EFEK ANTIBAKTERIAL COPPER

Ide judul:
1. copper-containing surfaces on microbial environmental
contamination
2.

Role of copper in reducing hospital environment

contamination*
A.L. Casey a, D. Adams a, T.J. Karpanen a, P.A. Lambert b, B.D. Cookson c,
P. Nightingale a, L. Miruszenko a, R. Shillam a, P. Christian a, T.S.J. Elliott a,*

Healthcare-associated infections (HCAIs) continue to cause significant morbidity

and mortality. These HCAIs are thought to cost the National Health Service (NHS)
in the region of £1 billion each year. It has been variously estimated that between
15% and 30% of HCAIs could be prevented by compliance with infection control
practices and appropriate hygiene measures, including hand hygiene Despite the
lack of direct evidence to prove that environmental contaminants are responsible
for HCAIs, there is increasing evidence suggesting that the environment may act
as a reservoir for at least some of the pathogens causing HCAIs. This is of concern
as touching such contaminated surfaces may lead to acquisition on the hand and
subsequent transfer to other inanimate objects or to patients Copper has been
demonstrated to kill a range of micro-organisms in vitro including Escherichia coli,
MRSA, Listeria monocytogenes, influenza A virus and C. difficile.

HAI sampai saat ini masih menjadi penyebab morbiditas dan mortalitas yang
signifikan. HAI diperkirakan menelan biaya National Health Services (NHS) di
wilayah dengan kisaran 1 juta euro setiap tahunnya. Diperkirakan 15-30% HAI
dapat dicegah melalui kepatuhan pada praktik pengendalian infeksi dan tindakan
kebersihan yang tepat, termasuk kebersihan tangan. Meskipun belum cukup bukti
bahwa kontaminasi lingkungan menjadi penyebab langsung atas HAI tetapi
terdapat peningkatan bukti yang menunjukkan bahwa lingkungan dapat berperan
sebagai reservoir untuk setidaknya beberapa patogen penyebab HAI.
Hal ini menjadi perhatian karena menyentuh permukaan yang telah
terkontaminasi dapat menyebabkan akuisisi pada tangan dan selanjutnya akan
mentransfer patogen kontaminan tersebut kepada benda mati lain atau kepada
pasien.
Tembaga telah terbukti dapat membunuh berbagai mikroorganisem in vitro
termasuk Eschericia coli, Methicillin-Resistant Staphylococcus aureus (MRSA),
Listeria monocytogenes, virus influenza A, dan Clostridium difficile.

Median numbers of microorganisms harboured by the copper-containing items

were between 90% and 100% lower than their control equivalents at both the
07:00 and 17:00 sampling time-points.
Contamination of hand contact surfaces may act as an important reservoir for
micro-organisms. These micro-organisms may then be transmitted via the hands
to other inanimate objects or to patients.
it is increasingly accepted that the environment plays an important role. Repeated
failures of proposed benchmark values were observed on standard toilet seats at
both sampling time-frames.
It is likely that the contamination occurred following each disinfection and this
again highlights the need for more continuous protection of commonly used
surfaces in the hospital environment.
By comparison, the number of microorganisms isolated from the copper-
containing push plates was significantly lower and no indicator micro organisms
were detected
It may therefore be desirable to reduce microbial contamination via a continuous
method such as with the application of copper.
Indeed, it has been reported that in laboratory tests copper has a complete kill
time of 30 min for EMRSA-16 when microbial concentrations reflect
environmental contamination.
The results of this trial clearly demonstrate that copper-containing items offer the
potential to significantly reduce the numbers of microorganisms in the clinical
environment.
However, the use of antimicrobial surfaces should not act as a replacement for
cleaning in clinical areas, but as an adjunct in the fight against HCAI.

The application of antimicrobial materials for frequent hand-touch surfaces may

help to reduce microbial contamination and therefore cross-contamination.
Penerapan material antimikrobial pada permukaan yang sering disentuh dapat
mengurangi kontaminasi mikroba sehingga kontaminasi silang juga nantinya
dapat berkurang.
The Antimicrobial Efficacy of Copper Alloy Furnishing in
the Clinical Environment: A Crossover Study
T. J. Karpanen, PhD;1 A. L. Casey, PhD;1 P. A. Lambert, DSc;2 B. D. Cookson, FRCPath;3 P. Nightingale,
PhD;4 L. Miruszenko, RGN;5 T. S. J. Elliott, DSc5

Prevention of healthcare-associated infection (HCAI) is recognized as an essential

element in the safe delivery of health care.

