Updated May 2022
Infection control is far from a new challenge in your health care facilities. Before the pandemic, two million hospital-acquired infections (HAIs) caused 90,000 related deaths each year, according to STAT. Then 2020 welcomed in an entirely new burden for hospitals: COVID-19.
With an increased awareness of sanitary surfaces for infection control, hospitals and health care facilities reexamined solutions that help prevent the spread of viruses and bacteria. In fact, Allegion’s latest research, 2022 Health Care Trends Report: A study on how health care facilities are using technology to meet the demands of the changing landscape, found that 80 percent of hospitals addressed their door hardware as a preventative measure and more than half purchased products with antimicrobial properties.
While many are using antimicrobials, I found it interesting to learn about the types of products in place. The most popular products in use today are silver-based coatings. However, these products have not been certified to protect against viruses—and they only prevent bacteria versus killing them. While cooper has shown more promising results in reducing the spread infections, its adoption is much lower today. So why are hospitals not adopting copper as much as other products?
Let’s start by exploring how antimicrobial copper allows work and tips for choosing products for your hospital.
Antimicrobial copper alloy has been in the spotlight lately, although its uses are not entirely new to the health care market. Copper alloy-based products, as well as silver ion-based options, have been widely available for many different types of applications, from linens to bedrails to door hardware.
In February 2008, the U.S. Environmental Protection Agency (EPA) approved the registration of 275 antimicrobial copper alloys, which permits certain public health claims that copper, brass and bronze are capable of killing harmful, potentially deadly bacteria, according to the Copper Development Association Inc. That number grew by 80 in the next three years.
Then in February 2021, the EPA announced in a press release that select copper alloy solutions have been proven to provide long-term effectiveness against viruses, including SARS-CoV-2, the virus that causes COVID-19. The EPA’s announcement states that copper alloys are “the first product with residual claims against viruses to be registered for use nationwide.”
The Copper Development Association’s Antimicrobial Copper Alloys- Group 1 (EPA Reg. No. 82012-1), which is made of at least 95.6 percent copper, is now listed as a supplemental residual antimicrobial product for coronavirus on the EPA website.
In summary, today antimicrobial copper alloys are considered bactericidal, but only products with high amounts of copper are virucidal. It's expected that more advancements with copper will come, giving the health care market more options in antimicrobials. Afterall, interest is there.
A 2016 survey conducted by Allegion found that about one in five health care customers were using some form of antimicrobial solution. Since then, interest has surged. Our 2021 research shows that 73% are using these products more today than before the pandemic.
One frequently asked question with surface technologies like copper alloys is how do you know it’s working? With CuVerro Shield™ by Aereus Technologies, the copper alloy surface Allegion uses for its door hardware, bacteria are killed1 using a process called ionic bonding. Bacteria recognize copper ions in the alloy as an essential nutrient and allow the ions to pass through their membrane. Upon entering, the ions provide a lethal dose that interferes with cell function and membrane integrity. Cell respiration and metabolism are impeded and DNA damage may occur. The bacteria can no longer consume food or reproduce, so they die. Read more about why copper is antimicrobial.
Bacteria reside on every surface we touch—and they can live on for months if the surface is not disinfected. For example, staphylococcus aureus, including MRSA (Methicillin-Resistant Staphylococcus aureus), can survive on a dry surface for anywhere from seven days to seven months, per BMC Infectious Diseases research.
Laboratory testing has concluded that when cleaned regularly, CuVerro® surfaces reduce 99.9 percent of bacterial contamination within two hours of exposure1. EPA testing showed it was effective against common disease-causing bacteria: MRSA, staphylococcus aureus, enterobacter aerogenes, pseudomonas aeruginosa, escherichia coli O157:H7 and VRE (vancomycin resistant enterococci).
“Antimicrobial copper begins killing infectious bacteria on contact, then keeps killing it,” said Kon John, sales director at CuVerro, North America. “Unlike stainless steel, copper alloy-based solutions, like those we produce, can continuously kill bacteria between cleanings, even when a high volume of patients or medical personnel come into contact with doors made with antimicrobial copper.”
A study published in the January 2020 Journal of the American Medical Directors Association, “Copper for the Prevention of Outbreaks of Health Care–Associated Infections in a Long-term Care Facility for Older Adults,” equipped one wing of a nursing home with copper surfaces and compared incident rates for healthcare-related infections during the time of the study. It found that “the risk of hand-transmitted health care–associated infection was significantly lower in the area equipped with copper surfaces.”
