Scientific References

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 Marleine Williams, Project Co-ordinator, Copper Development Association.

Browse the entire list or use the category filters below.

 

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Antimicrobial Characteristics of Copper
H T Michels, ASTM Standardization News, October 2006.

Article provides an overview on the antimicrobial characteristic of copper. Describes the research performed to date and the potential applications of antimicrobial copper products. Includes a letter from the editor which highlights the article.

Potential use of copper surfaces to reduce survival of epidemic methicillin-resistant Staphylococcus aureus in the healthcare environment
J O Noyce, H Michels and C W Keevil, Journal of Hospital Infection, Vol 63, Issue 3, pp 289-297, July 2006

Demonstrates copper's ability to kill epidemic Methicillin-resistant Staphylococcus aureus under different conditions in comparison to stainless steel. Illustrates effects of bacteria concentration, temperature and copper content on antimicrobial efficacy.

Use of Copper Cast Alloys to Control Escherichia coli O157 Cross Contamination during Food Processing
J O Noyce, H Michels, and C W Keevil, Applied and Environmental Microbiology, pp 4239-4244, June 2006.

Investigates ability of copper to kill Escherichia coli O157:H7 which is responsible for diseases caused by food contamination. Incorporates beef juice with bacteria to simulate food cross contamination scenario. High copper containing alloys greatly reduced the amount of E. coli O157:H7 at room (22C) and low temperatures (4C). Stainless steel, the control, had no effect.

The survival of Escherichia coli O157 on a range of metal surfaces
S A Wilks, H Michels and C W Keevil, International Journal of Food Microbiology, 105 (2005), pp 445-454.

Compares the survivability of an infectious strain of Escherichia coli on copper alloys and stainless steel. Copper alloys exhibited a large reduction within several hours while stainless steel did not.  Addresses the advantages of alloying and suggests using antimicrobial surfaces in environments where bacterial contamination is a concern.

Copper Alloys for Human Infectious Disease Control
H T Michels, J P Noyce, S A Wilks and C W Keevil. Copper for the 21st Century, Materials Science & Technology 2005 (MS&T’05) Conference, Pittsburgh, PA, September 25-28, 2005, ASM, ACerS, AIST, AWS, TMS, ISSN: 1546-2498

Illustrates the ability of copper alloys to kill several food borne pathogens known to cause infection. Also demonstrates efficacy against Methicillin-resistant Staphylococcus aureus which is largely responsible for hospital acquired infections. Stainless steel, the control, had no effect on any of the pathogens. Results suggest copper alloys may reduce the levels of infectious pathogens on surfaces in contact with food and touched by humans.

Inactivation of Escherichia coli and coliform bacteria in traditional brass and earthenware water storage vessels
P Tandon, S Chhibber and R Reed, Antonie van Leeuwenhoek (2005) 88:35-4, 14pp

The detection and enumeration of indicator bacteria such as Escherichia coli is used to assess the extent of faecal contamination of drinking water. On the basis of this approach, the effectiveness of storing water contaminated with faecal indicator bacteria in brass or earthen vessels (mutkas) of the type used in rural India have been investigated.

Suspensions of bacteria in sterile distilled water were maintained for up to 48 h in each vessel and enumerated by surface plate counts on nutrient agar (non-selective) and several selective coliform media at 37 °C either under standard aerobic conditions, or under conditions designed to neutralise reactive oxygen species (ROS), e.g. using an anaerobic cabinet to prepare plates of pre-reduced growth medium or by inclusion of sodium pyruvate in the growth medium, with incubation of aerobically-prepared plates in an anaerobic jar.

The counts obtained for E. coli decreased on short-term storage in a brass mutka; counts for selective media were lower than for equivalent counts for non-selective medium, with ROS-neutralised conditions giving consistently higher counts than aerobic incubation. However, after 48 h, no bacteria were cultivable under any conditions. Similar results were obtained using water from environmental sources in the Panjab, and from rural households where brass and earthern mutkas are used for storage of drinking water, with enumeration on selective coliform media (presumptive total coliforms). In all cases results indicated that, while storage of water in a brass mutka can inactivate E. coli and coliforms over a 48 h period, standard aerobic plate counting using selective media may not be fully effective in enumerating sub-lethally damaged bacteria.

