A New Tool to Fight Hospital-Acquired Infections:Antimicrobial Copper Touch Surfaces

Archelle Georgiou, MD

Georgiou Consulting, LLC

Harold T. Michels, PhD., P.E.

Senior Vice President, Technology and Technical Services

Copper Development Association

Michael G. Schmidt, PhD.

Director, Office of Special Programs and Professor and Vice Chair Department of Microbiology and

Immunology, Medical University of South Carolina

September 20, 2013

Benefits of Antimicrobial Copper Touch Surfaces

and The Patient Safety Challenge

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MD, Johns Hopkins

University School of

Medicine

Former clinician and

Managed Care executive,

UnitedHealth Group

Medical Expert for various

media outlets

Archelle Georgiou, MDGeorgiou Consulting, LLC.

3

Harold Michels, PhDCopper Development Association, Inc.

Senior Vice President

PhD. Materials Science

Professional Engineer, licensed in

NY and CA

Over 40 years experience in non-

ferrous metals in research and

marketing

Authored and co-author of numerous

peer-reviewed articles on metallurgy

and the antimicrobial properties of

copper

4

Director, Office of Special

Programs

Professor and Vice Chair, Dept.

of Microbiology and Immunology

Numerous research interests,

most notably, the control of

hospital-acquired infections

Principal Investigator of DoD

copper clinical trials

Michael Schmidt, PhD Medical University of South Carolina

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Average adult touches up to 30 objects per minute

80% of infectious diseases are transferred by touch*

*Tierno, 2001

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Infectious microorganisms can survive in scratches on

disinfected surfaces such as stainless steel

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Hospital Acquired Infections

2,000,000: Annual number of infection

100,000: Annual number of deaths

Annual Cost to US Healthcare System

$45,000,000,000

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1. The Deficit Reduction Act of 2005

• Limits reimbursement for certain hospital acquired infections

2. Section 3025 of the Affordable Care Act

• Financial penalties to hospitals with above average readmission

rates

3. Section 1886 of the Affordable Care Ac

• Value-based purchasing: financial (dis)incentives to hospitals based

on quality metrics, including UTI and vascular catheter infections

10

Agenda

What is Antimicrobial Copper?

Available Products

Antimicrobial Performance

Laboratory testing

Environmental and Clinical Testing

Patient Safety Challenge Details

Q&A

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Copper Development Association

Not-for-profit trade association representing the U.S. copper industry

Defends and grows existing markets and explores new applications for copper and

copper based metals (alloys)

www.copper.org

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Copper is man’s oldest metal and a very versatile material

Color: copper, metallic

Properties:

Ductile

Malleable

High thermal conductivity

High electrical conductivity

Easily alloyed

Good corrosion resistance

Readily available

Highly recyclable

Antifouling

Antimicrobial

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Man has used copper’s antimicrobial properties safely for

centuries

Long before the germ theory of disease was developed,

civilizations used copper to kill disease-causing organisms.

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What is Antimicrobial Copper? A family of EPA-Registered

copper alloys that intrinsically kill bacteria

Solid, copper-based metal

alloys (e.g. brass, bronze)

Bent, formed,

welded, cast,

stamped, etc.

Durable environmental

surfaces

Not a coating or surface treatment!

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Sinks

Manufacturers: Just Manufacturing, Elkay Commercial Products

Handwash stations, scrub sinks,

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IV Poles

Manufacturers: Pedigo, Midbrook Medical

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Patient Transport

Manufacturer: Pedigo

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Railings and Grab Bars

Manufacturers: Wagner Companies, Rocky Mountain Hardware, CuSalus by Colonial Bronze

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Building Products

Manufacturers: Arrowhart, CuSalus by Colonial Bronze, Rocky Mountain Hardware

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Work Surfaces

Manufacturers: Midbrook Medical, CuSalus by Colonial Bronze,

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Work Surfaces

Manufacturers: Midbrook Medical

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Building Hardware

Manufacturers: Rocky Mountain Hardware, CuSalus by Colonial Bronze, Trimco, Ingersoll Rand

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Cabinet Hardware

Manufacturers: CuSalus by

Colonial Bronze, Rocky Mountain

Hardware

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Cabinet Hardware


Colonial Bronze, Rocky Mountain

Hardware

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Equipment/Cart Handles


Colonial Bronze

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Keyboards

Manufacturers: Operator Interface Technology

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More Products Being Added, Check Back Frequently

AntimicrobialCopper.com

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Antimicrobial Copper Kills Methicillin-Resistant

Staphylococcus aureus (MRSA)

1.E+00

1.E+02

1.E+04

1.E+06

1.E+08

0 60 120 180 240 300 360

Bacte

ria C

ou

nt

(per

ml.)

