Sometimes novel solutions to modern problems can come from an old and unexpected source, using age-old techniques. In the case of healthcare-associated infections, it turns out that copper, a substance known for its antimicrobial properties since ancient times (well before people even knew what microbes were), has found a new role in the present-day healthcare setting.
In April, Sentara Martha Jefferson Hospital and Sentara RMH Medical Center began using copper-infused linens and patient gowns in all inpatient rooms. The linens won’t be used in the Emergency Department, in Labor and Delivery (known as the Family Birthplace at Sentara RMH), in Outpatient Services or in the operating rooms, as the health benefits of copper appear to occur primarily in locations where patients spend more time.
The decision to switch to copper-infused linens, which have a distinctive tan or salmon hue, was based on a 10-month clinical trial conducted at Sentara Leigh Hospital in Norfolk that found copper to be effective in preventing the spread of infections in healthcare settings. Both Sentara Martha Jefferson and Sentara RMH also will retrofit all inpatient rooms with copper-infused bedside tables and bed handrails later this year.
“Sentara is constantly putting into place evidence-based best practices that make a real difference in the care we provide our patients,” says Donna Hahn, DNP, RN, NEA-BC, vice president for acute care services and chief nurse executive at Sentara RMH. “Sentara hospitals already outperform many facilities across the country in terms of incidences of healthcare-associated infections. Using copper linens is just one more way for us to demonstrate our commitment to providing the best care possible to our communities.”
Physiologically, copper plays an important role in the function of the nervous system, immune system, heart and skin. The antimicrobial use of copper dates back to the ancient Egyptians, Romans and Hindus. Modern research has shown, in fact, that copper-enhanced materials are effective in killing 99.9 percent of bacteria on contact within just a few hours.
“We don’t really know how the copper works to reduce infections, but we think it may have a disruptive effect on bacterial cell walls, preventing the flow of fluid into and out of cells,” says Mike Ashby, MD, vice president of medical affairs at Sentara Martha Jefferson. “We believe that anything we can do to decrease the risk of hospital-associated infections is worthwhile—the last thing we want is for somebody to come to us for a medical problem and then get an infection while in one of our facilities.”
The clinical trial at Sentara Leigh is considered the world’s largest so far to test the effectiveness of copper against healthcare-associated infections. The trial determined that hard surfaces and linens infused with copper oxide compounds contributed to an 83 percent reduction in Clostridium difficile (C. diff). The study also found a 78 percent overall reduction in multidrug-resistant organisms (MDROs) like C. diff, as well as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE), in a real-world clinical environment. These results occurred in a hospital with a robust protocol for managing infection risk, certified by the healthcare-accrediting body DNV-GL Healthcare.
Published in the peer-reviewed American Journal of Infection Control in September 2016, the results of the Sentara Leigh trial were presented a month later at the annual conference of the Infectious Disease Society of America. Based on the significance of the findings, Sentara Healthcare is making the change to copper-infused products in all 12 of its hospitals in Virginia and North Carolina.
Sentara partnered with two Virginia corporations to conduct the trial. Richmond-based Cupron Inc. invented the proprietary copper oxide technology used in the surfaces and textiles, while Norfolk-based EOS Surfaces LLC developed the copper oxide-infused hard surfaces, such as countertops, bathroom sinks, bedside tables and bedrails. Both companies have registered their products with the U.S. Food and Drug Administration as nontoxic, nonsensitizing and nonirritating to the skin. In addition, the preventive biocidal surfaces produced by EOS are the only synthetic hard surfaces registered by the U.S. Environmental Protection Agency for public health claims against bacteria contamination.
Comfort in Copper
Patients shouldn’t notice a difference in how the copper linens feel compared to the gowns, sheets and towels that were used previously.
“The linens and gowns are very comfortable in terms of softness and warmth,” says Becky Brubaker, RN, MSN, infection preventionist at Sentara RMH. “The copper is put right into the polymers from which the sheets, blankets and towels are made, and though the cotton/polyester blend linens are free of dyes, the copper naturally gives them a soft salmon hue. Low levels of copper ions are continuously released as a patient lies in bed, so these products are always working to reduce bacteria-related problems.”
Although the color of the linens may change over time, they won’t lose their copper-based antimicrobial properties. “The technology is embedded within the fibers,” notes Andrea Alvarez, MPH, infection preventionist at Sentara Martha Jefferson.
For patients who have a copper allergy or medical conditions like Wilson’s disease or Menkes syndrome that affect copper levels in the body, Sentara Martha Jefferson and Sentara RMH will still have hospital linens available that aren’t infused with copper.
In addition to the new linens, all standard infection-control protocols—particularly hand-washing—are still in place in Sentara hospitals.
“We want to do everything we can to prevent infections, and these copper linens and surfaces are just one piece of the infection-prevention puzzle,” Alvarez adds. “Sentara is committed to providing safe patient care, and every day, every employee is dedicated to supporting that goal. We’re excited about deploying these new copper-enhanced materials and want patients to understand that this is just one more way in which we are working toward the goal of always keeping our patients safe, and creating an environment that promotes comfort and healing.”