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 Table of Contents  
REVIEW ARTICLE
Year : 2022  |  Volume : 9  |  Issue : 3  |  Page : 406-409

Copper-based fabric for healthcare professionals to prevent healthcare-associated infections: A futuristic/dreamed uniform


1 Department of Nursing, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
2 Department of Nursing, Indian Railway Health Services, Bikaner, Rajasthan, India

Date of Submission08-Apr-2022
Date of Acceptance23-Jun-2022
Date of Web Publication29-Sep-2022

Correspondence Address:
Dr. Shatrughan Pareek
Department of Nursing, Indian Railway Health Services, Bikaner, Rajasthan 334005
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mgmj.mgmj_44_22

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  Abstract 

Healthcare-associated infections (HAIs) have a major impact on public health worldwide. Till now, we are relying on hand washing and environmental disinfection, but the compliance rate of hand washing and adequate supply of materials is always a catch. Alongside patients, surfaces and supplies act as reservoirs of microorganisms in healthcare settings. The reduction in organisms may prove to be an effective strategy to decline HAIs. The use of gold and silver in commercial textiles is prohibited because of the high cost rather than having excellent antibacterial and antimicrobial properties, so copper has become the best choice for researchers as it possesses similar properties to gold and silver and has other characteristics such as its durability, corrosion resistance, prestigious appearance, and ability to form complex shapes. It has been found that copper brings down the microbial burden of high-touch surfaces in healthcare settings. The fundamental properties of copper offer a theoretical advantage to regular cleaning, as the effect is continuous rather than episodic. So the use of copper-impregnated textiles in hospital areas whether in form of bed linen or uniforms for health professionals, as well as patients, can be a viable alternative to decline the levels of infection in healthcare settings, and with the discovery of copper-encapsulated hospital beds and fabrics, dividends will likely be paid in improved patient outcomes, lives saved, and healthcare cost saved. The application of copper in fabrics for healthcare professionals will be a sound initiative to prevent HAIs. The fabric may help decline the infection rate and mortality among hospitalized patients.

Keywords: Copper-based fabric, dreamed uniform, healthcare professionals, healthcare-associated infections


How to cite this article:
Sharma M, Pareek S. Copper-based fabric for healthcare professionals to prevent healthcare-associated infections: A futuristic/dreamed uniform. MGM J Med Sci 2022;9:406-9

How to cite this URL:
Sharma M, Pareek S. Copper-based fabric for healthcare professionals to prevent healthcare-associated infections: A futuristic/dreamed uniform. MGM J Med Sci [serial online] 2022 [cited 2022 Dec 7];9:406-9. Available from: http://www.mgmjms.com/text.asp?2022/9/3/406/357469




  Introduction Top


History indicates that many ancient civilizations, viz., the ancient Egyptians, the Greeks (400 BC), and the Indians used copper for sterilizing water and for many treatment purposes, even though they were not aware of the microbial world.[1] Copper has been the subject of recent microbiology research. The biocidal properties of copper on a wide range of pathogens, such as bacteria, fungi, and viruses, have been revealed by many laboratory studies.[1],[2] The potency of copper extends to methicillin-resistant Staphylococcus aureus (S. aureus)[3] and vancomycin-resistant enterococci.[4] Apart from being an effective antimicrobial agent, the exposure to copper has been correlated with enhanced wound healing.[5] Bacterial colonization is greatly reduced when copper alloys are used on external surfaces in a therapeutic context,[6],[7] and in recent times, copper-laden fabrics have also been studied.[8] When compared with noncopper exposure, a study found that pediatric patients exposed to copper-surfaced objects in the controlled environment of the intensive care unit had lower healthcare-associated infection (HAI) rates.[9],[10] In this sense, it is vital to pay consideration to the various fabrics used in healthcare settings, worn by personnel, such as coats and uniforms, as well as those worn by patients, such as bed and bath linens and gowns, which play a chief role in microbial contamination and dissemination.