The Effects of Copper Alloy Surfaces on the Viability of Bacterium, E. coli 0157:H7
H T Michels, S A Wilks and C W Keevil. The Second Global Congress Dedicated to Hygienic Coatings & Surfaces, Orlando, Florida, USA, 26-28 January, 2004, Paper 16, Published by Paint Research Association, Middlesex, UK, ISBN 0-9543164-5-2, 2004.

Tests the viability of E. coli O157:H7 on a variety of copper alloy surfaces. All tested copper alloys rendered the bacteria non viable after several hours. E. coli O157:H7 has been responsible for a number of food recalls and can survive on stainless steel for days. Results suggest copper alloys will be useful beyond food processing applications.

The Antimicrobial effects of copper alloy surfaces on the bacterium, E. coli 0157:H7
H T Michels, S A Wilks and C W Keevil, Proceedings of Copper 2003 - Cobre 2003, The 5th International Conference, November 30-December 2, 2003, Santiago, Chile, Vol. 1 - Plenary Lectures, Economics and Applications of Copper, pp. 439-450

Investigates the viability of E. coli O157:H7 on 25 copper alloy surfaces at 20C and 4C (refrigeration temperature).  Bacteria reduction occurred with all alloys and was faster at the higher temperature and on alloys containing higher levels of copper.  Further research is recommended to determine copper's effect on moulds and other organisms that cause respiratory infections.

A Publication of The Canadian Institute of Mining, Metallurgy and Petroleum, Montreal, Quebec, Canada, 2003.

Doorknobs: a source of nosocomial infection?
P J Kuhn, Diagnostic Medicine, 1983.

Discusses the unique bactericidal properties of copper and brass compared to stainless steel and aluminum against various organisms.  Results suggest that hospitals should utilise brass (copper alloy) hardware to minimise bacterial growth on these surfaces.

Enhancing Patient Safety through Strategic Placement of Copper Surfaces
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.

 

Surface Structure Influences Contact Killing of Bacteria by Copper
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.

epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England
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.

Understanding the Role of Facility Design in the Acquisition and Prevention of Healthcare-associated Infections
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).

Inactivation of Norovirus on Dry Copper Alloy Surfaces
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.

Evaluation of new In Vitro efficacy test for antimicrobial surface activity reflecting UK hospital conditions
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.

Financial Benefits after the Implementation of Antimicrobial Copper in Intensive Care Units (ICUs)
P Efstathiou, E Kouskouni, S Papanikolaou, K Karageorgou, Z Manolidou, M Tseroni, E Logothetis, C Petropoulou, V Karyoti. Antimicrobial Resistance and Infection Control 2013, 2(Suppl 1):P369

Meeting extract - Antimicrobial Resistance and Infection Control, 2nd International Conference on Prevention and Infection Control (ICPIC 2013), Geneva, Switzerland, 25-28 June 2013.

Objectives: Aim of this study was to evaluate the reduction on Intensive Care Unit (ICU) microbial flora after the antimicrobial copper alloy (Cu+) implementation as well as the effect on financial - epidemiological operation parameters.

Methods: Medical, epidemiological and financial data into two time periods, before and after the implmentation of copper (Cu 63% - Zn 37%, Low Lead) were recorded and analysed in a General ICU.  The evaluated parameters were: the importance of patients' admission (Acute Physiology and Chronic Health Evaluation - APACHE II and Simplied Acute Physiology Score - SAPS), microbial flora's record in the ICU before and after the implementation of Cu+, as well as the impact on epidemiological and ICU's operation financial parameters.

