New ways for reducing bacterial & viral presence on touch surfaces

ISKU

Advances in material science can reduce how long bacte-ria and viruses persist

Each day we all come in contact with contaminated surfaces. Public transport, door knobs, key-boards, elevator buttons, telephones, desks — all have been touched by many others. When 80% of infectious diseases are transferred by touch — direct and indirect — thoroughly cleaning such surfaces becomes a pressing necessity [1]. But cleaning is a partial answer.

Even the strictest hand washing and disinfection protocols can only go so far to prevent infec-tions, even in hospitals. This calls for a touch surface that continually kills infectious microbes. Isku Interior now offers two persistent solutions for doing just that — Antimicrobial Copper and Silver Ion Technology.

New ways of combating Antibiotic ResistanceAntibiotic resistant pathogenic bacteria are a serious problem. In an increasingly urbanized wor-ld, pathogens travel and thrive. The spread of MRSA and ESBL have been linked to tourism. This is a global threat, and a risk to human health as we know it.

Ascendant super bugs mean that common and life-threatening infections are becoming increa-singly untreatable. Today, 700,000 people die yearly because of hospital-acquired infections. A recent study estimates this could rise to 10,000,000 by 2050.

Developing new antibiotics, using existing ones more strictly, and enforcing better hygiene and cleaning procedures will only work so far. When common disinfectants and chemicals oftentimes make the situation worse, these just aren’t enough to combat the problem.

Antimicrobial surfaces are our new weapon for preventing the spread of the worst and drug-re-sistant infections in cities, public facilities and healthcare settings.

How the Antibiotic Resistance spreads? The spread of antibiotic resistance. Microbes build resistance to our drugs over time, leading to resistant strains which spread throug-hout the community. Healthcare facilities are especially at risk, and can act as key vectors unless the full three step regime of strict hand washing, regular cleaning and use of antimicrobial surfaces is enforced.

The key issue: reducing pathogen survival rates and duration

The most common nosocomial pathogens can survive on surfaces for months. Without regular preventive surface disinfection, they become a continuous source of transmission. The main route of transmission in a healthcare environment is via a healthcare professional’s transiently contaminated hands.

A single hand contact with a contaminated surface results in pathogen transfer — a full 100% with Escherichia coli, Salmonella spp., and Staphylococcus aureus, 90% with Candida albicans and between 16-61% with viruses. Contaminated hands may transfer viruses up to 5 more sur-faces — or 14 other subjects — as well as re-contaminate an already cleaned surface. While good hand hygiene will reduce cross contamination, compliance rates are known to be around 50% even with healthcare professionals. [2]

The longer a nosocomial pathogen persists on touch surfaces, the longer it may be a source of transmission. Gram-positive bacteria, such as Enterococcus spp., Staphylococcus aureus, or Streptococcus pyogenes survive for months on dry surfaces. Gram-negative bacteria, such as Acinetobacter spp., Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, Serratia mar-cescens or Shigella spp., can survive on dry surfaces for months — as can Mycobacteria and

spore-forming bacteria. The leading nosocomial fungal pathogen Candida albicans can survive up to four months on dry surfaces. Most respiratory tract viruses — e.g. corona, influenza or SARS — can survive on surfaces for a few days and gastrointestinal tract viruses — e.g. astro-virus, HAV, polio or rotavirus — will persist for approximately 2 months.

BioCote silver ion technologyDurability of antimicrobial efficacy and safetyDurability of antimicrobial efficacy in materials treated with BioCote, a silver phosphate glass, was studied through artificial ageing. According to a hospital bed manufacturer, hospital beds are every two weeks on average, and the estimated life-span of a hospital bed is 25 years. Law laboratories in Birmingam, UK, conducted a study where test panels were washed 1500 times with a 5 minute, 65 °C water spray. Antimicrobial efficacy was tested using Staphylcoccus aureus and Eschererechia coli 0157. Laboratory tests showed that antimicrobial efficacy remained on the original level after 1500 washes, equal to 25 years of use. [3]

Articles treated with BioCote are safe to use. Silver migration levels are low, as tested by totally immersing a BioCote-treated food container into simulants according to EU Regulation 10/2011 [4]. Material migration during a 10 day immersion at 60 °C into simulants A, B and D2 was between 0.3 and 3.2, well below the limit value of 10 mg/dm2. Silver migration into simulant B (acetic acid 3% w/v) was 21.1 µg, again well below its limit value (50 µg) [5]. The use of BioCo-te-powder-based antimicrobial additive in a polymer carrier is certified as food-safe — and sui-table for food contact, and meets the requirements of a HACCP-based Food Safety Program (Food container material food zone classification is FZP) [6]. The oral reference dose (RfD), or daily risk-free consumption level, for Silver is 5 µg/kg of bodyweight [7].

