Clinical trials show copper reduces bacterial burden by >97% and the risk of infection by >40%.
Clinical trials investigating Antimicrobial Copper's potential to help fight pathogens that cause healthcare-associated infections are providing proof of efficacy in challenging clinical environments around the world.
Laboratory testing has demonstrated conclusively that
Antimicrobial Copper continuously kills bacteria that cause
infections and is the most effective touch surface. Now,
clinical trials under way around the world are demonstrating the
benefit of Antimicrobial Copper in actual use conditions.
These are taking place in many hospital settings around the world,
providing a variety of trial protocols, ward types (geriatric,
intensive care and general medical), local clinical strains of
organisms and national healthcare environments to put Antimicrobial
Copper to the test.
Results show that microbial contamination is significantly and
consistently reduced on copper compared to standard surfaces, by
greater than 90%.
Results from a US clinical trial, funded by the Department of
Defense, take this evidence to a new level by evaluating the
connection between contamination on frequently touched surfaces and
patient acquisition of infections. The preliminary findings
demonstrate that patients treated in ICU rooms fitted with copper
and copper alloy products have a greater than 40% reduction in risk
of acquiring an infection.
The preliminary data from this trial was presented at the 1st
WHO International Conference on Infection Prevention and Control in
July 2011. This has been supported by a poster
at the 19th Annual Health Forum and American Hospital Association
Leadership Summit .
An overview of the different clinical trials is presented
Three medical centres - The Medical University of South
Carolina, Charleston (MUSC), The Ralph H Johnson Veterans
Administration Medical Center, Charleston, South Carolina and the
Memorial Sloan Kettering Cancer Center in New York City -
participated in a clinical trial assessing copper's antimicrobial
efficacy in intensive care units (ICUs). The institutions
replaced stainless steel, aluminium and plastic touch surfaces with
antimicrobial copper alloys, hereafter referred to as 'copper', on
the following frequently-touched objects within selected rooms in
each of the ICUs: bed rails, overbed tray tables, chairs, call
buttons, data devices and IV poles.
The surfaces shown to be most contaminated and, not
surprisingly, in closes proximity to patients and visitors, were
replaced with copper components.
During the trial, the level of bacterial contamination on an
equivalent number of the selected copper and non-copper surfaces
was determined weekly. No changes were made to clinical
practices or cleaning regimes in the study rooms.
The trial, conducted by infectious disease clinicians and led by
Dr Michael Schmidt, Professor and Vice Chair of the Microbiology
and Immunology Department at MUSC, was executed in three
- The first stage established the baseline microbial
burden on the frequently-touched objects in ICU rooms before
installation of the copper products. The average microbial burden
of the rooms was found to be 16,885 colony forming units (cfu) per
100 cm2 .
- The second stage was the replacement of the most
contaminated touch surfaces with copper and subsequent comparison
of the microbial burden on these and non-copper equivalent surfaces
over a period of 135 weeks. The median bioburden observed on copper
surfaces was 97% less than on the control surfaces
- The third stage, reported at ICPIC
2011, assessed the incidence of
healthcare-associated infections in ICU rooms with and without
copper products. Results to date show that there is a
significant reduction in the risk of acquiring an infection in
rooms where copper products are installed.
The number of copper components in the individual rooms was
recorded throughout each patient's stay, e.g. whether or not the
patient was in a bed with copper rails (bariatric patients needed
special beds which were not available with copper rails).
The preliminary results show that where patients were in a room
with 75% of the copper components present (by surface area), they
had a 40.4% lower risk of acquiring an infection (N=651, p=0.039).
This percentage increased to 61% if the patients were in a 'copper'
bed in a copper room (N=541, p=0.006). For patients in a copper
room with all copper components present throughout their stay, the
risk reduction was 69.1% (N=642, p=0.008).
The results to date suggest that replacement of key
frequently-touched surfaces with copper components reduces
microbial burden, which results in a significant and consistent
reduction in infection rates:
- Copper reduces the median amount of microbes by 97%.
- Virtually no MRSA or VRE were found on the copper
- Microbial burden reduction on copper surfaces continuously
achieves the same levels as terminal cleaning.
