{"id":2952,"date":"2021-03-19T09:15:05","date_gmt":"2021-03-19T07:15:05","guid":{"rendered":"https:\/\/halco.gr\/?p=2952"},"modified":"2021-04-13T13:58:48","modified_gmt":"2021-04-13T10:58:48","slug":"sustained-reduction-of-microbial-burden-on-common-hospital-surfaces","status":"publish","type":"post","link":"https:\/\/halco.gr\/el\/sustained-reduction-of-microbial-burden-on-common-hospital-surfaces\/","title":{"rendered":"Sustained Reduction of Microbial Burden on Common Hospital Surfaces"},"content":{"rendered":"
Michael G. Schmidt,a Hubert H. Attaway,a Peter A. Sharpe, b Joseph John, Jr., c Kent A. Sepkowitz,d Andrew Morgan,a Sarah E. Fairey,a\u00a0Susan Singh,d Lisa L. Steed,e J. Robert Cantey,f Katherine D. Freeman,g Harold T. Michels,h and Cassandra D. Salgadof\u00a0Medical University of South Carolina, Department of Microbiology and Immunology, Charleston, South Carolina, USAa; Irwin P. Sharpe and Associates, West Orange, New<\/em>
\nJersey, USAb; Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USAc; Memorial Sloan Kettering Cancer Center, Department of Medicine,\u00a0Division of Infectious Diseases, New York, New York, USAd; Medical University of South Carolina, Department of Pathology and Laboratory Medicine, Charleston, South\u00a0Carolina, USAe; Medical University of South Carolina, Department of Medicine, Division of Infectious Diseases, Charleston, South Carolina, USAf; Albert Einstein College of\u00a0Medicine of Yeshiva University, Montefiore Medical Center, Department of Epidemiology and & Population Health, Bronx, New York, USAg; and Copper Development\u00a0Association, New York, New York, USAh<\/em>
\n<\/span><\/h6>\n

 <\/p>\n

The contribution of environmental surface contamination with pathogenic organisms to the development of health care-associated infections (HAI) has not been well defined. The microbial burden (MB) associated with commonly touched surfaces in intensive care units (ICUs) was determined by sampling six objects in 16 rooms in ICUs in three hospitals over 43 months. At month 23, copper-alloy surfaces, with inherent antimicrobial properties, were installed onto six monitored objects in 8 of 16 rooms, and the effect that this application had on the intrinsic MB present on the six objects was assessed. Census continued in rooms with and without copper for an additional 21 months. In concert with routine infection control practices, the average MB\u00a0found for the six objects assessed in the clinical environment during the preintervention phase was 28 times higher (6,985 CFU\/\u00a0100 cm2; n\u00013,977 objects sampled) than levels proposed as benign immediately after terminal cleaning (<250 CFU\/100 cm2).<\/h6>\n
During the intervention phase, the MB was found to be significantly lower for both the control and copper-surfaced objects.<\/h6>\n
Copper was found to cause a significant (83%) reduction in the average MB found on the objects (465 CFU\/100 cm2; n\u00012714\u00a0objects) compared to the controls (2,674 CFU\/100 cm2; n\u00012,831 objects [P<0.0001]). The introduction of copper surfaces to\u00a0objects formerly covered with plastic, wood, stainless steel, and other materials found in the patient care environment significantly\u00a0reduced the overall MB on a continuous basis, thereby providing a potentially safer environment for hospital patients,
\nhealth care workers (HCWs), and visitors.<\/h6>\n
Despite best efforts promoting infection control protocols (28,\u00a033), hospital-acquired infections (HAI) remain a common\u00a0complication of hospital care, occurring at an estimated rate of 2\u00a0million infections annually in the United States (30). At issue is the\u00a0source of the microbes responsible for HAI. Much work has focused\u00a0on the transfer of microbes from patients to health care\u00a0workers (HCWs) and vice versa, and it is likely that commonly
\ntouched items serve as significant reservoirs for these microbes.<\/h6>\n
Microbes have an inherent ability to colonize any surface.\u00a0Studies have shown that microbes can persist for weeks on stainless\u00a0steel surfaces and polymeric materials used to fabricate touch\u00a0surfaces in hospitals (22). Methicillin-resistant Staphylococcus aureus\u00a0(MRSA) may exist on surfaces for as long as 360 days (37, 38),\u00a0and spore-forming bacteria, including Clostridium difficile, can\u00a0survive for months. The longer a nosocomial pathogen persists on\u00a0a surface, the longer it may be a source for transmission to a susceptible\u00a0patient or HCW (5, 13, 17, 21, 26, 29). Frequently\u00a0touched surfaces such as doorknobs, push plates, bed rails, faucet\u00a0handles, and poles supporting intravenous fluid supplies (IV\u00a0poles) have been identified as reservoirs for the spread of pathogenic
