Potential effectiveness of copper surfaces in reducing health care–associated infection rates in a pediatric intensive and intermediate care unit: A nonrandomized controlled trial

•The built hospital environment serves as a significant and continuous reservoir of microbes capable of colonizing and infecting patients.•Cleaning, hand hygiene, and infection control bundles while effective cannot completely eliminate this risk.•Augmenting the built hospital environment with continuously active antimicrobial surfaces fabricated from U.S. Environmental Protection Agency–registered copper surfaces can significantly lower the microbial burden, helping to augment existing infection control strategies.•Addition of a limited number of copper-surfaced components to multibed rooms in pediatric intensive care units resulted in reductions in health care–associated infections (HAI) from 13.0 to 10.6 per 1,000 patient days when comparing the HAI incidence rates of patients cared for in rooms with copper with those cared for in rooms without copper components, respectively, for a crude relative risk reduction of 0.19 (90% confidence interval, 0.46 to -0.22).•Copper surfaces warrant serious consideration when contemplating the introduction of no-touch disinfection technologies for reducing burden to limit acquisition of health care–associated infections. BackgroundStudies have consistently shown that copper alloyed surfaces decrease the burden of microorganisms in health care environments. This study assessed whether copper alloy surfaces decreased hospital-associated infections in pediatric intensive and intermediate care units.MethodsAdmitted infants were assigned sequentially to a room furnished with or without a limited number of copper alloyed surfaces. Clinical and exposure to intervention data were collected on a daily basis. To avoid counting infections present prior to admission, patients who stayed in the hospital <72 hours were excluded from analysis. Health care–associated infections (HAIs) were confirmed according to protocol definitions.ResultsClinical outcomes from 515 patients were considered in our analysis: 261 patients from the intervention arm of the study, and 254 from the control arm. Crude analysis showed an HAI rate of 10.6 versus 13.0 per 1,000 patient days for copper- and non–copper-exposed patients, respectively, for a crude relative risk reduction (RRR) of 0.19 (90% confidence interval, 0.46 to -0.22). Conducting clinical trials to assess interventions that may impact HAI rates is very challenging. The results here contribute to our understanding and ability to estimate the effect size that copper alloy surfaces have on HAI acquisition.ConclusionsExposure of pediatric patients to copper-surfaced objects in the closed environment of the intensive care unit resulted in decreased HAI rates when compared with noncopper exposure; however, the RRR was not statistically significant. The clinical effect size warrants further consideration of this intervention as a component of a systems-based approach to control HAIs. Studies have consistently shown that copper alloyed surfaces decrease the burden of microorganisms in health care environments. This study assessed whether copper alloy surfaces decreased hospital-associated infections in pediatric intensive and intermediate care units. Admitted infants were assigned sequentially to a room furnished with or without a limited number of copper alloyed surfaces. Clinical and exposure to intervention data were collected on a daily basis. To avoid counting infections present prior to admission, patients who stayed in the hospital <72 hours were excluded from analysis. Health care–associated infections (HAIs) were confirmed according to protocol definitions. Clinical outcomes from 515 patients were considered in our analysis: 261 patients from the intervention arm of the study, and 254 from the control arm. Crude analysis showed an HAI rate of 10.6 versus 13.0 per 1,000 patient days for copper- and non–copper-exposed patients, respectively, for a crude relative risk reduction (RRR) of 0.19 (90% confidence interval, 0.46 to -0.22). Conducting clinical trials to assess interventions that may impact HAI rates is very challenging. The results here contribute to our understanding and ability to estimate the effect size that copper alloy surfaces have on HAI acquisition. Exposure of pediatric patients to copper-surfaced objects in the closed environment of the intensive care unit resulted in decreased HAI rates when compared with noncopper exposure; however, the RRR was not statistically significant. The clinical effect size warrants further consideration of this intervention as a component of a systems-based approach to control HAIs.