On average, Americans will spend 36 years in bed over the course of their lifetime, according to a report in the New York Post (March 21, 2019) based on a research study conducted by OnePoll for Slumber Cloud.
However, this doesn’t account for lying in a hospital bed or stretcher or a long-term care facility bed, which likely – and logically – increases those numbers.
From a healthcare perspective, experts say that inpatients spend a great deal of time in bed (whether stationary in rooms or in transit around the facility) and that mattresses represent the No. 2 touchpoint for caregivers and potentially the No. 1 touchpoint for patients.
This raises the question about a healthcare organization’s bed and mattress maintenance procedures, which include cleaning, disinfecting, sterilizing, repairing and even replacing when necessary.
Healthcare Purchasing News reached out to more than a half dozen experts in beds, mattresses, and disinfection and sterilization products and procedures for their insights in a brief, non-scientific poll.
Save for laundering linens and sheets, healthcare staffers remain marginally better than ordinary citizens at home when it comes to maintaining hygiene with their beds – but then they have to be because of all the exposure to bacterial and viral microorganisms that cause infections.
Report card
HPN asked these experts to assess their impressions of how well healthcare organizations keep their beds and mattresses hygienic. Nearly 85% responded “fair” to “poor” with the majority of that group leaning toward fair (67%). At the extremes, no one rated efforts as excellent but at the same time no one classified efforts at “those need to be maintained?” Roughly a third, however, rated efforts as “good,” based largely on product offerings in active use and a multidisciplinary program in place to maintain beds and mattresses.
Root causes?
HPN then posed an appropriate follow-up to the bed and mattress maintenance assessment question on what experts attribute their initial response. They could choose more than one option among five specific reasons or derive one of their own.
“Lack of priority (among so many other growing priorities)” led the tally with 67%, followed by “failure/lack of following appropriate and optimal cleaning/disinfecting/sterilizing/repair instructions and protocols” from product manufacturers at 50%. Only a third indicated a “failure/lack of appropriate and optimal cleaning/disinfecting/sterilizing/repair instructions and protocols.” While some claimed hospital staffers didn’t have necessary instructions, more expressed they didn’t adhere to whatever instructions they had anyway. Another third chose a simple “lack of awareness” as the culprit.
Experts acknowledge the challenges and try to place activities – or lack thereof – in context. Staffing and timing play a key role.
But Mathieson urges caution in that this issue isn’t “as black and white as it seems,” she noted. “Deeper in, it’s not that facilities do not have protocols or do not follow protocols. It’s a combination of factors. It’s not so much about intensity, but rather how often/prevalent each issue is seen across the country based on the current environment.” She ranks short staff that leads to rushing protocols at the top, followed by a lack of optimal products and services to do the job, followed by the lack of adhering to appropriate instructions and protocols.
“Healthcare facilities are typically faced with a time limit when turning over patient rooms, which rarely provides sufficient time to effectively clean and disinfect the beds and mattresses, let alone the rest of the room,” Lybert noted. “It is incredibly important that the manufacturer take this into consideration during design and provide instructions that support this process. Healthcare professionals often use the same type of disinfectant for everything they are cleaning. Testing and validating that these disinfectants can be used is needed. If not, there may be a process for getting the correct disinfectant approved.”
“I believe hospital staff have the best of intentions to ensure beds and mattresses are thoroughly cleaned, treated and maintained,” he said. “In recent years, the industry’s work of highlighting the shortcomings of hospital bed and mattress maintenance and the risks they present to patient safety have helped increase awareness of these challenges. Despite this increased awareness, the incidence of the fluid ingress into patient mattresses and beds still occurs far too often.
“Staff turnover will always present a challenge around education and awareness,” Rotter continued. “Hospitals must prioritize and emphasize best practice as part of standard protocol to ensure beds and mattresses can be properly cleaned and treated. This means following manufacturers’ instructions which often suggests avoiding oversaturation of the surfaces to prevent fluid ingress as well as wiping down the mattress surfaces with water after treatment and allowing the mattress to fully dry before placing it back on the bed or surgical table.”
Such awareness motivated Cone Health to organize a project to oversee quality in this area, according to Waddell.
