I am in the local hospitals fairly frequently, and they are still installing stainless steel touch surfaces everywhere, including in public bathrooms adjoining emergency rooms and critical care areas. That’s the equivalent of a tire shop scattering caltrops in the road outside their store.
Human pathogens like coronaviruses love stainless steel, it’s free parking for them, and a proven vector of nosocomial infections.
I don’t see it that way. “Working on the problem” would involve installing readily available bare brass, instead of continuing to install stainless every day.
Developing processes to make stainless more expensive isn’t a solution to the increasing rate of nocosomial infections; primarily, that will just make it more difficult to tell the difference between appropriate and inappropriate use of metals in hospitals.
Nurses want to help people. Doctors want to heal people. But for profit medical business wants to make money. The medical facilities installing oligodynamic touch surfaces are all in countries with socialised medicine.
The effective surface cleaners used in hospitals to control infection are all chlorine bleach-based. Brass corrodes and blackens in contact (or even exposed to the vapor of) bleach, while copper corrodes and leaches dangerous copper salts in the same circumstances.
Stainless shrugs off bleach without corrosion or leaching off dangerous poisons. As such, it is an appropriate choice for healthcare environments.
Thank you. I was furiously searching my brain for that reason they said they can’t use copper and coming up empty. There is truth in the wisdom saying that for every complex and baffling problem, there is a simple, obvious solution that is completely wrong.
The use of these cleaners breeds resistant pathogens, as was shown in US military field hospitals, unless you are using them at strengths that are unsafe for cleaning staff. In every test, stainless has proven to be a highly inappropriate choice for healthcare environments - and instituting expensive measures to continue doing the wrong thing (such as my local hospital tripling the frequency of clorox wiping) doesn’t make any sense.
The science has been clear for decades now. Having underpaid cleaning staff expose themselves to bleach isn’t fixing the problem, it’s just creating more problems.
Stainless is pretty great in kitchens and in some kinds of laboratories, because in an environment where it is frequently heated and/or scrubbed the durability and corrosion resistance are a big plus.
The ability of stainless steel to harbor and spread infection is not a complex problem. Prior to the installation of stainless, the majority of hospitals used brass touch surfaces, which were superior, even when covered with tarnish and hand crud.
This is based on either misunderstanding or intentional misrepresentation. Pathogens do not develop “resistance” to bleach in a healthcare setting. There are some pathogens that have mild resistance innately and can pass it horizontally to other microorganisms in a sitation with very low chlorine concentration and very high microbial load - i.e. In wastewater treatment plants. Healthcare environments are the opposite - high chlorine concentration with relatively low microbial load.
Cleaning staff use PPE - gloves, face shield, mask, gown - at every facility I visit across the country.
You need to catch up on your science. Surface exposure transmission of COVID was all the rage in 2020 but has subsequently been shown to be almost nonexistent.
Regarding the “study” you cited. First, that was a press release, not a study. Second, that study didn’t compare stainless steel to copper, it compared plastic to copper. Third, it compared microorganism growth during same-patient cleaning but not to post-discharge cleaning, which is when they use terminal cleaning techniques - which is weird because it called that out in the press release but there are no results for it in the paper. Post-discharge cleaning is what’s relevant, because cross-contamination from patient-to-patient is what’s relevant, not same-patient contamination. Practically speaking, patients don’t infect themselves, as they are already exposed to their own microbiome.
Regarding the title of the press release, that’s borderline unethical. They most certainly didn’t study mortality differences between the two types of surfaces. That’s utter bullshit. “Saves Lives” my ass.
Hardly unethical. In every experiment I’ve read of, there’s been shown to be less survival of human pathogens when stainless was replaced with copper or a copper alloy.
This really is simple. There are massive amounts of data to show that oligodynamic metals are a safe and effective means of limiting the persistence of human pathogens of all sorts, and using those metals is known to be cheap and effective since they were in use for hundreds of years before the introduction of stainless steel.
