Best Practices: Using copper to fight infections

Two years ago, Grinnell (Iowa) Regional Medical Center, a 49-bed rural hospital, began running an experiment. After terminal cleaning—the thorough scrubdown a room receives after a patient is discharged—germ levels were rebounding even when the room was left empty. The hospital set hopes on one natural substance that might keep microbes from returning: copper.

“It's such an elegant solution to help support improving the cleanliness of hospitals, because it cleans 24/7,” said Todd Linden, Grinnell's CEO. “You don't have to teach it how to wash its hands.”

Copper's sterilizing properties have been used since ancient times. More recently, researchers have discovered that copper alloys destroy MRSA, norovirus and other pathogens. These materials damage bacterial DNA and respiration, leading to cell breakdown, and inactivate certain viruses, often within hours.

Grinnell outfitted six of the 13 single rooms and three of the five double rooms in its medical-surgical suite with bed rails, toilet flush levers, grab bars, soap dispenser push plates, light switches, IV poles and other “high touch” surfaces made of copper alloy (90% copper, 10% nickel, by weight).

The same objects in the remaining rooms were left with their original plastic, porcelain and metal surfaces. Over the course of the next 12 months, researchers from Grinnell College took samples from both sets of rooms, regularly testing 20 different surfaces and objects, whether rooms were occupied or not.

After terminal cleaning, 88% of the bacterial samples from rooms outfitted with copper fell below recommended concentration levels. By contrast, 55% of the samples taken from the other rooms exceeded that threshold.

Grinnell is one of a handful of hospitals looking to copper to kill multidrug-resistant organisms and reduce healthcare-acquired infections, the direct and indirect costs of which range from $96 billion to $147 billion annually in the U.S.

When Sentara Leigh Hospital in Norfolk, Va., decided to tear down and rebuild in stages, it took the opportunity to install copper-infused products in the first wing it replaced, which was completed in 2013. Hard surfaces, such as bed rails, sinks and countertops, were made with a copper-impregnated composite, and patients received copper-laced linens and gowns.

The hospital educated its staff and patients on the initiative. It was especially well-received by families and patients, said Dr. Gene Burke, executive medical director for clinical effectiveness with Sentara Healthcare, the hospital's parent system.

“We did have to work with our laundry to launder the copper products separately,” said Terrie Edwards, who was president of Sentara Leigh when the hospital decided to use copper and is now a corporate vice president for the system. Copper linens cost about 10% more than ordinary linens, but the hospital ends up breaking even because they last longer, she said.

Ultimately, the new wing had 78% fewer healthcare-associated infections related to multidrug resistant organisms including C. difficile, compared with a baseline period, Burke and others found when they studied infection rates in the two hospital sections. And infection rates didn't change in the old wing.

Their study concluded that hard surfaces and linens imbued with copper “may be useful technologies” to prevent healthcare-acquired infections, but that additional research was necessary to determine whether reduced infections were attributable to the use of copper.

Copper is no silver bullet, many caution. It should be one of many tools used in healthcare settings to fight infections. Copper may be a piece of the puzzle for reducing healthcare-acquired infections, said Dr. Louise Dembry, president of the Society for Healthcare Epidemiology of America. “Where it's going to fit and how it fits are still being considered.”

Copper also can't protect patients in all circumstances, Dembry pointed out. If a person enters a hospital room without washing his hands and then touches a patient IV line, it won't matter that the room has copper countertops.

At Grinnell, the average cost of outfitting a room was $5,500, according to Linden, with most products costing about 15% more in copper than in stainless steel. He called the return on investment “significant.”

Dembry was not so certain. She called for more studies to show how different amounts and placements of copper materials affected infection rates to help gauge whether copper is worth the cost.

Using copper isn't feasible for all hospitals. Sentara was able to install hard surfaces with copper-impregnated material because it was being rebuilt. Retrofitting would have been disruptive to patients, Burke said.

But hospitals can still use copper for infection control without complete retrofitting. Sentara, for instance, is planning to outfit its other 11 hospitals with copper-laced textiles, overbed trays, bedside table tops and bed rails. “We are waiting for our new construction to go in and replace all the horizontal surfaces,” Burke said.