“I had the pleasure of leading a multidisciplinary team in a project called ‘The Clean Bed Initiative,’” he told HPN. “This body of work involved input from Nursing, Environmental Services, Patient Transport, Radiology and Repair Technicians. In creating the work, we were able to track bed movement through all aspects of hospital workflow and observe movement of the patient from admission to discharge.” (For more details on Cone Health’s CBI, read “Cone Health elevates bed, mattress maintenance to higher priority.")
Potential solutions
HPN then asked experts how bed and mattress maintenance efforts and outcomes could be improved. They could choose more than one option among six potential selections or generate one of their own.
Not surprisingly, education topped the list as all chose “Provide more frequent and more in-depth inservice education and training on proper inspection and cleaning/disinfecting/sterilizing/repair.” Next up involved calls for a specific type of product, as in “Provide cleaning/disinfecting/sterilizing products that don’t harm the bed and mattress (raw) materials while successfully destroying/killing infectious microbes.”
Two viewpoints split third place with one focusing on mattress composition and the other on enhancing the maintenance process. Half of respondents opted for “Manufacture beds and mattresses using (raw) materials that either can withstand or repel harsh chemicals in the cleaning/disinfecting/sterilizing products needed to destroy/kill infectious microbes,” while “Encourage going beyond manual wiping, visual inspection, single-step procedure,” captured another 50% response.
No one picked switching to disposables/single-use products for everything or to outsource the entire process to an independent third-party service company.
Ecolab’s Rotter urges providers and suppliers alike to gain a “clear understanding of the factors that impact life expectancy of the patient equipment and the trade-offs” to get control of the process.
“One of the most common challenges I hear from hospital staff preventing the following of manufacturer instructions is the added burden and resources required to do so,” he said. “Staff, already under extreme time and resource constraints, simply do not feel it is feasible. They lack the support and buy-in from management to ensure these additional steps can be taken. Consequently, the hospital may bear the extra burden of replacement costs if they are not following manufacturer instructions intended to maximize the life expectancy of the equipment.
“Manufacturers often establish life expectancy of equipment based on compatibility testing, expected use and treatment patterns using commonly available cleaning/disinfecting agents in the regions [where] the products are sold,” Rotter continued. “This life expectancy determination is most likely based on best practices being utilized and extra steps being taken.”
Rotter recognizes what providers really want in context of the demands placed on them.
“The reality is, hospital staff want cleaning/disinfecting products that provide rapid kill of the organisms of concern, while being the most economical, lowest toxicity, in any format of choice, residue-free, compatible with as many surfaces possible and requiring only a one-step application,” he noted. “Such a product would be ideal, yet there always must be a compromise with these factors. The tradeoffs end users must choose, change with the chemistry used, the materials of construction of the equipment, the desired hospital infection control strategies, available budget, or the need for hospitals to turn rooms quickly to maximize profits.”
This is where infection prevention must step in.
“What infection preventionists are charged with is striking a balance as best they can, acknowledging there may never be the ideal process for all surfaces,” Rotter said. “This is not an easy task. Specifically for patient mattresses, the product selected for the degree of soiling might require removal of unsightly residues left behind, or a budget to support replacement costs of the mattresses that are not lasting as long, either because the chemistry chosen is too aggressive for the substrate, there is a lack of use of the best practices intended to prolong the life of the equipment, or a combination thereof.”
Rotter credits manufacturers for trying to do their part as well.
“Disinfectant and equipment manufacturers alike continue to innovate, so there is hope that some of these challenges can be solved through new product offerings,” he said. “In the meantime, until the ideal scenario is achieved for patient mattresses specifically, awareness of these variables and ownership of those [that] can control are necessary for infection control strategies around patient beds. Patient safety is of the utmost importance. It should not take a back seat to hospital budgetary constraints.”
Healthcare Surfaces Institute’s Lybert believes that providers should ask that bed and mattress manufacturers go one step further in their process.
“Request manufacturers test for surface disinfection compatibility,” she insisted. “There currently are no requirements or guidelines or validation that products and surfaces can be effectively cleaned and disinfected using standard disinfectants. Cleaning and disinfection are a fundamental requirement, yet we have very little information about what disinfectants can be used on mattresses and beds without damage. We also aren’t sure when damage begins to happen. Microscopic damage provides microbial reservoirs once the surface on the outside has been damaged the ability to clean and disinfect beneath the surface is impossible. Understanding that the mattress has the potential to be cleaned sometimes up to 14 times a day, it is important to understand which disinfectants can be used to minimize damage.”
