New business model supports use of copper in hospitals

York Health Economics Consortium develops economic assessment model to convince health chiefs of the efficacy of copper installations

Evidence is growing to support the use of copper touch surfaces

A unique health economics assessment of the role of copper in preventing healthcare associated infections (HCAIs) demonstrates rapid payback on the capital investment.

Health economics evaluations are typically applied to medication or surgery costs, but this study from York Health Economics Consortium (YHEC) – part of the University of York in the UK – investigated the economic benefits of applying an engineering and design approach to infection control, deploying antimicrobial copper touch surfaces in intensive care units (ICUs).

The group carried out an extensive literature search and gathered expert opinions to verify the data they used to enumerate the return on investment of a copper intervention. Their calculation was based on comparative component costs, reduced infection rates, and reduced cost of care over a five-year period.

Copper alloy surfaces offer an alternative way to reduce the increasing number of HCAIs without having to worry about changing healthcare worker behaviour

The YHEC study investigated the cost-effectiveness of a copper intervention, comparing expenditure on components with improvements in patient outcomes and other tangible benefits. This investigation allowed the derivation of a spreadsheet-based model that uses the best current, published information and shows the rapid return on investment of a copper intervention. It also calculates the impact on bed days and quality-adjusted life years (QALY). The model is simple, transparent and fully referenced, and allows input of data for adaptation to specific local settings.

And using UK data, the model predicts that the cost of replacing six key frequently-touched surfaces in a 20-bed ICU with antimicrobial copper equivalents would be recouped in less than two months, based on fewer infections and the resulting shorter lengths of stay.

Dr Matthew Taylor, YHEC’s director and one of the paper’s authors, said: "After the initial two months, ongoing cost savings will accrue from the reduction in blocked beds and better-directed staff resources."

The decision to concentrate on ICUs came after the publication of research by the US Department of Defense.

While it had been widely proven that copper surfaces had fewer germs on them, the question remained: would this translate to reductions in infections and, if so, by how much?

. Because the antimicrobial effect is a continuous property of copper, the regrowth of deadly bacteria is significantly less on these surfaces, making a safer environment for hospital patients

In order to help answer this, frequently-touched near-patient surfaces were replaced with antimicrobial copper equivalents, the bioburden was monitored regularly, and HCAIs recorded. ICU rooms were chosen as intensive care patients are at higher risk from infections due to the severity of their illnesses, the frequency of invasive procedures, and high interaction with healthcare workers.

Patients were randomly placed in available rooms with or without antimicrobial copper surfaces, and the rates of HCAIs were compared over a period of 21 months in three US hospitals: The Medical University of South Carolina, Charleston, The Ralph H Johnson Veterans Administration Medical Center, Charleston, and the Memorial Sloan Kettering Cancer Center in New York City.

In rooms equipped with just six antimicrobial copper surfaces, patients’ risk of acquiring an HCAI was reduced by 58%.

Trial leader, Dr Mike Schmidt, vice chairman of microbiology and immunology at the Medical University of South Carolina, said of the findings: “Copper alloy surfaces offer an alternative way to reduce the increasing number of HCAIs without having to worry about changing healthcare worker behaviour. Because the antimicrobial effect is a continuous property of copper, the regrowth of deadly bacteria is significantly less on these surfaces, making a safer environment for hospital patients.”

One thing flagged up during YHEC’s investigation was the fact that copper touch surfaces are capital expenditure items, and this complicates the decision-making process and multiplies the number and discipline of stakeholders involved.

Often the infection control team need to review the evidence and convince themselves that a copper intervention is worth pursuing, but then the capital budget holders need to be convinced about the cost effectiveness. In addition, procurement managers need to understand how to spot an efficacious product.

But the findings of their assessment will provide the much-needed evidence to convince those holding the pursestrings of the speed of payback.

Now the clinical evidence has moved to a new level and the cost benefit of improved patient outcomes can be modelled, hospital project teams need to work together to make their own site-specific assessment of how antimicrobial copper touch surfaces can benefit their patients

A spokesman at the International Copper Association said of the results: “A common misconception is that copper is expensive. In fact, the material cost forms a very small part of an overall component price, and copper and its alloys are cost-effective to work with and form products from.

“Additionally, when considering the specification of antimicrobial copper touch surfaces for a new build or refurbishment, comparing the cost of a copper handle with a standard one is only looking at half the story. It is not a like-for-like comparison as the intrinsic properties of the copper alloy offer a significant advantage, contributing to a more hygienic environment and, in the case of the newly-reported ICU scenario, a significant reduction in infections.”

Knowing which products to choose is also a barrier to adoption, so to assist with specification the International Copper Association runs the Cu+ approval scheme to help identify products that are made from approved copper alloys. Cu+-marked products will retain their rapid antimicrobial efficacy over many years, even when scratched, are not lacquered (allowing contact between the surface and the bacteria), and are offered by companies who understand the technology and use approved antimicrobial copper alloys that have passed rigorous testing.

The association spokesman said: “So, now the clinical evidence has moved to a new level and the cost benefit of improved patient outcomes can be modelled, hospital project teams need to work together to make their own site-specific assessment of how antimicrobial copper touch surfaces can benefit their patients.

“For products with no price premium compared to standard ones, the decision should be especially easy: specify durable products benefitting from copper’s intrinsic property to improve environmental hygiene.”

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