Il rame contro le infezioni nosocomiali - Congresso SIMPIOS 2016
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Transcript of Il rame contro le infezioni nosocomiali - Congresso SIMPIOS 2016
Superfici antibatteriche in rame:
cosa ci insegnano i clinical trial Marco Crespi – Istituto Italiano del Rame
Congresso Nazionale SIMPIOS, Rimini, 9-11 maggio 2016
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Indice
1. Rame: test di laboratorio
2. Rame: i clinical trial
3. Conclusioni
4. Rame antibatterico: approfondimenti e bibliografia
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1. Rame: test di laboratorio
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Il rame contro i batteri
La letteratura scientifica cita la capacità del rame di inattivare o eliminare diversi
tipi di batteri, funghi e virus nocivi:
• Acinetobacter baumannii • Legionella pneumophilia
• Adenovirus • Listeria monocytogenes
• Aspergillus niger • MRSA (con E-MRSA)
• Candida albicans • Poliovirus
• Campylobacter jejuni • Pseudomonas aeruginosa
• Clostridium difficile • Salmonella enteriditis
• Enterobacter aerogenes • Staphylococcus aureus
• Escherichia coli (ceppo O157:H7) • Bacilli della tubercolosi
• Helicobacter pylori • VRE
• Influenza A (ceppo H1N1) • ….
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2. Rame: i clinical trial
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Rame antibatterico e clinical trial
Un po’ di storia
1) 1983: le maniglie in ottone ospitano meno batteri
2) 2008: al Selly Oak Hospital (UK), il primo importante clinical trial
3) 2010: Asklepios Clinic (D), si osserva una diminuzione delle infezioni
www.europeanhospital.com: “Copper Fittings beat bacteria”
T.J. Karpanen, A.L. Casey, P.A. Lambert, B.D. Cookson, P. Nightingale, L. Miruszenko, T.S.J. Elliott: ”The antimicrobial efficacy of copper alloy
furnishing in the clinical environment: a crossover study”
P.J. Kuhn: “Doorknobs: a source of nosocomial infection?”
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Clinical trial USA (3 ospedali)
(2007-2011)
Tre ospedali: Medical University of South Carolina (6 stanze); Memorial
Sloan Kettering Cancer Center (6); Ralph H. Johnson Veterans
Administration Medical Center (4).
Terapia intensiva: sponde dei letti; tavolini mobili; braccioli delle poltrone;
piantane porta-flebo. Monitor, pulsanti dei dispositivi di chiamata, mouse.
Durata complessiva: dic.2007 – giu.2011 (in tre fasi)
Da: H.T. Michels, C.W Keevil, C. Salgado, M.G. Schmidt: “From Laboratory research to a clinical trial: copper alloy surfaces kill bacteria and
reduce Hospital-acquired infections”
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Risultati seconda fase
Batteri isolati
nelle stanze
Somma sui 6 oggetti, media (cfu/100cm2)
rame 2.521
non rame 14.813
riduzione: 83%
Sponde dei letti Valori medi (cfu/100cm2)
rame 366
non rame 6.471
Da: Michael G Schmidt, Hubert H Attaway,e al.: “Sustained Reduction of Microbial Burden on Common Hospital Surfaces through Introduction of
Copper”
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Risultati seconda fase
Da: Michael G Schmidt, Hubert H Attaway,e al.: “Sustained Reduction of Microbial Burden on Common Hospital Surfaces through Introduction of
Copper”
Distribuzione
(cfu/100cm2)
0
0-250
250+
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terza fase
Oggetto Rame
(tot: 294)
Non rame
(tot: 320)
No HAI o colonizzazione 273 (92,86%) 279 (87,19%)
HAI e/o colonizzazione 21 (7,14%) 41 (12,81%)
• Solo HAI (1) 10 (3,40%) 26 (8,12%)
• Solo colonizzazione (2) 4 (1,36%) 12 (3,75%)
Dati su 614 pazienti;
durata: 11 mesi
(HAI: Healthcare Acquired Infections) (1) P= 0.013 (2) P= 0.063
37 pazienti hanno contratto un’infezione nosocomiale durante i prelievi:
89% delle infezioni con > 500 cfu/100 cm2
Da: Cassandra D. Salgado ed al.: “Copper Surfaces Reduce the Rate of Healthcare-Acquired Infections in the Intensive Care Unit”
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terza fase
Da: Cassandra D. Salgado ed al.: “Copper Surfaces Reduce the Rate of Healthcare-Acquired Infections in the Intensive Care Unit”
Spostamento di oggetti durante la degenza:
Rame: 137 pazienti su 294 con tutti i 6 oggetti in rame
Non rame: 270 pazienti su 320 con nessun oggetto in rame
Doppio cieco non è possibile. Come valutare i risultati?
