bacteria kills people copper kills bacteria
TRANSCRIPT
Bacteria Kills People
Copper Kills Bacteria
Todd Linden
President and CEO
Grinnell Regional Medical Center
Peter Sharpe
Vice President
Irwin P Sharpe and Associates
Why Copper Matters to a Hospital CEO
Because it matters to my board
It matters to my physicians
It matters to my CFO
and most importantly it matters to my patients
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
ldquoGo West Young Man Go Westrdquo
Home to Grinnell College
First Prepaid Health Plan 1921
We Are a Tweener
First Curve to Second Curve Markets
The Guardian reported Antibiotic-resistant bacteria with the potential to cause untreatable infections pose a catastrophic threat to the population the chief medical officer for Britain warns in a report calling for urgent action worldwide
How medicine is killing us all Antibiotics superbugs and the next global pandemic
In The News
Antibiotic Resistant Bacteria
Klebsiella pneumoniae Methicillin-resistant
Staphylococcus aureus Clostridium difficile
Extensively Drug Resistant Tuberculosis Drug-resistant Gonorrhea Shiga toxin-producing Escherichia coli
According to the CDC this particular class of superbug called carbapenem-resistant
Enterobacteriaceae or CRE has been found only in hospitals or nursing homes rather than in the community
Nearly All Antibiotics Are Now Obsolete
In the last 34 years Big Pharma has only come up with two new classes of antibiotics Both are now obsolete
Antibiotic sales for livestock rose 16 percent between 2009 and 2012 More sub-therapeutic antibiotic is used in Iowa for livestock production than used to tread humans in the entire USA
Record-High Sales of
Antibiotics for
Livestock Production
In The News
Between 5 and 10 of patients admitted to hospitals in developed countries contract at least one hospital-acquired infection during their stay
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
Hospital Associated Infections (HAIs)
Hospital Associated Infections (HAIs)
The cost of HAIs
bull 2 Million infectionsyear
bull 100000 deathsyear
bull $45 Billion ndash annual cost to treat infections
bull Antibiotics becoming less effective and new ones not being developed fast enough
Direct cost of HAIs for typical hospital is $8 million per year to treat infections dagger
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
daggerSource American Hospital Association ldquoFast Facts on Hospitalsrdquo fileCUsersbxmea1Downloads101207fastfactspdf 2012 AHA Annual Survey
Hospital Associated Infections (HAIs)
HAIs add on average $43000 to hospital charges
Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
WITH HAI
NO HAI $9377
$52096
Hospital Associated Infections (HAIs)
Readmissions due to HAIs wonrsquot be reimbursed
Patients that developed clinical cultures for MRSA VRE or C difficile during hospital stay were 60 percent more likely to be readmitted within 30 days than patients with negative or no clinical cultures Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
Readmission Penalties
Hospital-Acquired Conditions
Beginning in FY 2015 adds a 1 percent penalty to hospitals in the top quartile
of rates of Hospital-Acquired Conditions resulting in reductions in payment of $15 billion over 10 years
ldquoSince both in importance and time health precedes disease so we ought to consider first how health may best be preserved and then how one may best cure diseaserdquo
-Galen of Pergamon
C170 AD
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Why Copper Matters to a Hospital CEO
Because it matters to my board
It matters to my physicians
It matters to my CFO
and most importantly it matters to my patients
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
ldquoGo West Young Man Go Westrdquo
Home to Grinnell College
First Prepaid Health Plan 1921
We Are a Tweener
First Curve to Second Curve Markets
The Guardian reported Antibiotic-resistant bacteria with the potential to cause untreatable infections pose a catastrophic threat to the population the chief medical officer for Britain warns in a report calling for urgent action worldwide
How medicine is killing us all Antibiotics superbugs and the next global pandemic
In The News
Antibiotic Resistant Bacteria
Klebsiella pneumoniae Methicillin-resistant
Staphylococcus aureus Clostridium difficile
Extensively Drug Resistant Tuberculosis Drug-resistant Gonorrhea Shiga toxin-producing Escherichia coli
According to the CDC this particular class of superbug called carbapenem-resistant
Enterobacteriaceae or CRE has been found only in hospitals or nursing homes rather than in the community
Nearly All Antibiotics Are Now Obsolete
In the last 34 years Big Pharma has only come up with two new classes of antibiotics Both are now obsolete
Antibiotic sales for livestock rose 16 percent between 2009 and 2012 More sub-therapeutic antibiotic is used in Iowa for livestock production than used to tread humans in the entire USA
Record-High Sales of
Antibiotics for
Livestock Production
In The News
Between 5 and 10 of patients admitted to hospitals in developed countries contract at least one hospital-acquired infection during their stay
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
Hospital Associated Infections (HAIs)
Hospital Associated Infections (HAIs)
The cost of HAIs
bull 2 Million infectionsyear
bull 100000 deathsyear
bull $45 Billion ndash annual cost to treat infections
bull Antibiotics becoming less effective and new ones not being developed fast enough
Direct cost of HAIs for typical hospital is $8 million per year to treat infections dagger
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
daggerSource American Hospital Association ldquoFast Facts on Hospitalsrdquo fileCUsersbxmea1Downloads101207fastfactspdf 2012 AHA Annual Survey
Hospital Associated Infections (HAIs)
HAIs add on average $43000 to hospital charges
Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
WITH HAI
NO HAI $9377
$52096
Hospital Associated Infections (HAIs)
Readmissions due to HAIs wonrsquot be reimbursed
Patients that developed clinical cultures for MRSA VRE or C difficile during hospital stay were 60 percent more likely to be readmitted within 30 days than patients with negative or no clinical cultures Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
Readmission Penalties
Hospital-Acquired Conditions
Beginning in FY 2015 adds a 1 percent penalty to hospitals in the top quartile
of rates of Hospital-Acquired Conditions resulting in reductions in payment of $15 billion over 10 years