Pencegahan Healthcare-associated infection (HCAI) telah disadari sebagai sebuah

elemen penting dalam pemberian layanan kesehatan yang aman. Strategi
pencegahan yang dimiliki terdiri dari berbagai macam pendekatan mulai dari
pengembangan dan pengauditan berbagai kebijakan kontrol infeksi dalam rangka
meningkatkan praktik kebersihan pelayanan kesehatan. Kebersihan lingkungan
merupakan kunci dalam pencegahan HCAI di rumah sakit sebab lingkungan
merupakan reservoir dan sumber potensial berbagai patogen yang nantinya dapat
ditransmisikan kepada pasien rentan baik secara langsung maupun melalui tangan
para petugas medis, pasien lain, dan pengunjung.

Prevention strategies have included many different approaches that range from
developing and auditing evidencebased infection control policies to sustained
improvements in hygiene practices

Environmental hygiene has been regarded as one of the key areas in the
prevention of HCAI in hospital and acute care settings
The clinical environment may serve as a reservoir and a potential source of
pathogens, with microorganisms being transferred to susceptible patients directly
from the environment or by the hands of healthcare workers, patients, and
visitors

A reduction in the microbial load in the environment may therefore aid in

decreasing transmission of microorganisms within the healthcare environment
when applied with other infection-prevention measures, including appropriate
hand hygiene.

However, many cleaning methods do not prevent subsequent microbial

recolonization of surfaces, and therefore new technologies that provide a
sustained effect, such as antimicrobial-impregnated surface materials, are being
explored

banyak metode pembersihan tidak mencegah rekolonisasi permukaan mikroba

berikutnya, dan karena itu teknologi baru yang memberikan efek berkelanjutan,
seperti bahan permukaan yang diresapi antimikroba, sedang dieksplorasi

It has been well recognized that copper has intrinsic antimicrobial properties with
activity against a broad spectrum of microorganisms

Copper ions interfere with several microbial metabolic activities and interrupt the
integrity of the cellular DNA, the cytoplasmic membrane, and the cell wall.
The Study of the Antimicrobial Properties of
Selected Engineering Materials’ Surfaces
Olawale Samuel Fatoba1,2*, David Ehigie Esezobor2, Olaitan Lukman Akanji1,
Abiodun Joseph Fatoba3, Damilola Macgregor2, John Etubor2

The real concern is that about eighty percent of infections illnesses are transmitted by touch
Copper Alloys for Human Infectious Disease Control
H.T. Michels1; S.A. Wilks2; J.O. Noyce2; and C.W. Keevil2

In addition, copper alloys are easily alloyed, available in a range of aesthetically

pleasing colors, highly recyclable, widely available, and, as will be presented in
this paper, exhibit antimicrobial activity.
characteristics of copper alloys account for the enduring, diverse and growing
uses of copper alloys. These include: high electrical and thermal conductivity,
malleability, ductility, a range of mechanical properties and good corrosion
resistance.

In an earlier study [2], which was carried out in a hospital, brass doorknobs
showed sparse growth of bacteria, while stainless steel doorknobs were found to
be heavily contaminated.

E. coli O157:H7
Copper 99,9% At 20°C, the bacteria count decreases by about one order of
magnitude (one log) over 75 minutes and then falls off rapidly and reaches zero at
90 minutes. The zero point, which corresponds to a 9-log drop, indicates that the
bacteria, which are E. coli O157:H7, are no longer viable and are dead

a brass containing 85% copper and 15% zinc, is shown in Figure 2. At 20°C, the
bacteria count decreases slowly during the first 30 minutes. The count then shows
a rapid 3-log drop at 45 minutes followed by another rapid 6-log reduction at 60
minutes where the bacteria count is zero
The inhibitory effects of the brasses on E. coli O157:H7 are similar to but lesser
than those seen in the coppers.
Y90 is essentially a copper zinc alloy, or brass, with lesser amounts of manganese
and nickel. The latter two elements improve tarnish resistance. Alloy Y90 follows
the pattern seen brasses. At 20°C, the bacteria count decreases slowly, by one log,
during the first 90 minutes. And it reaches a zero bacteria count at 120 minutes.

