This document summarizes a webinar presentation about antimicrobial copper surfaces. The presentation discussed the need for antimicrobial surfaces in healthcare settings to prevent infections. It provided an overview of the antimicrobial properties of copper and clinical evidence that copper surfaces continuously kill bacteria and viruses. The presentation also described available copper product options and the results of clinical trials showing that copper surfaces reduce bacteria levels in hospital rooms.

1. 1
Antimicrobial Copper: New Evidence and Lessons from an Early Adopter

2. 2
Sponsored by:

3. 3
Webinar Console
Q+A –Submit a question
Resources List –Access website links and download slides
Help - Troubleshoot a technical issue
CE Certificate– Generate your Program Quiz at the end of the webinar
Submit a CE Inquiry

4. 4 A Special Note about CE Credit: Our CE process has changed slightly. To receive credit for today’s program, you must click the Green CE Certificate widget at the conclusion of the program and complete the quiz.
Program Quiz – Generated at the end of the program

5. 5
Twitter Widget
Join the discussion on Twitter!
•Click the blue Twitter button at the bottom of the player
•Click the “Post” and “Authorize” Buttons
•Start Tweeting and sharing at our hash tag #HCDLiveWebinar automatically!

6. Adam Estelle
Project Engineer
Copper Development Association
Antimicrobial Copper: New Evidence and Lessons from an Early Adopter

7. 7
Agenda
1.The need for antimicrobial surfaces
2.What is antimicrobial copper?
3.Available products
4.New laboratory evidence
5.Clinical testing of antimicrobial copper
6.Pullman Regional Hospital: use case

8. 8
Antimicrobial Copper touch surfaces offer a powerful new infection-prevention tool. They work 24/7 to eliminate the bacteria that cause healthcare-acquired infections without staff behavioral changes. They are a one-time cost that provide long-term benefits.

9. 9
Copper Development Association
Not-for-profit trade association
Develop new uses for copper and its alloys
Provide education and training to end-users
www.Copper.org, www.AntimicrobialCopper.com

10. 10
The need for antimicrobial surfaces

11. 11
Hospital-acquired infections result in substantial loss of life, a significant decrease in the quality of patient care, and add an additional cost to the US healthcare system of $45 billion dollars.
Scott RD. The Direct Medical Costs of Healthcare-Associated Infections in U.S. Hospitals and the Benefits of Prevention. Atlanta: Centers for Disease Control and Prevention, 2009.

12. 12
Putting the HAI problem into perspective
Annual loss of life from HAI’s in America is equivalent to one jumbo jet full of passengers crashing EVERY DAY!

13. 13
Adults touch up to 30 objects a minute
80% of infectious diseases transferred by touch
TIERNO, P. (2001): The Secret Life of Germs. Atria Books: New York, NY, USA.

14. 14
The built environment is a source of pathogens Total bacteria count per 100 cm2 (n = 668 rooms)
Schmidt et al. “Sustained reduction of microbial burden on common hospital surfaces through introduction of copper” J. Clin. Microbiol. 2012, 50(7):

15. 15
Rotavirus: 60 days
VRE: 4 months
Acinetobacter spp: 5 months
C.diff spores: 5 months
MRSA: 7 months
E. coli: 16 months
S. typhimurium: 4.2 years
Germs can survive on surfaces for a long time
1)KRAMER, A., SCHWEBKE, I. & KAMPF, G. 2006. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis. 6:130.

16. 16
Good hygienic practices are essential, but what happens in between cleanings?

17. 17
Hospital surfaces still harbor unsafe levels of microorganisms, even after cleaning
% of Rooms with Contaminated Surfaces
MRSA1
46% (18 out of 41 Rooms)
VRE2
22% (8 out of 37 Rooms)
C. diff3
78% (7 out of 9 Rooms)
1)Blythe et al. J Hosp Infect 1998;38:67-70
2)Goodman et al. ICHE 2008;29:593-9
3)Eckstein et al. BMC ID 2007;7:61

18. 18
Hospital surfaces still harbor unsafe levels of microorganisms, even after cleaning
Room Type
Total Bacteria
(CFU/100cm2)
Antibiotic Resistant Bacteria (CFU/100cm2)
After Routine Cleaning
5,780
480
After Terminal Cleaning
790
23
A. M. SHAMS et al. Assessment of the Overall and Multi-drug Resistant Organism (MDRO) Bioburden on Environmental Surfaces in Healthcare Facilities. Poster #1366, IDWeek 2014
CDC sampled surfaces* in 11 hospitals
*Tested surfaces include: door hardware, bed rails, IV poles, grab bars, flush handles, over-bed tables, TV remotes, telephones, nurse call buttons

