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Hospital Mattresses: A Vector for Spreading Clostridium difficile

JAN 04, 2018 | KRISTI ROSA
Clostridium difficile (C. diff) is known to cause around 250,000 infections per year, as well as a staggering 14,000 deaths. In response to this growing problem, health care workers everywhere have been channeling their efforts into preventing the life-threatening infection in their facilities. One way to do this is by strengthening disinfection efforts, but, as one researcher boldly pointed out at the 5th Annual International C. diff Awareness Conference & Health Expo, one of the biggest vectors for spreading C. diff is largely unrecognized: hospital mattresses.

“You’re at risk for getting C. diff infections if you’re getting antibiotics, on proton pump inhibitors, if people aren’t washing their hands—those kinds of things have been well-recognized. But the big risk to inpatients is the mattress,” Edmond A. Hooker, MD, DrPH, professor in the Department of Health Administration at Xavier University, told Contagion® in an exclusive interview. “Patients are exposed to the mattress; they’re lying on it for hours on end, and these mattresses cannot be cleaned. With the current cleaning methods being used today, they are not being cleaned adequately enough, and  we need to change.”

Even after terminal cleaning, the mattresses are not clean, Dr. Hooker stressed in his presentation, and he listed at least 30 peer-reviewed studies that supported his statement. This research begs the question of why the mattresses are not being disinfected properly. According to Dr. Hooker, one of the answers is time. Many hospitals ask Environmental Services (EVS) workers to turn a room over in just 20 minutes, which, according to Dr. Hooker, makes it impossible to clean all items in the room.

“If you are truly cleaning and disinfecting every part of that room, it takes almost 30 minutes just to clean the bed,” he explained. “You’ve got to wipe the top of the mattress, the sides, the bottom, the bed deck, the handrails, up underneath, the wheels—all of that is potentially contaminated. And [they]’re not doing that; they usually spend about 3 minutes on the bed. Three minutes to disinfect a major piece of equipment.”

Properly cleaning a mattress is a multistep process which requires rinsing, something that health care staff just don’t have time for. “I can tell you right now, there’s not a hospital on the planet rinsing after they clean, then disinfecting, and then rinsing again,” Dr. Hooker said. “Nobody’s doing that; it would take them an hour just to clean the bed. They would be tied up for an hour, and that hospital has patients coming out of the operating room, patients in the emergency room. I had 50 in-patients being held in my emergency room just last week—50.”

The other problem is the chemicals that are being used in hospitals to clean the mattresses.

“Hospital hard surfaces are a lot easier to clean because the chemicals were made for hard surfaces,” Dr. Hooker told Contagion®. “Unfortunately, the mattress is a soft, porous surface; it was intended to be that to stop all of the bed sores. And so, if you think about a 1970’s car with a vinyl seat—you sat in it, you sweated, and you stuck to it, and that was miserable. Well, that’s not good for a patient either, and that’s what mattresses used to be like.”

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