ldquoSince both in importance and time health precedes disease so we ought to consider first how health may best be preserved and then how one may best cure diseaserdquo
-Galen of Pergamon
C170 AD
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
ldquoGo West Young Man Go Westrdquo
Home to Grinnell College
First Prepaid Health Plan 1921
We Are a Tweener
First Curve to Second Curve Markets
The Guardian reported Antibiotic-resistant bacteria with the potential to cause untreatable infections pose a catastrophic threat to the population the chief medical officer for Britain warns in a report calling for urgent action worldwide
How medicine is killing us all Antibiotics superbugs and the next global pandemic
In The News
Antibiotic Resistant Bacteria
Klebsiella pneumoniae Methicillin-resistant
Staphylococcus aureus Clostridium difficile
Extensively Drug Resistant Tuberculosis Drug-resistant Gonorrhea Shiga toxin-producing Escherichia coli
According to the CDC this particular class of superbug called carbapenem-resistant
Enterobacteriaceae or CRE has been found only in hospitals or nursing homes rather than in the community
Nearly All Antibiotics Are Now Obsolete
In the last 34 years Big Pharma has only come up with two new classes of antibiotics Both are now obsolete
Antibiotic sales for livestock rose 16 percent between 2009 and 2012 More sub-therapeutic antibiotic is used in Iowa for livestock production than used to tread humans in the entire USA
Record-High Sales of
Antibiotics for
Livestock Production
In The News
Between 5 and 10 of patients admitted to hospitals in developed countries contract at least one hospital-acquired infection during their stay
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
Hospital Associated Infections (HAIs)
Hospital Associated Infections (HAIs)
The cost of HAIs
bull 2 Million infectionsyear
bull 100000 deathsyear
bull $45 Billion ndash annual cost to treat infections
bull Antibiotics becoming less effective and new ones not being developed fast enough
Direct cost of HAIs for typical hospital is $8 million per year to treat infections dagger
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
daggerSource American Hospital Association ldquoFast Facts on Hospitalsrdquo fileCUsersbxmea1Downloads101207fastfactspdf 2012 AHA Annual Survey
Hospital Associated Infections (HAIs)
HAIs add on average $43000 to hospital charges
Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
WITH HAI
NO HAI $9377
$52096
Hospital Associated Infections (HAIs)
Readmissions due to HAIs wonrsquot be reimbursed
Patients that developed clinical cultures for MRSA VRE or C difficile during hospital stay were 60 percent more likely to be readmitted within 30 days than patients with negative or no clinical cultures Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
Readmission Penalties
Hospital-Acquired Conditions
Beginning in FY 2015 adds a 1 percent penalty to hospitals in the top quartile
of rates of Hospital-Acquired Conditions resulting in reductions in payment of $15 billion over 10 years
ldquoSince both in importance and time health precedes disease so we ought to consider first how health may best be preserved and then how one may best cure diseaserdquo
-Galen of Pergamon
C170 AD
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
ldquoGo West Young Man Go Westrdquo
Home to Grinnell College
First Prepaid Health Plan 1921
We Are a Tweener
First Curve to Second Curve Markets
The Guardian reported Antibiotic-resistant bacteria with the potential to cause untreatable infections pose a catastrophic threat to the population the chief medical officer for Britain warns in a report calling for urgent action worldwide
How medicine is killing us all Antibiotics superbugs and the next global pandemic
In The News
Antibiotic Resistant Bacteria
Klebsiella pneumoniae Methicillin-resistant
Staphylococcus aureus Clostridium difficile
Extensively Drug Resistant Tuberculosis Drug-resistant Gonorrhea Shiga toxin-producing Escherichia coli
According to the CDC this particular class of superbug called carbapenem-resistant
Enterobacteriaceae or CRE has been found only in hospitals or nursing homes rather than in the community
Nearly All Antibiotics Are Now Obsolete
In the last 34 years Big Pharma has only come up with two new classes of antibiotics Both are now obsolete
Antibiotic sales for livestock rose 16 percent between 2009 and 2012 More sub-therapeutic antibiotic is used in Iowa for livestock production than used to tread humans in the entire USA
Record-High Sales of
Antibiotics for
Livestock Production
In The News
Between 5 and 10 of patients admitted to hospitals in developed countries contract at least one hospital-acquired infection during their stay
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
Hospital Associated Infections (HAIs)
Hospital Associated Infections (HAIs)
The cost of HAIs
bull 2 Million infectionsyear
bull 100000 deathsyear
bull $45 Billion ndash annual cost to treat infections
bull Antibiotics becoming less effective and new ones not being developed fast enough
Direct cost of HAIs for typical hospital is $8 million per year to treat infections dagger
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
daggerSource American Hospital Association ldquoFast Facts on Hospitalsrdquo fileCUsersbxmea1Downloads101207fastfactspdf 2012 AHA Annual Survey
Hospital Associated Infections (HAIs)
HAIs add on average $43000 to hospital charges
Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
WITH HAI
NO HAI $9377
$52096
Hospital Associated Infections (HAIs)
Readmissions due to HAIs wonrsquot be reimbursed
Patients that developed clinical cultures for MRSA VRE or C difficile during hospital stay were 60 percent more likely to be readmitted within 30 days than patients with negative or no clinical cultures Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
Readmission Penalties
Hospital-Acquired Conditions
Beginning in FY 2015 adds a 1 percent penalty to hospitals in the top quartile
of rates of Hospital-Acquired Conditions resulting in reductions in payment of $15 billion over 10 years
ldquoSince both in importance and time health precedes disease so we ought to consider first how health may best be preserved and then how one may best cure diseaserdquo
-Galen of Pergamon
C170 AD
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
We Are a Tweener
First Curve to Second Curve Markets
The Guardian reported Antibiotic-resistant bacteria with the potential to cause untreatable infections pose a catastrophic threat to the population the chief medical officer for Britain warns in a report calling for urgent action worldwide
