I recently received an email from the Copper Development Association entitled “Five Good Reasons to Install Antimicrobial Copper Touch Surfaces”. The five reasons are as follows:
- “Continuous and significant bioburden reduction, 24/7.
- Improved patient outcomes.
- A supplement to standard hygiene practices.
- Simple, cost-effective intervention.
- Payback in less than one year.”
I agree with all of these points in principle, and like the recently published copper study a lot, but I recently had two experiences that gave me three good reasons why not to “copperize” a hospital room.
Firstly, I was kindly given a copper pen at a conference. I’ve had it for a few months now and it’s beginning to look slightly the worse for wear (note the tarnishing where my grubby mits have been holding it, and the bright shiny part that has had less exposure to air underneath the swivel top). Is this how a bedrail would look after a few months of use?
Secondly, the pen works well but my hands smell of metal after using it. Would it be the same after touching my copper bedside table?
Thirdly, we had a new boiler installed last year resulting in a small pile of scrap copper pipes. I eventually got around to taking the copper pipes to the scrap metal merchant last weekend, expecting to get nothing for them and he gave me £50. So, exactly how much would it cost to “copperize” a hospital room, and would you really see ‘payback in less than one year’?
I appreciate that much of this may have to do with the composition of the copper alloy. I would imagine that reducing the amount of copper in the alloy would mean lower cost, less smell and less tarnishing. However, it would also reduce the ability to inactivate microbes deposited on the surfaces, so the research data really only applies to the composition of the copper alloy in the items that were tested. Also, there’s been some academic criticism of the copper study on the Controversies in Hospital Infection Prevention blog which is worth reading.
There are still a lot of questions around the implementation of copper surfaces in hospital rooms, and there are other options to consider. But I do think we should be thinking seriously about evaluating the clinical impact and cost-benefit of implementing antimicrobial surfaces.
Reflections on Infection Prevention and Control 
From a clinician’s standpoint, who cares? If copper reduces the incidence of HAI and the attending patient complications and enormous hospital costs, it’s well worth incorporating copper touch points in every healthcare facility.
Copper is not an end all, be all solution to hospital infections, but it will be one of multiple modalities needed to address HAI.
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Rick, useful thoughts thanks. I agree with you on one level. We’re in the business of maximizing patient safety, not achieving a return on investment. However, cost and cost-effectiveness are important because we need to implement the most cost-effective interventions first, particularly in these times of austerity. Organisations like NICE have guidelines to assist in making these sorts of decisions. One of the comments that I received on twitter in relation to this post was ‘use your money on cleaning’. The problem is, we have basically no data on comparative effectiveness of environmental interventions. As more studies are performed we’ll be able to make more informed decisions about the most cost-effective environmental interventions. In the mean time, we need to implement interventions that have been shown to be effective and make some sensible judgments about likely comparative effectiveness.
There’s also the issue of acceptability. Even if the implementation of copper surfaces works and is cost-effective, if the copper surfaces in the room make a patient’s stay uncomfortable to the point of unacceptability, patients will begin to ‘vote with their feet’. In light of the move towards patient choice in healthcare, this could be a real concern.
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Copper does work like several other metals to passively lower bioloads in a room. but at a cost of USD$12000 per room is very expensive. Since every Hospital has budget issues an great alternate is VLR Titanium Dioxide. Spray in OR or ICU cost is less than $500.00. If UV lights are used fro terminal clean it protect the surfaces and decreases the cycle time. If Hydrogen Periode is used it protects the metals from corroding. Once applied it works for 1 to 3 years. It also cleans the air of pollutants, see how Trane uses it PCO action in the HVAC system.
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Frank, thanks for your comment. I think Titanium Dioxide is another promising candidate for a successful antimicrobial surface. I have several questions / comments for you. Firstly, anything that is applied to a surface (like spraying titanium dioxide) vs inherently part of the surface (such as copper) will have limitations in terms of durability. It will have to resist the mechanical action of cleaning in order to stay on the surface, and will presumably lose activity over time as it is rubbed off and require re-application? Secondly, does it inactivate C. diffcile spores? Thirdly, the Trane product using titanium dioxide in an HVAC system is a very different application to spraying titanium dioxide on surfaces.
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Comparing copper pipe with copper antimicrobial surfaces is apples-to-oranges. Copper pipe is generally solid metallic copper of 99%+ purity, chosen largely for its malleability compared with other suitable materials. If it was desirable to use a pure (99%+) copper, it would only need to be plated over a conductive material. But it may not be ideal to use such pure copper on surfaces subject to heavy use, even as a plating; it’s too soft, too easy to scratch. An alloy with a copper content of about 60-70% is sufficient to give an antimicrobial effect. Most people do not find the smell of brass or bronzes particularly objectionable; in fact they have been used to make common household goods, including cooking and food storage vessels, for thousands of years.
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Thanks for your comment Richard. My point was not to compare copper pipe with copper-containing antimicrobial surfaces. Indeed, I make the point that the exact composition of the alloy will affect it’s properties. It was just a (admittedly provocative) illustration of the cost of copper. It does seem that the % of copper in the alloy will affect efficacy though.
I can’t speak for the feelings of others on how they find brass surfaces, but I have always found them pretty objectionable! I suspect I’m not alone.
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Sorry to be picking up on this thread at a late stage. Here’s my ten pence worth!
The cost of “copperisation” is indeed massively outweighed by the reduction of HCAIs, per York Health Economics Consortium research. https://www.york.ac.uk/news-and-events/news/2013/research/antimicrobial-copper/
Regarding aesthetics, one copper alloy that seems to be attractive is a 90% copper, 10% nickel alloy that is primarily used in the marine / offshore industry, due to its corrosion resistance, strength, cold-workability and commercial availability.
Interestingly, in lab tests of antimicrobial efficacy, where all the alloys tested showed rapid kill of all pathogens (especially under typical indoor temp/humidity conditions), this alloy showed similar kill-time against murine norovirus to ‘pure’ copper grade Cu-DHP: 10,000 to zero in under 5 minutes.
The colour of that alloy is not as “steampunk” as pure copper, nor as ‘bling’ as brass. It’s like a warm stainless steel hue – and it is quite colour-stable, with less visual difference between and oxidised condition than most of the other copper alloys evaluated.
Mind you, regular cleaning using standard clinical cleaning materials will reduce oxidisation. Personally, I use detergent with a little citric acid to clean copper materials: the detergent shifts the grease, the citric acid brings the surface back to bright; so the surface looks new and is ready to do its rapid contact-kill of pathogens, between cleans and between touches.
Hope this helps…?
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