\nmicrobes (3, 27) which can easily contaminate hands and\u00a0equipment of HCWs, who, in turn, can transmit these pathogens\u00a0to patients during routine care.<\/h6>\n
A concentration of less than 250 aerobic CFU per 100 cm2 of\u00a0surface area has been proposed as a standard for being considered\u00a0benign immediately after terminal cleaning (11, 19). When the\u00a0microbial burden (MB) exceeds this level, transmission from the\u00a0surfaces to health care workers and\/or patients likely increases. To\u00a0date, while there have been multiple protocols for hand hygiene\u00a0and room cleaning, there have been few strategies that can consistently\u00a0minimize the MB found in the environment. CDC guidelines\u00a0for disinfection and sterilization of healthcare facilities (28)\u00a0describe reducing rates of HAI through appropriate use of disinfection\u00a0and sterilization of the patient care environment. These\u00a0guidelines incorporate a disinfection strategy devised more than\u00a040 years ago (34) on the basis of the predicted degree of risk involved\u00a0in the use of inanimate objects: \u201ccritical\u201d risk, which includes
\nitems that enter sterile tissue (surgical instruments); \u201csemicritical\u201d\u00a0risk, which includes items that come into contact with\u00a0mucous membranes or nonintact skin (endoscopes); and \u201cnoncritical\u201d\u00a0risk, which includes items that come in contact only with\u00a0skin. Environmental surfaces fall within the noncritical category\u00a0(16, 31, 34). Increasing evidence suggests that enhanced cleaning\/\u00a0disinfection of environmental surfaces can reduce contamination\u00a0of HCWs and thus reduce transmission of hospital pathogens (4).<\/h6>\n
However, numerous reports indicate that a high percentage of environmental surfaces are not terminally cleaned well (7\u20139).\u00a0When samples from objects in hospital rooms were cultured, 94%\u00a0of those from rooms housing vancomycin-resistant enterococcus\u00a0(VRE)-infected patients and 100% of those from rooms housing\u00a0C. difficile patients were extensively contaminated with the organisms\u00a0(12).<\/h6>\n
In vitro (24, 25, 39) and in vivo (10, 15, 20) studies have established\u00a0the effectiveness of metallic copper surfaces as an antimicrobial\u00a0material for its ability to reduce the concentration of bacteria\u00a0on hard surfaces. In this study, we have expanded on these\u00a0observations by characterizing the MB associated with commonly\u00a0touched objects surfaced with and without copper in the intensive\u00a0care unit (ICU) in order to understand the risk that the MB might\u00a0represent and the benefit that a perpetually active copper material\u00a0might offer in continuously reducing the MB in the built hospital\u00a0environment.<\/h6>\n
MATERIALS AND METHODS<\/strong>
\nSetting. A multisite study was conducted within the ICUs of three separate
\nU.S. hospitals. The study was approved by the institutional review\u00a0boards for all sites as well as by the Office of Risk Protection of the United\u00a0States Army, the sponsor of the work. The Medical University of South\u00a0Carolina (hospital 1) located in Charleston, South Carolina, is a 660-bed\u00a0academic facility with 17 medical ICU beds. The Memorial Sloan Kettering\u00a0Cancer Center (hospital 2) located in New York, New York, is a 432-bed cancer hospital with 20 medical-surgical ICU beds. The Ralph H.\u00a0Johnson Veterans Administration Medical Center (hospital 3), also in\u00a0Charleston, is a 98-bed hospital with 8 medical ICU beds.<\/h6>\n
Study design. The MBs associated with six common, frequently\u00a0touched objects with which patients, HCWs, and visitors routinely nteract\u00a0between daily routine cleanings (Table 1) were measured weekly for 43\u00a0months using 6 rooms each from hospitals 1 and 2 and 4 rooms from\u00a0hospital 3 for a total of 16 rooms. Commencing during month 23 (intervention\u00a0phase), the six objects associated with half of the study rooms\u00a0were surfaced with a continuously active antimicrobial material, metallic\u00a0copper, in order to determine the effect on the MB.<\/h6>\n