There are massive amounts of data to show that stainless steel, despite all its wonderful anti-corrosive properties, harbors many kinds of human pathogen. In an environment where it is not being routinely heat sterilized and scrubbed, it creates additional ongoing overhead costs and, in practice, is part of an ongoing endorsement of cleaning staff being exposed to harsh chemicals.
You can find a ton of literature and historical data, only a google away.
But remember the Tyson principle - if you google for something to prove you are correct, that’s just looking for confirmation bias and the opposite of science. Google for evidence that disproves your position, and that is a form of research (not as good as direct experimentation, obviously, but still valid meta research).
Coronavirus transmission is primarily aerosol. But if you touch a stainless door handle and then touch your face or nose, you can get all kinds of bugs, including Coronaviruses, which survive just fine on stainless, but die on raw brass.
The claim “saves lives” better be backed up with a human mortality study, sufficiently powered and with close IRB oversight. That is not what this study examined.
No. There are exactly zero studies comparing HAI morbidity and mortality with brass or copper surfaces vs stainless steel. That claim cannot reasonably be made with the data to date. You’re over-reaching based upon a relatively small number of bench studies and very limited studies within a clinical environment. Historical use of brass surfaces actually goes against your point as HAI rates were much higher historically.
No need for google. We’re talking about one of my areas of professional expertise. I have been an invited participant in APIC/AORN workshops on HAI prevention. That’s not an appeal to authority, just making sure you understand how flat your tacit accusation falls in the face of reality. You’re not dealing with a google-happy lay person on this.
Again, fomites are not a significant transmission pathway for COVID, and even moreso in a hospital environment where disinfectants are used on a constant rotation.
You wanna know what the single most effective step that’s been taken in the last decade to prevent fomite-mediated HAIs? Letting liquid disinfectants dry. There were a number of papers published between 2012-2017 expressing concern about rising HAI rates despite terminal cleaning in ICUs. Turns out that they were simply rushing the process. Waiting the necessary 3-5 minutes to let the disinfectant dry was all it took to reach 10^-6 for most pathogens and 10^-4 for the difficult ones like C. difficile.
ETA: and let’s also talk about Dr. Schmidt. He’s an expert and a really smart guy. Copper as an antimocrobial is his lab’s expertise, and many of the papers that talk about that are from his group. But attempting to extrapolate his team’s work to clinical practice in a sweeping manner shows a naivete of how research and specialised academic research labs work. You can’t just look at one lab’s work and paenut butter it across an industry. That’s why there are consensus teams like APIC/AORN to discuss the work of multiple labs and how they interact with the practical and economic reality of clinical environments.
One more thing that might help clarify why hospitals haven’t widely adopted copper or brass surfaces over disinfecting stainless steel.
Hospital cleaning protocols have to be validated. That means they have to innoculate surfaces with a loading dose of pathogens of interest, such as Staph aureus and C. diff, apply their cleaning protocol, then test how many colony-forming units of those microorganisms are left afterwards. It’s expensive testing - C. diff tests run $20k per test and more. The protocol has to show 10^4 reduction to be considered effective disinfection.
The study you cited showed 94% reduction of pathogens on copper. That’s insufficent reduction to qualify as disinfection. It wouldn’t pass. The other problem is disinfection has to be a treatment. I already cited what happens to copper when exposed to bleach - it forms toxic salts. So we can’t treat it with bleach. We have to depend on its passive anti-microbial properties, which are insufficient for disinfection. But even if they were, it’s unvalidatable without continuous testing of the surface at $20k+ per test.
I hope that helps make clear why at this point, copper surfaces are not a good solution for disinfection in hospitals.
No, it’s still not at all clear to me. The current system is patently not working - I am frequently in hospitals, and expect to be in one later tonight. The cleaning staff are not effectively sterilizing the surfaces, the infections continue to spread, and the idea that we should “stay the course” with a strategy that is not working makes no sense to me. I’ve watched hospitals literally remove working, less expensive copper alloy hardware and replace it with more expensive stainless hardware that we know is problematic; that makes no sense to me. And again I do not understand your rush to defend it; purposely and unnecessarily using these metals in medical settings is not ethically different from a tire seller scattering nails in the road next to their shop.