tin-phosphor bronze nominally containing 95% copper, 5% tin and 0.2%

phosphorous, On C51000, the bacteria count drops quite slowly, by about a half
log, over the first 60 minutes and then falls off rapidly for the next 45 minutes and
reaches zero at 105 minutes.
C71000, a copper-nickel containing 80% copper and 20% nickel, and C75200, an
alloy containing 65% copper, 17% zinc and18% nickel, which is called a nickel
silver because of its color. At 20°C, they both show very slow reductions during
the first 90 minutes. Alloy C71000 then drops off rapidly during the next 30
minutes and reaches zero at 120 minutes, while C75200 takes only 15 minutes to
fall off rapidly and reach zero at 105 minutes.

These included stainless steel (S30400), which contains 74% iron, 18% chromium
and 8% nickel and is widely used in food processing and healthcare applications,
polyethylene, a common food cutting board material, and a stainless steel with a
silver-containing coating. the bacteria count at 20°C is virtually unchanged on the
uncoated stainless steel for the first 90 minutes and then falls by one log during
the next 90 minutes. that the uncoated stainless steel exhibited a 5-log drop at
20°C over two days. During a long-term 28-day test at 20°C, uncoated stainless
steel, again, exhibited a 5-log drop over two days, as shown in Figure 6. The
bacteria count then remained constant at around 4 logs, for the next 26 days.

bacteria count on polyethylene was unchanged for the first 180 minutes, and
decreased by one log over the next 180 minutes. When compared to uncoated
stainless steel, the silver-containing coating on stainless steel, which is a
commercial antimicrobial product, displays were similar, but the latter exhibited
somewhat less of a drop in bacteria count,

Methicillin-Resistant Staphylococcus aureus

at 20°C The bacteria, counts taken on C19700, an alloy containing 99% copper 
a rapid 7-log falloff to zero is seen within 75 minutes
brass containing 80% copper and 20%zinc  7-log drop to zero occurs in 270
minutes alloy containing 55% copper, 27% zinc and 18% nickel  3-log drop is
observed after 270 minutes.

The first is that the inhibitory effects of a given copper alloy decreases as
temperatures decreased, from 20°C to 4°C. The second trend is that the inhibitory
effects decrease as copper content of the alloys decreases.

The slower response observed in C75200 is probably related to its lower copper
content. However, the slower response, or longer time to drop to zero bacteria
count observed in C70600, at 75 minutes, may be a result of the better corrosion
resistance of C70600 relative to these first four alloys.

Better corrosion resistance correlates with lower availability of the cupric ion,
Cu+2. The cupric ion is believed to be responsible for the antimicrobial action of
copper.

In contrast to the copper alloys, the stainless steel, UNS S30400, a popular
material for food-processing equipment and healthcare applications, has little or
no inhibitory effect.

This is still a high bacteria count for both materials, especially when ingestion of
only 10 to 50 individual bacteria may be sufficient to cause infection. Thus,
stainless steel surfaces and, particularly, those with a silver-containing coating still
have a potential to adversely affect human health after two days. These levels
persisted for 28 days in the case of uncoated UNS S30400, at which point the test
was terminated.

The ways in which copper acts on microorganisms is a complicated subject, and

beyond the scope of this paper. However, a few of the many proposed
mechanisms include:
• If proteins are complexed or altered, they can no longer perform their normal
functions [11].
• Copper complexes form radicals (that inactivate viruses) [12, 13].
• Metals, such as copper, may disrupt enzyme structure [14].
• Inactivation is due to oxidation potential of the ion [15].
• Transition metals (including copper) facilitate deleterious activity in superoxide
radicals [16].
• Cu+2 can form protein chelates through a protein’s carboxylate and amino
groups, thereby inactivating a protein [17].
• Divalent cations, such as Cu+2, may strain protein structure, causing hydrogen
bonds within the DNA to break, and thus opening the double helix [11].
• If the nucleic acid helix is stabilized or destabilized by chelation with a metal ion,
replication or transcription is altered, thereby rendering the microorganism
inactive [11].
 Cu+2 has a specific affinity for DNA and can bind and disorder helical structures
by crosslinking within and between DNA strands [18].
 Cu+2 may complex messenger RNA (and thereby play a role in disinfection of
viruses) [19].
 Cu+2 has a strong affinity for O-, N- and S- sites in proteins [20].
 Disinfection due to metal complexes is important in enabling a possible entry
through a cells membrane [11].
 Copper can interact with lipids, causing their peroxidation and opening holes in
the cell membrane [21].
 Studies on copper-injured E. coli cells indicate that the respiratory chain is
damaged at least one site [22] and is associated with impaired cellular
metabolism [23].

