PRODUCTS & SERVICES “In most areas of the hospital, turnover


is an issue, and staff need to be trained to inspect mattresses properly,” he advised. “This education also extends to the man- agement level, who needs to understand not only the cost avoidance that can be achieved by utilizing a robust inspection program, but also the impact of improper cleaning on the spread of infection in the hospital and health of patients.” Solid mattress covers can extend the prod-


uct’s life but even those can be damaged by other cleaning and clinical products, accord- ing to Surface Medical’s Lam. “Because they are in constant use, hospital


mattress covers are frequently damaged by sharp objects and by the caustic clean- ing agents used during routine disinfec- tion and terminal cleaning,” he noted. “If they are not properly maintained, hospital mattresses can become reservoirs of deadly pathogens, leading to the possible spread of hospital-associated infections (HAIs) to patients and staff.”


Consequently, Lam emphasizes the need for routine awareness of mattress cover intactness for infection prevention as tan- tamount to any maintenance program. “A mattress is usually concealed by bed linens, so damage tends to escape notice by hospital staff until it is cleaned between patients,” he indicated. “This scenario is problematic, however, because staff may not want to risk removing a much-needed mattress from service while a replacement mattress is sourced. Sadly, this means minor damage such as rips or punctures are often overlooked until they become too big to ignore, but even a small puncture can allow pathogens to enter the mattress core and render the equipment ‘uncleanable,’ putting patients and staff at risk of contracting an HAI. The US FDA has received hundreds of reports of patients that have [been attributed to] a damaged mattress soaked with blood or other bodily fluids.” Healthcare organizations should not limit bed and mattress maintenance to those products alone, but should extend their efforts to bed linens and what patients wear while lying on them, according to Samlane Ketevong, senior director, Certification, Textile Rental Services Association of America (TRSA), which


Samlane Ketevong


supports companies that supply, launder and maintain linens and uniforms. “Patients’ contact with gowns and bed lin- ens make it imperative that every healthcare facility properly handle and maintain the cleanliness of these healthcare textiles,” she urged. “Research shows that environmental contamination can lead to infectious disease


outbreaks in hospitals, and therefore, every surface these linens encounter must be care- fully inspected.” TRSA members launder an estimated 90 percent of North American hospital linen volume, and many follow the standards of the association’s “Hygienically Clean Healthcare” certification, which is verified by independent third-party inspections and microbial testing, according to Ketevong. “Pathogens can exist on surfaces for hours


or even months, making safe handling pro- cedures critical from transportation to stor- age and distribution, ensuring [healthcare textiles] remain as clean as when they were laundered,” she cautioned. “Linens should remain covered and a physical separation of clean and soiled [healthcare textiles] should always be maintained. Clean [healthcare textiles] must be properly stored, ideally in a designated clean holding room, away from all possible contaminants, on organized and labeled shelves. Upon distribution, health- care staff need to be mindful of keeping the [healthcare textiles] away from potentially contaminated surfaces and uniforms.” Stryker encourages “proper and regular maintenance” of beds and mattresses to optimize performance, even if such over- sight must be conducted by an external third party service provider, including the original equipment manufacturer (OEM). “It is rare to have an experienced and ded- icated bed repair technician in a hospital’s BioMed department, and thus beds and mattresses are often low on the priority list,” the Stryker spokesperson stated. “This is especially true because of the criticality of the other equipment needing attention or if spare beds are available. Therefore, partner- ing with an OEM repair service allows for regular maintenance inspections and is like having an in-house expert bed technician at your request.”


It’s so easy


Bed and mattress company executives recognize how easy it can be to miss or neglect proper and thorough maintenance of these products. “When a visual inspection fails to detect micro damage, when cover permeability testing or support surface evaluation are not conducted when needed, or when inef- fective manual cleaning occurs at time of termination any failure of these processes is still, unfortunately, a reflection of how underappreciated these risks pose to not to only patients and staff but to visitors as well,” lamented Medtrica’s Willoughby. Aitken from Linet Americas zeroes in on the mindset of taking something for granted. “Mattresses have the out-of-sight, out-


of-mind issue,” he noted. “They are almost always hidden from view by the sheets and


48 June 2023 • HEALTHCARE PURCHASING NEWS • hpnonline.com


are not considered a medical device that needs proper maintenance and inspection.” But he also singles out the number and variation of staff involved. “Multiple departments seem respon- sible for the mattress,” he observed. “Housekeeping for cleaning and disinfec- tion, nursing staff for its clinical suitability and biomedical for its control in the case of an active surface. Historically there is often little to no coordination between these groups regarding mattress maintenance.” The Stryker spokesperson points to the


“lower criticality of this specific equipment and overall availability for internal teams to fix the products.


“The inability to gain access to the beds


and mattresses can also lead to missing proper maintenance,” the spokesperson continued. “Communication with floor staff, such as Nursing, [Environmental Services] and Transport team members is key to suc- cess in this area.” Surface Medical’s Lam warns against overlooking the importance of intact treat- ment surfaces for patient safety. “Without routine inspection protocols in place, a nurse or environmental services staff might not identify infection risks such as fluid ingress due to a minor puncture,” he said. “It is important for a hospital to proactively look for and address damage to ensure patient surfaces are intact and cleanable, rather than waiting until the dam- age is too big to ignore or fluid ingress has already occurred.” TRSA’s Ketevong expresses concern


about a healthcare organization’s internal procedures and standards for preserving clean linen once delivered from a TRSA- certified supplier, homing in on guidelines from The Centers for Disease Control and Epidemiology (CDC) that she says may be “very limited and not clearly defined.” She cites CDC guidelines as stating,


“‘hygienic and common-sense storage and processing of clean textiles is recom- mended,’ With room for interpretation, this could mean something different for every facility or individual. Instead, having clear and concise rules and regulations would limit the margin of error and guarantee the safe storage and handling of clean [health- care textiles],” she added.


Elevating priorities


Bed and mattress company executives concur that hospitals and other health- care facilities must make product main- tenance a higher priority across the board, which hinges on and stems from increased education.


Surface Medical’s Lam pinpoints three priorities: “Educating staff on the impor- tance of intact treatment surfaces to HAI


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