19. 19
Surfaces quickly re-contaminate after cleaning
Attaway H. et al. “Intrinsic bacterial burden associated with intensive care unit hospital beds: Effects of disinfection on
population recovery and mitigation of potential infection risk ” American Journal of Infection Control 40 (2012) 907-12
Hospital Bed Rails

20. 20
Surfaces quickly re-contaminate after cleaning
Attaway H. et al. “Intrinsic bacterial burden associated with intensive care unit hospital beds: Effects of disinfection on
population recovery and mitigation of potential infection risk ” American Journal of Infection Control 40 (2012) 907-12
Hospital Bed Rails

21. 21
Viruses can rapidly spread throughout facilities
 Tracer virus placed on one doorknob and table top in office buildings
 Within 2 to 4 hours, the virus was detected on 40 to 60 percent of
workers, visitors and commonly touched objects.
Gerba C "Impact of a quaternary ammonium compound (QAC) disinfectant on the spread
of viruses in facilities" ICAAC 2014; Abstract K-1722.

22. 22
What is Antimicrobial Copper?

23. 23
Copper is a widely used commercial metal

24. 24
Formable
Non- Magnetic
Electrically Conductive
Aesthetic
Corrosion resistant
Thermally
Conductive
Essential nutrient
Recyclable
Antimicrobial
Catalytic
Ductile
Malleable
Easy to alloy
Easy to join
Machinable
Copper Properties
Copper has many properties and is used in a broad range of applications and products
MEDICAL & HEALTHCARE
.
.
.
AQUACULTURE
& AGRICULTURE
ELECTRICITY
TRANSMISSION
& DISTRIBUTION
AUTOMOTIVE HARNESSES & MOTORS
ELECTRICITY GENERATION
HVAC & REFRIGERATION
INDUSTRIAL
EQUIPMENT
& FITTINGS
VEHICLE RADIATORS
ENERGY STORAGE
ELECTRONICS
& IT
COMMUNICATIONS
NETWORKS
ELECTRICAL
WIRING
BUILDERS HARDWARE
PLUMBING
& PIPING
ARCHITECTURAL
SURFACES
CONSUMER
APPLIANCES
& TOOLS
INDUSTRIAL
TRANSFORMERS
& MOTORS
RAIL & MARINE
EQUIPMENT
Copper (Product) Applications
Metallic copper is inherently antimicrobial

25. 25
Copper is an inherently antimicrobial element
Long before the germ theory of disease was developed, civilizations used copper to kill disease-causing organisms.

26. 26
Copper’s properties can be enhanced by combining with other elements to make alloys

27. 27
Copper alloys are not red, soft metals

28. 28
What is “antimicrobial copper?” Solid surfaces that continuously kill bacteria
Solid, copper-based metals
Bent, formed, welded, cast, stamped, etc.
Durable surfaces
Not a coating or surface treatment!

29. 29
Antimicrobial copper surfaces kill Methicillin- Resistant Staphylococcus aureus (MRSA)
1.E+00
1.E+02
1.E+04
1.E+06
1.E+08
0
60
120
180
240
300
360
Bacteria Count
Time (minutes)
Copper
Brass (80% copper)
Stainless Steel
NOYCE, et al. 2006a. Potential use of copper surfaces to reduce survival of epidemic meticillin-resistant Staphylococcus aureus in the healthcare environment. J Hosp Infect. 63, 289-97.