The BioCote active silver particles are available in sizes from 5 µm to 40 µm (5000 -40000 nm), which fall outside the size definition of nanoparticle (1-50 nm) [8].

Migration of silver from packaging ma-terial into edibles. This may not exceed the level needed for the HACCP certifi-cation.

The ISO 22196 testISO 22196 is an internationally recognized standard test for evaluating the antibacterial activity of non-porous plastic materials, paint films and other materials treated with antibacterial substan-ces. The ISO 22196 test method quantitatively evaluates the antibacterial activity of non-porous materials against microorganisms over a 24-hour contact period. [9]

In the test, a bacterial suspension is applied to the test and control pieces. Microorganism-inocu-lated test pieces are then covered with a sterile thin membrane to spread the inoculum, to avoid dehydration and promote good contact between the antimicrobial surface and the organisms. Samples are incubated for 24 hours at 35°C and RH 90%. Microbial counts are determined be-fore and after incubation. Reduction of microorganisms is calculated using initial count against surviving micro-organisms.

The ISO 22196 standard specifies the use of Staphylococcus aureus and Escherichia coli. How-ever, tests using MRSA, Pseudomonas, Listeria, Salmonella, Bacillus, Acinebacter as well as fungi such as Aspergillus and Candida can also be carried out. While the standard specifies an incubation period of 24 hours, other time periods can also be accommodated.

Testing procedure: ISO 22196 / JIS Z 2801: 1) Preparation of sample 2) Sterilization 3) Application of bacterial solution on the surface 4) Incubation 5) Washing and removing bacteria from the sample 6) Analysis.

Bacteria vs. BioCoteDosing of antimicrobial silver phosphate (glass particles) into Isku’s furniture materials follows BioCote recommendations to ensure that they fulfill safety limits and contain enough silver for eliminating microbes, including multi-drug resistant bacteria.

On the 9th April 2013 BioCote issued a press release stating they had commissioned testing of their antimicrobial technology against a carbapenem-resistant Enterobacteria (CRE). An in-dependent ISO 22196 test demonstrated elimination of over 99.99% of Klebsiella pneumoniae bacteria. [10] BioCote technology is known to be effective against four multi-resistant bacteria.

1. ESBL (Extended Spectrum Beta Lactamase producing Escherichia coli)2. CRE (Carbapenem-resistant Enterobacteriaceae, Klebsiella pneumoniae)3. MRSA (Methicillin-resistant Staphylococcus aureus)4. VRE (Vancomycin-esistant Enterococcus)

Under the microscope — how silver phosphate glass performs

Silver ions can kill more than 600 kinds of bacteria. BioCote antimicrobial additives have been tested to perform against a wide range of microbes. Some of most common are listed on the next page. [11]

Bacteria Acinetobacter baumannii Bacillus subtilis Campylobacter coli Campylobacter jejuni Clostridium difficile (excluding spore form) Escherichia coli 0157 Enterobacter aerogenes Enterococcus faecalis Legionella pneumophila Listeria monocytogenes Salmonella enteritidis Salmonella typhimurium Shigella spp. Staphylococcus aureus Staphylococcus epidermidis Staphylococcus faecalis

Fungi Fungi are tested for specific applications via ASTM G21 09.

Materials treated with BioCote typically score 0-1 for fungal growth. Molds Aspergillus niger Aspergillus brasiliensis Penicillium sp.

Yeast Candida albicans

Viruses H1N1

Reduction in bacteria in short term contactIn a test, surfaces containing BioCote antimicrobial additive were exposed to a specified number of bacteria (e.g., 1.96 x 106 cfu; Initial). Following bacterial exposure according to ISO 22196, the surfaces were incubated at 37 °C for either 15 minutes or 2 hours. Reduction in bacteria on these surfaces was 86% at 15 minutes and 96% at 2 hours. Bacteria type and specification of surface materials were not reported [12].

