Improving Patient Safety AND Reducing Clinical Costs

Reduced Microbial Bioburden = Improved Patient Safety

Reducing microbial bioburden on frequently-touched clinical surfaces is now recognised as fundamental to improving patient safety.
Healthcare-Associated Infections (HCAIs) are still prevalent in healthcare; Antimicrobial Resistance (AMR) is making the situation worse.

Strategic use of effective antimicrobial materials, as an adjunct to cleaning and hand hygiene, is proven effective – not only at reducing microbial bioburden on clinical touch surfaces – but also at reducing the infection risk to patients.

Reduced microbial bioburden on copper items in clinical settings (Salgado, 2013)
Recent research into antimicrobial efficacy under typical dry usage conditions shows a marked difference between copper alloys and other materials marketed as antimicrobial:
There is a wealth of robust evidence, spanning nearly 40 years, supporting the use of clinical touch-surface items made from copper alloys. This translational science article gives a useful overview with relevant citations:
Making clinical touch surfaces from copper & copper alloys gives rapid and continuous reduction of microbial bioburden, without change to cleaning regime or staff behaviour, this reduces the infection risk to patients and staff.
Helping To Tackle Antimicrobial Resistance
But that is not all – further research shows that copper has a role to play in helping to reduce the spread of AMR.

Horizontal Gene Transfer, a key element of AMR spread and development, takes place on standard clinical touch surfaces, but not on copper.

Installing touch-surfaces made from copper alloys – proven to lower HCAI rates – will also help to reduce antibiotic prescription levels.
Cost-Benefit Analysis: Astounding Results Indicated
Prevention of HCAIs is better, cheaper, and more ethical than simply trying to treat them.
Research by York Health Economics Consortium (YHEC) indicates very rapid initial payback plus significant long-term savings from installing copper touch surfaces.
Most commonly-used clinical disinfectants are compatible with copper materials, when used in accordance with manufacturer’s guidelines.
Routine cleaning to remove dirt and soil is necessary for good sanitation and to assure the effective antimicrobial performance of the copper alloy surface.  Cleaning agents typically used for traditional touch surfaces are permissible; the appropriate cleaning agent depends on the type of soiling and the measure of sanitisation required. Normal oxidation or wear of copper-alloy surfaces will not impair the antimicrobial effectiveness of the product.
A French study on use of copper over more than three years in five long-term care facilities concluded that, even with standard cleaning, copper alloy touch surfaces were an effective solution to reduce bacterial spread:
Feedback From Early Adopters
Feedback from the several sites around the world that have installed copper touch surfaces is positive.

At Grinnell Regional Medical Center in the US, post-installation assessment shows that the copper surfaces maintain ‘terminal clean’ levels of microbial bioburden even in ‘closed’ hospital rooms:

Recognition in design guidelines and healthcare ratings systems around the world

The benefits of strategic use of copper touch surfaces have been recognised in healthcare design guidelines and quality assessment systems around the world.   These include:

  • Health Protection Scotland, 2017
  • ECRI Institute: Top 10 Technology Watch List for the Hospital C-Suite, 2014
  • CNESH: Canadian Network for Environmental Scanning in Health, 2014
  • AHRQ: US Agency for Healthcare Research and Quality, 2013
  • CMJ: Polish National Centre for Quality Assessment in Healthcare, 2016
  • EPIC3: NHS England NICE-accredited guidelines, 2014
  • Finnish Building Information Foundation Indoor Hygiene, 2017
  • International WELL Building Standard™, 2016
  • IGBC: Indian Green Building Council – Healthcare Facilities Rating System Guidelines, Pilot Version, 2016


Healthcare providers are under pressure to improve efficiency, resilience to seasonal challenges (such as ‘flu and norovirus) and to reduce their antibiotic prescription levels.

A robust body of evidence shows that strategic use of copper touch surfaces – a simple intervention – offers significant and long-term benefits for patients and healthcare providers alike.