30. 30
Staphylococcus aureus
Enterobacter aerogenes
Escherichia coli O157:H7
Pseudomonas aeruginosa
Methicillin-Resistant S. aureus (MRSA)
Vancomycin-Resistant E. faecalis (VRE)
Antimicrobial copper is registered by the EPA to make public health claims against 6 bacteria

31. 31
EPA registered claims for antimicrobial copper
This surface delivers continuous and ongoing antibacterial* action, remaining effective in killing greater than 99.9% of bacteria* within two hours

32. 32
EPA registered claims for antimicrobial copper
This surface kills greater than 99.9% of bacteria within two hours, and continues to kill 99% of bacteria* even after repeated contamination

33. 33
EPA testing: continuous reduction of MRSA
>99% kill on copper after 8 exposures over 24 hrs with no cleaning in between
Stainless Steel
Antimicrobial Copper
Bacteria per coupon

34. 34
0
3,000,000
6,000,000
9,000,000
12,000,000
15,000,000
18,000,000
21,000,000
24,000,000
27,000,000
0
3
6
9
12
15
18
21
24
Bacteria
Time (hours)
EPA testing: continuous reduction of MRSA
Stainless Steel
Antimicrobial Copper

35. 35
Infection prevention is a multifaceted challenge
Antimicrobial copper surfaces supplement infection control practices

36. 36
Available Antimicrobial Copper Products

37. 37
Sinks
Manufacturers: Just Manufacturing, Elkay Commercial Products, MD-Cu29
Hand wash stations, scrub sinks

38. 38
IV poles
Manufacturers: Pedigo, Midbrook Medical

39. 39
Patient transport
Manufacturer: Pedigo

40. 40
Railings and grab bars
Manufacturers: Wagner Companies, Rocky Mountain Hardware, CuSalus by Colonial Bronze

41. 41
Building products
Manufacturers: Arrowhart, CuSalus by Colonial Bronze, Rocky Mountain Hardware, MD-Cu29

42. 42
Work surfaces
Manufacturers: Midbrook Medical, CuSalus by Colonial Bronze,

43. 43
Work surfaces
Manufacturers: Midbrook Medical

44. 44
Building hardware
Manufacturers: Rocky Mountain Hardware, CuSalus by Colonial Bronze, Trimco

45. 45
Cabinet hardware
Manufacturers: CuSalus by Colonial Bronze, Rocky Mountain Hardware,
MD-Cu29

46. 46
Cabinet hardware
Manufacturers: CuSalus by Colonial Bronze, Rocky Mountain Hardware,
MD-Cu29

47. 47
Equipment/cart handles
Manufacturers: CuSalus by Colonial Bronze

48. 48
Keyboards/mice
Manufacturers: Operator Interface Technology

49. 49
Multi-surface push/pull device
Manufacturer: The Copper Shark, MD-Cu29

50. 50
Over 20 manufacturers are offering products made from antimicrobial copper materials

51. 51
Check website for additional product categories
AntimicrobialCopper.com

52. 52
New Laboratory Evidence

53. 53
Carbapenem-Resistant Enterobacteriaceae (CRE)
9,000 infections/year, US
600 deaths/year, US
CRE is resistant to nearly all available antibiotics
“This bacteria is an immediate
public health threat that requires
urgent and aggressive action.”

54. 54
Survival of CRE on copper, stainless steel and plastic surfaces
Material
2hrs
3hrs
Copper (99.9%)
25.87%
99.99%
Stainless steel
0
0
Plastic (PVC)
0
0
Starting concentration: 106 Colony Forming Units per sample
% reductions over time
Souli et al. Antimicrobial activity of copper surfaces against carbapenemase-producing contemporary
Gram-negative clinical isolates. J Antimicrob Chemother. (2013) 68 (4): 852-857

55. 55
Norovirus
23,000,000 illnesses/year, US
800 deaths/year, US
3,000 cases reported on cruise ships in 2012
“Norovirus is the leading cause of
illness and outbreaks from
contaminated food in the United States.”

56. 56
Norovirus unable to infect host cells after 2 hours exposure to copper surfaces at room temperature
Infectious virus recovered from stainless steel surfaces
No infectious virus recovered from copper surfaces
Stainless steel
Copper
Warnes SL, Keevil CW (2013) Inactivation of Norovirus on Dry Copper Alloy Surfaces. PLoS ONE 8(9): e75017. doi:10.1371/journal.pone.0075017

57. 57
Antimicrobial copper surfaces kill C. diff spores
WEAVER, et al. 2008. Survival of Clostridium difficile on copper and steel: futuristic options for hospital hygiene. J Hosp Infect. 68, 145-51.

