JCM 2012年7月：铜表面可降低院内获得性感染

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来自南加利福尼亚医科大学的研究表明: 在常常容易被医护人员和病人触及的院内表面上加用铜，可以降低院内获得性感染发生的危险。这项研究发表在2012年7月《临床微生物学杂志》期刊上。

在美国每年因院内获得性感染死亡人数几近100000人，数值相当于一年中每天一架宽体客机坠毁。在美国，大约有5%的住院患者-每天近5500人，每年200万人-会发生院内感染，医疗保健费用增加450亿。在这项研究中，采用3家医学重症护理病房常见接触表面的微生物负荷为对象，首先评估那些表面的风险性，其次明确铜表面是否能降低微生物负荷和风险。这项研究分为两个阶段，铜表面使用前后，持续43个月。

在铜表面使用前，“我们得知在常见接触表面的平均微生物负荷量是公认良好水平的28倍，其表明对于患者存在感染风险，”研究者Michael Schmidt说道。通过安装铜表面，可降低83%的微生物负荷。研究团队总结道，在常见接触物体上采用铜表面方法可提供一个实质上的安全环境。“鉴于美国院内获得性感染通常适当地增加住院时间19天和43000美元的花费，铜表面的使用值得进一步的研究和优化，” Schmidt说道，并指出这是尾随癌症、心脏病和中风之后的第四大致死因素。他同时提到“铜已被人类使用上千年，首先作为工具使用，其次作为抗感染因子传播的工具。”

(M.G. Schmidt, H.H. Attaway, P.A. Sharpe,J. John, Jr., K.A. Sepkowitz, A. Morgan, S.E. Fairey, S. Singh, L.L. Steed,J.R. Cantey, K.D. Freeman, H.T. Michels, and C.D. Salgado，2012. 铜表面持续性减少院内常见表面微生物负荷，《临床微生物杂志》，50:2217-2223.)

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Sustained Reduction of Microbial Burden on Common Hospital Surfaces through Introduction of Copper
Michael G. Schmidta, Hubert H. Attawaya, Peter A. Sharpeb, Joseph John Jr.c, Kent A. Sepkowitzd, Andrew Morgana, Sarah E. Faireya, Susan Singhd, Lisa L. Steede, J. Robert Canteyf, Katherine D. Freemang, Harold T. Michelsh and Cassandra D. Salgadof
+ Author Affiliations

aMedical University of South Carolina, Department of Microbiology and Immunology, Charleston, South Carolina, USA
bIrwin P. Sharpe and Associates, West Orange, New Jersey, USA
cRalph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
dMemorial Sloan Kettering Cancer Center, Department of Medicine, Division of Infectious Diseases, New York, New York, USA
eMedical University of South Carolina, Department of Pathology and Laboratory Medicine, Charleston, South Carolina, USA
fMedical University of South Carolina, Department of Medicine, Division of Infectious Diseases, Charleston, South Carolina, USA
gAlbert Einstein College of Medicine of Yeshiva University, Montefiore Medical Center, Department of Epidemiology and & Population Health, Bronx, New York, USA
hCopper Development Association, New York, New York, USA

ABSTRACT
The contribution of environmental surface contamination with pathogenic organisms to the development of health care-associated infections (HAI) has not been well defined. The microbial burden (MB) associated with commonly touched surfaces in intensive care units (ICUs) was determined by sampling six objects in 16 rooms in ICUs in three hospitals over 43 months. At month 23, copper-alloy surfaces, with inherent antimicrobial properties, were installed onto six monitored objects in 8 of 16 rooms, and the effect that this application had on the intrinsic MB present on the six objects was assessed. Census continued in rooms with and without copper for an additional 21 months. In concert with routine infection control practices, the average MB found for the six objects assessed in the clinical environment during the preintervention phase was 28 times higher (6,985 CFU/100 cm2; n = 3,977 objects sampled) than levels proposed as benign immediately after terminal cleaning (<250 CFU/100 cm2). During the intervention phase, the MB was found to be significantly lower for both the control and copper-surfaced objects. Copper was found to cause a significant (83%) reduction in the average MB found on the objects (465 CFU/100 cm2; n = 2714 objects) compared to the controls (2,674 CFU/100 cm2; n = 2,831 objects [P < 0.0001]). The introduction of copper surfaces to objects formerly covered with plastic, wood, stainless steel, and other materials found in the patient care environment significantly reduced the overall MB on a continuous basis, thereby providing a potentially safer environment for hospital patients, health care workers (HCWs), and visitors.

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采样点：
Representative frequently touched objects and their respective placements in the ICU.

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Assessment of the inherent microbial burden associated with frequently touched objects. The average concentrations of bacteria (classified by type) were
determined from samples collected from six inanimate objects for a period of 23 months (n
668 rooms). Bed rails, dark blue bars; call buttons (hospitals 1 and
3) and computer mice (hospital 2), red bars; arms of chairs, yellow bars; tray tables, light blue bars; data input devices (base of monitor bezel [hospitals 1 and 2]
and palm rest of laptop computer [hospital 3]), purple bars; IV poles, gray bars. (The call button data represent values obtained from call buttons at 2 sites
and from a computer mouse at the third due to the absence of a call button at that site.)

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Copper lowered the MB found on common, frequently touched objects. (A) Comparison of the average MBs between rooms with (green bars; n
501
rooms) and without (red bars; n
511 rooms) copper-surfaced items. Samples were collected over a period of 21 months, processed, and statistically analyzed
as described in Materials and Methods (*, P<0.05).

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(B [noncopper objects] and C [copper objects]). Average concentrations of bacteria (classified by type)
recovered from bed rails (dark blue bars), call buttons (hospitals 1 and 3) and computer mice (hospital 2) (red bars), arms of chairs (yellow bars), tray tables (light
blue bars), data input devices (base of monitor bezel [hospitals 1 and 2] and palm rest of laptop computer [hospital 3]) (purple bars), and IV poles (gray bars).
(The call button data represent values obtained from call buttons at 2 sites and from a computer mouse at the third due to the absence of a call button at
that site.)

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Frequency distribution of the MB resident on all objects (classified by type) during the intervention. The MBs observed for each sample from rooms with
copper-surfaced objects are represented on the left; those observed for each sample from rooms without copper-surfaced objects are represented on the right. The
concentration of bacteria observed for each sample was placed into one of three categories, 0 CFU/100 cm2 (green bars), 1 to 250 CFU/100 cm2 (yellow bars), and
250 CFU/100 cm2 (red bars), and the final percentage, rounded to the nearest whole number, of each category was determined.

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本文最终的结论：

Reducing the overall MB on a continuous basis with the introduction of continuously active antimicrobial copper surfaces, as evidenced in this study and others, may provide a safer environment for hospital patients, HCWs, and visitors.

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最后，上传一下全文。

我抛砖引玉，希望大家积极参与讨论，谢谢！


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琇琅2012

美国是走在前面啊！在我们还在规范我们的行为学习如何控制院感的时候，人家已经开始研究如何预防了，谢谢楼主带给我们最新的前沿动态！

蓝鱼o_0

谢谢您提供的资料。这是个良好的角度。虽然医疗环境在控制和预防HCAI中的作用毋庸置疑，但是我们似乎片面的理解为消毒和隔离等措施。

通过这种铜或者抑菌铜，达到控制微生物的bioburden，从而有效的降低交叉感染传播的风险是个非常好的角度。