Fabrication of items surfaced with copper alloys. The objects surfaced
\nwith copper were fabricated using copper alloys registered with the\u00a0U.S. EPA for their inherent ability to kill bacteria (36). Four items were
\ncommon to all hospitals: the side rails of the patient bed, the over-bed tray
\ntable, the IV pole, and the contact surface of the arm rests of the visitor\u2019s
\nchair (Fig. 1). Two other frequently touched objects were also sampled
\nfrom each site (Table 1). For additional details on fabrication, please see
\nthe supplemental material.<\/h6>\n
Environmental cleaning regimens. Each of the study sites followed
\nroutine standards of environmental cleaning and disinfection as prescribed\u00a0by their respective infection control programs. This required that\u00a0all objects and surfaces be cleaned at least once each day using a prescribed\u00a0hospital-grade disinfectant and upon patient discharge. Three U.S. EPAregistered\u00a0disinfectants were used during the intervention. Virex 256 disinfectant\u00a0was used for routine and terminal cleaning. Dispatch disinfectant\u00a0was used to clean rooms housing patients with a confirmed case of Clostridium\u00a0difficile, and Cavicide disinfectant was used for spot cleaning. Additionally,\u00a0during the preintervention phase, one site, hospital 2, used the disinfectant\u00a0Elimstaph no. 2 (Walter G. Legge Company, Inc., Peekskill, NY) rather\u00a0than Virex 256 for its routine and terminal cleaning. The products were all\u00a0used according to the label instructions and were consistently applied.<\/h6>\n
Sample collection procedure. Surfaces were sampled once each week,
\nexcluding weeks with U.S. federal holidays, at approximately 9 a.m. using
\na sterile template measuring either 10 cm by 10 cm or 4 cm by 25 cm
\nplaced over each surface. The exposed area was vigorously wiped using
\nuniform pressure and motion, 5 strokes horizontally and 5 strokes vertically,\u00a0for a total of 10 strokes. Samples were transported to Medical University\u00a0of South Carolina and processed as previously described (1). MB\u00a0was reported as CFU per 100 cm2. For greater detail, see materials and\u00a0methods in the supplemental materials.\u00a0Calculations and statistical analysis. The average MB of each item\u00a0was calculated, and theMBof each room was determined as the sum of the\u00a0MBs of the six objects within that room. The Kruskal-Wallis test was used\u00a0to compare the average MBs associated with objects and rooms (EpiInfo;\u00a0CDC, Atlanta, GA) between the preintervention and intervention phases\u00a0as well between copper-surfaced rooms and control-surfaced rooms. A P\u00a0value of \u00010.05 was considered statistically significant. The antimicrobial\u00a0efficacy of copper was calculated as the difference in average MBs between\u00a0copper and noncopper objects and rooms and was expressed as the percentage\u00a0with which copper reduced the MB.<\/h6>\n
RESULTS<\/strong>
\nIntrinsic microbial burden found on common, frequently\u00a0touched objects. Over the 43 months of the study, samples were\u00a0recovered from 9,522 objects in 1,587 rooms across three study\u00a0sites. The average MB found for the six objects assessed in the\u00a0clinical environment during the preintervention phase was 28\u00a0times higher (6,985 CFU\/100 cm2; n \u0001 3,977 objects sampled)\u00a0than levels commonly accepted as benign, \u0002250 CFU\/100 cm2\u00a0(Fig. 2) (11, 18, 19, 23, 40). The latter value was exceeded for\u00a0each object sampled. Bed rails were the most heavily burdened\u00a0of the objects, averaging a concentration 69 times greater than\u00a0the level proposed as benign immediately after terminal cleaning\u00a0or 17,336 CFU\/100 cm2, with a standard error of sampling\u00a0of \u00032,896 CFU\/100 cm2. (For additional details, please see\u00a0Table S1 in the supplemental material). The majority of microorganisms\u00a0(64%) were staphylococci, and approximately 90%\u00a0of the population recovered was coagulase negative.<\/h6>\n
