News - January 2018
Ancient metal proves its worth in bug battle
Approximately four million people across the EU acquire a healthcare-associated infection (HCAI) every year, of which approximately 37,000 of those die as a result.
Over the past decade, this worrying statistic has thrown the spotlight on infection prevention and control measures within healthcare settings.
While hand hygiene and top-notch cleaning regimes are central to this ongoing battle; the physical environment also has a part to play.
Antimicrobial surface materials and products are becoming increasingly commonplace in our hospitals, health centres and care homes.
But one particular material is proving to be a frontrunner, with an already impressive, and still-growing, evidence base supporting its use across the sector.
Copper and copper alloys are engineering materials that are durable, colourful, recyclable and widely available in various forms suitable for a range of manufacturing purposes.
They offer a suite of options for product designers and are known and proven to have intrinsic antimicrobial properties.
With broad-spectrum and rapid efficacy, antimicrobial copper - as the materials are collectively known - have been shown time and time again to kill pathogenic microbes in the laboratory and the clinical environment, significantly and continuously reducing bacteria.
What makes copper products particularly popular is that their bug-busting effect is continuous and has been proven to be far more effective under typical indoor conditions than products containing additives such as silver.
Copper also remains effective even after repeated wet and dry abrasion and recontamination and these properties last the lifetime of the product. There is a lack of evidence of long-term efficacy of other materials under real-life conditions.
These benefits, and low maintenance needs, are making copper products much more widely specified within contemporary hospital architecture and design.
Speaking to hdm, Angela Vessey, director of Copper Development Association, explains: “There is a solid and growing evidence base that really confirms that copper and copper alloy touch surfaces are a useful extra measure to boost infection control.
“They are effective against bacteria - even antibiotic-resistant strains like MRSA and VRE - fungi, and none has been to survive on a copper or copper alloy surface.”
One of the leading copper research centres in the work is the University of Southampton and it boldly broadcast a live laboratory trial conducted by Professor Bill Keevil in which antimicrobial copper was shown to eradicate 10,000,000 MRSA bacteria in just eight minutes.
An academic paper based on this research and published in the Journal of Applied and Environmental Microbiology concluded: “This study is the first to show very-rapid killing of fingertip contamination of MRSA and MSSA on copper alloys, and the authors propose that incorporation of copper alloy surfaces may help to reduce the transmission of MRSA and MSSA from contaminated surfaces.”
The path of destruction
Clinical studies in the UK and the US were the first to confirm the laboratory efficacy, reporting >80% reduction of bacteria on copper surfaces.
In a US ICU trial in 3 hospitals, an associated 58% reduction in infections was reported. This evidence base continues to expand, with further studies conducted in different healthcare systems, clinical areas, touch surface components, and local strains of bacteria, each helping to further prove the efficacy of copper for long-term, wide-spectrum infection prevention and control.
In particular, the research has provided evidence to support the specification of copper for key touch surfaces within hospitals, including bed rails, drip stands, keyboards, taps, handrails, door handles, and push plates.
Vessey said: “The way in which copper works totally destroys the DNA of the bacteria, so there is no chance of horizontal gene transfer, the way in which bacteria can share resistance. As such, its use is becoming increasingly significant in the drive to tackle antimicrobial resistance.”
Specification of antimicrobial copper is currently still a local decision, often led by an enlightened champion. The expanding evidence base should start to be reflected in more-official guidance recognising the use of copper as key to infection prevention in hospitals.
In fact, Health Protection Scotland recently reviewed evidence from 18 articles covering 14 scientific studies and made a ‘Recommendation for Clinical Practice’ stating: “Copper alloy environmental and equipment surfaces may be considered for high-touch sites (eg bed rails) as an additional measure to supplement existing procedures for routine cleaning, but does not replace the requirement for routine cleaning to be performed.”
Vessey is hoping other countries in the UK will now follow suit.
“It’s about prioritising the touch points that are most highly contaminated and frequently touched and in the areas where the most vulnerable patients are housed, for example in neonatal units, intensive care units and burns units,” she said.
There are more than 200 companies globally that now offer products made from, or incorporating, copper and copper alloys.
And ongoing studies are expected to boost that number over the coming months and years.
Vessey said: “Basic components are readily available and there can a small, or no, cost difference, but the effect on infection prevention make them much more attractive.”
Allgood is one of those manufacturers, providing a wide range of copper alloy ironmongery products, including the Contego range.
Breaking the chain
The company’s spokesman, Franz Lorenschitz, said “HCAIs put additional pressure on healthcare systems - making breaking the chain of infection of paramount importance.
“Although stringent hygiene and cleaning practices aid this process; preventing the spread of infections by incorporating antimicrobial copper ironmongery for high-frequency touch points, such as door handles, can prove extremely effective.
“Eradicating well-known pathogens, antimicrobial copper can effectively inactivate bacteria, fungi and viruses. In addition, as this quality is intrinsic to the metal, it never wears out or expires and will continue to breakdown pathogens 24 hours a day, seven days a week. This presents several benefits for healthcare environments.”
Armitage Shanks has incorporated copper components into its Markwik 21+ mixer tap; while Screwfix has added a range of copper light switches by British manufacturer, Varilight, to its catalogue.
These are just a few examples of how manufacturers are using evidence to enhance their R&D activities.
But, what is needed to further increase the range of products available, are firm testing methods against which the efficacy of newly-produced items can be judged.
Vessey said: “This is the next stage for us and we hope that soon there will be firm guidance which will enable manufacturers to increase the number of products available, and will give specifiers the reassurance they need to install these as part of their ongoing infection prevention and control measures.”