Scientific studies in recent years have identified the patient environment as a potential source for hospital-acquired infection (HAIs). That is progress, because there was a time when it was given little recognition as a source of cross-contamination.
New approaches to environmental care call for new and improved products and protocols, noted Adam Estelle, Project Engineer, Copper Development Association, Inc. “Frequently touched surfaces enable the spread of infectious pathogens throughout healthcare facilities, which contributes to HAI acquisition. To combat bioburden, hand washing and routine disinfection of surfaces are the first line of defense. However, these conventional tools fall short, because they are intermittent and depend on human behavior. On average, healthcare providers wash their hands less than half of the times they should. Bioburden can also rapidly rebound on surfaces in the time between cleanings. Evidence-based antimicrobial-surface technologies can help address these gaps and enhance infection-prevention programs through a systems-based approach.”
Copper is their weapon of choice in the battle against HAIs. Being inherently antimicrobial, copper requires no pharmaceuticals or chemicals to kill pathogens. A super advantage is that copper does not contribute to the global problem of antimicrobial resistance.
Estelle explained how copper can be used in the patient environment to thwart HAIs. “Copper alloys are solid metals with inherent, broad-spectrum antimicrobial properties. These versatile engineering materials are fabricated into durable, attractive products, such as door hardware and IV poles, that continuously kill greater than 99.9 percent of pathogens within two hours. Copper alloys are not a coating or an additive, and the antimicrobial properties do not diminish or wear out. No additional maintenance is required beyond routine cleaning to remove dirt and grime. Copper alloys are also completely recyclable and are made mostly from recycled content.”
When checking out products, the importance of researching scientific evidence supporting product claims cannot be underrated. Estelle offered such evidence: “Copper alloys secured Environmental Protection Agency (EPA) public-health registration in 2008 after rigorous efficacy testing against infectious bacteria including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus. Additionally, well-over 100 peer-reviewed publications have reported on the broad-spectrum efficacy of copper alloys in laboratory, clinical, and field settings.” Estelle also referred to a review by Michels and Michels,1 in which the large body of scientific evidence on the efficacy of copper alloy was summarized recently.
Estelle also referred to a multi-year U.S. Department of Defense-funded clinical trial conducted in the intensive care units of three hospitals (Memorial Sloan Kettering Cancer Center, Medical University of South Carolina, and Ralph H. Johnson VA Medical Center), which reported that patients treated in rooms outfitted with copper items contracted an impressive 58 percent fewer infections.2
Class 1 Inc. is another company focused on solutions that do not require chemicals or human involvement to be effective in thwarting HAIs. Keith McGlone, Director, IPC, Business Development, said, “Class 1 Inc’s EIP (engineered infection prevention) is focused on creating reductions in the HAI rate with engineered solutions without chemical or human actions or errors.”
“Environmental services plans to clean and disinfect most surfaces once a day,” McGlone continued. “Research shows that, in daily cleaning, only 30 percent or so of surfaces are cleaned. Any contribution to reduce transmission by reducing the bioburden will contribute to lower infection rates. Class 1 Inc. contributes in the area with our Aereus BioFree Copper-coated Toilet Seat and SmartFlo3 Hand Hygiene Sink.”
“Copper has been shown to dramatically reduce bacteria and virus levels,” said McGlone. “The toilet seat is a way to reduce levels of bioburden in the high-touch area. When our Asept.1x is added to the bathroom the impact is higher again.” The Asept.1x UVC Disinfection System employs smart sensor technology designed to disinfect patient bathrooms or equipment rooms after each use.
McGlone explained how the self-disinfecting sink works. “SmartFlo3 uses reactive oxygen species (ROS) created in the sink by splitting regular water molecules with electricity. The ROS disinfects the sink, drain, trap, and pipes by reacting with all organic matter. Working automatically to disinfect with every hand wash, and on scheduled intervals, the drain and trap remain pathogen free.”
