Depending on the light, you may not even notice it. But look closely, and the handicap access buttons that open doors inside Pullman Regional Hospital shine with an unmistakably rosy hue. The handles on many drawers and cabinets show the same warmth. In bathrooms, the faucet handles patients touch are an intentionally vivid and noticeable shade of copper.
"It gives [hospital staff] a conversation point with the patients to say that we're doing everything we can to decrease infections," says Ed Harrich, director of surgical services.
What makes these new copper alloy fixtures significant isn't how they look, but what they do: Copper surfaces naturally kill the microbes that can thrive in hospitals. In an effort led by Harrich, Pullman Regional Hospital is the first institution of its size to install copper surfaces so widely in an effort to fight the spread of infections.
Nosocomial infections — those acquired in a health care facility — are a costly and deadly problem at hospitals across the nation. The Centers for Disease Control and Prevention estimates that 1 in 25 patients nationwide has a hospital-acquired infection at any given time, with more than 700,000 patients affected per year. Officials have seen progress in the past decade as hospitals improve sanitation practices, but outbreaks remain common.
On surfaces like plastic or stainless steel, microbes can linger for days or even weeks. Someone who comes into contact with an infection can spread this invisible "bioburden" to multiple surfaces, Harrich says, where it waits like "little booby traps" until the next guest or staff member unknowingly comes into contact. What makes copper so valuable is that it works around the clock without requiring anyone to change their behavior.
"Now, it doesn't mean we decrease our handwashing — hopefully it puts more focus on handwashing," Harrich says. "And we still clean like we've always cleaned with our anti-germicidals. But now you have this little helper behind the scenes."
The way copper kills microbes is complex and not yet fully understood, but documented accounts of copper as a health care tool date back to the ancient Egyptians. The ancient Greeks applied a copper powder to wounds, and many cultures have used copper vessels to hold drinking water. Modern organic farming makes use of copper sprays to fight plant diseases. At a level invisible to the human eye, copper weakens the membranes of microbes and then interferes with internal cell functions. Within a few minutes, even antibiotic-resistant bacteria like methicillin-resistant Staphylococcus aureus, known as MRSA, begin to die.
Despite copper's long history, it's only recently been promoted for use in hospitals. In 2008, the Environmental Protection Agency registered five copper alloy products as the first proven antimicrobial metal on the market, approving the claim that these copper products "kill 99.9% of bacteria within two hours."
Beginning the same year, a study funded by the Department of Defense and sponsored by the Copper Development Association looked at the effect of copper surfaces in intensive care units at three institutions in New York and South Carolina. First, the study identified the surfaces with the greatest presence of microbes, which turned out to be bed rails, tables, IV poles, and nurses' stations. Next, the study compared copper-outfitted rooms to standard rooms, and followed up on the rate of nosocomial infections. Rooms with copper showed an 80 percent reduction in bioburden compared to the standard rooms, and significantly fewer patients in copper rooms developed infections.
A few critics have pointed out that funding for most of the research about copper's antimicrobial properties has come from the copper industry, but so far the results have been significant. One question is whether the distinctive appearance of copper affects the outcome by making staff and visitors more mindful of cleanliness — but on a practical level, that's a useful effect, too.
Kyle Sexton of the Copper Development Association says it's been key to gather enough evidence to convince the medical community, which isn't going to accept an unproven technology. Two main barriers are the cost of replacing parts, especially in large hospitals, and getting buy-in at all levels of large institutions.
"There can be a lot of people you need to convince," Sexton says.
He points to Purell, which was invented in 1988 but lost money for years before hand sanitizer become widely used in health care centers. (Bottles of hand sanitizer are mounted in convenient places on the walls at Pullman Regional.)
In the next few years, the Copper Development Association hopes to encourage more hospitals to embrace copper as a defense against infections, and copper surfaces could also be used in giant sports facilities, public transit and airports. A study of Atlanta airport drinking fountains retrofitted with a subtle nickel-copper alloy found that the copper reduced surface bacteria by about 80 percent. Case studies for the Copper Development Association include the Ronald McDonald House in Charleston, South Carolina, where copper railings, handles and sinks protect children with fragile immune systems. Other institutions are trying copper on a trial basis, or in limited areas like fitness centers.
A $10,000 grant from the Copper Development Association jump-started Pullman Regional Hospital's copper installation, and Sexton says the hospital stood out as an ideal place to showcase the technology because of the staff's enthusiasm for the project.
"We could really see the sincerity and dedication they had about patient care," Sexton says.
Initially, Harrich imagined fully outfitting the hospital's three operating rooms. But after thinking about where the copper could have the most impact, the plan shifted to identifying the most important touchpoints throughout the hospital. There are now more than 600 touchpoints installed, which will double as all the cabinet handles are replaced.
Of course, bright copper tarnishes — just think of the Statue of Liberty or an old penny. (Pennies before 1982 are mostly copper; since then, they're mostly zinc.) The housekeepers at Pullman Regional Hospital felt that any tarnishing made it look like they weren't doing their job, even if the copper was technically clean, so now they use Bar Keepers Friend cleanser every so often to keep the faucet handles shiny.
More companies are entering the market and prices are becoming more competitive, but it's still difficult to find copper versions of all the necessary hardware. An Idaho company called Rocky Mountain Hardware custom-made Pullman's distinctive copper sink handles from a mold. Pullman Regional Hospital eventually aims to use copper for bed rails, patient tables and the arms of chairs. They have prototypes for light switches, and would like to replace door handles and metal push bars on doors.
"This goes beyond the dollar sign," Harrich says. "This is about doing the right thing, and that's why we're in this business — to take care of people."♦