By J. Darrel Hicks, Contributing Writer

Healthcare facilities use a host of materials and surfaces that require attention from environmental services (EVS) departments in order to control the spread of infections. As an example of one specific source of contamination, consider this actual patient incident report: 

“Emergency department patient placed on stretcher. When the patient laid down on stretcher, the nurse noticed blood on the sheet. Patient assessment found no areas of bleeding. Patient immediately moved to another stretcher. Bloody stretcher then examined and found to have blood ooze from the mattress when weight placed on it. The mattress cover was removed, and the underlying mattress foam was found to be soaked with blood from a previous patient. Stretcher and mattress had been cleaned per protocol in between patients.” 

Mattress covers are designed to protect the mattress core from fluids. But these covers can wear out, tear and become damaged, creating openings for fluids to penetrate. When bodily fluids like blood or urine encounter a damaged mattress, they can be absorbed into the mattress core. For example, if a patient lies on a compressed mattress, these fluids can then be squeezed out. 

The odds of getting a healthcare-associated infection (HAI) increase if previous bed occupants had an HAI. Patients are two-three times more likely to be infected with C. diff if previous bed occupants had C. diff. 

Medline evaluated 85 facilities with 5,121 surfaces on which patients lay and checked for: holes, tears, poor response — rebound or exuding liquid — when compressed, stains, internal damage, thinning areas and torn zippers. If the surface got a red tag, it was replaced immediately. Fifty-nine percent of 3,023 evaluated surfaces received a red tag. 

A study published in 2021 by the Society for Healthcare Epidemiology of America found that 75 percent of damaged mattresses were less than four years old. The American Hospital Association depreciation table calls for asset life of five years for mattresses. Failures at two years double the per-patient cost — with no increase in reimbursement — wasting capital resources. 

Poor cleaning and disinfection techniques contribute to the persistent contamination of patient mattresses. Manufacturers of hospital beds and mattresses recommend cleaning the mattress with soap and water, disinfecting the surface and rinsing the surface. It is also recommended to only use disinfectants with a pH of 5-9. 

Chemical manufacturers have tested disinfectants on hard non-porous surfaces but not on soft surfaces. Any claim of efficacy of disinfectants against bacterial pathogens only applies to the use of the product on hard, non-porous surfaces. 

Mattresses are soft surfaces, and using disinfectants on these soft surfaces should be considered off-label. To be deemed disinfected, the EVS process and product must attain a 6 log10 reduction of pathogens. But it is not the EVS worker’s fault. There are no disinfectants with an EPA-registration for soft, porous surfaces. 

The manufacturer instructions for use for a common hospital mattress allows for bleach or other sporicidal products to be used when cleaning and disinfecting are necessary. These chemical disinfectants work for those operations but not as a one-step wipe and walk processing of the mattress. 

At terminal discharge, EVS workers can follow these steps when processing a surface where a patient lays: 

• Use a general purpose cleaner to pre-clean any visible soil, such as bodily fluids. 
• Use 1-2 pounds of pressure with a general purpose cleaner to remove non-visible soil. 
• Rinse the surface with water and wipe dry. 
• Apply the sporicidal disinfectant to the dry surface and allow for the proper contact time, which might require two or three applications. 
• After the disinfectant contact time is attained, rinse the surface with water and wipe dry.

Depending on the disinfectant’s contact time, processing the mattress will require five-fifteen minutes. 

J. Darrel Hicks, BA, MESRE, CHESP, Certificate of Mastery in Infection Prevention, is the past president of the Healthcare Surfaces Institute. Hicks is nationally recognized as a subject matter expert in infection prevention and control as it relates to cleaning. He is the owner and principal of Safe, Clean and Disinfected. His enterprise specializes in B2B consulting, webinar presentations, seminars and facility consulting services related to cleaning and disinfection. He can be reached at darrel@darrelhicks.com, or learn more at www.darrelhicks.com.