Strategic use of clinical touch-surface items made from copper / copper alloys is proven to be an effective supplement to infection control – with dramatic results shown by laboratory testing and clinical trials – without the need to change behaviour of healthcare workers, cleaning staff or patients.

Reducing infections will improve patient safety – this is one of the five strategic objectives in the WHO Global Action Plan for tackling Antimicrobial Resistance.

Achieving clinical cost-savings and freeing-up beds is a fundamental part of improving healthcare efficiency. The YHEC research provides a strong business case for copper touch surfaces.

Strategic use of copper materials for touch surfaces is a simple measure for healthcare providers to improve their overall performance, their finances and their reputation; with wider social and economic benefits.

The wide range of copper alloys available means that products made from them do not even have to look like copper or brass. Some of the alloys are practically indistinguishable from stainless steel, yet have proven antimicrobial efficacy.

We hope this is helpful and thought-provoking.
If you have any questions, please do not hesitate to contact us.

Research partners wanted!

Plastic materials with in-use antimicrobial efficacy


We are currently looking for evidence and researchers regarding durability and antimicrobial efficacy  under dry usage conditions of plastic materials in healthcare and hygiene-critical settings.

These plastic materials need to be:

  • antimicrobially effective under typical indoor / dry conditions*
  • durable
  • resistant to disinfectants used in “deep clean” or outbreak situations in hospitals
  • suitable for injection-moulding processes
  • low cost / comparable to standard plastics

*These two papers indicate why this is necessary


Please contact us ASAP if you can help with this.

Look forward to hearing from you soon and please ask if you have any questions.

Plastic peril – the cost of convenience?

Our oceans are contaminated with plastic.. So why do we use so much of it in healthcare?

Greenpeace volunteers collect plastic rubbish from Manila Bay, Philippines. 2006

Plastics must now be the most common materials in our hospitals – especially touch surfaces in clinical settings.  Why, when microbiologists tell us just how readily microbes attach to plastic surfaces?

Furthermore, we have known for years that most plastic materials are sensitive to damage from disinfection products, rendering them even better-suited to microbial attachment and biofilm formation.

In contrast, some simple everyday metals, fully recyclable (and with a high recycled content when new) are not only durable and attractive, but proven to be very effective against microbes – bacteria, viruses, yeasts and fungi… even under typical indoor (dry) usage conditions.

So, these metals can work continuously – between touches and between cleans – to destroy pathogens rapidly and thereby reduce the infection risk to patients and staff.

The strategic use of copper and copper-alloys, as a simple adjunct to cleaning and hand hygiene, is now recognised in design guidelines and healthcare quality assessment schemes around the world as a simple and cost-effective measure to improve patient safety and healthcare provider finances.

Materials matter – for healthcare and for our planet.

Project Opportunity: our ref 2015E12A

One of our UK NHS Trust clients is keen to fit copper door handles, push plates and light switches during their refurbishment programme over the next 5 years, across two hospital sites.
They want to standardise components across both sites. They will accept natural copper / copper-alloy colours, as part of a visual statement, so there are no alloy constraints.

The first step is a preliminary “meet the buyer” meeting on 19th Jan 2016 between 12-3pm, for the Trust team to see products and budget prices.

This invitation is open to manufacturers of Cu+ approved copper door handles, push plates and light switches.
Product robustness appropriate for harsh environments such as hospitals is essential, and grade 4 category certification to EN 1906 required for door handles.
Interested companies must have presence and support in the UK, and be able to attend a “meet the buyer” meeting held at the Trust premises on 19th January 2016.
If you and your products meet these requirements, please contact us and express your interest by 5pm on 4th Jan 2016.

To make this fair, we would suggest your price information should be provided in a sealed envelope to the Trust buyer.
Please note the limited space / numbers constraints at the event.
The Trust will be looking to see product samples and pricing, to enable a swift decision.
Product cost will naturally be a major consideration, and please note the requirement for hospital items to withstand rough handling / abuse.