How medicine is killing us all Antibiotics superbugs and the next global pandemic
In The News
Antibiotic Resistant Bacteria
Klebsiella pneumoniae Methicillin-resistant
Staphylococcus aureus Clostridium difficile
Extensively Drug Resistant Tuberculosis Drug-resistant Gonorrhea Shiga toxin-producing Escherichia coli
According to the CDC this particular class of superbug called carbapenem-resistant
Enterobacteriaceae or CRE has been found only in hospitals or nursing homes rather than in the community
Nearly All Antibiotics Are Now Obsolete
In the last 34 years Big Pharma has only come up with two new classes of antibiotics Both are now obsolete
Antibiotic sales for livestock rose 16 percent between 2009 and 2012 More sub-therapeutic antibiotic is used in Iowa for livestock production than used to tread humans in the entire USA
Record-High Sales of
Antibiotics for
Livestock Production
In The News
Between 5 and 10 of patients admitted to hospitals in developed countries contract at least one hospital-acquired infection during their stay
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
Hospital Associated Infections (HAIs)
Hospital Associated Infections (HAIs)
The cost of HAIs
bull 2 Million infectionsyear
bull 100000 deathsyear
bull $45 Billion ndash annual cost to treat infections
bull Antibiotics becoming less effective and new ones not being developed fast enough
Direct cost of HAIs for typical hospital is $8 million per year to treat infections dagger
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
daggerSource American Hospital Association ldquoFast Facts on Hospitalsrdquo fileCUsersbxmea1Downloads101207fastfactspdf 2012 AHA Annual Survey
Hospital Associated Infections (HAIs)
HAIs add on average $43000 to hospital charges
Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
WITH HAI
NO HAI $9377
$52096
Hospital Associated Infections (HAIs)
Readmissions due to HAIs wonrsquot be reimbursed
Patients that developed clinical cultures for MRSA VRE or C difficile during hospital stay were 60 percent more likely to be readmitted within 30 days than patients with negative or no clinical cultures Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
Readmission Penalties
Hospital-Acquired Conditions
Beginning in FY 2015 adds a 1 percent penalty to hospitals in the top quartile
of rates of Hospital-Acquired Conditions resulting in reductions in payment of $15 billion over 10 years
ldquoSince both in importance and time health precedes disease so we ought to consider first how health may best be preserved and then how one may best cure diseaserdquo
-Galen of Pergamon
C170 AD
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
First Curve to Second Curve Markets
The Guardian reported Antibiotic-resistant bacteria with the potential to cause untreatable infections pose a catastrophic threat to the population the chief medical officer for Britain warns in a report calling for urgent action worldwide
How medicine is killing us all Antibiotics superbugs and the next global pandemic
In The News
Antibiotic Resistant Bacteria
Klebsiella pneumoniae Methicillin-resistant
Staphylococcus aureus Clostridium difficile
Extensively Drug Resistant Tuberculosis Drug-resistant Gonorrhea Shiga toxin-producing Escherichia coli
According to the CDC this particular class of superbug called carbapenem-resistant
Enterobacteriaceae or CRE has been found only in hospitals or nursing homes rather than in the community
Nearly All Antibiotics Are Now Obsolete
In the last 34 years Big Pharma has only come up with two new classes of antibiotics Both are now obsolete
Antibiotic sales for livestock rose 16 percent between 2009 and 2012 More sub-therapeutic antibiotic is used in Iowa for livestock production than used to tread humans in the entire USA
Record-High Sales of
Antibiotics for
Livestock Production
In The News
Between 5 and 10 of patients admitted to hospitals in developed countries contract at least one hospital-acquired infection during their stay
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
Hospital Associated Infections (HAIs)
Hospital Associated Infections (HAIs)
The cost of HAIs
bull 2 Million infectionsyear
bull 100000 deathsyear
bull $45 Billion ndash annual cost to treat infections
bull Antibiotics becoming less effective and new ones not being developed fast enough
Direct cost of HAIs for typical hospital is $8 million per year to treat infections dagger
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
daggerSource American Hospital Association ldquoFast Facts on Hospitalsrdquo fileCUsersbxmea1Downloads101207fastfactspdf 2012 AHA Annual Survey
Hospital Associated Infections (HAIs)
HAIs add on average $43000 to hospital charges
Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
WITH HAI
NO HAI $9377
$52096
Hospital Associated Infections (HAIs)
Readmissions due to HAIs wonrsquot be reimbursed
Patients that developed clinical cultures for MRSA VRE or C difficile during hospital stay were 60 percent more likely to be readmitted within 30 days than patients with negative or no clinical cultures Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
Readmission Penalties
Hospital-Acquired Conditions
Beginning in FY 2015 adds a 1 percent penalty to hospitals in the top quartile
of rates of Hospital-Acquired Conditions resulting in reductions in payment of $15 billion over 10 years
ldquoSince both in importance and time health precedes disease so we ought to consider first how health may best be preserved and then how one may best cure diseaserdquo
-Galen of Pergamon
C170 AD
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
The Guardian reported Antibiotic-resistant bacteria with the potential to cause untreatable infections pose a catastrophic threat to the population the chief medical officer for Britain warns in a report calling for urgent action worldwide
How medicine is killing us all Antibiotics superbugs and the next global pandemic
In The News
Antibiotic Resistant Bacteria
Klebsiella pneumoniae Methicillin-resistant
Staphylococcus aureus Clostridium difficile
Extensively Drug Resistant Tuberculosis Drug-resistant Gonorrhea Shiga toxin-producing Escherichia coli
According to the CDC this particular class of superbug called carbapenem-resistant
Enterobacteriaceae or CRE has been found only in hospitals or nursing homes rather than in the community
Nearly All Antibiotics Are Now Obsolete
In the last 34 years Big Pharma has only come up with two new classes of antibiotics Both are now obsolete
Antibiotic sales for livestock rose 16 percent between 2009 and 2012 More sub-therapeutic antibiotic is used in Iowa for livestock production than used to tread humans in the entire USA
