How clean should a hospital mattress be following terminal cleaning?
At a minimum, the FDA recommends mattresses, generally considered a non-critical medical device, undergo low-level disinfection, which is defined as: “A lethal process utilizing an agent that kills vegetative forms of bacteria, some fungi, and lipid viruses.”23 This should be able to achieve a 99.9999% reduction in Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, and representatives of the Klebsiella and Enterobacter genus.24 However, many patients often lie on mattresses with non-intact skin (e.g. port-a-cath, open wounds, dermatitis). Medical devices that make contact with non-intact skin are considered semi-critical medical devices.23 Because linens do not prevent mattresses from contamination25 and the FDA states that devices should be tested to the worst-case scenario, mattresses should be disinfected at least to the level recommended for semi-critical medical devices: high-level disinfection.
FOLLOW-UP: Perform a study on your mattresses to see if they remain contaminated after terminal cleaning. ATP Meters and conventional swabs can underestimate your contamination.26-28 Consider using alternative testing to identify contamination on mattresses.
References
23. Reprocessing Medical Devices in Health Care Settings: Validation Methods and Labeling. fda.gov. https://www.fda.gov/media/80265/download. Published March 17, 2015. Updated June 9, 2017. Accessed September 11, 2020.
24. Enforcement Policy for Sterilizers, Disinfectant Devices, and Air Purifiers During the Coronavirus Disease 2019 (COVID-19) Public Health Emergency. fda.gov. https://www.fda.gov/media/136533/download. Published March 2020. Accessed September 11, 2020.
25. Guidelines for Environmental Infection Control in Health-Care Facilities: G. Laundry and Bedding. cdc.gov. https://www.cdc.gov/infectioncontrol/pdf/guidelines/environmental-guidelines-P.pdf. Published 2003. Updated July, 2019. Accessed February 5, 2020. Pg. 118-119.
26. APIC Practice Guidelines Committee (PGC) Position Statement on Adenosine
Triphosphate (ATP) Testing of Reusable Textiles in Healthcare Facilities. APIC. http://www.apic.org/Resource_TinyMceFileManagerPosition_StatementsAPIC_position_ATP_and_reusable_textiles_082012.pdf. Published August 15, 2012. Accessed September 4, 2020.
27. Corbella X, Pujol M, Argerich MJ, et al. Environmental sampling of Acinetobacter baumannii: moistened swabs versus moistened sterile gauze pads. Infect Control Hosp Epidemiol. 1999;20(7):458-460. doi:10.1086/503137
28. Hooker EA, Allen SD, Gray LD. Comparison of rayon-tip swabs and film plates for use in collecting and quantifying bacteria on hospital bed mattresses. Am J Infect Control. 2011;39(5):E191-E192. doi:10.1016/j.ajic.2011.04.014