The study was repeated using Isku’s antimicrobial CPL laminate and a water-borne lacquer. Do-sing of silver phosphate glass followed BioCote recommendations. The modified ISO 22196 test specified incubation times of 30 and 60 minutes, respectively [13]. Before the test, the laminate samples were heat-treated for 10 minutes at 150 °C to remove any unreacted monomers.

Material and bacteria used in the test

CPL laminate Staphylococcus aureus Escherichia coli

Water borne lacquer Staphylococcus aureus Escherichia coli

Reduction on bacteria 30 minutes 60 minutes

96.44 % 99.99 %88.98 % 99.99 %

95.38 % 97.70 %77.81 % 99.99 %

All antimicrobial materials used by Isku are tested by BioLabTests, an independent UK-based laboratory according to the ISO 22196 standard, using a 24-hour incubation time. Tests show that reduction of bacteria (Staphylococcus aureus and Escherichia coli) is in all samples >99.8% [14].

To visualize microorganisms on silver-treated and untreated polymers, BioCote carried out an epi-fluorescent microscopy study with a live/dead staining system together with Birmingham Uni-versity Technology Hub Imaging Core [15]. The samples were tested according to the ISO 22196 standard to observe the material’s performance against Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa. Reduction in bacteria in all samples was greater than 99.6%. The test bacteria, Pseudomonas aeruginosa, E. coli and Salmonella spp, were applied on treated and untreated polymer samples and incubated for 3 hours at 37°C to initiate biofilm formation and to accumulate sufficient cellular damage via silver’s biocidal action. The bacteria were coloured with molecular dyes to separate live ones from the dead. Fluorescent microscopy imaging revealed that 37% of the cells were dead on the control material vs. 94% on BioCote-treated material.

BioCote — proven to work against virusesViruses cause human disease by infecting cells of the body. Viral diseases are averted by rende-ring the virus non-infectious before it can enter the cells. Antiviral vaccines typically convert the virus from an infectious to noninfectious form. This study quantified the conversion of influenza A H1N1 virus from an infectious to non-infectious form because of its exposure to materials con-taining silver [16]. The following materials containing antimicrobial silver phosphate glass were tested using the ISO 22196 standard: butadiene styrene (ABS), polycarbonate (PC), thermoplas-tic polyurethane (TPU), polyvinyl chloride (PVC) and polybutylene terephthalate (PBT) polymers, laminated wood board and wet and powder paints.

A set amount of infectious H1N1 viruses were applied to both antimicrobial and control material surfaces and left overnight. In the morning, the viruses were recovered from these surfaces and counted using an immunological microplate plaque assay. Results shown for PC, ABS and lami-nate showed a 99.99% reduction in viable, or infectious H1N1 virus particles.

Case Studies: Silver

Case: Open plan office(A BioCote study in an open office occupied by up to 15 people)

Case: Occupational health care centerIn refurnishing the Finnish occupational health care center Apila during Summer of 2016, both antimicrobial copper and silver phosphate glass were used on touch surfaces. Table tops at a doctor’s room, a meeting room and canteen as well as chair seating, chair armrest and three plinth surfaces were studied. The surfaces were alloed to adjust to the specific environment mic-

The modern office environment can become a challenge when trying to maintain a healthy and productive space. Hot desking, shared facilities, common contact surfaces, circulated air and ex-tended interactions at close proximity create the ideal circumstances for illness causing and even antibiotic resistant microbes to pass from employee to employee. Either through person-to-per-son contact or indirectly via shared surfaces and office items.

In this case, furniture was introduced to the office at the proper time to allow adjusting to the spci-fic office microbiome. Swab samples were then collec ted afternoons on a weekly basis between April and September 2017.

All office furniture and items were used in exactly the same way by the office staff, and subjected to the same, standard cleaning regime. The laboratory isolated and counted bacteria, as well as recorded colony diversity from both treated and untreated items. Isku’s antimicrobial desk top showed on average a 95.14% reduction in bacteria. The hard surfaces of a metal-frame chair saw a 80.23% reduc-tion in bacteria [17]. Validation tests were carried out according to the ISO 22196 standard.

While antimicrobial surfaces are not inten-ded to replace cleaning, the study clearly demonstrated a significant reduction in the bacteria present on materials and objects treated with silver-based antimicrobial technology compared to identical, untreated counterparts. In conclusion, a comprehensive cleaning regime, increased hand hygiene, and the introduction of antimicrobial protection to common touch sur-faces would significantly reduce the microbial load on all surfaces. All this would help in creating a more healthy, hygienic and productive work environment.

robiome and to achieve a level of contamination comparable with untreated products being mo-nitored (the following summer, standard furniture was introduced for reference purposes).