- The deployment of copper surfaces led to a 40 to 70% reduction
in infection rates
- Copper's antimicrobial activity is continuous - it works
non-stop and around the clock.
In a separate outpatient study, not only was the reduction in
microbial bioburden confirmed but a halo effect was observed -
reduced contamination in the vicinity of the copper surfaces.
The copper surfaces were shown to reduce the risk of exposure to
environmental microbes by 17%.
In the UK, Professor Tom Elliott, Consultant Microbiologist and
Deputy Medical Director at University Hospitals Birmingham NHS
Foundation Trust, led a trial at Selly Oak Hospital, Birmingham.
The trial took place on a general medical ward fitted with both
copper and standard components. It aimed to demonstrate copper's
ability to reduce environmental contamination and improve patient
outcomes as part of a 'care bundle' - a package of measures to
The first results from the trial, following sampling of three
products - taps, push plates and toilet seats - were presented at
the Interscience Conference on Antimicrobial Agents and
Chemotherapy (ICAAC) in Washington DC, USA, in October 2008. These
results show that surfaces made from materials that contain copper
kill a wide range of potentially harmful micro-organisms,
significantly reducing the number of these organisms that can come
into contact with patients, visitors and staff. Data from the three
products sampled over a ten-week period showed that items made from
copper had 90 - 100% fewer micro-organisms on them, compared with
the same items made from standard materials (chrome-plated brass,
aluminium and plastic).
Professor Elliott explains: "What this must mean is that the
risk of picking up an infection is reduced, because we know that
one of the vehicles where organisms can spread from one surface to
another is by touching them. So the results are very exciting.
"The findings of a 90 to 100% killing of those organisms, even
after a busy day on a medical ward with items being touched by
numerous people, is remarkable. So it may well offer us another
mechanism for trying to defeat the spread of infection."
The copper products installed for the clinical trial - door
furniture, bathroom fittings, trolleys and overbed tables, have all
been subject to the standard NHS cleaning protocols and
formulations, including toilet and spillage cleaning. During the
24-36 months after installation, only some mild surface oxidation
has taken place. With their copper, gold and bronze colours, the
copper components appear markedly different to the standard
components but were widely accepted by staff, patients and
The second phase of the trial involved sampling of the full
range of copper and control surfaces over a period of 6 months to
gather more data. Results reinforce the earlier findings,
showing significantly lower levels of contamination on the copper
surfaces compared to controls. The paper reporting on the
second phase of the UHB Selly Oak clinical trial is now in press
In Chile, 70,000 nosocomial infections are reported each year,
most commonly from common hospital-borne pathogens such as S.
aureus, P aeruginosa and A. baumanii.
In a 30-week clinical trial at the Hospital del Cobre, in
Calama, extensive microbial analyses were implemented at the
facility's intensive care unit (ICU). Nine hundred and ninety
copper surfaces from 90 rooms containing six different copper
objects were studied against an equivalent number of rooms and
surfaces containing non-copper objects. Over-bed tables were
made from copper alloy C70600. Bedrails were clad with copper
alloy C11000 foils. Visitor chairs were fitted with copper
alloy C70600 armrests. Copper alloy C71000 intravenous poles
were provided. Writing pens used to input data on a touch
screen were made from brass (70% Cu, 30% Zn).
Results of this clinical trial demonstrated an approximately 90%
reduction of microorganisms on the copper items compared to the
controls after ten weeks. A reduction in the total microbial
burden was seen for each class of microbe evaluated.
Furthermore, continuous antimicrobial activity of copper persisted
throughout the study.
Copper was effective in reducing microbial loads on all 6
surfaces tested (ie bed rails by 91%, bed levers by 82%, tray
tables by 83%, chair arms by 92%, monitor pens by 49% and IV poles
Average microbial burden counts in rooms with copper touch
surfaces were significantly lower than rooms without copper
surfaces. Staphylococci were the most predominant
microorganism isolated and copper was effective in reducing the
Staphylococci microbial burden.