Record-High Sales of
Antibiotics for
Livestock Production
In The News
Between 5 and 10 of patients admitted to hospitals in developed countries contract at least one hospital-acquired infection during their stay
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
Hospital Associated Infections (HAIs)
Hospital Associated Infections (HAIs)
The cost of HAIs
bull 2 Million infectionsyear
bull 100000 deathsyear
bull $45 Billion ndash annual cost to treat infections
bull Antibiotics becoming less effective and new ones not being developed fast enough
Direct cost of HAIs for typical hospital is $8 million per year to treat infections dagger
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
daggerSource American Hospital Association ldquoFast Facts on Hospitalsrdquo fileCUsersbxmea1Downloads101207fastfactspdf 2012 AHA Annual Survey
Hospital Associated Infections (HAIs)
HAIs add on average $43000 to hospital charges
Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
WITH HAI
NO HAI $9377
$52096
Hospital Associated Infections (HAIs)
Readmissions due to HAIs wonrsquot be reimbursed
Patients that developed clinical cultures for MRSA VRE or C difficile during hospital stay were 60 percent more likely to be readmitted within 30 days than patients with negative or no clinical cultures Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
Readmission Penalties
Hospital-Acquired Conditions
Beginning in FY 2015 adds a 1 percent penalty to hospitals in the top quartile
of rates of Hospital-Acquired Conditions resulting in reductions in payment of $15 billion over 10 years
ldquoSince both in importance and time health precedes disease so we ought to consider first how health may best be preserved and then how one may best cure diseaserdquo
-Galen of Pergamon
C170 AD
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Antibiotic Resistant Bacteria
Klebsiella pneumoniae Methicillin-resistant
Staphylococcus aureus Clostridium difficile
Extensively Drug Resistant Tuberculosis Drug-resistant Gonorrhea Shiga toxin-producing Escherichia coli
According to the CDC this particular class of superbug called carbapenem-resistant
Enterobacteriaceae or CRE has been found only in hospitals or nursing homes rather than in the community
Nearly All Antibiotics Are Now Obsolete
In the last 34 years Big Pharma has only come up with two new classes of antibiotics Both are now obsolete
Antibiotic sales for livestock rose 16 percent between 2009 and 2012 More sub-therapeutic antibiotic is used in Iowa for livestock production than used to tread humans in the entire USA
Record-High Sales of
Antibiotics for
Livestock Production
In The News
Between 5 and 10 of patients admitted to hospitals in developed countries contract at least one hospital-acquired infection during their stay
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
Hospital Associated Infections (HAIs)
Hospital Associated Infections (HAIs)
The cost of HAIs
bull 2 Million infectionsyear
bull 100000 deathsyear
bull $45 Billion ndash annual cost to treat infections
bull Antibiotics becoming less effective and new ones not being developed fast enough
Direct cost of HAIs for typical hospital is $8 million per year to treat infections dagger
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
daggerSource American Hospital Association ldquoFast Facts on Hospitalsrdquo fileCUsersbxmea1Downloads101207fastfactspdf 2012 AHA Annual Survey
Hospital Associated Infections (HAIs)
HAIs add on average $43000 to hospital charges
Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
WITH HAI
NO HAI $9377
$52096
Hospital Associated Infections (HAIs)
Readmissions due to HAIs wonrsquot be reimbursed
Patients that developed clinical cultures for MRSA VRE or C difficile during hospital stay were 60 percent more likely to be readmitted within 30 days than patients with negative or no clinical cultures Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
Readmission Penalties
Hospital-Acquired Conditions
Beginning in FY 2015 adds a 1 percent penalty to hospitals in the top quartile
of rates of Hospital-Acquired Conditions resulting in reductions in payment of $15 billion over 10 years
ldquoSince both in importance and time health precedes disease so we ought to consider first how health may best be preserved and then how one may best cure diseaserdquo
-Galen of Pergamon
C170 AD
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
According to the CDC this particular class of superbug called carbapenem-resistant
Enterobacteriaceae or CRE has been found only in hospitals or nursing homes rather than in the community
Nearly All Antibiotics Are Now Obsolete
In the last 34 years Big Pharma has only come up with two new classes of antibiotics Both are now obsolete
Antibiotic sales for livestock rose 16 percent between 2009 and 2012 More sub-therapeutic antibiotic is used in Iowa for livestock production than used to tread humans in the entire USA
Record-High Sales of
Antibiotics for
Livestock Production
In The News
Between 5 and 10 of patients admitted to hospitals in developed countries contract at least one hospital-acquired infection during their stay
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
Hospital Associated Infections (HAIs)
Hospital Associated Infections (HAIs)
The cost of HAIs
bull 2 Million infectionsyear
bull 100000 deathsyear
bull $45 Billion ndash annual cost to treat infections
bull Antibiotics becoming less effective and new ones not being developed fast enough
Direct cost of HAIs for typical hospital is $8 million per year to treat infections dagger
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
daggerSource American Hospital Association ldquoFast Facts on Hospitalsrdquo fileCUsersbxmea1Downloads101207fastfactspdf 2012 AHA Annual Survey
Hospital Associated Infections (HAIs)
HAIs add on average $43000 to hospital charges
Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
WITH HAI
NO HAI $9377
$52096
Hospital Associated Infections (HAIs)
Readmissions due to HAIs wonrsquot be reimbursed
Patients that developed clinical cultures for MRSA VRE or C difficile during hospital stay were 60 percent more likely to be readmitted within 30 days than patients with negative or no clinical cultures Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
Readmission Penalties
Hospital-Acquired Conditions
Beginning in FY 2015 adds a 1 percent penalty to hospitals in the top quartile
of rates of Hospital-Acquired Conditions resulting in reductions in payment of $15 billion over 10 years
