Originally published by our sister publication Infectious Disease Special Edition

By Ethan Covey

Nearly three-fourths of hospital beds and mattresses are damaged, placing patients at an increased risk for infection, according to findings from a new study.

The study found mattress failures were very common in hospitals, and one-fourth of all bed frames had areas of rust (Infect Control Hosp Epidemiol 2023;44[3]:501-503).

“Hospital mattresses are the highest touchpoint for every patient, and failed mattresses put patients at risk,” said Edmond A. Hooker, MD, DrPH, the chief medical officer of Trinity Guardion, in Batesville, Ind., and an associate professor in the Department of Health Services Administration at Xavier University, in Cincinnati. “This is the third published article demonstrating that mattress failure rates are extremely high.”

While regular inspection of beds and mattresses and replacement of damaged/soiled components is widely recommended, previous studies have shown that damage is common.

Frequently, damage can be caused by the use of strong disinfectants, which may result in a breakdown of mattress covers over time.

“Mattress failure is a problem in every hospital,” Dr. Hooker said. “The chemicals being used to clean the mattresses are not approved or intended to be used on these soft porous surfaces, and they destroy the mattress quickly.”

Dr. Hooker and his colleagues conducted an examination of all beds and mattresses located in four midwestern U.S. hospitals. Each mattress was externally examined, opened and inspected, and an LED was used to identify smaller punctuate defects in the mattress covers. Bed frames were also inspected for evidence of rust. When possible, the age of the mattress was determined via inspecting manufacturer labels.

A total of 727 beds and mattresses were evaluated. Of these, 72% were damaged, 47% were recommended for mattress cover replacement and 25% required replacement of the entire mattress and cover.

Of the mattresses that required replacement, 95% had large staining visibly present. And among 340 mattress covers that needed replacement, 52% had visible holes or staining inside the cover.

While only 41% of mattresses had tags indicating the date of manufacture, damage that required replacement of the cover was present in 50% of those less than four years old.

“The FDA, CDC and bed manufacturers recommend routine inspection of all mattresses for damage, and this requires that the mattress be unzipped and opened up,” Dr. Hooker said. “Many mattresses that look fine from external inspection have failed, many of which have blood, body fluids and bacteria inside of them.”

This contamination, the investigators said, can lead to an increased risk for infection for patients.

The study is also the first to report on the prevalence of rust on hospital bed frames. Rust was identified on 24% of beds, and widespread on 9% of beds. The presence of rust, the investigators reported, makes cleaning and disinfection difficult. Repairing rusted frames requires disassembly and sending the parts to an external location for sandblasting and powder coating.

“More hospitals need to do 100% bed audits to see that they have huge number of failed mattresses that must be taken out of service,” Dr. Hooker said.

Dr. Hooker is a medical advisor for Trinity Guardion, which manufactures a launderable bed barrier.