Time (minutes)

Copper Stainless Steel

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Copper surfaces continuously kill MRSA and other

bacteria, even after repeated contaminations

8 inoculations over 24 hrs, no cleaning in between

Stainless

Steel

Antimicrobial

Copper

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0

3,000,000

6,000,000

9,000,000

12,000,000

15,000,000

18,000,000

21,000,000

24,000,000

27,000,000

0 3 6 9 12 15 18 21 24

CF

U /

co

up

on

Time (hours)

Stainless

Steel

Antimicrobial

Copper

Antimicrobial Copper’s Efficacy vs MRSA

Copper surfaces continuously kill MRSA and other

bacteria, even after repeated contaminations

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Staphylococcus aureus

Enterobacter aerogenes

Escherichia coli O157:H7

Pseudomonas aeruginosa

Methicillin-Resistant Staphylococcus aureus

(MRSA)

Vancomycin-Resistant Enterococcus faecalis

(VRE)

Antimicrobial Copper has been approved by the EPA to

make public health claims against 6 infectious bacteria

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Clostridium difficile

Listeria monocytogenes

Norovirus

Acinetobacter baumanii

Fusarium solani

Rotavirus

Rhinovirus

Mycobacterium tuberculosis

Candida albicans

Aspergillus spp.

Fusarium spp.

CRE

Influenza A (including H1N1)

MRSA

Aspergillus fumigatus

Klebsiella pneumoniae

Legionella pneumonphila

Salmonella enteric

Salmonella Typhi

Vibrio cholerae

Campylobacter jejuni

Penicillian chrysogenum

Copper surfaces kill many other organisms

And more…

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Clostridium difficile

Listeria monocytogenes

Norovirus

Acinetobacter baumanii

Fusarium solani

Rotavirus

Rhinovirus

Mycobacterium tuberculosis

Candida albicans

Aspergillus spp.

Fusarium spp.

CRE

Influenza A (including H1N1)

MRSA

Aspergillus fumigatus

Klebsiella pneumoniae

Legionella pneumonphila

Salmonella enteric

Salmonella Typhi

Vibrio cholerae

Campylobacter jejuni

Penicillian chrysogenum

Copper surfaces kill many other organisms

And more…

Public health claims are only approved for the

six bacteria on the previous slide.

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Smaller amounts of bacteria are killed much

faster on Antimicrobial Copper surfaces

Typical levels

found on hands

and everyday

objects

MRSA on Copper

Michels et al, Int. J. Metalcast, 2008

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How does copper kill bacteria? Several theories have

been confirmed, others are being investigated

*Dr. Grass, Dr. Keevil, Dr. Rensing & Dr. Solioz

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A: Copper ions on the surface are recognized

as an essential nutrient, and enter the cell


In General:

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B: A lethal dose of copper ions interferes with

normal cell functions and membrane integrity


In General:

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B: A lethal dose of copper ions interferes with

normal cell functions and membrane integrity

C: Copper ions impede cell respiration/metabolism,

sometimes causing DNA damage


In General:

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Federal control of pesticide

distribution, sale, and use

Assures that pesticides will be

properly labeled

Pesticides will not cause

unreasonable harm to humans

or the environment and are

efficacious if public health

claims are made

EPA Regulates antimicrobials through the Federal

Insecticide, Fungicide, and Rodenticide Act (FIFRA)

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Official EPA Statement

“[Antimicrobial Copper has] been rigorously tested and [has]

demonstrated antimicrobial activity. After consulting with independent

organizations – the Association for Professionals in Infection Control

and Epidemiology (APIC) and the American Society for Healthcare

Environmental Services (ASHES) – as well as a leading expert in the

field (Dr. William A. Rutala, Ph.D., M.P.H.) the Agency has concluded

that the use of these products could provide a benefit as a

supplement to existing infection control measures. ”

- U.S. Environmental Protection Agency*

*http://www.epa.gov/pesticides/factsheets/copper-alloy-products.htm

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Use of Antimicrobial Copper is not a substitute

for good hygienic practices

Antimicrobial Copper needs to be seen as a supplement

Periodic surface cleaning must continue

Antimicrobial Copper alloy surfaces must not be waxed, painted,

lacquered, varnished, or otherwise coated. The alloys tarnish to

varying degrees, which does not impair their antimicrobial efficacy.

DISCLOSURES• The work described here was supported by the US

Army Medical Research and Materiel Command

under Contract No. W81XWH-07-C-0053.