ldquoSince both in importance and time health precedes disease so we ought to consider first how health may best be preserved and then how one may best cure diseaserdquo
-Galen of Pergamon
C170 AD
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Nearly All Antibiotics Are Now Obsolete
In the last 34 years Big Pharma has only come up with two new classes of antibiotics Both are now obsolete
Antibiotic sales for livestock rose 16 percent between 2009 and 2012 More sub-therapeutic antibiotic is used in Iowa for livestock production than used to tread humans in the entire USA
Record-High Sales of
Antibiotics for
Livestock Production
In The News
Between 5 and 10 of patients admitted to hospitals in developed countries contract at least one hospital-acquired infection during their stay
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
Hospital Associated Infections (HAIs)
Hospital Associated Infections (HAIs)
The cost of HAIs
bull 2 Million infectionsyear
bull 100000 deathsyear
bull $45 Billion ndash annual cost to treat infections
bull Antibiotics becoming less effective and new ones not being developed fast enough
Direct cost of HAIs for typical hospital is $8 million per year to treat infections dagger
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
daggerSource American Hospital Association ldquoFast Facts on Hospitalsrdquo fileCUsersbxmea1Downloads101207fastfactspdf 2012 AHA Annual Survey
Hospital Associated Infections (HAIs)
HAIs add on average $43000 to hospital charges
Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
WITH HAI
NO HAI $9377
$52096
Hospital Associated Infections (HAIs)
Readmissions due to HAIs wonrsquot be reimbursed
Patients that developed clinical cultures for MRSA VRE or C difficile during hospital stay were 60 percent more likely to be readmitted within 30 days than patients with negative or no clinical cultures Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
Readmission Penalties
Hospital-Acquired Conditions
Beginning in FY 2015 adds a 1 percent penalty to hospitals in the top quartile
of rates of Hospital-Acquired Conditions resulting in reductions in payment of $15 billion over 10 years
ldquoSince both in importance and time health precedes disease so we ought to consider first how health may best be preserved and then how one may best cure diseaserdquo
-Galen of Pergamon
C170 AD
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Antibiotic sales for livestock rose 16 percent between 2009 and 2012 More sub-therapeutic antibiotic is used in Iowa for livestock production than used to tread humans in the entire USA
Record-High Sales of
Antibiotics for
Livestock Production
In The News
Between 5 and 10 of patients admitted to hospitals in developed countries contract at least one hospital-acquired infection during their stay
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
Hospital Associated Infections (HAIs)
Hospital Associated Infections (HAIs)
The cost of HAIs
bull 2 Million infectionsyear
bull 100000 deathsyear
bull $45 Billion ndash annual cost to treat infections
bull Antibiotics becoming less effective and new ones not being developed fast enough
Direct cost of HAIs for typical hospital is $8 million per year to treat infections dagger
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
daggerSource American Hospital Association ldquoFast Facts on Hospitalsrdquo fileCUsersbxmea1Downloads101207fastfactspdf 2012 AHA Annual Survey
Hospital Associated Infections (HAIs)
HAIs add on average $43000 to hospital charges
Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
WITH HAI
NO HAI $9377
$52096
Hospital Associated Infections (HAIs)
Readmissions due to HAIs wonrsquot be reimbursed
Patients that developed clinical cultures for MRSA VRE or C difficile during hospital stay were 60 percent more likely to be readmitted within 30 days than patients with negative or no clinical cultures Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
Readmission Penalties
Hospital-Acquired Conditions
Beginning in FY 2015 adds a 1 percent penalty to hospitals in the top quartile
of rates of Hospital-Acquired Conditions resulting in reductions in payment of $15 billion over 10 years
ldquoSince both in importance and time health precedes disease so we ought to consider first how health may best be preserved and then how one may best cure diseaserdquo
-Galen of Pergamon
C170 AD
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Between 5 and 10 of patients admitted to hospitals in developed countries contract at least one hospital-acquired infection during their stay
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
Hospital Associated Infections (HAIs)
Hospital Associated Infections (HAIs)
The cost of HAIs
bull 2 Million infectionsyear
bull 100000 deathsyear
bull $45 Billion ndash annual cost to treat infections
bull Antibiotics becoming less effective and new ones not being developed fast enough
Direct cost of HAIs for typical hospital is $8 million per year to treat infections dagger
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
daggerSource American Hospital Association ldquoFast Facts on Hospitalsrdquo fileCUsersbxmea1Downloads101207fastfactspdf 2012 AHA Annual Survey
Hospital Associated Infections (HAIs)
HAIs add on average $43000 to hospital charges
Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
WITH HAI
NO HAI $9377
$52096
Hospital Associated Infections (HAIs)
Readmissions due to HAIs wonrsquot be reimbursed
Patients that developed clinical cultures for MRSA VRE or C difficile during hospital stay were 60 percent more likely to be readmitted within 30 days than patients with negative or no clinical cultures Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
Readmission Penalties
Hospital-Acquired Conditions
Beginning in FY 2015 adds a 1 percent penalty to hospitals in the top quartile
of rates of Hospital-Acquired Conditions resulting in reductions in payment of $15 billion over 10 years
ldquoSince both in importance and time health precedes disease so we ought to consider first how health may best be preserved and then how one may best cure diseaserdquo
-Galen of Pergamon
C170 AD
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Hospital Associated Infections (HAIs)
The cost of HAIs
bull 2 Million infectionsyear
bull 100000 deathsyear
bull $45 Billion ndash annual cost to treat infections
bull Antibiotics becoming less effective and new ones not being developed fast enough
Direct cost of HAIs for typical hospital is $8 million per year to treat infections dagger
