jaykus, Applied and Environmental Microbiology, 15 May 2015
Human norovirus (HuNoV) represents a significant public health burden worldwide and can be environmentally transmitted. Copper surfaces have been shown to inactivate the cultivable surrogate murine norovirus, but no such data exist for HuNoV.
The purpose of this study was to characterize the destruction of GII.4 HuNoV and virus-like particles (VLPs) when exposed to copper alloy surfaces. Fecal suspensions positive for a GII.4 HuNoV outbreak strain or GII.4 virus-like particles (VLPs) were exposed to copper alloys or stainless steel for 0 to 240 min and recovered by elution. HuNoV genome integrity was assessed by RT-qPCR (without RNase treatment), and capsid integrity was assessed by RT-qPCR (with RNase treatment), transmission electron microscopy (TEM), SDS-PAGE/Western blot analysis, and a histo-blood group antigen (HBGA) binding assay.
Exposing fecal suspensions to pure copper for 60 min reduced GII.4 HuNoV RNA copy number by approximately 3 log 10 when analyzed by RT-qPCR without RNase treatment, and 4 log 10 when a prior RNase treatment was used.
The rate of reduction in HuNoV RNA copy number was approximately proportional to the percent copper in each alloy. Exposing GII.4 HuNoV VLPs to pure copper surfaces resulted in noticeable aggregation and destruction within 240 min, an 80% reduction in VP1 major capsid protein band intensity in 15 min, and near complete loss of HBGA receptor binding within 8 min. In all experiments, HuNoV remained stable on stainless steel.
These results suggest that copper surfaces destroy HuNoV, and may be useful in preventing environmental transmission of the virus in at-risk settings.
Meyer, T.J. 2015. International Journal of Biological, Biomolecular, Agricultural, Food and Biotechnological Engineering. Vol:9, No:3.
For centuries humans have used the antimicrobial properties of copper to their advantage. Yet, after all these years the underlying mechanisms of copper mediated cell death in various microbes remain unclear. We had explored the hypothesis that copper mediated increased levels of lipid peroxidation in the membrane fatty acids is responsible for increased killing in Escherichia coli.
In this study we show that in both gram positive (Staphylococcus aureus) and gram negative (Pseudomonas aeruginosa) bacteria there is a strong correlation between copper mediated cell death and increased levels of lipid peroxidation.
Interestingly, the non-spore forming gram positive bacteria as well as gram negative bacteria show similar patterns of cell death, increased levels of lipid peroxidation, as well as genomic DNA degradation, however there is some difference in loss in membrane integrity upon exposure to copper alloy surface.
S. L. Warnes, E. N. Summersgill and C.W. Keevil, Applied and Environmental Microbiology, 1 December 2014
Norovirus is one of the most common causes of acute viral gastroenteritis. The virus is spread via faecal oral route, most commonly from infected food and water, but several outbreaks have originated from contamination of surfaces with infectious virus.
In this study a close surrogate of human norovirus causing gastrointestinal disease in mice, murine norovirus type 1 (MNV-1), retained infectivity for more than 2 weeks following contact with a range of surface materials including Teflon (polytetrafluoroethylene, PTFE), polyvinyl chloride (PVC), ceramic tiles, glass, silicone rubber and stainless steel. Persistence was, slightly prolonged on ceramic surfaces.
A previous study in our laboratory observed that copper and copper alloy dry surfaces rapidly inactivated MNV-1 and destroyed the viral genome. In this new study we have observed that a relatively small change in percentage copper, between 70-80% in copper nickels and 60-70% in brasses, had significant influence on the ability of the alloy to inactivate norovirus. Nickel alone did not affect virus but zinc did have some antiviral effect which had a synergistic effect with copper and resulted in increased efficacy of brasses at lower percentage copper.
Electron microscopy of purified MNV-1 that had been exposed to copper and stainless steel surfaces suggested a massive breakdown of the viral capsid had occurred on copper. In addition, MNV-1 that had been exposed to copper and treated with RNase demonstrated a reduction in viral gene copy number. This suggests capsid integrity is compromised on contact with copper, allowing copper ion access to the viral genome.
