Role of the Microbial Burden in the Acquisition and Control of Healthcare Associated Infections: The Utility of Solid Copper Surfaces - Use of Biocidal Surfaces for Reduction of Healthcare Acquired Infections - page 62

The purpose of this chapter is to review the role of the environment of care as it
pertains to microbial contamination and risk of HAI to patients as well as describe
the novel use and efficacy of antimicrobial copper surfaces in mitigating this risk.
We will discuss problematic pathogens in healthcare, their ability to contaminate
and persist in the environment, their ability to contaminate the healthcare provider,
and ultimately their ability to directly or indirectly result in colonization and
infection in the patient. We will briefly review the traditional measures utilized
to reduce the microbial burden associated with the healthcare environment but
focus our discussion on the use of continuously active antimicrobial solid copper
for this purpose. Given that, we describe the proposed mechanism of action for
copper's antimicrobial property, its activity against pathogens commonly found in
healthcare, as well as the clinical efficacy of placing solid copper surfaces into the
patient care environment.
4.2 Role of the Environment in Healthcare Infection
The majority of healthcare associated infections are thought to occur via transmis-
sion from the patient's own endogenous flora. However, there is increasing evi-
dence that there exists significant transmission of microbes from healthcare
personnel and the hospital environment to vulnerable patients. A study published
in 1991 estimated that the causative source of an HAI in the Intensive Care Unit
(ICU) was the patients' endogenous flora 40-60 % of the time and antibiotic driven
changes in flora 20-25 % of the time. Cross-infection via the hands of personnel
accounted for 20-40 % of cases and other sources, including contamination from
the environment, accounted for the remaining 20 % [ 101 ]. It has been established
that the inanimate hospital environment can become contaminated with nosocomial
pathogens after exposure to colonized patients [ 36 ]. This environment includes
surfaces within the hospital room (bedrails, bedside tables, etc.) and medical
equipment. A review of the available literature in 2002 concluded that personal
and environmental hygiene reduced the spread of infections [ 1 ]. More recent
literature has provided additional evidence that contaminated hospital surfaces
are a source of transmission of nosocomial pathogens [ 57 ]. Otter and colleagues
delineated the continuous, omni-directional and complex nature of how microbes
can easily move between infected or colonized patients, healthcare workers, and
objects resident in the built environment (Chap. 3 and ref [ 57 ]) (Fig. 4.2 ).
4.2.1 Microbes in the Built Environment
Microbes have an innate ability to contaminate and potentially establish residence on
any surface. Surfaces with frequent hand contact and in close proximity to the patient
are often colonized with nosocomial pathogens, and most of these pathogens can