58. 58
Antimicrobial copper surfaces kill germinating C. diff spores faster
Stainless
steel
Copper
99.8% reduction in 3 hours
WHEELDON et al. Antimicrobial efficacy of copper surfaces against spores and vegetative cells of Clostridium difficile: the germination theory. J Antimicrob Chemother. 2008 Sep;62(3):522-5

59. 59
Antimicrobial copper surfaces inactivate Influenza A
Stainless Steel Samples: 6 hours
Antimicrobial Copper (99.9%) Samples: 6 hours
2,000,000
1,000,000
500,000
500,000
< 500
2,000,000
NOYCE, et al. 2007. Inactivation of influenza A virus on copper versus stainless steel surfaces.
Appl Environ Microbiol, 73, 2748-50.

60. 60
Listeria monocytogenes
Clostridium difficile
Influenza A (including H1N1)
Rotavirus
Rhinovirus
Acinetobacter baumanii
Mycobacterium tuberculosis
Candida albicans
Aspergillus spp.
Fusarium spp.
Fusarium culmonium
Fusarium oxysporium
Fusarium solani
Aspergillus flavus
Aspergillus fumigatus
Klebsiella pneumoniae
Legionella pneumonphila
Salmonella enteric
Salmonella Typhi
Vibrio cholerae
Campylobacter jejuni
Penicillian chrysogenum
Antimicrobial copper also effective against:
And more…

61. 61
100+ Peer-Reviewed & Published Papers

62. 62
2014 top 10 technology watch lists include copper

63. 63
Clinical Testing of Antimicrobial Copper

64. 64
US trials were carried out in the ICU’s of three very different facilities with diverse patient profiles
Memorial Sloan Kettering Cancer Center, New York City
Medical University of South Carolina, Charleston, SC
Ralph H. Johnson VA Hospital, Charleston, SC
Supported by Congress, funded by Department of Defense

65. 65
 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.

66. 66
Determine the baseline bio-load on 6 objects in patient rooms
Compare bio- load on copper vs. non-copper objects
Measure infection rates of patients in copper vs. non- copper rooms
Testing the performance of antimicrobial copper surfaces in the clinical setting
Medical Intensive Care Units
Phase 1
Phase 2
Phase 3

67. 67
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

68. 68
Sampling the built environment

69. 69
N = 1113 Rooms
1)Salgado et al. “Microbial Burden of Objects in ICU rooms.” Poster presentation, Interscience Conference for Antimicrobial Agents in Chemotherapy (ICAAC), October, 2008.
2)Mulvey et al. “Finding a benchmark for monitoring hospital cleanliness.” J Hosp Infect 77 (2011)
Bio-load evaluation (before copper surfaces)

70. 70
Principle observations before copper intervention
Clinical environments carry an average microbial burden 35 times higher than levels commonly accepted as benign*
*Under 500 CFU/100cm2
1)Schmidt et al. J Clin Microbiol 2012;50(7):2217-2223
2)Mulvey et al. J Hosp Infect 77 (2011)

71. 71
Antimicrobial copper components in Ralph H. Johnson VA Medical Center

72. 72
Antimicrobial copper components in Memorial Sloan Kettering Cancer Center

73. 73
Bacteria decreased by 83% on copper surfaces
Schmidt et al. J Clin Microbiol 2012;50(7):2217-2223.

74. 74
Principle observations
Copper surfaces consistently achieved the terminal cleaning standard of 5 CFU/cm2 during clinical care
MRSA was only isolated once from 3,384 copper surfaces, a 99.9% reduction vs. control surfaces
Schmidt et al. J Clin Microbiol 2012;50(7):2217-2223.

75. 75
Do dirty surfaces cause HAIs?
Can copper surfaces reduce HAIs?
Investigating impact of copper surfaces on Healthcare Associated Infections over 1 year

76. 76
Contaminated surfaces increase infection risk
Salgado et. al. Copper surfaces reduce the rate of healthcare-acquired infection in the intensive care unit. Infection Control and Hospital Epidemiology, Vol. 34, No. 5, May 2013, pp. 479-486

77. 77
Patients treated in ICU rooms with copper surfaces had significantly fewer infections
Copper Rooms: 10 HAIs in 294 patients
Control Rooms: 26 HAIs in 320 patients
Normalize populations = 24 Infections in control rooms
= 14 Infections prevented in copper rooms
= 58% reduction in HAI (N=614, p=0.013)
Salgado et. al. Copper surfaces reduce the rate of healthcare-acquired infection in the intensive care unit. Infection Control and Hospital Epidemiology, Vol. 34, No. 5, May 2013, pp. 479-486