The antimicrobial surfaces were cleaned with aqueous ozone made with the Lotus Pro method. Validation tests for the materials were done following the ISO 22196 standard. Swab samples were taken once a week before the morning cleaning round. On average, antimicrobial surfaces saw a 57% reduction in bacteria. The table tops in the doctor’s room and canteen saw a 80% reduction in bacteria. Bacteria were identified using MALDI-TOF spectroscopy for a full overview of Apila’s microbiome.

Two outpatient units of a major NHS hospital in Birmingham (UK) provided treated (using silver treated antimicrobial materials) and control environments for a pilot study [18, 19]. Human move-ment patterns, general layout and floor surface areas were identified as comparable. Cleaning in both rooms was identical, including wet mopping of hard floors with detergent and sanitary area cleaning with detergent. Both facilities were used normally for 12 months before starting to take swap samples. The products treated with silver ions were: Door furniture and safety rails, wall tiling, electrical sockets and switches, clinical waste bins, lockers and storage systems, signs, cubicle curtains, water taps, treatment couches, curtain rails, wooden doors, timber moldings, window blinds and the furniture fabric itself. Validation tests for silver treated materials followed the Japanese Industrial Standard Z 2801:2000 method to measure the antibacterial activity in hydrophobic materials (>95% reduction in viable counts of Estherichia coli and Staphylococcus aureus).

Four swab samples were taken from each surface during a four-month period. CFU counts from

Case: Hospital outpatient units

silver treated products were between 62% and 98% lower than comparable, untreated products. The mean total viable count (TVC) from silver treated products at any point of this study was 98% lower than the mean TVC of the same, untreated product in the control room. Swabs were also collected in both environments from objects not included in the study. The objects were a sharps bin, an equipment trolley, the floor, a soap dispenser, a fridge door, a cupboard door, a work surface, a wall, a height gauge, a telephone, a paper towel dispenser, weighting scales, a skirting board, a computer keyboard and monitor, a wheelchair, safety railings and pillow cases.

The CFU counts on these untreated products in the room with silver treated products, were 43.5% lower than in the control room’s respective surfaces. Overall, the bacterial contamination was markedly lower in the room with silver treated items. No bacterial identification was done in

Case: Nursing homeAs a result of the increasing size of the elderly population, the role of nursing homes is expan-ding in the coming years. Numerous reports describe infections occurring in nursing homes that are caused by MRSA and various other pathogens. In this case study, a number of residential units were refurbished. One residence comprising a bedroom and a bathroom was refitted with a range of silver treated antimicrobial products [21, 22]. For the bedroom, the products were: door, door handle, architrave, light switch, electrical sockets, radiator guard, bed, bedding, wardrobe, bedside table, bin and curtains. In the bathroom, the products were: hand wash basin, safety rails, tap, molded sheet tiles, soap dispensers and the toilet seat. Residences were cleaned on a daily basis following standard procedure by the cleaning staff.

Validation tests for silver treated products were done according to the JIS Z 2801 standard. The test results showed over 95% reduction in viable counts of Escherichia coli and Staphylococcus aureus, compared to equivalent non-treated materials. Fourteen swab samples were collected from each product at two-week intervals during a period of six months. Swab samples were cul-

this study. In a small-scale test trial in two Finnish hospital rooms, silver treated taps displayed a 67% lower CFU compared to control water tap; and a silver treated door handle sho-wed a 29% reduction [20].

tured for total viable counts for bacteria. The difference in mean bacterial counts between silver treated products in the test residence and equivalent untreated products in the control residence ranged from 23% to 99%. The mean difference in bacterial counts between all treated and unt-reated materials in the bedroom was 97.2%. The bathroom’s mean difference was 92.4%.

Case: School classroomSchool classrooms present factors important for the spread of microbes — close contacts between people for prolonged periods, common touch surfaces and isolated cleaning. Good hygiene is vital to reducing the risk — and consequences — of microbial cross-contamination. A primary school in cooperation with Coventry University Department of Applied Sciences and Health in the UK was selected of this environmental study.