It has been reported that out of every 100 inpatients in a healthcare setting, 10 and seven patients get infected by HAI in developing and developed countries, respectively.[11] Various multicentric studies around the globe showed the prevalence of hospitalized patients acquiring at least one HAI ranged from 3.5% to 12%.[12],[13] A narrative review from India reported the incidence of HAI within the range of 4.4%–83.09%. A compilation of various studies indicated that the overall incidence of surgical site infection and catheter-related bloodstream infection in India ranged from 2% to 21% and 0.2% to 28%, respectively, with a rate of 0.5–47 per 1000 catheter days.[14],[15] Infectious agents continue to shed from infected or carrier patients or healthcare professionals and settle at various locations across healthcare facilities, where they remain viable for days, posing a risk of infection to other patients and staff. So we can consider the role of some of our traditional metals along with new technology.


  HISTORY OF COPPER’S ANTIMICROBIAL EFFECTS Top


The Egyptians were the first to mention the antimicrobial outcome of copper in 2600 BC. Drinking water was disinfected with copper vessels, and chest wounds were also treated with the same. In papyrus circa 1500 BC, it was stated that various adaptations of copper were used to treat infections, scalds, and itching.[16] Copper was found in significant quantities on Cyprus, a Greek island, and the ancient Greeks utilized it often. This is also the basis from which the Latin name for copper, cuprus, was derived. In the Hippocratic Collection, which was written in part by Hippocrates (460 to 377 BC), it was described that copper-containing wound dressings were recommended to treat leg ulcers.[5]


  Mechanism of action Top


The mechanism of action is postulated that the toxic effect of copper involves the rupture of the cell membrane, the production of reactive oxygen species, and the breakdown of bacterial DNA, resulting in cell death.[11] Copper resistance and the spread of antibiotic-resistant organisms are thought to be improbable because of this multitargeted method of action and the fast destruction of bacterial DNA.[6]


  Application of copper in hospitals Top


Hard surfaces

Copper Armour is a unique self-sanitizing coating that has bactericidal activity against key human diseases and considerably decreases the microbial burden on hospital surfaces, according to previous research. This compound could be utilized as a self-sanitizing coating in healthcare institutions to help with infection control.[17],[18] Another study found to support this evidence shows Staphylococcus and Micrococcus were two predominantly found species on touch surfaces, respectively, occurring 51.8% and 48.0%. In these facilities with low bioburden, copper surfaces effectively reduced the occurrence frequencies of three genera: Staphylococcus, Streptococcus, and Roseomonas. In only a few samples, pathogenic bacteria such as S. aureus, Enterococcus faecalis, and Enterococcus faecium were found. Methicillin-resistant S. aureus was also found on five of the control surfaces and one of the copper surfaces.[19]

Copper-impregnated products for skin pathologies

An improvement in skin appearance was documented in a preliminary clinical investigation on the safety of adult diapers treated with copper oxide in older patients.[20] For a half year, 16 patients wore copper diapers every day. There were no skin irritations or adverse responses regarding diapers during the trial period.

Future approach for the dreamed uniform

Some of the studies reported that copper oxide-impregnated materials, namely, bed sheets and patient apparel, are efficacious at reducing microbial load, resulting in a lower risk of HAIs.[21],[22],[23] Material scientists from the University of Manchester, working in conjunction with universities in China, have developed a “durable and washable, concrete-like composite material constructed from antibacterial copper nanoparticles” to deploy copper-impregnated fabric HAIs’ preventive measures. They have also found out how to attach the composite to wearable textiles such as cotton and polyester, which has previously been a stumbling hurdle for scientists. Techniques for attaching copper to materials such as cotton for medicinal and antimicrobial textile manufacture had limits before this discovery. The study team has now used a procedure called “polymer surface grafting” to anchor copper nanoparticles to cotton and polyester using a polymer brush, forming a strong chemical bond. This link, according to the experts, has resulted in exceptional washability and durability. The team also found their cotton and polyester-coated copper fabrics showed excellent antibacterial resistance against S. aureus and E. coli, even after being washed 30 times.[24]

