This article was originally published on MedicalDesign.com in August 2014.
Introducing Dr. Harold Michels
Harold Michels was the Senior Vice President of the Copper Development Association (CDA) for 15 years. Today, he acts as advisor to the association’s president. He holds a bachelor’s degree in mechanical engineering and a PhD in material science. His goal is to eliminate Hospital Acquired Infections (HAIs) by replacing much of the hospital, clinical and medical facilities hardware with copper-based alloys.
Harold T. Michels, PhD, PE, Advisor to the President of the Copper Development Association, Inc.
“When you look around, ancient societies used copper for protection from disease – hundreds of years before anyone discovered the germ theory. They used it because it worked. They didn’t know why, they just knew it did,” said Michels. “It’s probably the oldest bacteria and virus killer known to the human race, but as is often the case – what was proven in the past, needs to be proven again -- scientifically. That is what we are doing; proving the efficacy of copper in the medical arena.”
Where His Quest Began
“One of the things that always interested me was the anti-fouling properties of copper alloys in sea water. Barnacles don’t grow well on copper surfaces. I used to run a marine corrosion lab for another company and I was quite familiar with this, but as a scientist, I always asked, how does this actually work? I never got a good answer,” said Michels.
A student nurse project that was being conducted in a hospital in Erie, PA, in the 1980s measured bacteria on brass door knobs, which is a copper alloy, against aluminum and stainless steel door knobs, Michels said. The result was that there was very little contamination on the brass and quite a lot on the aluminum and stainless steel. However, this project wasn’t peer reviewed. So while working at CDA, Michels conducted a series of rigorous and extensive tests on a broad range of copper alloys and had the results published in peer-reviewed journals.
“I picked E. coli because that’s what the hospitals were looking at, and sure enough it worked. Shortly thereafter, I tested it against MRSA (Methicillin-Resistant Staphylococcus aureus), where the infection is caused by a strain of staph bacteria that's become resistant to the antibiotics commonly used to treat ordinary staph infections. Copper alloys are very effective in killing MRSA. From that point on, we focused strictly on hospitals,” he said.
Clinical Studies Prove the Theory
Extensive tests were performed on both Gram-negative and Gram-positive bacteria as well as viruses – everything was affected by the copper alloys. All were killed very rapidly. However, in order to promote these benefits of copper, CDA had to comply with EPA regulations. “It took four years of negotiation and testing, but ultimately, we received a public health registration for the six bacteria (see box below) that we tested, including two hospital super-bugs. That was obtained in 2008,” said Michels.
Shortly thereafter, he participated in a multisite clinical trial that tested the efficacy of antimicrobial copper. It was funded by the Department of Defense and supported by the U.S. Army Medical Research and Materiel Command. The clinical trial included three hospitals: the Medical University of South Carolina in Charleston, the Ralph H. Johnson Veterans Administration Medical Center in Charleston SC, and the Memorial-Sloan Kettering Cancer Center in New York.
Researchers spent three years on the study. Michels said that they initially went in and measured where the bugs were, and determined which components they should change based on levels of contamination. For the study, six objects were retrofitted with copper alloy surfaces that were originally made of plastic, wood or steel. These components included the hospital bedrail, IV pole, nurse call device, data input device (computer mouse, monitor bezel, laptop palm rest), overbed tray table and the arm rests of the visitor chair. Other rooms nearby represented experimental control rooms. The result was an 83% bacterial reduction on all the copper alloy surfaces, relative to the amount of bacteria found on the same surfaces in the control rooms
“The question is then, does this matter?” said Michels. “Will this positively impact patient outcome? Will it actually cut down on infections? We received permission from the three institutions and the U.S. Army, to conduct an infection reduction clinical trial. We collected the data on the patients and the doctors who examined the records were blinded. They didn’t know if patients were in copper rooms or non-copper rooms.”
“We were successful in having a paper published in a peer reviewed medical journal that showed a 58% reduction in hospital-acquired infections by only replacing 6 items in the patient room. That comprised less than 10% of the entire surface area of the room. So this was a remarkable outcome.”
There has yet to be a super bug that copper can’t kill. Copper compromises cell wall integrity and all vital functions of the bacteria or virus stop.
The paper on bio-load was published in the Journal of Clinical Microbiology in 2012 during infectious disease week and was cited as one of the ten most significant papers of the year. That was followed by an infection reduction paper in the SHEA journal Infection Control and Hospital Epidemiology in 2013, which received the same recognition. As a result, the ECRI listed antimicrobial copper as a “Top 10” technology that the CEOs of hospitals should be looking at in 2014.
Antimicrobial Copper is Not a Coating
“Copper alloys are actual engineering materials. We are talking about solid metal doorknobs, bed railings and push plates. There is a catalog of actual hospital fixtures and components that are readily available for purchase today,” said Michels. “The power of antimicrobial copper is that it continues to work. One of the tests we had to do for the EPA was to inoculate a surface eight times in a 24 hour period with a load of bacteria, and it kept reducing the bacteria – without even cleaning it in-between. It actually kept on working even though the inoculum of live bacteria was placed on top of the dead bacteria.”
He goes on to state some frightening facts: “Right now, if you go into a hospital without an infection –for tests or a minor surgical procedure, you have a 5% chance of coming down with an HAI. If you get an HAI, you have a 5% chance of dying from it. If you become an Intensive Care Unit patient, the percentage increases to 25%. Two million people get infections in U.S. hospitals each year; 100,000 die. That is the equivalent of a fully loaded, jumbo jet, crashing every day all year long with no survivors ─ not very good odds.”
Copper took the back seat when antibiotics came into being, but soon after the use of antibiotics, super bugs began to develop that required newer and stronger antibiotics – or were resistant to all antibiotics. Because of the way copper works, Michels explains that simply isn’t likely to happen. “We have yet to meet a super bug that copper can’t kill. It’s all in the way it works. It compromises cell wall integrity and all vital functions of the bug stop. Period. That’s how it kills them.”
The Holy Grail for Michels
Cost is a factor. It is higher than most other materials, however, as Michels states, infections are expensive too. “We know that the average cost to treat a HAI is anywhere from $29,000 to $43,000 per infection. Copper fixtures are not cheap but they are a one-time cost and they will show a payback to any medical facility in infection reduction in two months or less. From that point on, they just keep killing bacteria at no additional cost to the hospital – for life. We’re typically talking about components with more than 20-year life spans.”
“So in the end, all commercial copper alloy products are going to be slightly more expensive than their aluminum or stainless steel counterparts, but the payback is there in dollars and cents. How do you put a price on saving a life? It works. It keeps on working. It does not change with age,” Michels concludes.
Today, hospitals are the Holy Grail for Michels, because once antimicrobial copper finds acceptance in hospitals, it will adopted in other facilities infection transmission is a concern, such as schools, restaurants, theaters, transportation hubs, travel venues ---wherever people go. He says that copper will help all of us. It will keep us healthier. That’s the bottom line.