Keeping patients from getting sick during an inpatient stay has long been a problem for hospitals — and it’s an issue that has grown all the more pressing during a pandemic.
Even before the rise of Covid-19, hospitals have increasingly struggled to get health-care associated infections in check. There are 2 million such infections — and 90,000 related deaths — in U.S. hospitals every year.
As hospitals across the country hunt for ways to reduce the spread of pathogens to patients, a growing chorus of researchers is arguing that a simple swap might help: replace stainless steel surfaces with copper.
“Copper is the fastest thing that can kill anything,” said Michael Schmidt, a professor of microbiology and immunology at the Medical University of South Carolina and a leading researcher on antimicrobial copper.
Copper’s ability to neutralize microbes is well-known. Researchers studying SARS-CoV-2, the disease that causes Covid-19, noted back in March that the virus lasts for several days on stainless steel — which most hospitals use for the majority of surfaces — but dies within hours of landing on copper.
Despite the evidence on copper’s ability to bust up bacteria, many hospital leaders remain unconvinced. They argue it’s still not clear whether reducing the amount of a pathogen in a particular area of a hospital actually translates to a lower risk of infection.
“In infection prevention, we’re a pretty pragmatic bunch. We want to know that something is effective,” said Graham Snyder, medical director of infection prevention at UPMC in Pittsburgh. “There’s no doubt about it: Organisms are less likely to survive on an antimicrobial surface. Is that less likely to reduce infections? That’s very hard to prove.”
Schmidt and other researchers studying copper are hopeful that a growing body of research will help make the case for copper. In 2007, he began a study inside eight intensive care unit rooms at three U.S. hospitals where copper was installed on different objects: bedrails, overbed tray tables, intravenous poles, and armrests of visitors’ chairs, as well as on surfaces like nurses’ call buttons. Over six years, Schmidt found that infections in these rooms dropped 58% compared to eight unmodified ICU rooms. He also found significantly lower rates of VRE and MRSA bacteria, notorious for causing inpatient infections, in the copper rooms.
More recent research on copper shows similar promise. A 2016 clinical trial at Sentara Leigh Hospital in Virginia found that copper oxide surfaces led to a 78% reduction in drug-resistant microbes. Another clinical trial carried out that same year in Iowa demonstrated the same.
And last fall, Schmidt published his latest research, a nearly two-year study that showed that copper beds inside the ICU of a hospital in Indiana harbored an average of 95% fewer bacteria. (That study was supported by an “unrestricted research grant” from Bed Techs, which retrofits hospital beds with copper. Schmidt’s work has largely been funded by the Department of Defense, but he has also received support from a copper industry group to study the metal in non-patient-care settings.)
Researchers who study copper say its power lies in how it attacks a pathogen. In the presence of bacteria like E. coli, copper releases reactive ions that punch holes in the cell membrane, invade, and then shred the DNA and proteins within. Sometimes copper metal is even more, well, metal. Unlike gold or silver, copper contains a free electron in its outer orbital shell, which interacts with oxygen in the air — resulting in an energized form of oxygen, a molecular grenade of sorts that blasts through viral envelopes and blows up the germ-replicating instructions on the inside.
Hospitals have a clear incentive to curb the spread of pathogens. The average single-bed hospital room in the U.S. sees between four or five infections annually, and the cost, in terms of money wasted and lives lost, is high. For every one person who contracts an infection while in the hospital, their stays are estimated to be as much as 19 days longer, as well as about $43,000 more expensive.
While there is a correlation between installing copper and reducing the burden of bacteria, there is no proven causation between the presence of copper and the decrease in the number of patient infections a hospital sees — an outcome that some hospital leaders said they would like to see before making the switch.
There’s also the equally pragmatic matter of the overall cost of installing copper, which is far more expensive than plastic or stainless steel. For hospitals, which generally run on small operating margins, it’s more worthwhile to put extra money into patient care, including existing resources intended to keep people safe.
“It’s a zero-sum game. We don’t have the resources to do everything,” said David Weber, who, as medical director of epidemiology at UNC Health Care in North Carolina, works to help prevent health care-associated infections.
And as it currently stands, many hospitals already have easy-to-clean surfaces.
“I don’t need an antimicrobial surface to make sure bedrails aren’t a route of transmission,” Snyder said. “I might decide a better investment is making sure my environmental services team does a good job at cleaning.”
Some hospital leaders also said they’re not convinced that copper’s effectiveness will readily translate to the general hospital environment, given that most studies have been in the ICU.
“The health care community wants to know if this will work in all hospital rooms, and, candidly, we don’t know,” Schmidt said. “That’s one of the principal reasons hospitals are saying they’re reluctant to adopt.”
Still, Schmidt said the results gathered from studies in the ICU suggest that a hospital, on the whole, is likely to see a decrease in health care-associated infections with copper surfaces.
“The mission was to ask a simple question: Could I reduce the incidents of health care-associated infections? My answer was yes,” he said. “And I thought the market would take that observation and run with it.”