• Elemento di controllo standard in ogni stanza: la pediera del letto. Nessuna
differenza significativa tra le stanze in rame e non-rame (2.786 e 2.388
cfu/100 cm2)
• Elementi in rame: montati 9 mesi prima della raccolta dei campioni
• Il personale ospedaliero non era a conoscenza dell’inizio
Il tasso di infezioni nosocomiali non è variato lungo il periodo
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Maximum 2 lines Clinical trial Cile
Reparto pediatrico
Hospital de Ninos Roberto del Rio, Santiago: 16 stanze (8+8) nei reparti di
terapia intensiva e intermedi
Camere con anche con più 2 letti
Durata: 12 mesi (in due fasi)
Da: M.G. Schmidt; B. von Dessauer; C. Benavente; D.Benadof; P. Cifuentes; A. Elgueta; C. Duran; M.S. Navarrete: “Copper Surfaces are
Associated with Significantly Lower Concentrations of Bacteria on Selected Surfaces within a Pediatric Intensive Care Unit”
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Reparto pediatrico
Oggetti: sponde dei letti, culle, rubinetti, piantane portaflebo e banchi di
lavoro.
Tre leghe di ottone (rame 65÷85%)
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Reparto pediatrico
Stanza n. oggetti val. medio
cfu/100cm2
val. mediano cfu/100cm2
Rame 668 172 0
Non rame 652 1381 574
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Reparto pediatrico
”This study showed that through a reduction to burden,
through this intervention in the PICU, the HAI rates
decreased from 13.0 per 1,000 patient days for patients
treated in the control settings to 10.6 per 1,000 patient days
for patients treated in rooms with a limited number of copper
objects [….].
Although the relative risk reduction failed to achieve
statistical significance, we are encouraged that through
reducing burden with copper surfaces, we were able to
observe fewer infections among patients within the PICU.”
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Prima e dopo l’applicazione del rame
Stanza Sponde dei letti nelle stanze
«non rame»
Sponde dei letti nelle
stanze «rame»
Prima fase
(«pre-
intervento»)
Seconda fase
(«intervento»)
Riduzione
(%)
Seconda fase
(«intervento»)
Riduzione
(%)
MICU (1)
(USA)
17.336 6.471 - 63 366 - 98
PICU (2) (Cile)
4.800 1.313
- 73 43 - 99
in cfu/100 cm2
(1) MICU = Medical Intensive Care Unit (2) PICU = Pediatric Intensive Care Unit
Come varia il carico batterico prima e dopo l’installazione degli oggetti in lega di
rame?
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….ma il rame, conviene?
• Quante infezioni avvengono
nel mio ospedale/reparto?
• Quanto costa una giornata
in ospedale al SSN?
• Quante infezioni
potrebbe evitare il rame?
• Quanto costano gli
elementi in rame?
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….ma il rame, conviene?
• Costo extra per i componenti in rame: 52 K$
• Infezioni evitate nelle stanze in rame: 14
• Durata della fase 3: 338 giorni
• Costo per trattare 1 infezione: 28,4 K$ (x14 = 397,6 K$)
• Costi evitati 397,6 K$ : 338 giorni = 1.176 $/giorno
Stima effettuata sui clinical trial USA:
Payback 52 K$ : 1176 $/giorno = 44,2 giorni
Da: H.T. Michels, C.W Keevil, C. Salgado, M.G. Schmidt: “From Laboratory research to a clinical trial: copper alloy surfaces kill bacteria and
reduce Hospital-acquired infections”
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Tom Elliott (microbiologo e vice-direttore):
“The cost of fitting out the trial ward (a 20-bed
general medical ward) was equivalent to the
cost of just one-and-a-half infections”
Ospedale “Selly Oak”, Birmingham (UK)
Clinical trial
….ma il rame, conviene?
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I risparmi con il rame:
il modello di calcolo YHEC
• Confronta i costi delle infezioni e dell’installazione dei componenti in rame per valutare il
payback
• Sviluppato dall’Università di York
•Scaricabile su www.antimicrobialcopper.org/uk/the-business-case
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I risparmi con il rame:
il modello di calcolo YHEC
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I risparmi con il rame:
il modello di calcolo YHEC, esempio
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I risparmi con il rame:
il modello di calcolo YHEC, esempio
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I risparmi con il rame: non solo ospedali
5 scuole elementari, con maniglie e corrimano in
ottone.
Dati presi dalla 40a settimana 2011 alla 15a del
2012). Si sono rilevate le assenze.