No fee is imposed by ACT Surfaces Ltd to attend this event, nor will we be seeking to earn a commission on your product sales for this project.

Please email Andrew – quoting our ref 2015E12A – if you are able and willing to attend on Tues 19th Jan 2016, 12-3pm, in South East England, advising alloys and product details.

A concise ppt or pdf file of products and finishes in your range would be welcomed.
The inital focus is on door handles and light switches, however further items may become of interest to the Trust.

We will inform the client of interested suppliers at lunchtime on Tuesday 5th January 2016.

If necessary, due to space constraints, the Trust will shortlist invited companies on the basis of submitted and publicly-available information.

If you have any questions or concerns, please ask.

We wish you a happy Christmas and successful 2016.
ACT Surfaces Ltd

——– Forwarded Email ——–

Subject: Copper fittings
Date: Mon, 21 Dec 2015 13:57:10 +0000


Following our conversation today, could you please arrange to visit us on the afternoon of 19th January 2016?

As discussed, it would be useful to bring suitable manufacturers of copper fittings with you, who will be able to bring sample items along with estimated costs.

As I explained, we have multiple refurbishment and new build projects proposed in our Estates Strategy, which we are planning to action over the next five years. We are specifically looking to review the merits of copper based door handles, door push plates and light switches with a view to installing these products as standard fittings within our upcoming projects.

I will organise a meeting room with space for up to 5 interested manufacturers to display their products, from 12.00 noon to 15.00 hrs.

I will also invite suitably interested colleagues to visit with the manufacturers and yourself, to discuss the benefits of copper fittings and examine the products on display.

This staff consultation event will contribute to our decision making around the type of alloy and colour of copper fittings to install.

I look forward to meeting with you in the New Year.


Bang on the button…

Elevator buttons as unrecognized sources of bacterial colonization in hospitals

A study published in 2014 by the University of Toronto, analysed lift buttons and toilet washroom surfaces at 3 large urban teaching hospitals located in Toronto, Ontario.

The researchers found (perhaps because lift buttons are frequently used and only periodically cleaned):  “Elevator buttons had higher colonization rates than toilet surfaces in the same buildings.”

 Read that paper here:

This news article (Daily Mail, 2015) highlights research by the Centre for Superbug Solutions at the University of Queensland comparing bacterial contamination of typical office items.

Interestingly, swabs taken from the outside elevator button showed less bacterial loading than the buttons inside the elevator: “Some of the germiest surfaces were a mobile phone screen, a computer keyboard and a kitchen bench, while door handles, desks and chairs were much cleaner,” Dr Elliott said.

Read more:

In a different study, it was found that a single contaminated doorknob or elevator button can spread virus rapidly through entire office buildings, hotels or hospitals.

Using bacteriophage MS-2 as a surrogate for Norovirus, Charles Gerba and his researchers found that contamination of just one single doorknob or table top results in the spread of viruses throughout office buildings, hotels, and health care facilities.

Within 2 to 4 hours, the virus could be detected on 40 to 60 percent of workers and visitors in the facilities and commonly touched objects.

American Society for Microbiology. “How quickly viruses can contaminate buildings — from just a single doorknob.” ScienceDaily. ScienceDaily, 8 September 2014. <>.

These findings led to a further study, published in final edited form May 2016, investigating spread from a single person’s hands versus a single door push-plate, and efficacy of intervention measures to combat viral spread.

A bundle of good hand sanitation practice, cleaning and educational display material was found to be effective at reducing contamination on personal and communal fomites  (See for details).

Make a material change – go copper!

Abundant data from laboratory testing and in-situ clinical studies around the world shows that touch-surface items made from copper and copper alloys have a consistently lower microbial burden than standard items, without change to cleaning regimes or human behaviour. See

Copper / copper-alloy materials are very effective, especially under typical indoor conditions, at killing pathogens quickly and completely.
Use of copper materials for touch surfaces is recommended as an adjunct to hand hygiene and cleaning, to provide a greater degree of protection, between touches and between cleans.
The US EPA has registered over 500 copper alloys as able to make public health benefit claims relating to touch surfaces.
No other metal, not even silver, can make that claim.


