OR Manager - February 2019 - 26

An undercover hazard: Beware of 'clean' mattresses
ECRI Institute Perspectives
OR Manager, Inc, and ECRI Institute have
joined in a collaboration to bring OR Manager
readers periodic articles on topics such
as medical technology management and procurement, risk management, and patient
safety. ECRI Institute is an independent nonprofit that researches the best approaches
to improving patient care.
patient is lying on an apparently
clean bed or stretcher when
blood from a previous patient
oozes out of the surface. Clearly, you
don't want to put your patients through
that experience. But is your facility
doing enough to prevent it?
For
A
the second consecutive year,
ECRI Institute addresses the topic
of mattress and mattress cover contamination
on its annual Top 10 list of
health technology hazards. Obstacles to
addressing the issue persist, prompting
ECRI to not only retain the topic, but to
rank it as the Number 2 hazard on its
list for 2019.
Danger beneath the surface
A hospital bed or stretcher consists of
a frame, a foam or air mattress, and
a mattress cover. The mattress cover
is designed to prevent body fluids and
other contaminants from entering the
mattress. During room cleaning, the
mattress cover is cleaned and disinfected
to prepare the bed or stretcher
for the next patient.
Because it is protected by the cover,
the mattress itself is not cleaned between
patients. If, however, the integrity
of a mattress cover is compromised,
contaminants can contact or seep into
the mattress during patient care. These
contaminants can remain on, or in, the
mattress after cleaning, putting subsequent
patients, as well as staff, at risk
of exposure.
During a search of the Food and
Drug Administration's (FDA) Manufacturer
and User Facility Device Experience
(MAUDE) database covering the
period from 2008 to June 2018, ECRI
Institute identified five reports of patient
bloodborne pathogen exposure
from contaminated mattresses. That's
www.ormanager.com
in addition to the more than 700 reports
that FDA has received of mattress
covers failing to prevent blood
and other body fluids from leaking into
mattresses.
The mattress cover could remain
contaminated if the cleaning products
or procedures used are not appropriate
for the circumstances of use.
There's always the risk that staff will
either knowingly disregard the cleaning
instructions or mistakenly use inappropriate
cleaning and disinfection methods.
Providing comprehensive training,
supplying appropriate cleaning and disinfection
products, and educating staff
about the consequences of improper
cleaning are key steps to reducing that
risk.
Another potential challenge, howMattress
covers should be cleaned
and disinfected between uses, inspected
for signs of damage between
patients, and discarded when they have
exceeded their useful life.
Adequate cleaning and disinfection
requires the use of appropriate cleaning
products and procedures for the types
of contaminants present. Failure to do
so can result in contaminants remaining
on, or within, the mattress or cover. For
example, using a tuberculocidal product
would not be an effective disinfectant
for covers contaminated with bacterial
spores.
In addition, the use of products or
procedures that are incompatible with
the mattress cover material could damage
or degrade the mattress cover.
Such damage could allow the mattress
underneath to become contaminated
during subsequent use.
ever, is that not all mattress cover suppliers
recommend products and procedures
that will successfully remove
the likely surface contaminants without
compromising the cover's integrity-
that is, creating weak spots that could
allow leaks. In this situation, healthcare
facilities can't be sure which products
and procedures are appropriate.
If your mattress cover manufacturer
or rental company does not recommend
an antimicrobial product for all expected
contaminants, demand that they provide
this information. " Facilities need
to know how to properly reprocess mattress
covers after exposure to blood,
body fluids, or bacterial spores, " notes
Amanda Sivek, senior project engineer
in ECRI Institute's Health Devices
Group. " If this information isn't readily
apparent in the IFU [instructions for
use], ask-and be insistent. "
Instructions should specify that a
cover can be disinfected using (1) at
least one product from the US Environmental
Protection Agency's List E, which
covers registered antimicrobial products
that are effective against Mycobacterium
tuberculosis, human HIV-1, and
hepatitis B virus; and (2) at least one
product from EPA's List K, which covers
products that are effective against Clostridium
difficile spores. (For reference,
ECRI Institute has published lists of disinfectant
concentrations for all products
in List E and all products in List K.)
Identifying potential mattress or mattress
cover contamination-or identifying
products that are susceptible to
future contamination-requires rouContinued
on page 26
OR Manager | February 2019 25
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OR Manager - February 2019

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