Efstathiou et al.: P370: Antimicrobial copper (Cu+) implementation and its influence to the epidemiological data in elementary school population.
Antimicrobial Resistance and Infection Control 2013 2(Suppl 1):P370.
“….Clinical morbidity index of
students was recorded at 36,01%
(average 5 schools), while in the
community the same period (2011-
2012) the rate was 48,8%..”
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3. Conclusioni
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Strategie per combattere le infezioni nosocomiali
www.cleanroomtechnology.com/news/article_page/Polish_health_authority_first_in_Europe_to_recommend_antimicrobial_copper_in_hospitals/117774.
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Strategie per combattere le infezioni nosocomiali
Oggi, quante superfici avete toccato e quante mani avete stretto?
Superfici antibatteriche
in rame e sue leghe
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4. Rame antibatterico: approfondimenti e bibliografia
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Bibliografia (clinical trial)
T.J. Karpanen, A.L. Casey, P.A. Lambert, B.D. Cookson, P. Nightingale, L. Miruszenko, T.S.J. Elliott: ”The antimicrobial efficacy of copper alloy
furnishing in the clinical environment: a crossover study” (Infection control and hospital epidemiology, Vol. 33 No.1, Jan. 2012, p. 3-9)
P.J. Kuhn: “Doorknobs: a source of nosocomial infection?” (Diagnostic Medicine, 1983)
www.europeanhospital.com: “Copper Fittings beat bacteria”
(www.european-hospital.com/en/article/6156-Copper_fittings_beat_bacteria.html)
A. Mikolay, S. Huggett, L. Tikana, G. Grass, J. Braun, D.H. Nies: “Survival of Bacteria on Metallic Copper Surfaces in a Hospital Trial” (Appl
Microbiol Biotechnol, (2010) 87:1875-1879)
H.T. Michels, C.W Keevil, C. Salgado, M.G. Schmidt: “From Laboratory research to a clinical trial: copper alloy surfaces kill bacteria and reduce
Hospital-acquired infections” (Health Environments Research & Design, 2015 Oct. 9(1): 64-79
P.A, Sharpe, M.G.Schmidt: “Control and mitigation of healthcare–acquired infections: designing clinical trials to evaluate new materials and
technologies” (Health Environments Research & Design, vol. 5, n.1 p.94-115)
Da: M.G Schmidt, H.H. Attaway,e al.: “Sustained Reduction of Microbial Burden on Common Hospital Surfaces through Introduction of Copper”
(Journal of Clinic Microbiology, 2012 50 (7): 2217)
C.D. Salgado, K.A. Sepkowitz, J.F. John , J.R. Cantey, H.H. Attaway, K.D. Freeman, P. A. Sharpe, H.T. Michels and M.G. Schmidt : “Copper
Surfaces Reduce the Rate of Healthcare-Acquired Infections in the Intensive Care Unit” ( Infection Control and Hospital Epidemiology , vol. 34,
No. 5, Special Topic Issue: The Role of the Environment in Infection Prevention (May 2013), pp. 479-486 )
Efstathiou et al.: P369: “Financial benefits after the implementation of antimicrobial copper in intensive care units (ICUs)”.
(Antimicrobial Resistance and Infection Control 2013 2 (Suppl 1):P369.)
Efstathiou et al.: P370: “Antimicrobial copper (Cu+) implementation and its influence to the epidemiological data in elementary school
population.” (Antimicrobial Resistance and Infection Control 2013 2(Suppl 1):P370.)
M.G. Schmidt; B. von Dessauer; C. Benavente; D.Benadof; P. Cifuentes; A. Elgueta; C. Duran; M.S. Navarrete: “Copper Surfaces are
Associated with Significantly Lower Concentrations of Bacteria on Selected Surfaces within a Pediatric Intensive Care Unit” (American Journal of
Infection Control, 44(2016) 203-9)
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Articoli in italiano e siti internet
M. Crespi: “Il rame contro le infezioni nosocomiali” (Progettare per la Sanità, mag. 2012)
M. Crespi: “Rame antibatterico: le conferme dagli ospedali” (Tecnica Ospedaliera, sett. 2010)
Istituto Italiano del Rame: “Superfici antibatteriche in rame: le F.A.Q.”
Wikipedia: “Superfici di contatto antibatteriche in rame”
www.copperalliance.it. “Applicazioni – Sanità”
www.slideshare.net: “ll rame contro i batteri” (presentazione)
www.antimicrobialtouchsurface.com
www.antimicrobialcopper.org
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www.antimicrobialcopper.org
Grazie per l’attenzione
Viale Sarca 336 – 20126 Milano.
Tel.: 02 89 30 1330
[email protected] - www.copperalliance.it