Clinical application in various units of the hospital

The levels of bacteria and fungi found in air and surface samples from an operating block (operating rooms, intensive care units, surgery recovery rooms, and annexes corridors) were evaluated in survey research that followed the occurrence of numerous postsurgery infections at a transplant center of a hospital in Rome. Low concentrations of fungi were found in air and surface samples (ranging from 0 to 70 colony forming units (CFU)/m3 and from 0 to 21 CFU/cm2, respectively).[25]

Another study found that using copper oxide–impregnated biocidal fabrics in ventilator-dependent patients’ long-term care wards was linked to a considerable reduction in HAI indicators and antibiotic use.[21] Infected patients spread microorganisms in hospitals not only by releasing expectorating drops, fluids from infected wounds, excrement, urine, blood, and other corporeal fluids, but also through clothing and blankets, and healthcare workers are in constant contact with patients, so they require a barrier to prevent infection after repeated hand washing and disinfection. Using engineering and environmental control measures, disease spread could be avoided. In addition to regular cleaning and disinfection techniques, lasting antimicrobial materials such as copper can be used to maintain suitable hygienic standards, particularly on high-touch surfaces,[25] bed linen, and uniform of healthcare professionals.


  Conclusion Top


The antibacterial application of copper in health care is becoming increasingly apparent as research progresses toward clinical testing. The continuous and rapid broad-spectrum biocidal properties of both copper-containing hard surfaces and soft surfaces such as textiles and polymers may offer a novel and innovative advancement in the battle against HAIs. Traditional infection–prevention methods should not be abandoned; nevertheless, copper-coated surfaces and fabrics may improve their efficacy. The employment of these materials in the production of healthcare uniforms, on the other hand, requires more research to confirm their efficacy in reducing the microbial load in clinical practice. The application of copper in fabric for healthcare professionals will be a sound initiative to prevent HAIs. The fabric may help decline the infection rate and mortality among hospitalized patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Borkow G, Gabbay J Copper, an ancient remedy returning to fight microbial, fungal and viral infections. Curr Chem Biol 2009;3:272-8.  Back to cited text no. 1
    
2.
Borkow G, Gabbay J Copper as a biocidal tool. Curr Med Chem 2005;12:2163-75.  Back to cited text no. 2
    
3.
Noyce JO, Michels H, Keevil CW Potential use of copper surfaces to reduce survival of epidemic meticillin-resistant Staphylococcus aureus in the healthcare environment. J Hosp Infect 2006;63:289-97.  Back to cited text no. 3
    
4.
Borkow G, Gabbay J, Zatcoff RC Could chronic wounds not heal due to too low local copper levels? Med Hypotheses 2008;70:610-3.  Back to cited text no. 4
    
5.
Arendsen LP, Thakar R, Sultan AH The use of copper as an antimicrobial agent in health care, including obstetrics and gynecology. Clin Microbiol Rev 2019;32:e00125-18.  Back to cited text no. 5
    
6.
O’Gorman J, Humphreys H Application of copper to prevent and control infection. Where are we now? J Hosp Infect 2012;81:217-23.  Back to cited text no. 6
    
7.
Salgado CD, Sepkowitz KA, John JF, Cantey JR, Attaway HH, Freeman KD, et al. Copper surfaces reduce the rate of healthcare-acquired infections in the intensive care unit. Infect Control Hosp Epidemiol 2013;34:479-86.  Back to cited text no. 7
    
8.
Borkow G, Gabbay J Putting copper into action: Copper-impregnated products with potent biocidal activities. Faseb J 2004;18:1728-30.  Back to cited text no. 8
    
9.
von Dessauer B, Navarrete MS, Benadof D, Benavente C, Schmidt MG Potential effectiveness of copper surfaces in reducing health care-associated infection rates in a pediatric intensive and intermediate care unit: A nonrandomized controlled trial. Am J Infect Control 2016;44:e133-9.  Back to cited text no. 9
    
10.
Dollwet HHA, Sorenson JRJ Historic Uses of Copper Compounds in Medicine. Trace Elements in Medicine. 2nd ed. Arkansas: The Humana Press Inc.; 2001. p. 80-7.  Back to cited text no. 10
    