A classroom refurbished with computer desks, chairs, door handles, light switches, liquid soap dispensers, cabling, sockets, tables, storage trays, bookcases, storage units, castors, the carpet, radiator covers, window handles, wall and ceiling paint, PVC wall cladding and a drinking water dispenser were treated during their manufacture with antimi-crobial silver ions. These were subject-ed to the ISO 22196 antimicrobial test to measure antibacterial performance. Both the treated and the control class-room were cleaned daily by wiping des-ks, sinks and drawing board, as well as sweeping the hard floor and vacuuming the carpet. Weekly cleaning regime ad-ded dusting computers, shelves and

Antimicrobial copperTouch surfaces with copper alloys have been shown to significantly and continuously reduce the mean bioburden by over 90% in clinical trials in Chile, the UK and the US. Antimicrobial copper has proved an effective touch surface material that kills more than 99.9% of bacteria within two hours. Of course, this applies together with regular cleaning and disinfection routines and pro-grams.

Antimicrobial copper has been observed to be effective against bacteria, viruses, fungi and molds, including MRSA, Influenza A (H1N1), Norovirus, Coronavirus, Clostridium difficile and VRE.

Kill times vary according to organism, strain, copper content and temperature — being more rapid at 20°C. Typically copper kills MRSA in 15 minutes when inoculation is 103 CFU and in 60 minutes when inoculation is 106 CFU. On the whole, antimicrobial copper surfaces reduce E. coli 0157, Enterobacteria aerogenes, MRSA and VRE colony forming units by 99% within two hours.

Over 500 antimicrobial copper alloys have been approved by the US EPA. The alloys will oxidize to varying degrees, which does not influence their antimicrobial efficacy. To be effective, these surfaces must not be waxed, painted, lacquered, varnished or coated.

worktops and mopping non-absorbent floors.

Swab samples were collected weekly over a period of two months. A total of 122 samples from the antimicrobial classroom were analyzed to have between 30% and 99% fewer bacteria com-pared to the control classroom. The difference in total bacterial counts between the classrooms was 95.68%. The study included identification of bacteria from isolated samples. A full twenty percent reduction in absenteeism was observed during the academic year for students in the antimicrobial schoolroom.

Efficacy: Copper vs stainless steel

The EPA test battery

The three EPA approved test protocols used to register Antimicrobial Copper with public health claims are:

- Efficacy as a Sanitizer: measures viable bacterial count under typical indoor conditions after two hours. - Residual Self-Sanitising Activity: measures bacterial count before and after six wet and dry wear cycles during which bacteria are added in a standard wear apparatus.- Continuous Reduction of Bacterial Contaminants: measures bacteria after inoculating an alloy surface eight times in a 24-hour period without interme- diate cleaning or wiping.

The efficacy of Antimicrobial Copper products is tested against following disease-cau-sing bacteria: E. coli O157:H7, Methicillin-Resistant Staphylococcus aureus (MRSA), Staphylococcus aureus, Vancomycin-Resistant Enterococcus faecalis (VRE), Entero-bacter aerogenes, and Pseudomonas aeruginosa.

Copper — proven efficacy against multiple pathogens:

• Acinetobacter baumannii• Adenovirus• Aspergillus niger• Candida albicans• Campylobacter jejuni• Carbapenem-resistant Enterobacteriaceae• Clostridium difficile (including spores)• Coronavirus (Human 229E)• Enterobacter aerogenes• Escherichia coli O157:H7 • Helicobacter pylori• Influenza A (H1N1)• Klebsiella pneumoniae• Legionella pneumophila• Listeria monocytogenes• Mycobacterium tuberculosis• Norovirus or Norwalk-like virus• Poliovirus• Pseudomonas aeruginosa• Salmonella enteritidis• Staphylococcus aureus (MRSA, E-MRSA, MSSA)• Tubercle bacillus• Vancomycin-resistant enterococci (VRE)

Case studies: CopperThe introduction of copper surfaces to objects formerly covered with plastic, wood and stain-less steel found in the healthcare environment significantly reduces the overall microbiological burden, thereby providing a safer environment for hospital patients, health care workers, and visitors.

The results of a modest 1983 study showed that a brass lockset had little bacterial contamination 72 hours after inoculation with E. coli, while a stainless steel lockset remained heavily contami-nated [23].

The Medical University of South Carolina, Charleston (MUSC), The Ralph H Johnson Veterans Administration Medical Center, Charleston, South Carolina and the Memorial Sloan Kettering Cancer Center in New York City participated in a clinical trial to test copper’s antimicrobial effi-cacy in intensive care units (ICUs).