Comparing Copper versus Stainless Steel, repeated contamination over 24h between cleans
Continuous Reduction test results for MRSA on copper alloy C11000 and stainless steel S30400. Each inoculation added 650,000 CFUs.  More details at:
Bacteria (gram +ve or gram -ve), viruses, yeasts and fungi (including spores) are proven to die rapidly on copper / copper-alloy materials, with destruction of DNA (including plasmids) evident within seconds of contact on these metals. 

See this translational science article for a good overview and source of scientific references

No other material, such as silver-containing coatings, comes close to copper’s antimicrobial efficacy: particularly under typical indoor conditions:


*image: Elevator button made from CuNi 90/10 (CW352H) copper alloy, which has good corrosion resistance and similar fabrication properties to stainless steel, yet offers lifetime efficacy against microbes.

Lincolnshire hospital fits copper touch surfaces

Wide range of copper touch surface items installed in a Lincolnshire hospital: bed rails, over-bed table, visitor’s chair arms, light switches, electrical sockets, cabinet handles, door handles, grab rails, hand-rails, taps.

ENT consultant Mr Michael Oko was so impressed by copper’s intrinsic antimicrobial properties that he paid out of his own pocket for a room used for sleep apnoea trials to be fitted with copper-alloy items, and has started fund-raising to get more rooms fitted-out. What a champion!

See press release for full details, and donate via


2014-09-11th pr918-amc-new-patient-safety-initiative

Copper touch surfaces included in ECRI report of emerging technology

Copper touch-surface items are highlighted in a document published by the ECRI Institute titled: ‘Top 10 (Technologies) Hospital C-Suite Executives Watch List’ for 2014.

The overarching goal of the new document is to provide summaries of emerging technologies that can help hospital leaders improve capital planning efforts in 2014.

The fourth topic presented in the publication was the use of copper surfaces within healthcare facilities. A background explaining the troubles associated with healthcare-associated infections is given, along with a write-up on copper touch surfaces, including both scientific evidence and commentary on how strategically-implemented copper touch surface items can have a positive influence within healthcare facilities.

ECRI Institute’s conclusions were drawn from utilising data from EPA testing protocols, a Department of Defense funded Clinical Trial, and an AHRQ funded Clinical Trial currently under way at UCLA’s School of Engineering and Applied Science.

To read the document in its entirety, click here to access the ECRI Institute website.

Brief background on ECRI Institute:

Designated as an Evidence-Based Practice Center by the U.S. Agency for Healthcare Research and Quality and listed as a federal Patient Safety Organization by the U.S. Department of Health and Human Services, the ECRI Institute delivers publications that help decision makers ‘understand the hype vesus the evidence and the important issues to consider when deciding whether to be early adopters, middle adopters, or no-adopters.’

ECRI Institute claims to ‘have no vested interest in the technologies and issues we discuss other than to fulfill our mission to improve patient safety and cost-effectiveness of healthcare.’

Return on investment? What Payback period?

Copper touch surfaces installed in intensive care units (ICUs) pay for themselves in less than a year, according to a cost-benefit model developed by the York Health Economics Consortium (YHEC) and commissioned by the International Copper Association. This is due to the resulting reduction in surface bioburden and hence healthcare-associated infections (HCAIs).

Read more:-

Selly Oak Hospital ward trial

What difference did installing copper surfaces make to cleanliness within a 20 bed hospital ward?

90–100% less microbial contamination on copper items, compared to standard ones.

Professor Tom Elliot, Medical Director, University Hospitals Birmingham NHS Foundation Trust on the latest status of the trial:

‘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 [bacteria that cause] infection.’

Read the paper here