Results: During December 2010 and March 2011, and respectively during December 2011 and March 2012, comparative results showed statistically significant reduction on the microbial flora (CFU / ml) by 95% and the use of antimicrobial medicine (per day per patient) by 30% (p=0,014), as well as patients' hospitalisation time and cost.

Conclusion: The innovative implementation of antimicrobial copper in ICUs contributed to their microbial flora significant reduction and antimicrobial drugs use reduction with the apparent positive effect (decrease) in both patients' hospitalisation time and cost.  Under the present circumstances of economic crisis, survey results are of highest importance and value.

Disclosure of interest: None declared.

(Poster 369)

The Economic Assessment of an Environmental Intervention: Discrete Deployment of Copper for Infection Control in ICUs
M Taylor, S Chaplin, York Health Economics Consortium, York, UK, Antimicrobial Resistance and Infection Control 2013, 2(Suppl1):P368

Meeting extract - Antimicrobial Resistance and Infection Control, 2nd International Conference on Prevention and Infection Control (ICPIC 2013), Geneva, Switzerland, 25-28 June 2013.

Introduction: Health Economics evaluations are typically applied to medications or surgery costs, but this unique study has investigated the economic benefits of discrete deployment of antimicrobial copper alloy touch surfaces in ICUs.

Copper/copper alloy surfaces have been shown to act as an adjunct to standard infection control practices in diverse clinical settings, continuously reducing contamination by over 90%.  Moreover, work reported by Dr Michael Schmidt at the first ICPIC revealed the link between reduced bioburden and significant reductions in the risk of acquiring an HCAI.

This study investigates the cost-effectiveness of this intervention, comparing expenditure with the improvements in patient outcomes and other tangible benefits.

Methods: Following an extensive literature review and use of expert opinion a number of factors have been considered in this evaluation, including component cost and longevity balanced with cost of care.  Despite a lack of robust comparable data on the cost of HCAIs available in the public domain, good references were identified and used to  calculate cost of care.  Commercial data is available for the cost of the intervention and has been used to predict a return on investment (ROI) for installing a set of copper components as part of a new build or planned refurbishment.  Consideration is also given to who in a hospital might specify such an intervention, where the budget resides and where cost savings could be realised.  A model has been created to show the economic impact of an environmental intervention.

Results: The model predicts the cost of replacing key, frequently-touched surfaces in a 20-bed UK ICU with copper equivalents will be recouped in less than two months.  Thereafter, ongoing cost savings will accrue from the reduction in blocked beds and better-directed staff resources.

Conclusion: The investigation allowed the derivation of a spreadsheet-based model that uses the best current published information and shows the rapid ROI of a copper intervention.  It also calculates the impact on bed days and quality-adjusted life years (QALY).  The model is simple, transparent to those with knowledge of spreadsheets, and allows adaptation to specific local settings.

Disclosure of interest: None declared.

(Poster 368)

Implementation of Antimicrobial Copper in Neonatal Intensive Care Unit
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

(Poster 68)

Copper Surfaces Reduce the Rate of Healthcare-Acquired Infections in the Intensive Care Unit
Cassandra D Salgado, MD; Kent A Sepkowitz, MD; Joseph F John, MD; J Robert Cantey, MD; Hubert H Attaway, MS; Katherine D Freeman, DrPH; Peter A Sharpe, MBA; Harold T Michels, PhD; Michael G Schmidt, PhD. Infection Control and Hospital Epidemiology

Objective: Healthcare-acquired infections (HAIs) cause substantial patient morbidity and mortality. Items in the environment harbour microorganisms that may contribute to HAIs. Reduction in surface bioburden may be an effective strategy to reduce HAIs. The inherent biocidal properties of copper surfaces offer a theoretical advantage to conventional cleaning, as the effect is continuous rather than episodic.  We sought to determine whether placement of copper alloy-surfaced objects in an intensive care unit (ICU) reduced the risk of HAI.

Design: Intention-to-treat randomised control trial between 12 July 2010 and 14 June 2011.

Setting: The ICUs of 3 hospitals.

