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Hospital Mattresses: A Vector for Spreading Clostridium difficile

JAN 04, 2018 | KRISTI ROSA
Now, mattress developers are using “breathable fabric,” which allows for the moisture to get away from the patient, according to Dr. Hooker. However, the problem with this is, the chemicals that are being used to clean the mattresses were developed to be used on hard surfaces. “All the chemicals that are being used are the wrong chemicals; they don’t work and they damage the fabric, which causes cracks and crevices where C. diff and other nasty bugs can go down and hide,” Dr. Hooker stressed.

To make matters worse, regulatory agencies such as the US Food and Drug Administration (FDA), the US Environmental Protection Agency, and the Centers for Disease Control and Prevention (CDC), appear to be “turning a blind eye” to the issue, according to Dr. Hooker.

“They are great organizations with wonderful people working there, but they just haven’t done anything. The CDC has not updated their guidance since 2008 in the cleaning of mattresses, and the 2008 guidance didn’t really change much from the 2003 guidance. The CDC could say, ‘Effective immediately: clean these beds to a high level every single time,’ but, instead, they call it a noncritical surface; they say it’s noncritical because it doesn’t touch non-intact skin,” Dr. Hooker said. “The last time I checked, every single patient has non-intact skin; they’ve got an intravenous line in; they’ve got dermatitis; they’ve got a pressure ulcer; they just had an operation on their hip—that’s non-intact skin. And yet, we lay the patient on the mattress as if they’re being laid on a perfectly clean space and it's not clean. They put it in the noncritical category which means that you can use low-level disinfection.”

As per current practice in hospitals, unless a patient has documented multidrug-resistant organisms or C. difficile, they get ‘normal’ cleaning, which is a 1-step process using a quaternary ammonia cleaner. “Quaternary ammonium compound is the most commonly used disinfectant; it does not work for C. diff. It has been shown not to work for C. diff on hard surfaces, and it clearly isn’t going to work on soft surfaces,” Dr. Hooker explained.

Dr. Hooker reminded conference-goers of the chemicals that do work against C. diff; these are mainly bleach (for log 3 to log 5 reductions) and H2O2/Peracetic acid (for log 4 reduction). He pointed out that use of UV light only yields a log 1 reduction. Hydrogen peroxide vapor is another option that gives a log 5 reduction, but it takes hours to do. And, again, the chemicals available to kill C. diff only work for hard-porous surfaces. So, how do you kill C. diff on soft, porous surfaces, such as hospital mattresses?

Dr. Hooker discussed the use of a launderable mattress cover known as the Trinity Guardion Patient Barrier System, which is made of knit polyester fabric with a polyurethane coating on the patient side—the same breathable materials used in high-end mattresses. The cover was designed to prevent the penetration of bodily fluids and microorganisms, and, according to Dr. Hooker, it’s cost-effective, easy to use, and it works against C. diff.

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