Source Centers for Disease Control and Prevention ldquoThe Direct Medical Costs of Healthcare-Associated Infections in US Hospitals and the Benefits of Preventionrdquo httpwwwcdcgovHAIpdfshaiScott_CostPaperpdf March 2009
daggerSource American Hospital Association ldquoFast Facts on Hospitalsrdquo fileCUsersbxmea1Downloads101207fastfactspdf 2012 AHA Annual Survey
Hospital Associated Infections (HAIs)
HAIs add on average $43000 to hospital charges
Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
WITH HAI
NO HAI $9377
$52096
Hospital Associated Infections (HAIs)
Readmissions due to HAIs wonrsquot be reimbursed
Patients that developed clinical cultures for MRSA VRE or C difficile during hospital stay were 60 percent more likely to be readmitted within 30 days than patients with negative or no clinical cultures Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
Readmission Penalties
Hospital-Acquired Conditions
Beginning in FY 2015 adds a 1 percent penalty to hospitals in the top quartile
of rates of Hospital-Acquired Conditions resulting in reductions in payment of $15 billion over 10 years
ldquoSince both in importance and time health precedes disease so we ought to consider first how health may best be preserved and then how one may best cure diseaserdquo
-Galen of Pergamon
C170 AD
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Hospital Associated Infections (HAIs)
HAIs add on average $43000 to hospital charges
Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
WITH HAI
NO HAI $9377
$52096
Hospital Associated Infections (HAIs)
Readmissions due to HAIs wonrsquot be reimbursed
Patients that developed clinical cultures for MRSA VRE or C difficile during hospital stay were 60 percent more likely to be readmitted within 30 days than patients with negative or no clinical cultures Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
Readmission Penalties
Hospital-Acquired Conditions
Beginning in FY 2015 adds a 1 percent penalty to hospitals in the top quartile
of rates of Hospital-Acquired Conditions resulting in reductions in payment of $15 billion over 10 years
ldquoSince both in importance and time health precedes disease so we ought to consider first how health may best be preserved and then how one may best cure diseaserdquo
-Galen of Pergamon
C170 AD
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Hospital Associated Infections (HAIs)
Readmissions due to HAIs wonrsquot be reimbursed
Patients that developed clinical cultures for MRSA VRE or C difficile during hospital stay were 60 percent more likely to be readmitted within 30 days than patients with negative or no clinical cultures Source Kirkland KB Briggs JP Trivette SL Wilkinson WE Sexton DJ The impact of surgical site infections in the 1990s attributable mortality excess length of hospitalization and extra costs Infect Control Hosp Epidemiol 199920725-30
Readmission Penalties
Hospital-Acquired Conditions
Beginning in FY 2015 adds a 1 percent penalty to hospitals in the top quartile
of rates of Hospital-Acquired Conditions resulting in reductions in payment of $15 billion over 10 years
ldquoSince both in importance and time health precedes disease so we ought to consider first how health may best be preserved and then how one may best cure diseaserdquo
-Galen of Pergamon
C170 AD
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Readmission Penalties
Hospital-Acquired Conditions
Beginning in FY 2015 adds a 1 percent penalty to hospitals in the top quartile
of rates of Hospital-Acquired Conditions resulting in reductions in payment of $15 billion over 10 years
ldquoSince both in importance and time health precedes disease so we ought to consider first how health may best be preserved and then how one may best cure diseaserdquo
-Galen of Pergamon
C170 AD
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Hospital-Acquired Conditions
Beginning in FY 2015 adds a 1 percent penalty to hospitals in the top quartile
of rates of Hospital-Acquired Conditions resulting in reductions in payment of $15 billion over 10 years
ldquoSince both in importance and time health precedes disease so we ought to consider first how health may best be preserved and then how one may best cure diseaserdquo
-Galen of Pergamon
C170 AD
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
ldquoSince both in importance and time health precedes disease so we ought to consider first how health may best be preserved and then how one may best cure diseaserdquo
-Galen of Pergamon
C170 AD
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
-Galen of Pergamon
C170 AD
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Contaminated Surfaces
Susceptible Patients
Hands of Healthcare workers
Family Visitors
Infected Patients
Transmission of Infectious Bacteria
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Use All Available Options
Wash Hands Clean
Disinfect Alcohol gels
Protect
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
BUSINESS CASE bull Hand Hygiene
bull Chemical cleaners amp disinfectants
bull Inherently bactericidal surfaces
bull Extended Cleaning with Robots
bull Ultraviolet
bull Hydrogen Peroxide
Proposed Solutions for Clean Hospital Environments
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Text
Transmission of Infectious Bacteria
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
bull Why we clean
bull When we clean
bull How well we clean
bull What is a ldquosaferdquo level of risk
Putting Cleaning in Perspective
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Lower RISK of transmission
Eliminate Bacteria
Fewer infections
Better outcomes
amp lower costs
Why We Clean
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Evaluating Patient Zone Environmental Hygiene
in view of evidence that transmission of many healthcare acquired pathogens is related to
contamination of near patient surfaces and equipment
hospitals should develop programs to optimize the thoroughness of high touch surface cleaning as part of
terminal room cleaning at the time of patient discharge or transfer
When We Clean
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Daily Cleaning
When We Clean
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Terminal Cleaning
When We Clean
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Bacterial Contamination
Even though healthcare equipment and furnishings are designed to be easily cleanedhellip
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Dr Carling IL Dept of Public Health
How Well We Clean
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
How Well We Clean
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Kramer A BMC Infectious Diseases 20066130