• The views, opinions and/or findings presented

here are those of the author(s) and should not be

construed as an official US Department of the

Army position

If one full wide bodied jet was lost each

day would anyone fly?

they’re more friends than our enemies… until we consider

MICROBES, THEY’RE EVERYWHERE

Equivalent of between 500 to 1000

different types of lions, tigers and

bears!

we each lose about 2 million skin cells

an hour and as we just saw are

covered with bacteria…. So like

Charlie Brown’s friend… well he’s us!

CDC/James Gathany, 2009; 11161

We also help them move too…

even, within hospitals…

CDC/James Gathany, 2009; 11161

17,336

3,579

9,244

4,501

688

When we look, the risk is apparent!

250/100cm2 < Benign

THE CIRCLE OF HAI

Our opportunity as Reality

DOES IT IMPROVE CLEANLINESS?

16 rooms sampled weekly for a period of 21 months, n=1012

6,474

366

Risk was Significantly Lower with Copper

SAMPLING CONDUCTED WHILE ROUTINE CLINICAL CARE WAS UNDERWAYData illustrate the ubiquity and continuous risk that burden presents to the patient and how introducing copper

surfaces resulted in a continuous amelioration of burden and potentially risk

ROUTINE CLINICAL CARE IS HETEROGENEOUS

RESULTING IN A HETEROGENEITY OF RISK

• Touch surfaces in regularly cleaned ICU rooms may serve as significant microbiological reservoirs that could transfer microbes to patients, health care workers and visitors

• Copper reduced and maintained the microbial burden on common touch surfaces in the ICU at levels recommended immediately after terminal cleaning on a continuous basis

STUDY QUESTION

• Will the limited placement of copper surfaces within the ICU patient care environment reduce the rates of HAIs/HACs?

INITIAL RISK ASSESSMENT

BUT WAS IT REALLY THE BURDEN?

SUMMARY FINDINGS

Dose and object were important

– Considering Copper Arm vs.. Non Copper Arm

• Relative Risk Reduction of -58.1

• N=614, p=0.0132*– 11.00 Infections/1000 patient days in rooms without Copper

Objects

– 5.0 Infections/1000 patient days in rooms with Copper

• Average patient was exposed to 75% of the maximum dose in the

copper arm and saw 2.8% of the copper dose in the non-copper arm of

the study

• Severity of patient illness was significant

• Beds with copper rails were found to be significant

• Infection at the time of admission was significant

CONCLUSIONS

Risk mitigation of the environmental burden resulted in

a concomitant mitigation of the rates of HAI and HAC

rates for patients treated in rooms with antimicrobial

copper touch surfaces.

Use of Antimicrobial Copper Surfaces represents the

first instance where a “no-touch”, but continuously

active antimicrobial material was able to significantly

reduce the rate at which infections were contracted by

hospitalized patients.

Incorporation of copper into essential items within the

built environment of hospitals offers a unique solution

to control and limit HAIs in an efficient and cost

effective manner.

Infections were cut in half!

$45 Billion/2= savings

Lives saved

Infections prevented

Quality of life

Better outcomes

ACKNOWLEDGEMENTSThis work described here was supported by the US Army Medical

Research and Materiel Command under Contract No. W81XWH-07-C-0053

The views, opinions and/or findings presented here are those of the

author(s) and should not be construed as an official US Department of the

Army position

Authors are grateful for the technical assistance provided by Mr. Chuck

Stark, Mr. Dennis Simon and Ms. Katherine Zolman of Advanced

Technologies Inc., of Charleston, South Carolina

MICHAEL G. SCHMIDT, PETER A. SHARPE, CASSANDRA D. SALGADO,

JOSEPH JOHN JR. , KENT A. SEPKOWITZ, H.H. ATTAWAY, ANDREW MORGAN,

KATHERINE D. FREEMAN, J. ROBERT CANTEY, LISA L. STEED, AND H.T.

MICHELS

WHAT’S NEXT?

Additional studies

evaluating the critical

and optimal placement of

antimicrobial copper

touch surfaces within the

built environment are

warranted.

-CONCLUSION-

Copper continuously complements

cleaning controlling the bacterial

burden within the built

environment resulting in improved

patient outcomes

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Thank you!

Harold Michels, PhD, PE

[email protected]

(212) 251-7224

Michael G. Schmidt, PhD.

[email protected]

Archelle Georgiou, MD

[email protected]

A New Tool to Fight Hospital-Acquired Infections:Antimicrobial Copper Touch Surfaces

Healthcare

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