Hospital Mattress Failure Is a Potential Threat to Patient Safety

Damaged mattresses are common in hospitals and can potentially place patients at increased risk for infection. These are the findings of a study recently published in Infection Control & Hospital Epidemiology. The investigators assessed the conditions of beds and mattresses in 4 hospitals in midwestern United States. Investigators evaluated 727 beds and mattresses, finding that 523 (72%) had damage, 340 (47%) required mattress cover replacement, and 183 (25%) required replacement of the entire mattress.

“The results of this study reaffirm what previous research has shown–that cleaning methods used at hospitals today are inadequate, potentially endangering patients,” Edmond A. Hooker, MD, DrPH, author of the study and a professor at Xavier University, said in a statement.

For the study, each of the 727 beds and mattresses were examined by opening the mattress, then the mattress core was visually evaluated for evidence for damage. Next an LED light was used to identify smaller punctate defects in the cover. Finally, the bed frames were visually examined for evidence of rust.

The investigators collected data on mattress model, bed model, and mattress date of manufacture (if tag was present). They also noted stains present on the mattress cover (external surface of the bottom cover, inside top of cover, inside of bottom cover), damage to zipper or outside air connections. Punctate defects in cover were found with and without LED light, holes in the fire barrier, foam damage (compression, tearing, or crumbling), damage to inside air connections, unacceptable gel compression (greater than 3.2 cm), and rust visible on bed deck.

The majority of the beds needed a replacement of the entire mattress: 174( 95%) had large staining (greater than 15.2cm) visibly present. Of the remaining mattresses, 6 mattresses had gel failure, and 3 mattresses had no reason recorded. A total of340 covers needed replacement,176 (52%) of which had visible holes or staining of the inside of the cover. The firebarrier had damage in 79 (11%) of the beds. The investigators found beddeck rust on 175 beds (24%) and widespread rust on 65 beds (9%).

Hooker reports in the study that it “showed that most beds (72%) in a hospital system in the midwestern United States had damage. This research is the first to demonstrate that many of the failed mattresses wereless than 4 years old and that the prevalence of rust on the beddecks was substantial.”

Due to infection risk, the Centers for Disease Control and Prevention, the US Food and Drug Administration, and mattress manufacturers recommend replacement of damaged mattresses and covers. The American Hospital Association states that the life of the mattress is 5 years, and mattress manufacturers maintain that the expected life of the mattress is only 1 to 3 years.

Hooker cited some limitations of the study beginning with where the beds were located. Although hospitals were involved in the study, they were all part of a single health care system. Second, the beds and mattresses were primarily from a single manufacturer. Fewer than half the 727 mattresses (300, 41%) had tags denoting manufacturing dates. Replacement of the cover in 151 (50%) mattresses was necessary due to damage; 123 (81%) of those mattresses were less than 4 years old. Complete replacement, including cover and core, from damage was necessary in 58 (19%), of which 33 (57%) were less than 4 years old.

Because mattresses are the highest-touch element for a hospitalized patient, the risk of infection is potentially higher with a damaged mattress. The results of this study indicate that regular inspections of all mattresses and bed frames—regardless of age—must be conducted to minimize infection risks for patients.