Type of bacterium Duration of persistence
Acinetobacter 3 days - 5 months
Clostridium difficle (spores) 5 months
Escherichia coli 15 hours - 16 months
Enterococcus spp incl VRE and VSE
5 days - 4 months
Norovirus 3 weeks
Rotovirus 3 months
Listeria spp 1 day - months
Pseudomonas aeruginosa 6 hours - 16 months
Salmonella typhi 6 hours - 4 weeks
Staphylococus aureus incl MRSA
7 days - 7 months
How Long Pathogens Survive in Hospital Environment
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Increased Risk from Prior Room Occupant
Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants
Admission to intensive care unit rooms previously occupied by carriers of methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enteroccoci (VRE) had been found to confer a 40 increased risk of acquisition
Arch Intern Med 2011 Mar 28171(6)491-4 doi 101001archinternmed201164
Datta R1 Platt R Yokoe DS Huang SS
Risk of Acquiring Antibiotic-Resistant Bacteria From Prior Room Occupants FREE
We found a 40 increased odds of transmission of MRSA and VRE attributable to the carrier status of prior room occupants strongly suggesting a role for environmental contamination despite room cleaning methods that exceeded national standards Susan S Huang MD MPH Rupak Datta BS Richard Platt MD MS
Arch Intern Med 2006166(18)1945-1951 doi101001archinte166181945
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Looking Clean Isnrsquot Enough
Griffith CJ Cooper RA Gilmore J Davies C Lewis M An evaluation of hospital
cleaning regimes and standards J Hosp Infect 2000 45 19ndash28
httpinfectionthelancetcom Vol8 February2008
Visibly Clean
82 - 91
Microbiologically
Clean
30 - 45
Free from organic
soil
10 - 24
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
ldquoThe current research fits into the growing body of
evidence that the hospital environment is dirty is
not being cleaned well enough and that this failure
to clean the environment is leading to hospital-
acquired infections and deathsrdquo
Edmond A Hooker MD DrPHof the department of health services
administration at Xavier University Cincinnati
ldquoHospitals must stop ignoring the hospital
environment as the source of hospital acquired
infections (HAIs)rdquo
We Clean
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Whatrsquos the Level of Risk
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Whatrsquos the Level of Risk
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
How clean is clean Proposed methods for hospital cleaning assessment 1 A Al-Hamada S Maxwellb
Journal of Hospital Infection Volume 70 Issue 4 December 2008 Pages 328ndash334
Whatrsquos the Level of Risk
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
bullHand washing under 50 compliance bullDaily Cleaning Not thorough enough with patient in room bullTerminal Cleaning
Not often enough (avg every 5 days) Not thorough enough gt50 of time
bullSupplemental Cleaning Not often enough (Only after terminal cleaning) Additional resources (Equipment PTE Training) Rooms out of service for 2-6 hours
bullPathogens survive for weeks to months
Current Environment of Care (EOC)
People shed gt 1 million skin cells per day (Patients staff visitors)
bullCurrent protocols are not working HAI are still a problem Bacteria levels exceed accepted levels of risk
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Is Built Environment a Source for Infections
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Cleaner Hospitals with Copper Alloys
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
ldquoalthough the evidence remains suboptimal a number of high-
quality investigations now support environmental disinfection
as a control strategy And based on these data current
guidelines for pathogens such as C difficile MRSA VRE and
norovirus emphasize the importance of environmental
disinfection as a control measurerdquo
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Bacterial Contamination hellipcleaning does not kill all bacteria
(Electron microscope photo shows live bacteria in a scratch on recently sanitized stainless steel surface) - ldquoFormation of Biofilms by Listeria monocytogenes under Various Growth Conditionsrdquo Amy Wong Food Research Institute University of Wisconsin January 2005 Journal of Food Protection
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Bacterial Contamination Growing evidence is showing thathellip
hellipcopper surfaces have the ability to continually kill bacteria between scheduled cleanings Source GRMC preliminary data
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
How Copper Alloys Might Help Improve EOC
bull Inherent ability to kill bacteria
bullEPA Registered for public health claims
bullSupplement regular cleaning
bullContinuously active between cleanings24 hours a day
bullAfter installation
Do not rely on active human intervention
No additional PTEs
No special training
bullProven effectiveness
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
EPA-Required Efficacy Testing
EPA only allows companies to make public health claims for products approved and registered by EPA
EPA requires that Antimicrobials
bull Demonstrate efficacy
bull Present no harm to human health
bull Present no harm to environment
bull Be registered and labeled according to EPA guidelines
55
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
EPA Efficacy Test 1 ndash Kill bacteria within 2 hours
Source Environmental Protection Agency ldquoTest Method for Efficacy of Copper alloy Surfaces as a Sanitizerrdquo httpcuverrocomsitesdefaultfilestest_method_copper_alloy_surfaces_as_sanitizerspdf
EPA-Required Efficacy Testing
56
120
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
EPA Efficacy Test 2 ndash Permanence
Efficacy Will Not Wear Away
(Itrsquos solid metal)
EPA-Required Efficacy Testing
57
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
An Evidence Based Design Approach
58
Bacteria continue to grow on stainless while virtually all
bacteria on copper has been killed
EPA Efficacy Test 3 ndash Continuous reduction
Source Environmental Protection Agency ldquoTest Method for the Continuous Reduction f Bacterial Contamination on Copper Alloy Surfacesrdquo httpcuverrocomsitesdefaultfilestest_meth_contin_reduc_surfacespdf
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
MSKCC Cancer Center
RHJ VA Medical Center
Funded by the US Department of Defense under the aegis of the Telemedicine
and Advanced Technologies Research Center (TATRC) a section of the Army
Medical Research and Materiel Command (USAMRMC)
Efficacy of Copper Alloys in Clinical Environment