11.
Danasekaran R, Mani G, Annadurai K Prevention of healthcare-associated infections: Protecting patients, saving lives. Int J Community Med Public Health 2014;1:67-8.  Back to cited text no. 11
    
12.
Gastmeier P, Kampf G, Wischnewski N, Hauer T, Schulgen G, Schumacher M, et al. Prevalence of nosocomial infections in representative German hospitals. J Hosp Infect 1998;38:37-49.  Back to cited text no. 12
    
13.
Nicholls TM, Morris AJ Nosocomial infection in Auckland healthcare hospitals. N Z Med J 1997;110:314-6.  Back to cited text no. 13
    
14.
Ramasubramanian V, Iyer V, Sewlikar S, Desai A Epidemiology of healthcare-acquired infection—An Indian perspective on surgical site infection and catheter-related bloodstream infection. Indian J Basic Appl Med Res 2014;3:46-63.  Back to cited text no. 14
    
15.
Reddy BR, Vani J, Gade PS, Swapnil V, Kurkure SV Trends in surgical site infections in general surgery at a tertiary hospital. J Med Allied Sci 2012;2:19-22.  Back to cited text no. 15
    
16.
Copper Development Association (CDA). Reducing the risk of healthcare-associated infections: The role of antimicrobial copper touch surfaces. CDA Publication 196. Hempstead, UK: Grovelands Business Centre Boundary Way; 2014. p. 16. Available from: https://www.antimicrobialcopper.org/sites/default/files/upload/media-library/files/pdfs/uk/brochures/pub-196-reducing-risk-healthcare-infections.pdf. [Last accessed on 19 Jan 2022].  Back to cited text no. 16
    
17.
Montero DA, Arellano C, Pardo M, Vera R, Gálvez R, Cifuentes M, et al. Antimicrobial properties of a novel copper-based composite coating with potential for use in healthcare facilities. Antimicrob Resist Infect Control 2019;8:3.  Back to cited text no. 17
    
18.
Colin M, Charpentier E, Klingelschmitt F, Bontemps C, De Champs C, Reffuveille F, et al. Specific antibacterial activity of copper alloy touch surfaces in five long-term care facilities for older adults. J Hosp Infect 2020;104:283-92.  Back to cited text no. 18
    
19.
Weinberg I, Lazary A, Jefidoff A, Vatine JJ, Borkow G, Ohana N Safety of using diapers containing copper oxide in chronic care elderly patients. Open Biol J 2013;6:1-7.  Back to cited text no. 19
    
20.
Sun C, Li Y, Li Z, Su Q, Wang Y, Liu X Durable and washable antibacterial copper nanoparticles bridged by surface grafting polymer brushes on cotton and polymeric materials. J Nanomater 2018;2018:6546193.  Back to cited text no. 20
    
21.
Marcus EL, Yosef H, Borkow G, Caine Y, Sasson A, Moses AE Reduction of health care-associated infection indicators by copper oxide-impregnated textiles: Crossover, double-blind controlled study in chronic ventilator-dependent patients. Am J Infect Control 2017;45:401-3.  Back to cited text no. 21
    
22.
Sifri CD, Burke GH, Enfield KB Reduced health care-associated infections in an acute care community hospital using a combination of self-disinfecting copper-impregnated composite hard surfaces and linens. Am J Infect Control 2016;44:1565-71.  Back to cited text no. 22
    
23.
Lazary A, Weinberg I, Vatine JJ, Jefidoff A, Bardenstein R, Borkow G, et al. Reduction of healthcare-associated infections in a long-term care brain injury ward by replacing regular linens with biocidal copper oxide impregnated linens. Int J Infect Dis 2014;24:23-9.  Back to cited text no. 23
    
24.
Michels HT, Keevil CW, Salgado CD, Schmidt MG From laboratory research to a clinical trial: Copper alloy surfaces kill bacteria and reduce hospital-acquired infections. Herd 2015;9:64-79.  Back to cited text no. 24
    
25.
Bonadonna L, Briancesco R, Coccia AM Analysis of microorganisms in hospital environments and potential risks. Indoor Air Quality in Healthcare Facilities 2017:53-62.  Back to cited text no. 25
    




 

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