Pauline Bleichert, Christophe Espirito Santo, Matthias Hanczaruk, Hermann Meyer, Gregor Grass, BioMetals, International Biometals Society, 7 August 2014
In recent years several studies in laboratory settings and in hospital environments have demonstrated that surfaces of massive metallic copper have intrinsic antibacterial and antiviral properties. Microbes are rapidly inactivated by a quick, sharp shock known as contact killing. The underlying mechanism is not yet fully understood; however, in this process the cytoplasmic membrane is severely damaged. Pathogenic bacterial and viral high-consequence species able to evade the host immune system are among the most serious lethal microbial challenges to human health. Here, we investigated contact-killing mediated by copper surfaces of Gram-negative bacteria (Brucella melitensis, Burkholderia mallei, Burkholderia pseudomallei, Francisella tularensis tularensis and Yersinia pestis) and of Gram-positive endospore-forming Bacillus anthracis. Additionally, we also tested inactivation of monkeypox virus and vaccinia virus on copper. This group of pathogens comprises biothreat species (or their close relatives) classified by the Center for Disease and Control and Prevention (CDC) as microbial select agents posing severe threats to public health and having the potential to be deliberately released. All agents were rapidly inactivated on copper between 30 s and 5 min with the exception of B. anthracis endospores. For vegetative bacterial cells prolonged contact to metallic copper resulted in the destruction of cell structure.
M G Schmidt, C D Salgado, K A Sepkowitz, J F John, H H Attaway, III, R J Cantey, L L Steed, A A Estelle, H T Michels. Presented at the IPS Scottish Branch Conference 29 May 2014.
Poster presented on 29 May 2014 at the IPS Scottish Branch Conference 2014 - 'Get to Grips with SICPs' at Thistle Hotel, Glasgow, Scotland.
Marco Zeiger, Marc Solioz, Hervais Edongu, Eduard Arzt & Andreas S. Schneider. MicrobiologyOpen 2014; 3(3): 327–332.
Copper kills bacteria rapidly by a mechanism that is not yet fully resolved. The antibacterial property of copper has raised interest in its use in hospitals, in place of plastic or stainless steel. On the latter surfaces, bacteria can survive for days or even weeks. Copper surfaces could thus provide a powerful accessory measure to curb nosocomial infections. We here investigated the effect of the copper surface structure on the efficiency of contact killing of Escherichia coli, an aspect which so far has received very little attention. It was shown that electroplated copper surfaces killed bacteria more rapidly than either polished copper or native rolled copper. The release of ionic copper was also more rapid from electroplated copper compared to the other materials. Scanning electron microscopy revealed that the bacteria nudged into the grooves between the copper grains of deposited copper. The findings suggest that, in terms of contact killing, more efficient copper surfaces can be engineered.
H P Loveday, J A Wilson, R J Pratt, M Golsorkhi, A Tingle, A Baka, J Browne, J Prieto, M Wilcox. Journal of Hospital Infection 86S1 (2014) S1–S70
National evidence-based guidelines for preventing healthcare-associated infections (HCAI) in National Health Service (NHS) hospitals in England were originally commissioned by the Department of Health and developed during 1998-2000 by a nurse-led multi-professional team of researchers and specialist clinicians. Following extensive consultation, they were first published in January 2001 and updated in 2007. A cardinal feature of evidence-based guidelines is that they are subject to timely review in order that new research evidence and technological advances can be identified, appraised and, if shown to be effective for the prevention of HCAI, incorporated into amended guidelines.Periodically updating the evidence base and guideline recommendations is essential in order to maintain their validity and authority.
The Department of Health commissioned a review of new evidence and we have updated the evidence base for making infection prevention and control recommendations. A critical assessment of the updated evidence indicated that the epic2 guidelines published in 2007 remain robust, relevant and appropriate, but some guideline recommendations required adjustments to enhance clarity and a number of new recommendations were required. These have been clearly identified in the text. In addition, the synopses of evidence underpinning the guideline recommendations have been updated.
These guidelines (epic3) provide comprehensive recommendations for preventing HCAI in hospital and other acute care settings based on the best currently available evidence. National evidence-based guidelines are broad principles of best practice that need to be integrated into local practice guidelines and audited to reduce variation in practice and maintain patient safety. Clinically effective infection prevention and control practice is an essential feature of patient protection. By incorporating these guidelines into routine daily clinical practice, patient safety can be enhanced and the risk of patients acquiring an infection during episodes of health care in NHS hospitals in England can be minimised.
See Section 2.2, Hospital Environmental Hygiene, under Emerging Technology.