Thus, it appears that Cu+2 has the potential to disrupt cell function in several
ways. Since several of these mechanisms may be acting simultaneously, this may
reduce the ability of the microorganisms to develop resistance to copper. In
summary, the above mechanisms provide insight related to the complicated and
incompletely understood antimicrobial action of copper.

Saran :
Copper alloys can play an important role in the control of harmful infections.
However, it must be noted that the use of copper alloys will not be advocated as a
substitute for good housekeeping and hygienic practices, only as a supplement.
Registration for food processing and other applications will also be pursued.

Sekarang bahwa efek dari berbagai paduan tembaga telah ditunjukkan pada
kelayakan berbagai bakteri dan pada dua suhu, upaya akan fokus pada
pengembangan informasi tambahan yang diperlukan untuk adopsi paduan
tembaga oleh produsen peralatan perawatan kesehatan dan pengolahan
makanan . Ini akan mencakup pengujian daya tahan, kebersihan, efek disinfektan
umum, dan ketahanan korosi di lingkungan yang berhubungan langsung dengan
aplikasi yang dimaksud, peralatan perawatan kesehatan dan pengolahan
makanan, dan permukaan persiapan makanan

Pemanfaatan paduan tembaga untuk gagang pintu, pelat pintu dorong, faucet,
bedrails, tangga dan rel koridor dan lainnya perangkat keras, memegang janji
sebagai pendekatan pasif dan efektif untuk mengendalikan MRSA di fasilitas
kesehatan, termasuk rumah sakit, klinik, ruang pemeriksaan dokter dan panti
jompo. Pasar sasaran lainnya termasuk sekolah, bangunan umum, pusat
perbelanjaan, hotel, gimnasium, penjara, sistem angkutan massal, bandara, dan
kapal cruse.

Kesimpulan:
In summary, the results suggest that copper alloys that have antimicrobial
properties can be used for surfaces exposed to human touch or contact with food
and can contribute to a reduction in the transmission of potentially infectious
human pathogens.
P. Tandor, S. Chhibber, and R.H. Reed, “Inactivation of
Escherichia coli and Coliform bacteria in traditional brass
and earthenware water storage vessels,” Antonie van
Leeuwenhoek, 87, (2005), (in press).

In a recent laboratory study [1], pure cultures of a fecal indicator bacteria,

Escherichia coli, were stored in a brass vessel of unidentified composition and an
earthenware experimental control vessel for 6, 24 and 48 hours and then
cultured. Results indicated that bacteria counts were reduced at 6 hours in the
brass vessel versus the earthenware control. No bacteria were found in the brass
vessel after 24 hours.

Antibacterial properties of copper and its

alloys
J. Konieczny a,*, Z. Rdzawski

The cause-and-effect relationship between germs and development of a disease

was discovered in XVIII century. Only then the scientists became aware of the
antibacterial potential of copper. Copper is used currently for production of
bactericides.

Pure copper and its alloys are characteristic of the unique mechanical- and
physical properties. As early as in 1913 copper was established a standard for the
electrical conductivity. Currently, copper and its alloys are widely used in many
branches of the modern engineering. The extensive scope of application of pure
copper results from its very good electrical- and thermal conductivity (being
inferior in this respect only to silver), good cold and hot workability, and high
corrosion resistance. Thanks to these unique properties it finds application in
electronics, radio engineering, and electrical engineering

Regrettably, engineers and designers forgot in the last years about the unique
antibacterial properties which are characteristic of copper, and which were used
in the last centuries, in particular, in places coming often in contact with human
skin like, e.g., door handles.
Copper is one of the first metals which were known to people. The beginning of
smelting, casting, and forging of copper is dated about 5000 BC, however,
smelting of copper from the complex ores containing arsenic (As) and lead (Pb), is
dated 1000 years later, and obtaining bronze by fusing copper with tin ore and
copper with tin is dated at 2500-2200 BC.

