The bacteria-fighting super element that’s making a comeback in hospitals: copper

The bacteria-fighting super element that’s making a comeback in hospitals: copper

Sep 20, 2015

From the Washington Post

By Lena H. Sun

Ancient Egyptians used copper to sterilize chest wounds and drinking water. Greeks, Romans and Aztecs relied on copper compounds to treat burns, headaches and ear infections. Thousands of years later, the ancient therapeutic is being embraced by some hospitals because of its ability to kill bacteria and other microbes on contact, which can help reduce deadly infections.

At least 15 hospitals across the country have installed, or are considering installing, copper components on “high-touch” surfaces easily contaminated with microbes — faucet handles on sinks, cabinet pulls, toilet levers, call buttons and IV poles.

“We’ve known for a long time that copper and other metals are effective in killing microbes, so it wasn’t a great leap to incorporate copper surfaces into hospitals,” said John Lynch, medical director of infection control at Seattle’s Harborview Medical Center, which is redesigning a waste-disposal room to incorporate copper on light switches and door handles.

For many hospitals, the death of Ebola patient Thomas Eric Duncan last year at a Dallas hospital heightened concerns — two nurses caring for him caught the virus because of poor infection control. And even before that, public health officials had identified nearly two dozen dangerous pathogens — many of them resistant to virtually all antibiotics — whose spread in health facilities and elsewhere could result in potentially catastrophic consequences.

They include MRSA, a potentially deadly infection that is increasing in community settings; VRE, which can cause a variety of infections; and C. diff, which causes life-threatening diarrhea and sends 250,000 people to the hospital every year.

On any given day, about 1 in 25 patients in acute-care hospitals has at least one health-care-associated infection, according to the Centers for Disease Control and Prevention. Pneumonia and surgical-site infections are among the most common. In 2011, about 75,000 patients with health-care-associated infections died in the hospital.

Hospital officials aren’t the only ones interested in copper. Hartsfield-Jackson Atlanta International Airport installed drinking fountains retrofitted with antimicrobial copper surfaces. In Colorado Springs, the U.S. Olympic Committee’s flagship training center uses custom dumbbells with antimicrobial copper grips. So do two professional hockey teams, the Los Angeles Kings and St. Louis Blues. Even a Chick-fil-A in Morganton, N.C., installed antimicrobial copper on restroom door handles.

Copper can kill or inactivate a variety of pathogens by interacting with oxygen and modifying oxygen molecules. In bacteria, this disrupts the outer layer, damaging the genetic material and cell machinery, which can lead to cell death. A recent study found that copper also destroys norovirus.

There has been only one published clinical trial showing how copper reduces infections in hospitals. The results, however, were striking: Researchers said the study, which took place between July 2010 and June 2011, showed that copper surfaces reduced infection rates by 58 percent.

Now, the CDC is pressing for more research. Last week, it held a roundtable on environmental infection control in preventing Ebola and other health-care-associated infections. Officials, who are exploring copper and other technologies, are working with hospitals, academics and the copper industry.

The Defense Department, which funded the first clinical trial on copper and hospital-acquired infections, is researching copper’s effectiveness against one type of bacteria, acinetobacter, which can cause pneumonia or bloodstream infections among critically ill patients, including wounded soldiers returning from the battlefield.

Many experts have concluded that traditional methods for reducing hospital-acquired infections, such as hand washing, aren’t enough, because people don’t always do what they are supposed to do and many pathogens can survive for long periods on surfaces. That’s why hospitals are experimenting with other ways to destroy them, including using ultraviolet light and hydrogen peroxide vapor to target germs in nooks and crannies not easily reached by cleaning crews.

But those measures require actions by human beings — which is not the case with copper.

“It’s always working, it requires no human intervention, no supervision, and it’s acting continuously,” said Michael Schmidt, a microbiology professor at the Medical University of South Carolina and one of the researchers who conducted the first and largest study of copper surfaces in hospitals.

Besides the South Carolina hospital, the study involved Memorial Sloan Kettering Cancer Center in New York and the Veterans Affairs hospital in Charleston, S.C. About 600 patients who were admitted to the intensive-care units at the facilities were randomly assigned to receive care in traditional patient rooms or ones in which six frequently touched objects — such as bed rails, tables, IV poles and nurse call buttons — were made from copper alloys.

While welcoming the findings, researchers said additional studies are needed to answer many questions.

“Is there a minimal risk number out there — how many bacteria on a surface to really put people at risk?” said L. Clifford McDonald, a medical epidemiologist at the CDC.

“Right now, there’s not enough data on copper or other technologies to make firm recommendations on what hospitals should do,” he said. In the meantime, facilities should continue to thoroughly clean patients’ rooms and supplement that with disinfectants. And everyone, especially health-care workers, should wash their hands with soap and water.

At an American Hospital Association conference in July, Todd Linden, chief executive of Grinnell Regional Medical Center in Iowa, gave a 70-minute presentation on copper items installed in 13 of the hospital’s patient rooms. The 49-bed facility also plans to use copper in renovating its emergency room. Grinnell College biology professor Shannon Hinsa-Leasure is conducting a clinical trial on the hospital’s use of copper. The hospital’s fitness center also has copper components, including on its free weights. Olin Brass and its manufacturing partners donated products for the hospital; community donations paid for the fitness center.

Cost is an issue. Adding copper surfaces is about 15 to 20 percent more expensive than using traditional stainless steel. But the long-term benefits are worth it, Linden and Schmidt say.

A typical U.S. hospital room contains about $100,000 of goods and equipment, experts say. The average cost to outfit a hospital room with antimicrobial copper items is about $5,000, Linden said. But one infection adds $43,000 in patient costs, according to federal data. And under the Affordable Care Act, hospitals with higher infection rates and other patient injuries face decreases in their Medicare reimbursements.

The copper industry, meanwhile, provided financial help to several facilities interested in experimenting with copper surfaces.

The Copper Development Association gave $50,000 in grants to four hospitals in 2013 and 2014, said Adam Estelle, a project engineer with the trade group.The association began promoting copper’s antimicrobial properties in 2008, when several groups of copper products met standards of the Environmental Protection Agency to be registered as antimicrobial and effective in killing six types of bacteria, including MRSA, VRE and the deadly E. coli 0157 strain, the culprit in numerous food recalls, illnesses and deaths.

Pullman Regional Hospital in Washington state received a $10,000 grant from the copper industry group two years ago. The 26-bed hospital bought more than 1,200 cabinet drawer pulls and 22 handicapped-access buttons on doors.

Ed Harrich, chief of surgical services, and his staff have been methodically installing the hardware. He persuaded hospital administrators to approve another $10,000 for more items.

“If you looked at my cabinet pulls, they look like stainless steel, but we still get copper’s killing properties,” he said. “We’re still continuing to clean everything we can. But this is our little helper behind the scenes.”

Lena H. Sun is a national reporter for The Washington Post, focusing on health.