This promising research indicates that copper alloys might be a helpful tool in preventing the spread of HAIs when used with other preventative measures for infection control.
“Antimicrobial copper is ideal for high-touch surfaces, like door hardware,” said John. “Think about how many people come in and out of patient rooms or common areas like places for worship. While hand washing and regular cleaning are still necessary, antimicrobial copper used for door hardware can help improve the cleanliness of these high-touch surfaces and improve peace of mind for everyone in the facility.”
While copper alloy-based products have been proven most effective in killing bacteria—and have shown early potential with viruses according to the EPA’s announcement—copper in its purest form isn’t feasible for door hardware. It isn’t durable enough and will tarnish easily. And not all copper-infused and copper alloy products are created equal. Here are three things to consider when selecting door hardware with antimicrobial copper alloys.
Where’s the proof? It’s important to first look for information on testing that proves the manufacturer’s claims. How long does it take to kill bacteria or mitigate the spread of viruses? How effective is it in reducing the spread of each? Watch for keywords like “prevent” vs. “kill.” And always differentiate between bacteria and viruses.
What’s the difference? Virucidal agents can kill viruses, while bactericidal can kill bacteria. Being able to destroy one doesn’t guarantee it destroys the other. If something kills bacteria, it doesn’t mean it’s guaranteed to be effective in preventing the spread of the coronavirus. Continue to check the EPA website for claims specific to the prevention of SARS-CoV-2.
Remember, the EPA just began approving copper alloys for virucidal claims. As of April 2021, the current requirement is 95.6 percent copper content. Few, if any, door hardware products fall into this category, but as the EPA reviews more alloys with decreasing amounts of copper, there will be options that are ideal for health care doors.
2014 research by Charles Gerba of the University of Arizona tracked the spread of a tracer virus throughout the day. It found that the contamination of a single surface, like a door knob, could result in the spread of viruses throughout office buildings, hotels and health care facilities. If more copper-based solutions are approved for preventing the spread of viruses, like the coronavirus, health care facilities might be able to get an upper hand on limiting the spread of HAIs throughout their facilities.
How often does the solution need to be replaced? Adhesive wraps need to be replaced frequently, so it’s best to only consider those for temporary use. If you’re replacing a copper door knob wrap too frequently, you might spend more in time and resources than you would on a permanent solution.
Also remember to inquire about cleaning protocols. Antimicrobial surfaces are intended to mitigate bacteria contaminants between cleanings. For antimicrobial copper alloys to be successful, the surfaces must remain free of dirt and oils, which can form a barrier that limits the ionic bonding process.
A 2016 article in Healthcare Design Magazine said that $1,000 to $1,500 per patient or exam room can fund upgrades of the most frequently touched surfaces like door levers, cabinets and drawer pulls, and sink handles. More robust measures will average around $10,000, but the Copper Development Association Inc. projects this will be paid back in a year based on the reduction of HAIs.
Collingwood General and Marine Hospital in Canada uses copper-infused panels on the walls in its hallways and patient rooms, along with other copper-infused surfaces like bed rails, door handles and pulls, toilet seats and toilet handles.
While not specific to copper, our research highlights where hospitals have added antimicrobials—finding a notable rise in intensive care units.
Door hardware with antimicrobial copper alloys is ideal for a variety of applications and complements other healthy-building solutions like touchless access or hands-free door pulls.
Many openings, from main entrances to corridors—and even restrooms—would benefit from a completely touchless experience using an automatic operator and wave actuator. However, that’s not feasible in all locations, which is why it can be helpful to implement solutions based on each application. For antimicrobial copper alloys used for door hardware, consider doors that have medium levels of traffic like hospital patient rooms. High-traffic entrances might benefit from touchless access control while low-traffic offices just need regular cleaning protocols. Find what works best for your facility. And if you need help, Allegion consultants are available to help you develop a plan.
Footnote disclaimer:
1. Laboratory testing shows that, when cleaned regularly, CuVerro surfaces kill greater than 99.9 percent of the following bacteria within 2 hours of exposure: Methicillin-Resistant Staphylococcus aureus, Staphylococcus aureus, Enterobacter aerogenes, Pseudomonas aeruginosa, E. coli O157:H7, and Vancomycin-Resistant Enterococcus faecalis (VRE). The use of CuVerro® bactericidal copper products is a supplement to and not a substitute for standard infection control practices; users must continue to follow all current infection control practices, including those practices related to cleaning and disinfection of environmental surfaces. This surface has been shown to reduce microbial contamination, but it does not necessarily prevent cross contamination.
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