Patients: Patients presenting for admission to the ICU.

Methods: Patients were randomly placed in available rooms with or without copper alloy surfaces, and the rates of incident HAI and/or colonisation with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) in each type of room were compared.

Results: The rate of HAI and/or MRSA or VRE colonization in ICU rooms with copper alloy surfaces was significantly lower than that in standard ICU rooms (0.071 vs 0.123). For HAI only, Pp.020 the rate was reduced from 0.081 to 0.034 (Pp.013).

Conclusions: Patients cared for in ICU rooms with copper alloy surfaces had a significantly lower rate of incident HAI and/or colonisation with MRSA or VRE than did patients treated in standard rooms.  Additional studies are needed to determine the clinical effect of copper alloy surfaces in additional patient populations and settings.

Infection Control and Hospital Epidemiology , Vol. 34, No. 5, Special Topic Issue: The Role of the Environment in Infection Prevention (May 2013), pp. 479-486.

Copper Continuously Limits the Concentration of Bacteria Resident on Bed Rails within the Intensive Care Unit
Michael G Schmidt, PhD; Hubert H Attaway III, MS; Sarah E Fairey, BS; Lisa L Steed, PhD; Harold T Michels, PhD; Cassandra D Salgado, MD, MS Infection Control and Hospital Epidemiology, Vol. 34, No. 5.

Cleaning is an effective way to lower the bacterial burden (BB) on surfaces and minimize the infection risk to patients. However, BB can quickly return.  Copper, when used to surface hospital bed rails, was found to consistently limit surface BB before and after cleaning through its continuous antimicrobial activity.

Special Topic Issue: The Role of the Environment in Infection Prevention (May 2013), pp. 530-533.

Contact Killing of Bacteria on Copper is Suppressed if Bacterial-Metal Contact is Prevented and Induced on Iron by Copper Ions
Salima Mathews, Michael Hans, Frank Mücklich, Marc Solioz, Applied and Environmental Microbiology, April 2013, Vol 79, No 8. Copyright © American Society for Microbiology. doi:10.1128/AEM.03608-12.

Bacteria are rapidly killed on copper surfaces, and copper ions released from the surface have been proposed to play a major role in the killing process.  However, it has remained unclear whether contact of the bacteria with the copper surface is also an important factor.  Using laser interference lithography, we engineered copper surfaces which were covered with a grid of an inert polymer which prevented contact of the bacteria with the surface.  Using Enterococcus hirae as a model organism, we showed that the release of ionic copper from these modified surfaces was not significantly reduced.  In contrast, killing of bacteria was strongly attenuated.  When E.hirae cells were exposed to a solid iron surface, the loss of cell viability was the same as on glass.  However, exposing cells to iron in the presence of 4mM CuSO4 led to complete killing in 100 min.  These experiments suggest that contact killing proceeds by a mechanism whereby the metal-bacterial contact damages the cell envelope, which, in turn, makes the cells susceptible to further damage by copper ions.

Antimicrobial activity of copper surfaces against carbapenemase-producing contemporary Gram-negative clinical isolates
Souli M, Galani I, Plachouras D, Panagea T, Armaganidis A, Petrikkos G, Giamarellou H.

The antimicrobial activity of copper surfaces against a variety of contemporary carbapenemase-producing Gram-negative bacteria representative of the most problematic nosocomial pathogens worldwide was evaluated.

It was concluded that copper has significant antimicrobial activity against multidrug-resistant nosocomial Gram-negative pathogens. This supports the hypothesis that replacement of high-contact materials with copper could reduce the high burden of environmental contamination around high-risk patients. However, this strategy should be seen as an adjunctive measure to established cleaning protocols and to good hygiene practices for prevention of hospital-acquired infections.

4th Department of Internal Medicine, Athens University School of Medicine, University General Hospital 'Attikon', 1 Rimini Str. 124 62, Chaidari, Athens, Greece. J Antimicrob Chemother. 2012 Dec 9. [Epub ahead of print].