Kasus pertama yang tercatat menggunakan tembaga sebagai agen bakterisida

berasal dari Smith's Papyrus, yang dianggap sebagai dokumen medis pertama dan
tertua dalam sejarah umat manusia [13], yang kepengarangannya dianggap
berasal dari Imhotep, dokter dan arsitek Mesir yang melayani Firaun Djoser. Itu
berasal dari ca. 1700 SM, bagaimanapun, ini didasarkan pada teks-teks yang
berasal dari 3200 SM [14]. Tembaga dan senyawanya direkomendasikan sebagai
obat untuk "gemetar anggota badan" (istilah ini mungkin digunakan untuk
epilepsi), pengobatan luka bakar, penyakit kulit (gatal), dan juga label kulit di
leher. Tembaga dalam berbagai bentuk digunakan untuk pengobatan penyakit:
dari serpihan dan keripik tembaga logam, hingga garam dan oksida tembaga yang
terjadi secara alami. Malachite (Cu2CO3 (OH) 2) cukup sering digunakan, disebut
oleh zaman sekarang "pigmen hijau" atau chrysocolla (tembaga silikat), atau
tembaga klorida.

Scientific research has confirmed that copper may suppress the serious pathogens
which are the imminent danger to health or even lives of people. These are, first
of all, the methicillin-resistant Staphylococcus aureus (MRSA), infection with
Clostridium difficile (usually this infection occurs at hospitals, as infections with
Clostridium difficile bacteria are commonly the effect of antibiotics), Escherichia
coli (E.coli, colibacilli), and also legionella pneumophia (characteristic of
Legionellosis).

according to the European Centre for Disease Prevention and Control (ECDC)
about three million of infections connected with health service leads to about
50,000 demises yearly in Europe. It should be marked that about 80% of
infectious disease are transferred by touch contact. Among microorganisms which
are the reasons for hospital-acquired infections, the following are named: MRSA,
Escherichia coli, Klebsiella pneumoniae, Clostridium difficile. Although the
hospital-acquired infections may not be avoided, it was found,basedon
investigations, that the number of infections may be reduced by minimum 15%.
It is estimated that about 80% of the infectious diseases are transmitted by
contact. The equipment used commonly in hospitals (furniture, medical utensils)
is made from aluminium and stainless steel, which makes an impression of being
clean, yet may be the source of the pathogenic and lethal bacteria and viruses.

Therefore, items with which people are incontact, like door handles light
switches, trolleys, beds, tables, bedside cabinets, handrails, stairs , etc. may be
easily made from copper and its alloys taking advantage of their antibacterial
properties.

On 1 cm² of pure copper 10 million Staphylococcus aureus germs die within 90

minutes

Copper Development Association. Antimicrobial copper alloys - group II. EPA reg. no. 82012-2. Washington (DC): U.S.
Environmental Protection Agency, Office of Pesticide Programs; 2008 Feb 29. 12 p. ).

The International Copper Association and Copper Development Association have established an Antimicrobial
Copper “Cu+” mark that certifies EPA registration (in the United States) or otherwise experimentally proven
antimicrobial activities of copper alloys (worldwide).

 International Copper Association, Ltd. Antimicrobial copper products & services: directory of Cu+ approved
companies. CDA publication 211. New York (NY): International Copper Association, Ltd.; 2014. 100 p. Also
available: http://www.antimicrobialcopper.com/media/339585/amc-prod-dir.pdf.
 Antimicrobial copper touch surfaces. Product directory - USA. New York (NY): Copper Development Association
Inc.; 2014. 24 p.

Pure copper and its alloys are characteristic of the unique mechanical- and
physical properties. As early as in 1913 copper was established a standard for the
electrical conductivity. Currently, copper and its alloys are widely used in many
branches of the modern engineering.
Tembaga asli dan paduannya merupakan karakteristik dari

Recent independent laboratory testing led the EPA to register copper alloys for their inherent
ability to kill 99.9% of the following listed organisms within two hours: Vancomycin-resistant
enterococci (VRE), Staphylococcus aureus, Enterobacter aerogenes, Escherichia coli O157:H7,
Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus (MRSA). No other
solid metal surfaces have EPA registration to make public health claims.

Percobaan laboratorium independen baru-baru ini telah membuat panduan tembaga