Antimicrobial Copper Surfaces:
Laboratory and Clinical Performance and
Impact on Patient Safety
James H. Michel
Manager, Technical Services
Copper Development Association
September 14, 2011
Copper
Development
Association
2
Presenter
James H. Michel
M.S. Metallurgical Engineering
Over 38 years experience in non-
ferrous metals in research, sales
and marketing
Metallurgy instructor for the
American Society of Materials
Authored various articles on the
antimicrobial property of copper
3
Copper Development Association
Non-profit trade association representing the U.S.
copper industry
Explore new applications for copper and copper
based metals (alloys)
www.copper.org
4
US Healthcare-Associated Infection deaths =
One full jumbo jet crashing every day!
5
Hospital-acquired infections result in
substantial loss of life, a significant
decrease in the quality of patient care,
and an additional cost to the US
healthcare system of over $45 billion
dollars.
6
“The built environment in hospitals
[furnishings, equipment, hardware, and
more] likely accounts for at least 50% of
the HAI’s seen in the Medical Intensive
Care Units.” Dr. Michael G. Schmidt
Medical University of South Carolina WHO 1st International Conference on Prevention & Infection Control
July 1, 2011, Geneva
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Agenda
What is Antimicrobial Copper?
Hospital Surfaces Are Not Adequately Cleaned!
EPA Registration and Other Laboratory Testing
Clinical Testing: Implications to Patient Safety
Applications for Antimicrobial Copper
8
What is Antimicrobial Copper?
• 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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Copper alloys = Copper based metals
Copper + other elements (zinc, tin, nickel, and more)
Available in various forms: sheets, strips, plates, foils, rods, bars,
billets, and more
Brasses, bronzes, copper nickels, nickel silvers (copper-nickel-zinc)
Various colors
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Copper
C11000
Commercial Bronze
C22000
Red Brass
C23000
Brass
C24000
Cartridge Brass
C26000
Yellow Brass
C27000
Admiralty Metal
C44300
Phosphor Bronze
C51000
Phosphor Bronze
C52100
Aluminum Bronze
C61400
Aluminum Bronze
C62400
Aluminum Bronze
C62500
Aluminum Bronze
C63000
Silicon Aluminum Bronze
C64200
Silicon Bronze
C65100
Silicon Bronze
C65500
Silicon Manganese
Aluminum Brass
C67400
Manganese Bronze
C67500
Copper Nickel
C70600
Copper Nickel
C71500
Nickel Silver
C75200
Nickel Silver (Coin)
C76500
Tin Bronze
C90700
Aluminum Bronze
C95400
Copper alloys are available in a wide range of
colors
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Antimicrobial Copper is a portfolio of solid,
surface materials that continuously kill bacteria*
Solid, copper-based metal
alloys (e.g. brass, bronze)
Not a coating or surface treatment! *Laboratory testing shows that, when cleaned regularly, Antimicrobial Copper surfaces kill >99.9% of
MRSA, VRE, Staphylococcus aureus, Enterobacter aerogenes, Pseudomonas aeruginosa, and E. coli
O157:H7 within 2 hours
12
Antimicrobial Copper is a portfolio of solid,
surface materials that continuously kill bacteria*
Solid, copper-based metal
alloys (e.g. brass, bronze)
Bent, formed, welded,
cast, stamped, etc.
Not a coating or surface treatment! *Laboratory testing shows that, when cleaned regularly, Antimicrobial Copper surfaces kill >99.9% of
MRSA, VRE, Staphylococcus aureus, Enterobacter aerogenes, Pseudomonas aeruginosa, and E. coli
O157:H7 within 2 hours
13
Antimicrobial Copper is a portfolio of solid,
surface materials that continuously 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! *Laboratory testing shows that, when cleaned regularly, Antimicrobial Copper surfaces kill >99.9% of
MRSA, VRE, Staphylococcus aureus, Enterobacter aerogenes, Pseudomonas aeruginosa, and E. coli
O157:H7 within 2 hours
14
Humankind has benefited from the antimicrobial
properties of copper since ancient times
Humankind’s oldest metal: early uses include water transportation,
coins, jewelry, weapons, and more
Long before the germ theory of disease was developed, civilizations
used copper to kill disease-causing organisms
Egypt (2000 BC) – purify drinking water and treat wounds
Hippocrates (400 BC) – Treat leg ulcers related to varicose veins
Aztecs – Copper oxide and malachite for skin conditions
15
Agenda
What is Antimicrobial Copper?