Horizontal Transfer of Antibiotic Resistance Genes on Abiotic Touch Surfaces: Implications for Public Health
Sarah L. Warnes, Callum J Highmore, and C William Keevil, Centre for Biological Sciences, University of Southampton, Highfield Campus, Southampton, UK. doi: 10.1128/​mBio.00489-12 27 November 2012 mBio vol. 3 no. 6 e00489-12

Horizontal gene transfer (HGT) is largely responsible for increasing the incidence of antibiotic-resistant infections worldwide. While studies have focused on HGT in vivo, this work investigates whether the ability of pathogens to persist in the environment, particularly on touch surfaces, may also play an important role.

Antimicrobial Effect of Copper on Multidrug-resistant Bacteria
G. Steindl, S. Heuberger and B. Springer. Wiener Tierärztliche Monatsschrift – Veterinary Medicine Austria 99 (2012).

Copper has been used for centuries as a therapeutic agent in various cultures around the globe. With the emergence and spread of antibiotic resistance, the use of metallic copper alloys to control pathogenic microorganisms is attracting increasing attention. We investigated the antimicrobial effect of copper on three multidrug-resistant bacterial strains: methicillin-resistant  Staphylococcus aureus sequence type 398, CTX-M-15 producing  Escherichia coli and NDM-1 producing Klebsiella pneumoniae.

Copper coupons were inoculated with bacterial cell suspensions and incubated at room temperature. At set time points, bacteria were resuspended and plated onto nutrient agar and colony-forming units were counted. Results show a more than fivefold log-reduction of viable bacteria for CTX-M-15 producing  E. coli and NDM-1 producing  K. pneumoniae after 60 min of incubation on metallic copper compared to stainless steel. The same reduction of viable bacteria could be demonstrated for methicillin-resistant S. aureus sequence type 398 after 120 min of incubation.

Our data complement scientific evidence for copper´s antimicrobial properties on multidrug-resistant bacteria and suggest that the use of copper surfaces constitutes an approach to support the control of these organisms.

Application of copper to prevent and control infection. Where are we now?
O’Gorman J, Humphreys H, Journal of Hospital Infection (2012), http://dx.doi.org/10.1016/j.jhin.2012.05.009.

Background: The antimicrobial effect of copper has long been recognized and has a potential application in the healthcare setting as a mechanism to reduce environmental contamination and thus prevent healthcare-associated infection (HCAI).

Aim: To review the rationale for copper use, the mechanism of its antimicrobial effect, and the evidence for its efficacy.

Methods: A PubMed search of the published literature was performed.

Findings: Extensive laboratory investigations have been carried out to investigate the biocidal activity of copper incorporated into contact surfaces and when impregnated into textiles and liquids. A limited number of clinical trials have been performed, which, although promising, leave significant questions unanswered. In particular there is a lack of consensus on minimum percentage copper alloys required for effectiveness, the impact of organic soiling on the biocidal effect of copper, and the best approach to routine cleaning of such surfaces. Limited information is available on the ability of copper surfaces to eradicate spores of Clostridium difficile.

Conclusion: Additional studies to demonstrate that installing copper surfaces reduces the incidence of HCAI are required and the cost-effectiveness of such intervention needs to be assessed. Further research in a number of key areas is required before the potential benefits of using copper routinely in the clinical setting to prevent and control infection can be confirmed and recommended.

Copper and copper alloys are engineering materials that are durable, colourful and recyclable and are widely available in various product forms suitable for a range of manufacturing purposes. Copper and its alloys offer a suite of materials for designers of functional, sustainable and cost-effective products.

Copper and certain copper alloys have intrinsic antimicrobial properties (so-called ‘Antimicrobial Copper’) and products made from these materials have an additional, secondary benefit of contributing to hygienic design. Products made from Antimicrobial Copper are a supplement to, not a substitute for standard infection control practices. It is essential that current hygiene practices are continued, including those related to the cleaning and disinfection of environmental surfaces.

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