78. 78
Basic ROI calculation from US clinical trials
Low Cost Scenario ($29K/HAI)
14 infections prevented X $29,000/Infection = $406,000 Savings
$406,000 ÷ 338 days = $1,201/day
$52,000 (cost of copper products) ÷ $1,201/day
= 43.3 day payback period
High Cost Scenario ($43K/HAI)
14 infections prevented X $43,000/Infection = $602,000 Savings
$602,000 ÷ 338 days = $1,781/day
$52,000 (cost of copper products) ÷ $1,781/day
= 29.2 day payback period
*HAI cost projections based on AHRQ estimates *Estimated $52,000 to “copperize” 8 ICU Rooms (prototype pricing)

79. 79
Study conclusions
7% of surface area converted to copper
83% less bacteria on copper surfaces
58% fewer infections in copper rooms
50% of infections likely caused by environment
Salgado et al. Copper Surfaces Reduce the Rate of Healthcare-Acquired Infections in the Intensive Care Unit. Infect Control Hosp Epidemiol 2013;34(5):479-486

80. 80
Study conclusions
Use of copper alloy surfaces represents the first instance where a passive, continuously active antimicrobial material was able to significantly reduce the rate of HAI
Incorporation of copper into essential items within the built environment of hospitals offers a unique solution to reduce HAIs in an efficient and cost effective manner

81. 81
Pullman Regional Hospital Use Case

82. 82
Pullman Regional Hospital: Pullman, WA
Critical Access Hospital
95,000 sq ft level IV trauma center
25 patient beds, 3 ORs
24-hour emergency care

83. 83
Pullman Hospital installed antimicrobial copper surfaces throughout their facility
Faucet Levers

84. 84
Pullman Hospital installed antimicrobial copper surfaces throughout their facility
Door access devices

85. 85
Pullman Hospital installed antimicrobial copper surfaces throughout their facility
IV Pole Handles

86. 86
Pullman Hospital installed antimicrobial copper surfaces throughout their facility
Cabinet Hardware

87. 87
Antimicrobial copper surfaces were easy to install and required no additional staff training

88. 88
Pullman Hospital plans to install additional antimicrobial copper touch points
“Eventually we’d like to do all the chairs. The armrests here. The countertops. The bed rails. The bed handles.”
Ed Harrich, Director of Surgical Services

89. 89
Pullman Regional Hospital: designing innovation
“The cost of adding some copper surfaces in our facility is far outweighed by the financial and personal costs of ongoing care and prolonged illness in our patients.”
Scott Adams, CEO, Pullman Regional Hospital Forbes Blog Post, April 2014

90. 90
Pullman Regional Hospital: designing innovation
“It was really exciting to realize that we could do something that was fairly simple to implement and have such a dramatic impact.”
Scott Adams, CEO, Pullman Regional Hospital

91. 91
Take away messages
Extensive peer-reviewed evidence and EPA registration
58% reduction of HAIs observed in clinical trials
No behavioral changes or extra maintenance required
One time cost that provides long term benefits
Commercial products available from over 20 manufacturers

92. 92
Antimicrobial copper products not only help combat pathogens, they can be recycled, again and again, without any loss of performance, helping to conserve our planet’s resources.
Building a more sustainable and safer planet
www.AntimicrobialCopper.com

93. 93
Thank you
Adam Estelle
212-251-7232
adam.estelle@copperalliance.us
www.AntimicrobialCopper.com

94. 94
CE Certificate Information
•If you are experiencing technical issues, please click the Help button here.
•If you have any other questions, please contact the CE Helpdesk at: webinars@vendomegrp.com
•At this time, please click the green CE Certificate widget to generate your certificate

95. 95 IDCEC Certificates - Procedure 1.Within 5 business days – You will receive an email to fill out the course survey (login to IDCEC user profile) 2.After survey is complete, you will be provided with a printable IDCEC Certificate 3.This credit will be listed on your transcript * Please click the Purple “Contact Webinar Helpdesk” button should you have any questions*

96. 96 November 15-18 San Diego Convention Center San Diego, CA
Click here for more information!
Register Now!

97. 97
Facebook
Join our Group!
Linked-In
Join our Group!
Upcoming Healthcare Design webinars:
http://www.healthcaredesignmagazine.com/Webinars
Connect with our community…