Hospital Surfaces Are Not Adequately Cleaned!
EPA Registration and Other Laboratory Testing
Clinical Testing: Implications to Patient Safety
Applications for Antimicrobial Copper
16 Kramer A. BMC Infectious Diseases 2006;6:130
17 Kramer A. BMC Infectious Diseases 2006;6:130
MRSA 7 days to 7 months
18
C. difficile 5 months
Kramer A. BMC Infectious Diseases 2006;6:130
MRSA 7 days to 7 months
19
C. difficile 5 months
Kramer A. BMC Infectious Diseases 2006;6:130
MRSA 7 days to 7 months
VRE 5 days to 4 months
20
Where are the microbes in hospitals?
21
Cleaning has always been taken for granted
Cleaning has never been regarded as an
evidence-based science
Measuring the cleaning process and its impact on
the environment costs money.
Aesthetic considerations make cleaning difficult
to assess
We cannot see the enemy until
22
Touch surfaces
Infectious microorganisms can survive in scratches on disinfected surfaces,
but not on Antimicrobial Copper surfaces…
23
Agenda
What is Antimicrobial Copper?
Hospital Surfaces Are Not Adequately Cleaned!
EPA Registration and Other Laboratory Testing
Clinical Testing: Implications to Patient Safety
Applications for Antimicrobial Copper
24
Brass Doorknob
Little bacterial growth
Stainless Steel Doorknob
Heavy bacterial contamination
72 hours after inoculation with E. coli
Doorknobs: A Source of Nosocomial Infection?
by P. J. Kuhn, Diagnostic Medicine, Nov/Dec 1983
25
Antimicrobial Copper kills Methicillin-Resistant
Staphylococcus aureus (MRSA)
1
100
10,000
1,000,000
100,000,000
0 60 120 180 240 300 360
Bacte
ria C
ou
nt
(pe
r m
l.)
Time (minutes)
Copper Stainless Steel
*Laboratory testing shows that, when cleaned regularly, Antimicrobial Copper surfaces kill >99.9%
of MRSA, VRE, Staphylococcus aureus, Enterobacter aerogenes, Pseudomonas aeruginosa, and
E. coli O157:H7 within 2 hours
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E. Coli O157:H7 viability
Epifluorescence Images after Staining with Viability Fluorophore CTC
Solid Copper 0 minutes Stainless Steel
31,300,000 CFUs
31,400,000 CFUs
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Epifluorescence Images after Staining with Viability Fluorophore CTC
Solid Copper 30 minutes Stainless Steel
26,899,425 CFUs
1,600,000 CFUs
E. Coli O157:H7 viability
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Epifluorescence Images after Staining with Viability Fluorophore CTC
Solid Copper 60 minutes Stainless Steel
25,933,468 CFUs
2,740 CFUs
E. Coli O157:H7 viability
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E. Coli O157:H7 viability
Epifluorescence Images after Staining with Viability Fluorophore CTC
Solid Copper 120 minutes Stainless Steel
21,066,000 CFUs
<0.01% CFUs
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40+ Peer-reviewed & published papers
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Antimicrobial claims: EPA jurisdiction 6 registrations granted in 2008 with full human health
claims
35
Sample approved public health claims for
Antimicrobial Copper
This surface continuously reduces bacterial* contamination, achieving
99.9% reduction within two hours of exposure.
This surface kills greater than 99.9% of Gram-negative and Gram-
positive bacteria* within two hours of exposure.
This surface delivers continuous and ongoing antibacterial* action,
remaining effective in killing greater than 99.9% of bacteria* within
two hours.
*Laboratory testing demonstrates effective antibacterial activity against:
Methicillin-Resistant Staphylococcus aureus (MRSA), Vancomycin-resistant
Enterococcus faecalis (VRE), Staphylococcus aureus, Enterobacter aerogenes,
Pseudomonas aeruginosa, and E. coli O157:H7.