Ken Trinder, CEO, EOS Surfaces, LLC, also talked about products that reach beyond the basic tenets of environmental cleaning and infection prevention, and described how their collaboration with Cupron, Inc., strives to lower healthcare facilities’ rates of HAIs. “Despite improvements in hand-hygiene compliance, terminal cleaning, and patient involvement, achieving the goal of ‘zero harm’ means finding new ways to eliminate the pathogens that persist in our environment, ways that work continuously and efficiently.”
Trinder described EOSCU as a hard material impregnated throughout with copper that works by continuously and actively killing bacteria, reducing bacteria by 99.9 percent in under two hours. “Copper kills bacteria by rupturing the cell wall and through copper toxicity but, as an essential metal, it does not promote resistance.”
“The copper in EOSCU is guaranteed to last the life of the product — from bed rails to counter tops — retaining efficacy without additional human processes,” said Trinder. “Surfaces made from EOSCU can be cleaned with regular cleaning products and are compatible with ultraviolet light and hydrogen peroxide vapor. The surfaces work 24/7/365, reducing bioburden and HAIs, making them both effective in protecting patients as well as saving the facility funds they otherwise may spend treating preventable infections not covered by private insurance or reimbursed by Medicare.”
Trinder highlighted scientific evidence of EOSCU ’s efficacy. “EOSCU has undergone both laboratory and clinical testing. Our EPA public-health claims required a 100 percent pass rate at a third-party laboratory against a full array of pathogens and under a variety of conditions.
“In 2016, the American Journal of Infection Control published the results from a clinical trial of EOSCU and Cupron Medical Textiles at Sentara Leigh Hospital in Norfolk, VA, demonstrating a statistically significant reduction in HAIs caused by multi-drug resistant organisms and Clostridium difficile.3 The same journal published a bioburden study of EOSCU from the Central Texas VA, demonstrating a statistically significant reduction of bioburden in both standard and isolation patient rooms.”4
“The success of these products is captured by Gene Burke, MD, of Sentara,” noted Trinder. ‘The magnitude of change was such that our company decided we needed to change the standard of care, that our patients needed us to, and that our mission required us to bring forward this technology.’”
Cleaning electronic devices
Christian Davis, Vice President of Technology, Seal Shield, highlighted the adoption of electronic devices as sources of new vectors of cross-contamination in hospitals today. “These new appliances cannot be cleaned and disinfected with typical protocols,” said Davis. He believes, “Given the lack of acceptable cleaning and disinfection protocols for these devices, and their mobility within the organization, they pose the greatest risk of cross-contamination proliferation.” Davis referred to a study by Donskey5 that suggests portable equipment is the greatest threat of four major surfaces in hospitals: isolation rooms; hands of healthcare workers; skin, bedding, and clothing; and unidentified carriers.
Davis described Seal Shield’s core products as medical-grade, washable keyboards; mice; television remotes; mobility cases; and screen protectors, which all incorporate antimicrobial-product protection. The products are waterproof as well and can be cleaned in a dishwasher. Bleach, which would ruin many electronics, can be used on these devices. “The combination of waterproof and antimicrobial-product features allows an organization the ability to wipe, spray, or submerse our devices in any disinfectant or liquid while maintaining persistent protection with the embedded antimicrobials,” said Davis.
Seal Shield’s ElectroClave disinfects tablets and mobile phones by means of ultraviolet-light. It features smart-charging technology, a cloud-based mobile-device—management portal, and RFID tracking, with the ability to disinfect and charge four tablets or 10 phones at same time. It is device agnostic.
“Our advanced line of products, such as the ElectroClave, provides a platform for the hospital to disinfect mobile electronics that cannot come into contact with liquids, especially particular disinfectants,” said Davis. “ElectroClave has demonstrated 99.99 percent efficacy on both MRSA and carbapenem-resistant Enterobacteriaceae. The ElectroClave platform, for the first time, brings the ability to collect data around disinfection cycles on mobile electronics, to ensure compliance and validity.”
Davis said the cost of their core products is within 1 to 5 percent of a standard non—medical-grade peripheral. “The cost of the ElectroClave platform is around $10 per month per device.”