Health Environments and Research Design Journal, Vol 7, Supplement, 2013
This special issue focuses on healthcare-associated infections and is sponsored by the Agency for Healthcare Research and Quality (AHRQ), part of the US Department of Health and Human Services. The majority of articles are the result of a project sponsored by the AHRQ. The project was designed to assess the rigor of claims asserting that design interventions can decrease infection risk, and to identify design strategies grounded in evidence that appear to be effective in interrupting the transmission of HAIs. This project represents a multidisciplinary assessment of the current state of knowledge and identifies emerging trends in the field of infection prevention within the context of the built environment. Copper touch surfaces are mentioned in several articles (p31, p46 and p127).
Warnes SL, Keevil CW (2013)
Noroviruses (family Caliciviridae) are the primary cause of viral gastroenteritis worldwide. The virus is highly infectious and touching contaminated surfaces can contribute to infection spread. Although the virus was identified over 40 years ago the lack of methods to assess infectivity has hampered the study of the human pathogen. Recently the murine virus, MNV-1, has successfully been used as a close surrogate. Copper alloys have previously been shown to be effective antimicrobial surfaces against a range of bacteria and fungi. We now report rapid inactivation of murine norovirus on alloys, containing over 60% copper, at room temperature but no reduction of infectivity on stainless steel dry surfaces in simulated wet fomite and dry touch contamination. The rate of inactivation was initially very rapid and proportional to copper content of alloy tested. Viral inactivation was not as rapid on brass as previously observed for bacteria but copper-nickel alloy was very effective. The use of chelators and quenchers of reactive oxygen species (ROS) determined that Cu(II) and especially Cu(I) ions are still the primary effectors of toxicity but quenching superoxide and hydroxyl radicals did not confer protection. This suggests Fenton generation of ROS is not important for the inactivation mechanism. One of the targets of copper toxicity was the viral genome and a reduced copy number of the gene for a viral encoded protein, VPg (viral-protein-genome-linked), which is essential for infectivity, was observed following contact with copper and brass dry surfaces. The use of antimicrobial surfaces containing copper in high risk closed environments such as cruise ships and care facilities could help to reduce the spread of this highly infectious and costly pathogen.
M Ojeila, C Jermannb, J Holahb, S P Denyera, J-Y Maillard
The aim of this study was to develop a new antimicrobial surface test to replace the JISZ2801 that evaluates the activity of antimicrobial surfaces under parameters reflective of conditions in healthcare settings.
P Efstathiou, M Anagnostakou, E Kouskouni, C Petropoulou, K Karageorgou, Z Manolidou, S Papanikolaou, M Tseroni, E Logothetis, V Karyoti. Antimicrobial Resistance and Infection Control 2013, 2(Suppl1):O68.
Meeting extract - Antimicrobial Resistance and Infection Control, 2nd International Conference on Prevention and Infection Control (ICPIC 2013), Geneva, Switzerland, 25-28 June 2013.
Objectives: The aim of this study was to investigate the effectiveness of the application of antimicrobial copper alloys (Cu+) in a Neonatal Intensive Care Unit (NICU) in relation to the reduction of microbial flora.
Methods: At a Level III Neonatal Intensive Care Unit of a paediatric hospital, with the capacity of 26 incubators, antimicrobial copper (Cu+) was implemented on touch surfaces and objects. The copper alloy contains Cu 63% - Zn 37% (Lead Low). Microbiological cultures were taken in three different time periods, before and after the application of Cu+, using dry and wet method technique.
Results: In the above NICU, the reduction of microbial flora after the implementation of the antimicrobial copper (Cu+) on the selected surfaces and objects was statistically significant (n=15, p<0,05) and was recorded at 90%. The pathogens isolated at high rates (CFU / ml) prior to copper implementation were as follows: Klebsiella spp., Staph. Epidermidis, Staph. Aureus, Enterococcus spp.
Conclusion: This study highlights the positive impact of antimicrobial copper (Cu+) and demonstrates that copper implemented surfaces and objects are effective in neutralising bacteria which are responsible for Healthcare Acquired Infections in the nosocomial environment (HCAIs). The innovative implementation of antimicrobial copper in the NICU and the significant reduction of microbial flora heralds the reduction of antimicrobial drugs use, and a possible reduction of hospital acquired infections and hospitalisation time.
Disclosure of interest: None declared