Stainless steel, aluminum and plastic touch surfaces were replaced with antimicrobial copper alloys in selected rooms in each ICU. The most contaminated surfaces, those closest to patients and visitors, such as bed rails, overbed tray tables, chairs, call buttons, data devices and IV poles were replaced with copper components. No changes were made to clinical practices or cleaning regimes in the study rooms [24]. The microbial burden associated with commonly touched sur-

Case: Triple US Hospital study

faces in ICUs was determined by sampling six objects in 16 ICU rooms in ICUs over 43 months. In month 23, copper alloy items were installed in 8 of 16 rooms. The census continued in both test and control rooms for an additional 21 months. Copper was found to cause a significant (83%) reduction in the average microbiological burden found on the objects (465 CFU/100 cm2) com-pared to the controls (2,674 CFU/100 cm2mm which also results in a significant and consistent reduction in infection rates.

• Copper reduces the average number of microbes on touch surfaces by 83%.• The combined MRSA and VRE burdens were 96.8% lower on copper surfaces than on comparable plastic, wood, metal, and painted surfaces.• Copper surfaces diminish the density of bacteria to levels below those considered a risk to patients for the acquisition of an infection.• Microbial burden reduction on copper surfaces continuously achieves the same levels as terminal cleaning. • Copper surfaces in key touch surfaces in ICUs led to a 58% reduction in infection rates.• Copper’s antimicrobial activity is continuous.

Case: NHS Hospital, UKIn the UK, a test trial to demonstrate copper’s ability to reduce environmental contamination was carried out at a major NHS Hospital in Birmingham.

A general medical ward was fitted with both copper and standard components. The first results from sampling of three taps, push plates and toilet seats show that surfaces made from mate-rials that contain copper kill a wide range of harmful micro-organisms, significantly reducing the number of organisms that can come into contact with patients, visitors and staff. Data from over a ten-week period showed that items made from copper had 90 - 100% fewer micro-organisms on them, compared with the same items made from standard materials [25].

Case: HygTech Living LabIn Finland, copper based touch surfaces were tested as part of the HygTech project in real life Living lab environments [26]. Different facilities (hospital, kindergarten, office, retirement home) with varying cleaning practices and usage profiles and with multiple touch surface types (floor drain grilles, toilet flush buttons, door handles, light switches, closet touch surfaces, corridor hand rails, and toilet support rails) were studied.

The aim of the study was to identify which touch surfaces possess the highest bacterial loads in facilities where individuals routinely, e.g. work, recuperate or play — and to evaluate the antibac-terial efficacy of copper products (copper, brass) as functional materials in real-life circumstan-ces.

Total bacteria counts were shown to be lower on pure copper surfaces compared to reference surfaces (16±45 vs 105 ±430 CFU). The occurrence of Staphylocossus aureus (2 vs 6%) and Gram negative bacteria (21 vs 34%) were lower, while the occurrence of enterococci was on the same level (15%) on antimicrobial and control surfaces. The study concluded that copper touch surfaces can function as antibacterial materials and reduce the bacterial load, especially on fre-quently touched small surfaces.

In a 30-week clinical trial at Hospital del Cobre’s ICU in Calama, Chile, copper surfaces from 90 rooms, each containing 6 copper objects were studied against an equivalent number of rooms and surfaces with non-copper objects [27]. Products in the study were over-bed tables, bed rails, visitor chair armrests and intravenous poles. Even the pens used to input data on a touch screen were made from brass (70% Cu, 30% Zn).

After ten weeks, on average a 90% reduction of microorganisms was found on the copper items compared to the control surfaces. A reduction in the total microbial burden was seen for each class of microbe evaluated. What’s more, the continuous antimicrobial activity of copper persist-ed throughout the study.

Copper reduced microbial loads on all surfaces tested (bed rails by 91%, bed levers by 82%, tray tables by 83%, chair arms by 92%, monitor pens by 49% and IV poles by 88%). Average micro-bial burden counts in rooms with copper touch surfaces were significantly lower than in rooms without copper surfaces. The most predominant microorganism isolated — Staphylococci — was efficiently reduced by copper.

Case: Intensive Care Units

The world is facing an emerging mega-crisis of drug-resistant super bugs. Ever faster urbaniza-tion and international travel provide ample opportunities for microbes to spread from person to person — directly and via touch surfaces. Our shared spaces, from schools to hospitals are awash with pathogenic microbes that threaten healthcare as we know it.