Davis noted that their core products are deployed in 65 percent of all U.S. hospitals today. “The ElectroClave platform was released February 2017 and since has landed in five major healthcare organizations from the West to East Coast. This product has also been recently adopted by the Centers for Disease Control and Prevention (CDC) for the disinfection of mobile electronics in their Atlanta laboratories.
“Current studies evaluating and quantifying the effectiveness of the platform to maintain clean electronics for the operating room and the intensive care unit are engaged within two of the five organizations and will be presented at AORN and APIC in 2018. There have been numerous studies surrounding use of medical-grade keyboards and mice. One of the most influential of all the studies suggesting that using our core products is an obvious decision is by Rutala et al, “Bacterial Contamination of Keyboards: Efficacy and Functional Impact of Disinfectants.”6
David Schultz, CEO, Vioguard, talked about the Vioguard Self-Sanitizing Keyboard. “As many as 40 percent of HAIs are attributed to cross-infection from the hands of healthcare workers. The best way to reduce this cross-contamination is to stop it at its source. A large body of research identifies computer keyboards and curser-control devices as significant fomites of pathogens that lead to nosocomial infections. With so many keyboards being used so often and by so many healthcare workers, sanitizing them after every use is necessary to reduce cross-contamination. This is nearly impossible to accomplish manually, but technology makes it easy.”
Schultz explained how their product works. “The Vioguard Self-Sanitizing Keyboard is a Food and Drug Administration (FDA)-cleared, class-II medical device that uses the germicidal properties of ultraviolet light (UV-C) to automatically disinfect the keyboard and trackpad after every use. The system is 99.99 percent effective in killing harmful microorganisms within seconds, eliminating the need for manual disinfection. The system’s efficacy has been tested through rigorous FDA test protocol conducted by third-party laboratories.
“In a healthcare setting, regular keyboards are sanitized by manual wiping, which has limited efficacy for two reasons,” explained Schultz. “First, compliance with sanitizing protocols is a widespread problem in many hospitals. Second, even if protocols are followed, they usually specify sanitizing keyboards too infrequently to make a difference. A single touch of a contaminated surface can result in pathogen transfer. The Vioguard system is automatic, sanitizing the keyboard after each use, requiring no human interaction or compliance.”
Schultz said the Vioguard keyboard does not contribute to the development of antimicrobial resistance. “Unlike their resilient response to chemical disinfectants, microorganisms are unable to develop UV-C resistance. Widespread use of antibiotics and disinfectants continue to create chemical and drug-resistant ‘superbugs,’ which the CDC lists as a top threat for 2017. The Vioguard solution kills these superbugs and will not create new, resistant microorganisms.”
References
1. Michels HT, Michels CA. Copper alloys — The new ‘old’ weapon in the fight against infectious disease. Curr Trends Microbiol. 2016;10:23-45.
2. Salgado CD, Sepkowitz KA, John JF, et al. Copper surfaces reduce the rate of healthcare-acquired infections in the intensive care unit. Infect Control Hosp Epidemiol. 2013;34(5):479-486.
3. Sifri CD, Burke GH, Enfield KB. Reduced health care-associated infections in an acute care community hospital using a combination of self-disinfecting copper-impregnated composite hard surfaces and linens. Am J Infect Control. 2016 Dec 1;44(12):1565-1571.
4. Coppin JD, Villamaria FC, Williams MD, et al. Self-sanitizing copper-impregnated surfaces for bioburden reduction in patient rooms. Am J Infect Control. 2017 Jun 1;45(6):692-694.
5. Donskey CJ. Does improving surface cleaning and disinfection reduce health care-associated infections? Am J Infect Control. 2013 May;41(5 Suppl):S12-19.
6. Rutala WA, White MS, Gergen MF, et al. Bacterial contamination of keyboards: efficacy and functional impact of disinfectants. Infect Control Hosp Epidemiol. 2006 Apr;27(4):372-377.
Susan Cantrell
Susan Cantrell is Infection Prevention Editor for Healthcare Purchasing News.