MRSA and VRE were also frequently recovered from objects.\u00a0Bed rails had average concentrations of 151 CFU of MRSA\/100\u00a0cm2 and of 667 VRE\/100 cm2, and nurse call buttons had averages\u00a0of 146 CFU of MRSA\/100 cm2 and 16 CFU of VRE\/100 cm2 (Fig.\u00a02). The average concentrations of Gram-negative bacteria on bed\u00a0rails and call buttons were 57 and 109 CFU\/100 cm2, respectively,\u00a0and the average concentrations of Gram-negative bacteria resident\u00a0on the monitors and tray tables were higher at 5,914 and 8,572 CFU\/100cm2, respectively, reflecting a small number of outliers from samples\u00a0collected from hospital 2.<\/h6>\n
Copper lowered the MB found on common, frequently\u00a0touched objects. During the 21-month intervention, the antimi-crobial effect exerted by metallic copper surfaces was immediate\u00a0and consistently evident. A significant (83%) reduction in the average MB recovered from the copper-surfaced objects was seen.\u00a0Collectively, the average MB likely to be encountered from one of\u00a0the six copper-surfaced objects was 465 CFU\/100 cm2 (n \u0001 2,714\u00a0objects), while the average burden recovered from the control\u00a0items was 2,674 CFU\/100 cm2 (n \u0001 2,831 objects; P \u0002 0.0001).<\/h6>\n
The summative MB average for the six objects surfaced in copper\u00a0was also approximately 83% lower than the burden recovered\u00a0from the control objects (2,521 versus 14,813 CFU\/100 cm2) (see\u00a0Table S2 in the supplemental material). Considered individually,\u00a05 of the 6 objects surfaced in copper also saw significantly lower\u00a0burdens (Fig. 3A; see also Table S2 in the supplemental material).\u00a0Polypropylene bed rails were again the most heavily burdened of\u00a0the control objects sampled, with an average MB of 6,456 CFU\/100 cm2. In contrast, the MB recovered from copper bed rails was\u00a094% lower (366 CFU\/100 cm2) and this difference was significant\u00a0(P \u0002 0.0001). Finally, the antimicrobial activity of copper was
\nfound to be universal in its ability to kill many types of microbes\u00a0(Fig. 3B and C).<\/h6>\n
Copper surfaces were also found to attenuate the inherent variability
\nassociated with the MB resident on surfaces within the patient\u00a0care areas. A total of 83% of samples recovered from copper\u00a0bed rails were found to have an MB below 250 CFU\/100 cm2,\u00a0whereas only 20% of the samples recovered from the plastic rails\u00a0were found below this level (Fig. 4), suggesting that copper might\u00a0limit the heterogeneity of risk to the patient attributed to the variation\u00a0in MB by limiting the range of MB resident on commonly\u00a0touched surfaces. The dynamic nature of the MB resident on the\u00a0objects sampled, attributed to stochastic processes, was evident\u00a0throughout the trial (see Fig. S1 and S2 in the supplemental material).\u00a0A comparison of the summative MBs from the preintervention
\nand intervention phases found that the MB was 64.4%\u00a0lower during the intervention period of the trial (41,586 CFU\/100\u00a0cm2 [n \u0001 668 rooms] versus 16,188 CFU\/100 cm2 [n \u0001 511\u00a0rooms]; P \u0002 0.0001).<\/h6>\n
Effect of copper intervention on antibiotic-resistant bacteria.\u00a0Considering the frequency with which MRSA and\/or VRE\u00a0isolates were encountered over the study period, 169 (2.4%) of\u00a07,005 control objects were found to harbor MRSA, while 239\u00a0(3.4%) were found to harbor VRE. During the intervention phase,\u00a0MRSA and VRE were recovered with greater frequency from objects\u00a0in rooms without copper surfaces.MRSAwas recovered eight\u00a0times (0.3%; n \u0001 2,781 copper objects) compared to 19 times
\n(0.63%; n \u0001 3,004 [P \u0001 0.0804; control]), while VRE was recovered\u00a09 times from rooms with copper surfaces (0.3%) compared to\u00a091 times (3%) from control rooms (P\u00020.0001). On a per sample\u00a0basis, copper surfaces were approximately six times less likely to\u00a0harbor one of these organisms. Based on the summative MB measured\u00a0for each of the surfaces sampled over the intervention period,\u00a0the combined MRSA and VRE burdens were 96.8% lower on\u00a0copper surfaces than on comparable plastic, wood, metal, and\u00a0painted surfaces and were 98.8% lower on the bed rails, the most
\nheavily burdened object.<\/h6>\n
DISCUSSION<\/strong>