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Efficacy of Copper Alloys in Clinical Environment
Copper Alloy Surfaces placed in ICUrsquos
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
0
20
40
60
80
100
Bed Call Chair Tray Monitor IV Pole
Total
Bacteria 97
Total
Staph 90
VRE 9
MRSA 6
Total
Staph 90
VRE 5
MRSA 3
Total
Staph 71
VRE 4
MRSA 3
Total
Staph 82
VRE 1
Total
Staph 46
VRE 2
Total
Staph 38
VRE 1
Total
Staph 48
Total
Bacteria 82
Total
Bacteria 90
Total
Bacteria 62
Total
Bacteria 51
Total
Bacteria 68
GramNeg 3 GramNeg 3
MRSA 2 MRSA 1 MRSA 2
GramNeg 1 GramNeg 1 GramNeg 2
GramNeg 6
Percent of Surfaces Sampled Positive for Bacteria
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00
cm
2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
Average Bacteria Count
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
13147
6224
3327
2610
527 794
0
1400
2800
4200
5600
7000
8400
9800
11200
12600
14000
CF
U1
00 c
m2
Control Surfaces
250 CFUcm2
Level of Risk
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
Average Bacteria Count
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Control Surfaces--Plastic wood stainless chrome coatings 2008 - 2011
Comparison of Copper to Control Surfaces
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
1290000
1096019
258000
1680000
87000
237143
17700 63513 31800 24000 90000 9714 0
250000
500000
750000
1000000
1250000
1500000
1750000
Controlhellip
Control Surfaces = 1092 - 1126 Phase I-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole 2008 - 2011
Comparison of Copper to Control Surfaces
Maximum Bacteria Count
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
3959070
2512314
1365120
343410 167932
469637
184560 513248 364140 123390 224809 63057 0
400000
800000
1200000
1600000
2000000
2400000
2800000
3200000
3600000
4000000
4400000
Control Surfaces
Control Surfaces = 1092 - 1126 Phase II-III Copper Surfaces = 473 - 526 Phase II-III
Bed Call Chair Tray Data IV Rails Button Arms Table Input Pole
2008 - 2011
Comparison of Copper to Control Surfaces
Cumulative Bacteria Count
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
(Control Surfaces--Plastic wood stainless chrome coatings)
97 92
89
100 100 100 95
0
10
20
30
40
50
60
70
80
90
100
BedRail
ChairArms
DataInput
Avg AllSurfaces
CF
U1
00
cm
2
ICU Touch Surface
96
Reduction in Median Bioload Copper vs Control
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
7 9
13
21
0
5
10
15
20
25
lt500 501 - 2000 2001 - 8000 gt8000
HA
I A
cq
uis
itio
n d
urin
g
Pa
tient S
tay
CFU per 100 cm2 Cumulative Bacteria on the 6 high-touch Objects in Room (CFU 100 cm2)
Salgado et al
Correlation Between Bacteria and HAIs
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
919
81 34
966
Reduction with Copper
Control
Surfaces
14 38
962
Colonizations
HAIrsquos
Copper
Surfaces 0
50
100
150
Colonizations
HAIs
-64
-58
Copperrsquos Impact on Infection Rates
986
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
GRMC Clinical Trials
MedSurg Unit
Research Conducted by
Shannon Hinsa PhD Michael G Schmidt PhD
Associate Professor Biology Department Chair of Biological Chemistry Major Grinnell College Grinnell IA
Director Office of Special Programs Professor and Vice Chair Department of Microbiology and Immunology Medical University of South Carolina Charleston SC
Preliminary Findings
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Collaborative Effort
bull Grinnell Regional Medical Center
bull GRMC Fitness Center
bull Grinnell College
bull Medical University of S Carolina
bull Olin BrassCuVerro
bull Fabricators
70
bull Administrative Staff
bull MedSurg Team
bull Infection Prevention
bull Nursing
bull Facilities Management
bull Environmental Services
Fabricators Using CuVerro
bull American Standard Brands
bull AmFab
bull Colonial Bronze
bull EatonArrow Hart Division
bull Elkay
bull Frigo Design
bull Gojo
bull Grace Premier Fitness
bull Herman MillerNemschoff
bull Just Manufacturing
bull Larco
bull Midbrook Medical
bull MR Label
bull Operator Interface Technology
bull Pedigo
bull Rocky Mountain Hardware
bull Sloan Valve
bull Trimco
bull TSM
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
GRMC MedSurg
Unit
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
High-Touch Surfaces
bull Alcohol dispenser
bull Automatic door
openers
bull Bedside table
bull Cabinet pulls
bull Door levers
bull Faucets
bull Flush valves
bull Free weight equipment
72
bull Grab bars
bull IV poles
bull Keyboards and mice
bull Light switches
bull Over-bed tables
bull Receptacles wall
plates
bull Sinks
bull Soap dispensers
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Clinical Findings Show Consistency ICU amp MedSurg
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Median Reduction in Bacteria after copper alloy intervention
100
100
67
96
97
100
84
100
84
91
100
92
100
94
97
95
20 40 60 80 100 120
Door levers
Pass thru levers
Pass thru pulls
Bedside pulls
Grab bars
Toilet handle
Cart pulls
IV Pole
GP Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Keyboard
Overbed table
Reduction in Median Bioload
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
0
7
0
0
0
23
4
7
15
18
42
5
4
20 40 60 80 100 120
Door levers
Pass thru levers
Grab bars
Toilet handle
Cart pulls
IV Pole
Patient Sink
Faucet lever
Light switch
Auto door plate
Alcohol dispenser
Soap dispenser
Overbed table
Percent Surfaces with Zero Bacteria
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Hospital 1 Hospital 2 Hospital 3 Hospital 4 Hospital 5Median Microbial Burden
Control Objects
Comparison of the Bioload in Active Hospital Environments
90
R
edu
ctio
n
91
R
edu
ctio
n
96
R
edu
ctio
n
96
R
edu
ctio
n
93
R
edu
ctio
n
Bioload Reduction--Hospital Conformity
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
BUSINESS CASE
Brass Ring for Infection Reduction
Is Eliminating Bacteria
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
High Risk
Some Risk
No Risk Zero CFU100 cm2
1-250 CFU100 cm2
250+ CFU100 cm2
61 72
25
Control Surfaces
3
21
43
Copper
36
Schmidt MG Medical University of SC
New Standard for Infection Risk
GRMC Trials Preliminary Data Schmidt Hinsa-Leisure
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
One of the oldest alloys
protecting humankind
Could be newest ally in fight agains infections
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
For Improved Hospital Hygiene
Consider Copper Alloy Surfaces
Products made with CuVerro
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
reg
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim
Experience of Care
Population Health
Per Capita Cost
The Goal The Triple Aim