In the Asklepios Clinic, Wandsbek, in Hamburg, Germany,
aluminium door handles and plastic light switches in a geriatric
ward and its adjacent bathrooms have been replaced by copper alloy
equivalents. The patients in the control and trial wards have
similar profiles. The results to date show a significant reduction
in contamination on the copper components .
A trial conducted at a nursing home, in conjunction with the
Helsinki University Department of Public Health, compared
contamination on copper vs standard items in patient rooms,
bathrooms and communal areas. Copper components included dressing
trolleys, door handles, grab rails, handrails, shower drains and
push buttons. The first results show higher levels of contamination
on the non-copper items and presence of faecal and urinary
bacteria, (Staphylococcus aureus, E. coli and Candida
albicans) only on stainless steel, plastic and chromium
components. On copper and copper alloy surfaces, only Gram-positive
bacilli and cocci and normal environmental and skin flora were
Further trials are also under way in France, Spain, South
Africa, Greece and Japan.
 M G Schmidt, BMC Proceedings 2011, 5(Suppl 6):053 (Oral presentation delivered at 1st
International Conference on Prevention and Infection Control, June
29-July 2 2011, Geneva, Switzerland. Further information.
 Risk Mitigation of Hospital Acquired Infections
Through the Use of Antimicrobial Copper Surfaces
W R Moran, H H Attaway, M G Schmidt, J F John, C D
Salgado, K A Sepkowitz, R J Cantey, L L Steed, H T Michels. Poster
presented at the American Hospital Association and Health Forum
Leadership Summit 2011, July 17-19, 2011, San Diego, CA.
 Microbial Burden
of Objects in ICU Rooms
C D Salgado, K A Sepkowitz, T Plaskett, J F John, J R
Cantey, H H Attaway, L L Steed, H T Michels, M G Schmidt. October
A Pilot Study to Determine the Effectiveness of Copper in Reducing
the Microbial Burden (MB) of Objects in Rooms of Intensive Care
Unit (ICU) Patients
C D Salgado, A Morgan, K A Sepkowitz, J F John, J R
Cantey, H H Attaway, T Plaskett, L L Steed, H T Michels, M G
Schmidt. Poster 183, 5th Decennial International Conference
on Healthcare-Associated Infections, Atlanta, March 29, 2010
 Copper Surfaces Reduce Microbial Burden in
Out-Patient Infectious Disease Practice
B E Hirsch, H Attaway, R Nadan, S Fairey, J Hardy, G
Miller, S Rai, D Armellino, M Schilling, W Moran, P Sharpe, A
Estelle, J H Michel, H T Michels, M G Schmidt - presented in
a poster session at the Interscience Conference on Antimicrobial
Agents and Chemotherapy (ICAAC) in Boston, MA, September 13,
Role of Copper in Reducing Hospital Environment Contamination
A L Casey, D Adams, T J Karpanen, P A Lambert, B D
Cookson, P Nightingale, L Miruszenko, R Shillam, P Christian and T
S J Elliott, J Hosp Infect (2009),
The Antimicrobial Efficacy of Copper Alloy Furnishing in the
Clinical Environment; a Cross-over Study
T J Karpanen, A L Casey, P A Lambert, B D Cookson, P
Nightingale, L Miruszenko L and T S J Elliott. Infection Control
and Hospital Epidemiology ( in press).
Effectiveness of Copper Contact Surfaces in Reducing the Microbial
Burden (MB) in the Intensive Care Unit (ICU) of Hospital del Cobre,
V Prado, C Durán, M Crestto, A Gutierrez, P Sapiain,
G Flores, H Fabres, C Tardito, M Schmidt. Poster 56.044, presented
at the 14th International Conference on Infectious Diseases, Miami,
March 11, 2010.
Survival of Bacteria on Metallic Copper Surfaces in a
André Mikolay, Susanne Huggett, Ladji Tikana, Gregor Grass,
Jörg Braun and Dietrich H Nies. Applied Microbial and Cell
Physiology, DOI 10.1007/s00253-010-2640-1. May 2010
Antimicrobial Efficacy of Copper Touch Surfaces in Reducing
Environmental bioburden in a South African Community Healthcare
F Marais, S Mehtar and L Chalkley, J Hosp Infect