\nThe results of this study suggest that six common, frequently\u00a0touched objects with which HCWs, patients, and visitors routinely\u00a0interact carry a substantial MB and thus present a risk to\u00a0patients. These data underscore the need to ensure that cleaning is\u00a0completed in an effective manner, as bacterial concentrations resident\u00a0on items sampled were well above the values recommended\u00a0immediately after terminal cleaning (11, 18, 19, 23, 40). Concentrations\u00a0of bacteria on objects differed substantially (Fig. 4). The\u00a0stochastic behavior of the MB distributed across the three ICUs is
\nlikely attributable to the inherent dynamics of patient care, cleaning,\u00a0and patient characteristics as well as to other, unknown factors.<\/h6>\n
Incorporation of inherently and continuously active antimicrobial
\ncopper onto frequently touched surfaces in the ICU offered\u00a0an enhanced effect in combination with regular cleaning and\u00a0infection control practices that resulted in significantly lower MB\u00a0and potentially safer surfaces. Bed rails were the most heavily burdened\u00a0control objects, with a maximum MB of 306,000 CFU\/100\u00a0cm2, 17 times higher than the maximum value observed from a\u00a0copper-surfaced rail. In fact, 80% of plastic bed rails had bacterial\u00a0concentrations above the risk threshold for transferring infectious\u00a0bacteria (Fig. 4). In contrast, 83% of copper bed rails had levels\u00a0below this threshold. Thus, generally, during the conduct of patient\u00a0care, objects surfaced with copper carried concentrations of
\nbacteria at or below the threshold recommended immediately after
\nterminal cleaning (11, 18, 19, 23, 40). The levels of antimicrobial
\nactivity of the metallic copper surfaces were equivalent\u00a0throughout the course of the trial. This was evident from the observation\u00a0that over the course of sampling, 46% of copper bedrails\u00a0had no recoverable bacteria (Fig. 4). In contrast, only 3% of bed\u00a0rails sampled in control rooms failed to yield viable bacteria.<\/h6>\n
Similarly, the five other copper items had remarkably lower\u00a0burdens. The call button was the most heavily burdened of the\u00a0copper-surfaced objects evaluated; however, 71% of the samples\u00a0were below the proposed terminal cleaning threshold. The measured\u00a0levels for 75% of chair arms sampled, 90% of tray tables,\u00a091% of IV poles, and 90% of data input devices were below the\u00a0proposed standard of\u0002250 CFU\/100 cm2. In total, 45% of control\u00a0objects from the 511 rooms sampled exceeded an average MB
\nconsidered to represent a risk to patients, compared to just 16% of
\ncopper-clad objects. The most surprising finding was the 64%\u00a0decrease in MB between the preintervention and intervention\u00a0phases in the control rooms. This might be accounted for as a\u00a0consequence of a number of independent and uncontrolled variables:
\n(i) the presence of copper on the unit might have resulted in\u00a0better cleaning by the environmental services staff; (ii) the presence\u00a0of copper might have resulted in an antimicrobial halo that\u00a0limited the transfer of microbes between control rooms, as staff\u00a0were common to both rooms; or (iii) variations in compliance\u00a0with other infection control measures such as hand hygiene might\u00a0account for the differences seen.<\/h6>\n
Unlike programs designed to improve compliance with infection\u00a0control such as hand hygiene or barrier precautions, the antimicrobial\u00a0activity of copper-surfaced objects was not dependent\u00a0on additional training or supervision. It did not require alterations\u00a0to existing cleaning practices or add to the annual environmental\u00a0cleaning costs, as does the application of UV light and\/or hydrogen\u00a0peroxide vapor deposition for reduction in MB. Additionally,\u00a0reductions to the MB manifested by the copper objects during\u00a0active patient care approached the reduction level of 99.9% observed\u00a0in tests conducted for registration of copper-based surfaces
\nwith the U.S. EPA.<\/h6>\n
Recent literature provides increased evidence that contaminated
\nhospital surfaces may be a source of transmission of pathogens.\u00a0Kramer et al. reported that, in hospitals, surfaces with hand\u00a0contact are often contaminated with nosocomial pathogens and\u00a0may serve as vectors for cross-transmission (17). Stiefel et al.\u00a0found that in patient rooms with MRSA carriers,HCWsare just as\u00a0likely to contaminate their hands or gloves from contact with\u00a0commonly touched environmental surfaces as from direct contact\u00a0with colonized patients (35). Boyce (6) demonstrated that nurses\u00a0frequently acquired MRSA on their gloves after touching surfaces\u00a0near colonized patients, and a report by Bhalla and others found
