A Closer Look at Maintaining Hospital Mattresses and Surfaces

By Matt Phillion

Here’s a sobering statistic: a recent study of 423 EMS deliveries found that only 55% of stretcher surfaces were disinfected. With 155 million people admitted to the emergency department (ED) every year, these surfaces are a hot spot for potential contamination. Meanwhile, 50% of all foam surfaces in acute care are compromised within just four years, increasing the risk of surface-born transmission in high-contact environments.

“This is an area the industry has been struggling with for a while, but it’s also one of those things that can easily get overlooked,” says Kristen Thurman, PT, MPT, CWS, vice president of product management and clinical affairs at Agiliti.

It’s reached the point where patients, and even the media, have begun to highlight it. A quick online search for hospital mattresses and fluids will quickly turn up stories you’d probably rather not read or watch.

“But highlighting those situations can motivate the industry to take a deeper dive into what’s going on inside the mattresses,” says Thurman.

In some ways, COVID brought the issue further into the light, as hospitals used harsh chemicals normally used to disinfect hard surfaces.

“When you go in to disinfect a room to turn it over, at the time teams were using bleach on everything, and some hospitals still are. Hard surface cleaners are really meant for hard surfaces: countertops, floors, not mattresses or fabrics,” says Thurman.

And in the rush to turn rooms over, these chemicals are often left on the surface to disinfect them long enough to damage the waterproofing from the surface of the mattress, Thurman explains.

“When waterproofing is damaged or removed, all fluids are going right through the top cover, and when you do an inside audit of these mattresses, you’ll find stains you won’t see on the top,” says Thurman. “And it’s all about getting to the next patient when there aren’t enough beds.”

The FDA has put out guidelines pushing for hospitals to schedule quarterly or biannually audits to unzip the mattresses and look for stains, and to replace the top cover when holes appear.

“Hospitals usually don’t budget to replace mattresses more frequently than every five to seven years,” says Thurman. “But current research says those mattresses are already compromised in three to three-and-a-half years. Without budget available, often hospitals don’t want to look and see what lurks inside.”

But in contrast, though, Thurman points out that not doing a thorough audit can impact the bottom line even more.

“When patients are getting infections from laying on contaminated mattresses, the bottom line can be impacted even more,” she says.

Building a better product

Thurman points out that from the product perspective, manufacturers should be developing products that are appropriate for the space they are going to be used in. Rather than blaming the hospitals for not taking better care of the mattresses, she says, the industry should be asking “How do we create better products for use in the hospital versus caring for the equipment that isn’t designed for it?”

“At Agiliti, we’ve spent the last few years really looking at different things that can be done,” Thurman says. “For one, we found we can actually apply waterproofing to the top cover differently so that harsh chemicals do not break it down. We take our fabrics and submerge them in bleach for 10 days, not just leave it on the surface but fully submerge it to test it. Our top cover is intact after 10 days, whereas other fabrics show signs of breach in less than five days.”

The mattresses in hospitals unfortunately do take a beating, Thurman notes, so there needs to be a better way to protect them.

“We’ve added a second protective layer that is breathable and stretchable that acts as a secondary barrier so fluids won’t get through,” she says. “Replacing just a top cover is significantly cheaper than completely replacing the mattress.”

The conversation is going to happen regardless of whether organizations want to, Thurman notes.

“Several publications have come out recently that look at thousands of mattresses and found them compromised across the board. Some of this is just starting to come to light, but we’ve been talking about it for quite a while,” she says. “Now people are starting to audit their mattresses. The VA required their hospitals to audit their surfaces. Starting with 20% of mattresses and if the majority of those are compromised, then auditing all of them.”

Fortunately, there are experts in every organization capable of leading the charge toward better surface maintenance.

“Professionals in infection control and quality roles have really started to pay attention to this,” says Thurman. “Healthcare-acquired infections are still prevalent, as well as pressure injuries, and if a rise is seen in either one of those, it’s absolutely time to start looking at mattresses. Studies have shown if a patient has an infection in a hospital bed the next patient in that bed is almost six times as likely to get an infection—because no one caught that fluids had seeped inside.”

Gradual maintenance over complete replacement

Swapping out new mattresses adds up, but there are ways to develop better practices and processes, Thurman says.

“We do a lot of preventive maintenance—looking for rips and tears—starting that process early so organizations can replace a mattress at a time versus doing it all at once helps hospitals stay more within their budgets while still ensuring a safe place for patients to be cared for,” says Thurman.

The enhanced top cover and Agiliti’s proprietary CoreShield® can allow for the mattress itself to last closer to 10 years than the three to four years standard mattresses withstand.

“Start with EVS. They’re the ones who see it first,” says Thurman. “They have all the sheets off the bed, doing a full disinfection and turnover when a patient is discharged. That’s the best opportunity to look at the mattress. Get EVS on board.”

The time pressure to turn a room over remains a challenge for hospitals, though, she notes.

“That’s the biggest pushback, turnover time. But it’s also an opportunity to wash the surfaces down, unzip the mattresses and look for fluid ingress,” Thurman says.

It’s a change in practice and adds time, but it also adds value.

“This is where infection control can balance the story, explaining the downstream benefits not just saving money but improving hospital-acquired infection rates and patient satisfaction. And making sure you are not going to have a story on the news” about a dirty mattress, Thurman says.

The technology will continue to improve as manufacturers and expert clinicians work together to deeply examine these often-overlooked parts of patient care.

Different national and international organizations have begun looking at durability and how long a mattress really should last.

“Hospitals will say: we don’t want to purchase a mattress that breaks down in a short amount of time. It’s not only poor ROI but can also harm the patient,” she says.

Professional organizations have begun to publish updated guidelines and recommendations for both EVS and for outside vendors.

“Professional organizations are recommending mattress audits and then encouraging hospital procurement to truly understand the composition and limitations of the mattresses they are bringing into the hospital,” says Thurman. “Mattress construction has absolutely evolved in ways that will become the norm. I think it’s a matter of time. Manufacturers have the responsibility to construct better products, but also hospitals have the responsibility to start doing audits and truly look at support surfaces as a valued piece of equipment and not just something to lay a patient on.”

There’s also an opportunity to educate providers in general about how to take better care of these surfaces and the potential harm if they don’t.

“Once you start connecting those dots, we all get uneasy, but that leads to looking at and treating these surfaces differently,” says Thurman.

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.