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Thursday, July 3, 2014

Mattresses - A Secret Storage Sinkhole

Aside from kids with green boogers, there is not much that grosses me out.  Growing up on a farm you're introduced to the birds and the bees and all things in between at a very young age and if you're inquisitive like me, you are in the thick of it looking over a vet's shoulder or sweet talking the vet into letting you be the one to stick your hand or arm in all matter of places.  Without a doubt, I can handle blood, guts, vomit, poop and gore.

That was until, I read an article written by Bradbury et al that was published in AJIC titled "Potential bloodborne, pathogen exposure from occult mattress damage".   The reason for the brief report was a result of an occurrence where a patient after lying on a bed in a clean patient room noticed that the back of the bed pad and mattress were contaminated with a blood-like fluid.  The pressure from the patient's weight on the bed caused the blood-like fluid to seep from the mattress and stain the bed pad and sheets. #GROSS!

It was determined that the previous bed occupant had undergone a surgical procedure where it was possible they bled onto the mattress.  Examination of the mattress uncovered the fact that while the external cover was clean and appeared intact, the waterproof backing below the external cover had severely degraded and that there was a large stained area located in the mid-mattress region where a patient would normally lie.  As a result of this finding the facility then inspected 656 mattresses at the facility and identified 177 mattress (greater than 25%!!) with damage to the interior waterproof backing.  The result was replacement of the 177 offending mattresses, but the situation highlighted the fact that while the mattresses were cleaned and disinfected between patients, the facility did not have a process in place to inspect mattresses beyond the basic visual observation for external appearance.

This certainly highlights the need for a facility to have some sort of inspection process for mattresses that considers more than the external visual appearance. More importantly, it highlights the need to consider what type of materials we are choosing for mattress covers and the ability of these materials to withstand the frequency of cleaning and disinfection and general wear and tear within healthcare facilities.  As highlighted in an earlier blog "Mattresses...a soft place on which to lounge, nap or sleep" manufacturers who make the mattress material found on hospital beds recommend cleaning the mattress with soap and water, disinfecting the surface, and then rinsing.  For years Lee and I have recommended that hospital mattresses be rinsed post disinfection.  We weren't trying to create a make-work project. We weren't trying to complicate the cleaning and disinfection process for your housekeepers.  We were in fact actually trying to follow and comply with the instructions given by the mattress material manufactures to ensure that the disinfectants being used were used correctly.

I think Bradbury et al highlight the fact that mattresses need to be considered as a potential and very real reservoir for pathogens and given their delicate nature our infection prevention and control programs need to work closely with Environmental Services and Biomedical Engineering Departments to have a program in place that monitors the age of the mattress cover and the condition (both internally and externally) to ensure the next patient laying in the bed does not unwittingly get covered with someone's body fluids. I know I'll be hard pressed to "jump" on to a hospital bed the next time I head to the ER!

Bugging Off!



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