With more and more antibiotic resistant strains of bacteria appearing constantly, we are facing a world with more common and life-threatening infections. Developing new antibiotics, using exis-ting ones more strictly and en- forcing better hygiene and disinfection or cleaning procedures will only work so far, and will not answer the problem alone.

A new answer is called for. New antimicrobial surfaces are our new weapon for preventing the spread of the worst and drug-resistant infections in cities, public facilities and healthcare settings.

Isku offers two ways to arm your organization against common pathogenic bacteria and the worst super bugs: Antimicrobial Copper and BioCote Silver Ion technologies. Both offer permanent, test-proven efficacy against even the most drug-resistant microbes, being able in many case kill these outright within hours of inoculation. Combined with regular hand washing and cleaning regimens, they form the best known solution to thwarting and controlling microbial growth and spread.

Isku offers these surfaces as part of your furniture. A solution that will pay off the initial investment, potentially in months. A solution that completely transforms your touch surfaces, from safe har-bors to antibiotic resistant microbes to a vital part of keeping your hospitals, ICUs, schools, of-fices and more, not just safe, but continuously safe.

Management summary

Isku is a Finnish family-owned company established by Eino Vikström 1928 in Lahti, Finland. Isku’s products are known for its high quality. Isku designs and develops, produces and markets furniture, services and comprehensive interior solutions for homes, schools, offices, healthcare facilities as well as for all public spaces. In Finland, Isku has a number of its own sales and service centres. In addition to the inclusive service network in Finland, Isku operates in the Nordics, the Baltics, Po-land, Russia and the Middle East and is involved in projects all around the world. Isku has centralized its production to Lahti, Finland. Isku has certified quality, en-vironmental management and safety systems according to ISO 9001, ISO 14001 and OHSAS 18001 standards. Today, all Isku’s production is PEFC certified. All wood used in the production comes from sustainably and responsibly managed forests and the raw material’s chain of custody is known.

Sources

1. Tierno, 2001, The Secret Life of Gems. Atria Books: New York. [Referenced 10.1.2018]

2. How long time nosocomial pathogens persist on inanimate surfaces. A systema- tic review. Axel Kramer, Ingeborg Schwebke, Günter Kampf. BMC Infection Dise- ases, 2006, 6:130. Available: https://doi.org/10.1186/1471-2334-6-130 [Referenced 10.1.2018]

3. Life Cycle Analysis of BioCote Treated Products and cetificate of analysis from Law laboratories Ltd. 28.6.2002. Available: https://www.biocote.com/wp-content/ uploads/2017/12/biocote-durability-report-2017.pdf [Referenced 10.1.2018]

4. Regulation EU 10/2011 for plastics intended to come into contact with food. Available: http://www.intertek.com/food/contact/eu-10-2011/ [Referenced: 10.1.2018]

5. Test report, 15A12J6090, Smithers Pira (UK), 7.10.2015. [Referenced: 10.1.2018]

6. HACCP certificate I-PE-646-BIO-03, 9.3.2016. [Referenced: 10.1.2018]

7. EPA reference dose for silver, 2018. Available: http://www.silverhealthinstitute. com/epa-reference-dose-for-silver/ [Referenced 10.1.2018]

8. Regulatory Statement Regarding Nanomaterials, Regulatory Statement 904, Issue 6-11/12/2015, A. Summerfield/BioCote. [Referenced: 10.1.2018]

9. SFS-ISO 22196:2011 Measurement of antibacterial activity on plastics and other non-porous, 2018. Available: https://www.iso.org/standard/54431.html [Referenced: 10.1.2018]

10. BioCote technology proven effective against another ‘superbug’, 9.4.2013. Available: https://www.biocote.com/blog/biocote-technology-proven- effective-against-a-4th-multi-drug-resistant-superbug/. [Referenced: 10.1.2018]

11. Preliminary test report from BioLabTests, Coventry, UK. 27.10.2017. [Referenced 10.1.2018]

12. 86% reduction in bacteria in just 15 minutes. BioCote case study, 2017. [Referenced: 12.1.2018]

