The Environment and Infection Control- Making Progress Yet Questions Remain

The may issue of Infection Control and Hospital Epidemiology explores the role of the environment in infection prevention. The exact impact of the environment as source or cause of a hospital acquired infection remains debatable. It is estimated that 20% of all hospital acquired infection may be environmental in origin while 40%-60% are from a patient's endogenous flora, 20%-40% are from cross infection via HCW hands and 20%-25% are from antibiotic driven changes in flora.

Here is an interesting article in this issue exploring the impact of copper textile surfaces on hospital acquired infections.  The investigators determined whether placement of copper alloy-surfaced objects in an intensive care unit (ICU) reduced the risk of hospital acquired infection (HAI) across the ICUs of three hospitals. Patients were randomly placed in available rooms with or without copper alloy surfaces, and the rates of incident HAI and/or colonization with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) in each type of room were compared.

The rate of HAI and/or MRSA or VRE colonization in ICU rooms with copper alloy surfaces was significantly lower than that in standard ICU rooms (0.071 vs 0.123; P=0.02).  Patients cared for in ICU rooms with copper alloy surfaces had a significantly lower rate of incident HAI and/or colonization with MRSA or VRE than did patients treated in standard rooms.

These findings are tantalizing. A significant study weakness is that hand hygiene and disinfection practices were not monitored closely. These are significant confounders. In addition, it is neither cheap nor easy to widely install copper impregnated surfaces across the hospital environment.

How incrementally beneficial are technologies, such as copper impregnated surfaces, atop other infection prevention strategies and how should this technology be best employed, particularly given the cost? This is the million dollar question.

We have made progress but have yet to define the optimal strategy for textiles in infection prevention.