36
EPA registration - significance
Antimicrobial copper-
only solid surfaces
permitted to make
health claims
37
EPA registration - significance
Antimicrobial copper-
only solid surfaces
permitted to make
health claims
Provide continuous
antimicrobial action
38
EPA registration - significance
Antimicrobial copper-
only solid surface
permitted to make
health claims
Provide continuous
antimicrobial action
Kill bacteria* between
routine cleanings
*Laboratory testing shows that, when cleaned regularly, Antimicrobial Copper surfaces kill >99.9% of
MRSA, VRE, Staphylococcus aureus, Enterobacter aerogenes, Pseudomonas aeruginosa, and E. coli
O157:H7 within 2 hours
39
EPA registration - significance
Antimicrobial copper-
only solid surface
permitted to make
health claims
Provide continuous
antimicrobial action
Kill bacteria* between
routine cleanings
Disinfectants and
sanitizers only work when
applied
*Laboratory testing shows that, when cleaned regularly, Antimicrobial Copper surfaces kill >99.9% of
MRSA, VRE, Staphylococcus aureus, Enterobacter aerogenes, Pseudomonas aeruginosa, and E. coli
O157:H7 within 2 hours
40
EPA registration: required language
The EPA requires the following statement to be included when
making public health claims related to the use of Antimicrobial
Copper products:
“The use of an Antimicrobial Copper surface is a supplement to and
not a substitute for standard infection control practices; users must
continue to follow all current infection control practices, including
those practices related to cleaning and disinfection of environmental
surfaces. The Antimicrobial Copper surface material has been shown
to reduce microbial contamination, but it does not necessarily prevent
cross-contamination”
41
“[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 and the American Society for
Healthcare Environmental Services – as well as a leading expert in
the field (Dr. William A. Rutala, Ph.D., M.P.H., University of North
Carolina (UNC) Health Care System and UNC School of Medicine),
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
42
Agenda
What is Antimicrobial Copper?
Hospital Surfaces Are Not Adequately Cleaned!
EPA Registration and Other Laboratory Testing
Clinical Testing: Implications to Patient Safety
Applications for Antimicrobial Copper
43
Clinical Trials
Funded by the Department of Defense
Trials at three sites: Memorial Sloan-Kettering Cancer Center
Medical University of South Carolina
Ralph H. Johnson VA Medical Center
CDA provided materials procurement support only
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Antimicrobial Copper touch
surfaces will lower total bacteria
in hospital rooms
Less bacteria = lower risk of
infections
Lower infections = saved lives,
reduced treatment costs
Hypotheses:
Patients
Touch
Surfaces
Health
Care
Workers
Visitors
80% of infectious
diseases are
transmitted by
touch
TIERNO, P. (2001): The Secret Life of Germs. Atria Books: New York, NY, USA.
45
Determine the baseline bio-load on 6 objects in patient rooms
• Bed rails, IV stands, nurse’s call devices, visitor chair arms, over-bed tray tables, data input devices (mice, laptops, touch screen monitor)
Compare bio-load on copper vs. non-copper objects
• 8 rooms with copper objects vs. 8 rooms with non-copper objects
Measure infection rates of patients in copper vs. non-copper rooms
• No changes made to clinical care or handling of environmental surfaces
Testing the performance of antimicrobial copper
in the clinical setting
Medical Intensive Care Units
December 2007 June 2011
Phase 1 Phase 2 Phase 3
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Phase 1: Sampling the built environment
100 cm2 sterile templates placed over tested surfaces
Exposed area wiped in a vigorous side to side motion using five strokes both ways (ten total) applying even pressure
Bacteria liberated from wipe and plated
47
Phase 1: Selection of surfaces to sample
Surfaces Selected
Bed rails
IV stands
Over-bed tray tables
Data input devices (mouse, laptop, touch screen monitor bezel)
Visitor’s chair (arms)
Nurses’ call device
Surfaces Screened but not Selected
Laundry hamper
Door hamper
Drawer pulls
Faucet handles
Keyboards
Soap/EtOH dispenser
End table surface
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N = 1113 Rooms
Phase 1 results: Bio-load evaluation
Salgado et al. “Microbial Burden of Objects in ICU rooms.” Poster presentation, Interscience
Conference for Antimicrobial Agents in Chemotherapy (ICAAC), October, 2008.
49
Principal Observation Clinical environments carry an average microbial
burden 57 times higher than the levels commonly
accepted as benign (under 250cfu/ 100cm2 - *Dancer,
JHI 2011
N = 1113 Rooms Salgado et al. “Microbial Burden of Objects in ICU rooms.” Poster presentation, Interscience
Conference for Antimicrobial Agents in Chemotherapy (ICAAC), October, 2008.
Phase 1 results: Bio-load evaluation
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Bed rails Nurse’s call device
Data Input Monitor
Mouse
Over-bed tray
table Visitor’s chair Laptop
IV Pole
Phase 2: Antimicrobial Copper products installed
51
52
Phase 2: Results
Clinical trial results are preliminary and under review; claims related to clinical
trials will be submitted to U.S. EPA for review and approval
54
Phase 3 preliminary results*:
Infection-acquisition risk measurement
Study results will be submitted to U.S. EPA for review and
approval. Individual results may vary. Infection reduction claims for
antimicrobial copper surfaces are not permitted at this time.
