Infection Preventionist Stresses Importance of Bed and Mattress Maintenance

Can you give us an overview of bed and mattress maintenance from an infection preventionist standpoint?

This is a very big topic and it's an important one too. One thing that infection preventionists can do is terminal clean—watch terminal cleans being conducted by environmental services (EVS) because one step of the terminal clean process is ensuring that the mattress is being cleaned after a patient is discharged. What is used to clean should depend on the instructions for use on the mattress to see what chemicals are compatible and mattresses should be changed after certain periods of time, depending on what the manufacturers recommend. Sometimes it could be after five years. That's a standard or, perhaps, seven years. They need to see what the manufacturer recommends and what other healthcare organizations recommend, like the CDC, on the standard time mattresses should live in a hospital for and then change it appropriately.

But the mattress should be changed prior to that if they see that the mattresses are ripped or they have holes in them, because then you've created new environments for pathogens to live in. So that's another thing that infection preventionists should be looking at—making sure that mattresses are replaced as needed and appropriately.

Editor’s note: Guidelines from the CDC can be accessed here: https://www.cdc.gov/infection-control/hcp/environmental-control/laundry-bedding.html.

You mentioned EVS; can you tell us a little bit about the relationship between infection prevention and EVS as it pertains to this topic?

Infection prevention should always be in constant communication with environmental services. It should be two teams that work very closely together that have a strong working relationship.

Changing the sheets usually is done by two different parties. It could be the nursing staff that change the sheets. Let’s say a patient is there for an extended period of time: then it might be nursing staff changing it every day or periodically throughout the inpatient stay. But with room turnover, usually it's environmental services that assists with that. Or it could be the nursing staff. It really depends on the facilities and what their expectations are, but it's usually those two parties that will help and we need to ensure that we're changing the sheets appropriately and regularly, especially for that patient.

For example, if a patient has a lot of wounds, it might be more appropriate to change the sheets more often, or if they have a lot of bodily fluids or leakage coming from anywhere, it's probably more appropriate to change the sheets more often so it does depend on the patient’s diagnosis and what's happening.

We should change the sheets often, also for patients to have central lines, we need to ensure that those are being changed or any other devices are being changed regularly, because those sheets and mattresses can provide another vessel for pathogens to enter the bloodstream or through those devices.

What should organizations look for in a vendor when it comes to sheets?

Definitely something that's hospital grade and approved to be used in a hospital. Another thing is to look also at the instructions for use, because sometimes companies that make hospital linens might recommend replacing them after a certain period of time. It is also important to have a system in place to track their age.

Additionally, an important aspect for infection preventionists is obtaining sheets that are breathable. One has to take into consideration a large population in a hospital, so you don’t want a fabric that a lot of people are allergic to or that's uncomfortable or itchy because that can also affect the patients’ quality of care.

If it's itchy and uncomfortable and causing rashes, that's something to keep in mind. You want a fabric that is going to be comfortable for all patients and that won't cause them to have any skin irritation because their skin is their first line of defense. So it's important that they have something that's good quality and that won't provide them any skin discomfort because, a lot of times, patients are laying on those sheets for a long time, especially if they're bed bound, and that can increase their risk of infection or any issues with skin integrity.

What about bedframes themselves?

Bedframes are monitored by a hospital’s biomedical department and to ensure that they're working properly, they should be serviced based on what the manufacturer’s instructions are and the hospital’s policy. Typically, biomed will inspect bedframes at least once a year, and that should be instilled in the hospital.

Additionally, frames should be wipeable and wiped daily, because that is a high touch area and an area that is also frequently prone to contamination because patients might get food on it, they could get bodily fluids on it, they're resting on it, etc. And sometimes you even see patients hang urinals on them. So, the bed rails are definitely one of the areas in the room that are at most risk for contamination.

Any final thoughts?

Tracking mattresses is important! If the instructions say that they have to be changed by a certain time, I think it's helpful to have a system in place to ensure that those mattresses are being changed as required by the instructions for use. Additionally, infection preventionists should be looking to see if their facility might have a committee, like a biomedical committee or committee on linens, that they can join to put in their input.