\nthat 53% of hand imprint cultures were positive for one or more
\npathogens after contact with surfaces near hospitalized patients\u00a0(2). Other studies have found that patients treated in rooms previously
\noccupied by individuals with colonization or infection\u00a0with MRSA, VRE, and C. difficile are at a higher risk of acquiring\u00a0the organism than patients admitted to rooms where the previous\u00a0occupant did not have colonization or infection (14, 32).<\/h6>\n
The use of copper to control or reduce the MB on surfaces in\u00a0health care has been previously reported (10, 15, 20). In a South\u00a0African community health care facility, copper surfaces (desks,\u00a0trolleys) were associated with a 71% reduction inMBcompared to\u00a0control surfaces when sampled every 6 weeks for a period of 6\u00a0months (20). A recent crossover study in a 19-bed acute medical\u00a0ward found that many copper surfaces were associated with significantly decreased MB compared to control surfaces when sampled\u00a0weekly for 24 weeks, with reductions ranging from \u00040.4\u00a0CFU\/cm2 to \u000480.3 CFU\/cm2 (15). Also, as was seen in our study,\u00a0copper surfaces were significantly less likely to be contaminated\u00a0with indicator organisms such as VRE and coliforms. Our study\u00a0differs from those previous studies in several respects. Sampling in\u00a0our study was performed over a substantially longer period of time\u00a0(21 months), and the objects surfaced with copper were often\u00a0medical devices in close proximity to the patient and used routinely\u00a0during direct patient care. Additionally, the populations\u00a0cared for in the rooms involved in our study were critically ill and\u00a0generally not ambulatory, which reduced the influence of their
\ninteractions with other environmental surfaces within and outside\u00a0the room.<\/h6>\n
Reducing the overall MB on a continuous basis with the introduction\u00a0of continuously active antimicrobial copper surfaces, as\u00a0evidenced in this study and others, may provide a safer environment\u00a0for hospital patients, HCWs, and visitors.<\/h6>\n
ACKNOWLEDGMENTS
\nThis work was supported by the U.S. Army Material Command (contract
\nW81XWH-07-C-0053).
\nThe views, opinions, and\/or findings presented here are ours and\u00a0should not be construed as an official position of the U.S. Department of\u00a0the Army.
\nWe acknowledge assistance and technical support from Chuck Stark,
\nDennis Simon, Alan Tolley, and Kathy Zolman of ATI, North Charleston,\u00a0SC, and Adam Estelle, Wilton Moran, and Jim Michel of CDA.<\/h6>","protected":false},"excerpt":{"rendered":"

Michael G. Schmidt,a Hubert H. Attaway,a Peter A. Sharpe, b Joseph John, Jr., c Kent A. Sepkowitz,d Andrew Morgan,a Sarah E. Fairey,a\u00a0Susan Singh,d Lisa L. Steed,e J. Robert Cantey,f Katherine D. Freeman,g Harold T. Michels,h and Cassandra D. Salgadof\u00a0Medical University of South Carolina, Department of Microbiology and Immunology, Charleston, South Carolina, USAa; Irwin P. Sharpe … Continue reading<\/a><\/p>","protected":false},"author":1,"featured_media":2955,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12],"tags":[],"_links":{"self":[{"href":"https:\/\/halco.gr\/el\/wp-json\/wp\/v2\/posts\/2952"}],"collection":[{"href":"https:\/\/halco.gr\/el\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/halco.gr\/el\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/halco.gr\/el\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/halco.gr\/el\/wp-json\/wp\/v2\/comments?post=2952"}],"version-history":[{"count":3,"href":"https:\/\/halco.gr\/el\/wp-json\/wp\/v2\/posts\/2952\/revisions"}],"predecessor-version":[{"id":3665,"href":"https:\/\/halco.gr\/el\/wp-json\/wp\/v2\/posts\/2952\/revisions\/3665"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/halco.gr\/el\/wp-json\/wp\/v2\/media\/2955"}],"wp:attachment":[{"href":"https:\/\/halco.gr\/el\/wp-json\/wp\/v2\/media?parent=2952"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/halco.gr\/el\/wp-json\/wp\/v2\/categories?post=2952"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/halco.gr\/el\/wp-json\/wp\/v2\/tags?post=2952"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}