Support Surface Materials and Design Innovation: Preventing Fluid Ingress and Maximizing Investment Returns for Hospitals

Introduction: Fifty percent of acute care support surfaces are compromised within 3.8 years with an increase in failure odds of 67.6% with each additional year of age.1 Compromised surfaces have a 5.83 times greater risk for cross-contamination than that of controls. 2 The FDA recommends regular inspection of the top cover and internal components for fluid ingress and damage and replacing those damaged covers and surfaces to reduce the risk of infection to patients.2,3,4,5 Replacing surfaces is costly. Preserving their integrity prevents not only infections but also unnecessary spend. Innovative surface materials/construction was assessed to understand the impact on fluid ingress/cross-contamination and improved surface lifespan.  Methods:Surfaces considered patient-ready for use were thoroughly inspected to observe fluid ingress/contamination.4 First the top covers were inspected for holes, tears or internal staining. Then the top cover was removed to inspect internal components for damage and staining.  With any sign of fluid ingress into internal components, the recommendation is to replace the surface to prevent cross-contamination. 4  Surfaces from various manufacturers were inspected to understand how different constructions impacted surface longevity.  Results:Across 76 facilities, 849 surfaces with an average age of 6 years were inspected. One hundred and three (103) surfaces contained a welded-shield to prevent fluid ingress to the internal components if the top cover was damaged. None of these surfaces required full replacement. Of the remaining 743 without a welded-shield, 75% (556) sustained internal damage requiring full surface replacement.  Discussion: Innovative materials and construction prevented fluid ingress and contamination of surfaces preserving longevity of costly assets. Previous studies have shown that most surfaces sustain internal damage triggering replacement in less than five years. No welded-shield surface required full replacement and only 20% had cover damage.  The cost of replacing the 556 surfaces with internal damage (~$1500 per surface) totals $834,000.  Replacing only the top cover (~$200) of 20% would save $804,200. Surfaces with a welded-shield construction yield significant cost savings. Considering welded-shield surfaces did not require replacement, inspection of these surfaces beyond 6 years is warranted to understand total useful life.  References:1 Koshy T, Manista G, Nicholson L, Ikpeze T, Todd J, Black J. The state of support surface integrity in acute healthcare facilities. Poster presented at: NPIAP 2023 Annual Conference. March 17-19, 2023. San Diego, CA. 2 Sivek A, Davis J. How Wet Is Your Patient’s Bed? Blood, Urine, and Microbiological Contamination of Mattresses and Mattress Covers. Patient Safety Advisory. 2018;15(4). http://patientsafety.pa.gov/ADVISORIES/Pages/201812_FluidIngress.aspx. Accessed September 27, 2023. 3 “Safety Communications - Damaged or Worn Covers for Medical Bed Mattresses Pose Risk of Contamination and Patient Infection: FDA Safety Communication.” FDA Archive, Center for Devices and Radiological Health, wayback.archiveit.org/7993/20161022044101/http:/www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm3 48016.htm. Accessed 5 Sept. 2023. 4 Center for Devices and Radiological Health. Covers for hospital bed mattresses - keep them safe. U.S. Food and Drug Administration. Accessed September 27, 2023. https://www.fda.gov/medicaldevices/hospital-beds/covers-hospital-bed-mattresses-learn-how-keep-themsafe#:~:text=Over%20time%2C%20hospital%20bed%20mattress%20covers%20can%20wear,out% 20the%20next%20time%20the%20mattress%20is%20used. 5 Creamer E, Humphreys H. Journal of Hospital Infection. The contribution of beds to healthcareassociated infection: the importance of adequate decontamination. 2008;69:8-23. doi:doi:10.1016/j.jhin.2008.01.014