Copper could help stop hospital-acquired infections
- Antimicrobial copper can kill 99.9 percent of bacteria within two hours
- About one in 25 people get a hospital-acquired infection on any given day
- Hospitals do not implement antimicrobial copper because it costs almost double stainless steel
Copper has many roles in society, from conducting electricity to wiring cars. It also can save lives.
Replacing commonly touched hospital surfaces such as doorknobs, light switches and bed rails with products made of copper can reduce hospital-acquired infections by more than half, according to a 2013 clinical trial at three U.S. hospitals funded by the Department of Defense.
Hospital-acquired infections are a big problem in health-care facilities, especially for immune-deficient cancer patients. One of every 25 hospital patients acquires such an infection, which kills nearly 100,000 people a year, according to the Centers for Disease Control and Prevention.
And the cost to the health-care system is $33 billion annually, according to the CDC.
Still, just 50 health-care facilities across the entire North American continent have bought copper products from the leading manufacturer, including the Cancer Treatment Centers of America in Goodyear. One major reason is the cost for the metal is much higher than standard materials.
“Think about all of the surfaces you touch on any given day,” said Tony Kulik, director of product manufacturer CuVerro. “Anywhere that you are touching a surface, there is an opportunity for bacteria to collect, and that bacteria can cause infections.”
How it works
Copper naturally kills bacteria because of its conductive properties. When bacteria lands on copper, an electric current punches holes in the outer membrane of the bacteria’s cell, which weakens its reproductive abilities and eventually kills the bacteria.
Pure copper is soft and malleable, which is why it can be molded into flexible electric wires. To give copper more durability, the metal is mixed with other elements to create copper alloys. The most common are brass and bronze.
In 2008, after years of research, the Environmental Protection Agency allowed manufacturers to say certain copper alloys can kill 99.9 percent of bacteria within two hours.
These alloys have to contain least 60 percent pure copper to be designated as antimicrobial and cannot be coated with any wax, gloss or paint.
The copper alloys are registered with the EPA in the same category as Lysol or Clorox; however, while those products can only make health claims for single applications, copper has ongoing antibacterial effects, said Adam Estelle, project engineer for the Copper Development Association, the copper-industry trade association.
“The stark difference between a technology like copper and everything else that hospitals are doing to reduce infections is there is no behavioral element involved in it beyond routine cleaning,” Estelle said.
Other sanitation practices include regular surface cleaning with antibacterial products, hand washing, the use of rubber gloves by hospital staff and proper disposal of hazardous waste and human fluids.
Use in Arizona
The Cancer Treatment Centers of America in Goodyear installed antimicrobial light switches, outlet covers, drawer handles and towel racks and grab bars in the bathrooms of 14 patient rooms in its new third-floor unit that opened in April 2014.
“Since we are a cancer hospital, our patients are high risk, so I thought this would be a great tool for us to provide our patients,” said Alan Swain, assistant vice president of general services at the cancer-treatment center.
Swain declined to say what the cost was to do that.
The new installations are supplements for infection control, not substitutes, so the cancer center can’t calculate the effect of the copper on infection rates. The facility continues its normal sanitation practices of hand-washing and surface cleaning, said Megan Crosser, the infection-prevention and -control practitioner at the cancer-treatment center.
Despite the immunodeficiency of cancer patients, the hospital has low rates of hospital-acquired infections because of their various efforts to fight bacteria, Crosser said.
“(The antimicrobial copper) is just one aspect of the many different measures we use here to try and protect our patients from getting an infection,” she said. “The risk of infection here is extremely low, specifically the transmission of infection between people.”
A part of the Affordable Care Act may give hospitals a greater incentive to invest in antimicrobial copper products. Under the act, the top 25 percent of hospitals with high hospital-acquired infections face 1 percent Medicare reimbursement cuts. The payment reduction took effect in October 2014.
More than 700 hospitals in the U.S. are affected by the reduction, which together costs them $330 million in Medicare payments. In Arizona, 13 hospitals received the payment reduction because of their rates of hospital-acquired infections, according to the Centers for Medicare and Medicaid Services.
“Hopefully, they would see the benefit in a material that kills bacteria, like copper, and think that this could be something they could do on the proactive, preventative side to help potentially avoid some of those financial penalties,” Estelle said.
High prices, tight budgets
Despite pressures from the health-care system, the main suppressor of the material’s growth is price, according to Sydney Smith, associate principal and senior vice president for the architecture company HKS Inc., which built Phoenix Children’s Hospital.
Copper products can cost 30 to 50 percent more than stainless steel, which is the most commonly used hospital surface, he said. And hospitals still have to buy the same amount of cleaning supplies, on top of the high premium for copper.
“The reality is, whether it is copper or solid surface or stainless steel, you still are required to clean those surfaces,” Smith said. “That is where the delicate balance comes into play. It is hard to get a facility to understand why they should even consider using a product that costs them more to install and they still have to clean.”
Prices vary depending on the product. The transition to copper cabinet handles and light switches might be only a few dollars, while replacing more advanced equipment — such as keyboards, stretcher beds and IV poles — is an expensive investment, CuVerro’s Kulik said.
David Cottle, vice president of planning, design and construction at Phoenix Children’s Hospital, said hospital officials need more education about what antimicrobial copper can do and proof that these substances are cost effective before they will pay the higher premium.
Like most health-care facilities, the children’s hospital has been affected by state budget cuts and declining reimbursement rates for Medicaid over the past few years. The hospital’s focus is opening beds to patients rather than investing in new sanitation products, Cottle said.
“It is a good theory, but when the cost per linear foot is really high, that is hard for an owner to swallow because today’s dollars are harder and harder to get for capital,” he said.
Expanding beyond health care
Health care is the focus of antimicrobial copper manufacturers, but they also market to other industries with bacteria-rich environments like public transportation, schools, restaurants and fitness facilities.
The Los Angeles Kings hockey team bought antimicrobial copper dumbbells in December 2014 from Black Iron Strength, a manufacturer of the CuVerro brand.
“I think it has the potential to really be a massive market,” Kulik said. “The benefit of what CuVerro can bring to the market is pretty endless.”
Hospitals in Arizona with the highest hospital-acquired infection rates
Data is collected by the Centers for Medicare and Medicaid Services. All hospitals are scored from 1 to 10 based on their infection rates between 2011 and 2014. Those with a score of 7.0 and higher as of October 2014 faced a 1 percent Medicare reimbursement cut.
- Maricopa Medical Center (10.0) — Phoenix.
- Phoenix Indian Medical Center (10.0) — Phoenix.
- Banner Ironwood Medical Center (9.0) — San Tan Valley.
- Mercy Gilbert Medical Center (9.0) — Gilbert.
- Sells Indian Health Service Hospital (8.9) — Sells.
- Banner-University Medical Center Tucson Campus (8.7) — Tucson.
- Tucson Medical Center (8.7) — Tucson.
- St. Joseph’s Hospital and Medical Center (8.4) — Phoenix.
- Arizona Orthopedic and Surgical Specialty Hospital (8.0) — Chandler.
- Florence Hospital at Anthem, LLC (8.0) — Florence.
- Banner Gateway Medical Center (7.7) — Gilbert.
- Northwest Medical Center (7.7) — Phoenix.
- St. Luke’s Medical Center (7.7) — Phoenix.
Source: Centers for Medicare and Medicaid Services