13. Preliminary test report from BioLabTests, Coventry, UK. 27.10.2017. [Referenced: 12.1.2018]

14. Certificate of analysis BL056/2017. BioLabTests, Coventry UK. Date of testing: 2016-2017. [Referenced: 12.1.2018]

15. Proven under the microscope in the laboratory. BioCote case study, 2017. Available: https://www.biocote.com/wp-content/uploads/2017/09/CASE- STUDY-LABORATORY-2017.pdf. [Referenced: 12.1.2018] 16. 99.99 reduction in the H1N1 influenza virus on BioCote treated materials. BioCote case study, 2015. Available: https://www.biocote.com/wp-content/up loads/2015/11/BioCote-CS-H1N1.pdf. [Referenced: 12.1.2018] 17. 93% reduction in bacteria in an office environment. BioCote case study, 2017. Available: https://www.biocote.com/wp-content/uploads/2017/12/case-study-of fice-2017.pdf. [Referenced: 12.1.2018] 18. Reduction of bacterial contamination in a healthcare environment by silver anti- microbial technology. Lesley Taylor, Paul Phillips, Richard Hastings, Journal of Infection Prevention, January 2009, Vol. 10, no. 1, 8-14. Available: http://journals.sagepub.com/doi/abs/10.1177/1757177408099083? journalCode=bjib. [Referenced: 12.1.2018] 19. 96% reduction in bacteria in a hospital environment. BioCote case study, 2017. Available: https://www.biocote.com/wp-content/uploads/2017/09/CASE- STUDY-HOSPITAL-2017.pdf. [Referenced: 12.1.2018] 20. Antimikrobisten pintojen toimivuuden tutkiminen, Tiina Ahovaara, Camilla Joki- nen, Roosa Kantola, Maija Mikkola, Senni Pulli, Taru Turtiainen, Metropolia University of Applied Sciences, Degree programme of laboratory analytics, Inno- vation project, 15.12.2017. [Referenced: 12.1.2018] 21. Silver ion antimicrobial technology: decontamination in a nursing home. Paul Phillis, Lesley Taylor, Richard Hasting, British Journal of Community Nursing, 2009, 14 (5), 51-53. Available: https://doi.org/10.12968/bjcn.2009.14.Sup3.85161 [Referenced: 12.1.2018] 22. 95% reduction in bacteria in a nursing home. BioCote case study, 2015. Available: https://www.biocote.com/wp-content/uploads/2015/11/BioCo te-CS-Nursing-Home.pdf. [Referenced: 12.1.2018]

23. Doorknobs: A source of nosocomial infection? P. J. Kuhn, Diagnostic Medicine, Nov/Dec 1983. Available: https://www.antimicrobialcopper.org/sites/default/files/ upload/media-library/files/pdfs/uk/scientific_literature/kuhn-doorknob.pdf [Referenced: 16.1.2018]

24. Sustained Reduction of Microbial Burden on Common Hospital Surfaces through Introduction of Copper. Michael G Schmidt, Hubert H Attaway, Peter A Sharpe, Joseph John Jr, Kent A Sepkowitz, Andrew Morgan, Sarah E Fairey, Susan Singh, Lisa L Steed, J Robert Cantey, Katherine D Freeman, Harold T Michels and Cassandra D Salgado. J Clin Microbiol July 2012 vol. 50 no. 7 2217-2223. Published ahead of print 2 May 2012, Available: http://jcm.asm.org/content/50/7/2217.full [Referenced: 16.1.2018]

25. Role of Copper in Reducing Hospital Environment Contamination. A L Casey, D. Adams, T. J. Karpanen, P. A. Lambert, B. D. Cookson, P. Nightingale, L. Miruszenko, R Shillam, P Christian and T S J Elliott, J Hosp Infect (2009), Available: https://www.ncbi.nlm.nih.gov/pubmed/19931938 [Referenced: 16.1.2018]

26. Copper as an antimicrobial material in different facilities., J.Inkinen, R.Mäkinen, M.M.Keinänen-Toivola, K.Nordström, M.Ahonen, Letters in Applied Microscopy, 64, 2016, 19-26. [Referenced: 16.1.2018]

27. Effectiveness of Copper Contact Surfaces in Reducing the Microbial Burden (MB) in the Intensive Care Unit (ICU) of Hospital del Cobre, Calama, Chile. V Prado, C Durán, M Crestto, A Gutierrez, P Sapiain, G Flores, H Fabres, C Tardito, M Schmidt. Poster 56.044, presented at the 14th International Confe- rence on Infectious Diseases, Miami, March 11, 2010. Available: http://dx.doi.org/10.1016/j.ijid.2010.02.2083. [Referenced: 16.1.2018]