*Schmidt , Michael G. “Copper Surfaces in the ICU reduced the relative risk of acquiring an infection while hospitalized”,
Slide Session: Innovative Approaches to Infection Controls, WHO 1st International Conference on Prevention & Infection
Control, July 1, 2011, Geneva
55
This particular study found:
40% reduction in the risk of acquiring an infection (p=0.039, n=651) for
patients in rooms where some copper objects travelled out
Study results will be submitted to U.S. EPA for review and
approval. Individual results may vary. Infection reduction claims for
antimicrobial copper surfaces are not permitted at this time.
Phase 3 preliminary results*:
Infection-acquisition risk measurement
*Schmidt , Michael G. “Copper Surfaces in the ICU reduced the relative risk of acquiring an infection while hospitalized”,
Slide Session: Innovative Approaches to Infection Controls, WHO 1st International Conference on Prevention & Infection
Control, July 1, 2011, Geneva
56
This particular study found:
40% reduction in the risk of acquiring an infection (p=0.039, n=651) for
patients in rooms where some copper objects travelled out
61% reduction in the risk of acquiring an infection (p=0.006, n=541) for
patients in rooms with copper rails and some copper objects travelled out
Study results will be submitted to U.S. EPA for review and
approval. Individual results may vary. Infection reduction claims for
antimicrobial copper surfaces are not permitted at this time.
Phase 3 preliminary results*:
Infection-acquisition risk measurement
*Schmidt , Michael G. “Copper Surfaces in the ICU reduced the relative risk of acquiring an infection while hospitalized”,
Slide Session: Innovative Approaches to Infection Controls, WHO 1st International Conference on Prevention & Infection
Control, July 1, 2011, Geneva
57
This particular study found:
40% reduction in the risk of acquiring an infection (p=0.039, n=651) for
patients in rooms where some copper objects travelled out
61% reduction in the risk of acquiring an infection (p=0.006, n=541) for
patients in rooms with copper rails and some copper objects travelled out
69% reduction in the risk of acquiring an infection for patients in rooms
where copper objects never travelled out (p=0.008, n=462)
Study results will be submitted to U.S. EPA for review and
approval. Individual results may vary. Infection reduction claims for
antimicrobial copper surfaces are not permitted at this time.
Phase 3 preliminary results*:
Infection-acquisition risk measurement
*Schmidt , Michael G. “Copper Surfaces in the ICU reduced the relative risk of acquiring an infection while hospitalized”,
Slide Session: Innovative Approaches to Infection Controls, WHO 1st International Conference on Prevention & Infection
Control, July 1, 2011, Geneva
58
Agenda
What is Antimicrobial Copper?
Hospital Surfaces Are Not Adequately Cleaned!
EPA Registration and Other Laboratory Testing
Clinical Testing: Implications to Patient Safety
Applications for Antimicrobial Copper
59
EPA Approved Touch Surface Applications
MEDICAL &
HEALTHCARE
FOOD &
HOSPITALITY
PUBLIC
TRANSPORT
SCHOOLS
PUBLIC
BUILDINGS
SPORTS
FACILITIES
Touch Surface Applications
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Portfolio of products available and many more
being developed
61
How you can get involved
Introduce the benefits of Antimicrobial Copper
to your colleagues
AntimicrobialCopper.com
Find products
Schedule a presentation for your hospital
Sign up for our newsletter
More background science
See us at:
Association for the Healthcare Environment Annual Conference
September 25-29, Kissimmee, FL
The American Society for Healthcare Risk Management (ASHRM)
Annual Conference, October 16-19, Phoenix
62
Summary
Antimicrobial copper is the most effective touch surface
material
Hospital surfaces are not adequately cleaned!
Studies have demonstrated copper’s benefits in real world
settings
Antimicrobial Copper is the only solid surface registered
with EPA to kill disease causing bacteria
64
How to control bacteria in hospitals?
Medical Staff Areas Public Areas Patient Rooms
65
Use Antimicrobial Copper for contact surfaces
Medical Staff Areas Public Areas Patient Rooms
66
Thank you
Jim Michel
(212) 251-7210
Wilton Moran
(212) 251-7212
www.AntimicrobialCopper.com