Shetland NHS Board Standard Operating Procedure for Cleaning, Maintenance, Audit and Replacement of Mattresses Adapted from: Western Cheshire Primary Care Trust Policy 2009 Version Version 5 Completion date April 2016 Review date April 2018
Name of document Procedure on Cleaning, Maintenance, Audit and Replacement of Mattresses Registration Reference Number New Review Author Tina Bokor-Ingram Executive Lead Kathleen Carolan Proposed groups to present document to: Infection Control Team SCN/Team leader Meeting Clinical Governance Committee Date Version Group Reason Outcome 28 th Feb 2011 3 Infection Control Team PRO 27 th Jan 2011 3 SCN/Team Leader Meeting PRO 5 th April 2011 3 Clinical Governance Committee PRO 10 th April 2013 4 Infection Control Team Agreed 30 th April 2015 4 Infection Control Team Agreed 22 nd April 2016 5 ICT Changed to Standard Operating Procedure instead of Chapter Agreed Examples of reasons for presenting to the group Examples of outcomes following meeting 2
Professional input required re: content (PI) Professional opinion on content () General comments/suggestions (C/S) For information only (FIO) Significant changes to content required refer to Executive Lead for guidance (SC) To amend content & re-submit to group (AC&R) For minor revisions (e.g. format/layout) no need to re-submit to group (MR) Recommend proceeding to next stage (PRO) *To be attached to the document under development/review and presented to the group Please record details of any changes made to the document on the back of this form DATE CHANGES MADE TO DOCUMENT 20 th Jan Frequency of audit changed from 6 monthly to yearly April 15 Changes to community location for cleaning equipment 22 nd April 2016 Changed to Standard Operating Procedure instead of a Chapter in Infection Control Manual and updated following introduction of National Infection Prevention & Control Manual 3
Introduction The first outbreak of healthcare acquired infection (HAI) attributed to mattresses was reported by Stead (1979) (cited by Patel 2008). Several studies have subsequently replicated these findings, demonstrating that damaged mattresses can harbour microorganisms and be a potential, cause of cross infection (Patel 2005). Studies have furthermore shown that interface pressure between the mattress and the patient s skin may only be 40mmHg before occlusion of blood capillaries and ischemia develops (Staines 2009). The standard NHS mattress has been found to produce pressure as high as 70mmHg and even higher over areas of body prominences (MHRA 2010). Foam mattresses have a relatively short life expectancy and if used for longer periods will experience core fatigue. This can result in the patient sinking through the foam and being supported by the bed base (O Connor 2000). Poor maintenance of foam mattresses and their covers may lead to staining of the foam or inner surfaces of the mattresses covers. Recent research highlights that different types of trauma to the mattress cover can result in damage which is invisible to the naked eye, but can still allow fluid to enter the mattress (Russell 2001). Proper care, maintenance and cleaning of mattresses and covers can minimise this risk. It is recommended that auditing of the mattress and bed frames should occur every 12 months (MHRA, 2010) This Standard Operating Procedure is relevant to all staff across NHS Shetland involved in the use and maintenance of beds, mattresses and pressure relieving/reducing devices. Purpose To provide advice on cleaning and maintenance of mattresses To reduce the risk of HAI from mattresses To ensure that mattresses are replaced as soon as they become non compliant To provide guidance on the procedure for mattress replacement and provision of replacement mattresses. NB This relates to all mattresses e.g. trolleys, couches, hospital beds and cots. Responsibilities of staff: All staff (providing direct care in a clinical/ home/ residential setting must): Ensure that a risk assessment is undertaken when handling mattresses and ensure that personal protective equipment (PPE) is used. And where appropriate, encourage others delivering care to do so 4
Ensure mattresses are decontaminated between each patient usage, according to NHS Shetland Procedures Report to line managers any deficits in knowledge or other factors in relation to Standard Infection Control Precautions (SICPs) including facilities/equipment (e.g. advice required in relation to cross contamination of equipment) Undertake training which includes information on all aspects of mattress care. Senior Charge Nurses/Team Leaders/Head of Departments Ensure that local risk assessments related to all elements of mattress care are carried out That safe practices are adhered to in line with local procedures and policy That all incidents that occur in relation to inadequate mattress care are reported and to ensure subsequent actions are taken Ensure training is available to staff in your team/department Ensure that mattress care posters are displayed in relevant prominent areas and procedures are shared across the team Ensure that all staff are familiar with the mattress audits and that they know how to undertake the audit in their area Notify Senior Nurses when mattress replacements may be required to ensure that stock levels are maintained Infection Control Team To support managers to deliver appropriate mattress care through advice and training. General Good Practice All of the steps included in mattress care, as described in this procedure, are important and must be considered in order to avoid or reduce the transmission of infectious agents. All staff must adhere to the principles set out in the Control of Substances Hazardous to Health (COSHH). All staff must undertake appropriate risk assessments before placing any patient on a mattress Incident Reporting Any incidents where there are failures in mattress care and/or issues with cleaning products should be reported via DATIX. 5
Purchase and Procurement When cared for correctly a hospital mattress is effective for 5-6 years. A rolling replacement programme has been established to replace condemned mattresses, to ensure NHS Shetland is compliant with mattress care. On delivery to the hospital the mattresses should be marked with the date of purchase in indelible pen. This is necessary validate the warranty and will provide a way of indexing the mattress for audit purposes. Care of Mattresses Turning Mattresses that require turning will have this marked on the cover. The instructions on the mattress should be followed. This should occur when the mattress is being cleaned on the patient s discharge. In areas where patients stay over one month, mattresses should be turned monthly when making the patient s bed. Cleaning All mattresses should be cleaned between patients. The way in which the mattresses are cleaned depends upon the type of contamination and the susceptibility of the patient (Patel, 2005). However, the manufacturer s instructions must be adhered to. Alcohol wipes/solutions and Chlorhexidine should NOT be used as these cause break down of the waterproof cover and can be toxic to both staff and patient. What are the Steps to Performing Adequate Mattress Care? Preparation Gather all relevant equipment to ensure all that is needed to perform cleaning mattresses is at hand. Procedure for Foam Mattresses Personal Protection Equipment should be worn If the mattress has not been used in an infectious environment or contaminated with blood or bodily fluids the removal of dirt and spillages with neutral detergent and warm water should be adequate. If the mattress has been used in an infectious environment or contaminated with blood or bodily fluids the mattress cover should be cleaned as per NHS Shetland s protocol for the Management of Care Equipment Completely inspect the inner and outer surfaces of covers and their zip fasteners regularly for signs of damage. This must be done on at least a weekly basis. If the cover is torn, stained or soiled, the foam core should be examined. Damaged/soiled covers should be reported to Ward Manager/District Nurse/Team 6
Leader. If the core of the mattress is wet or badly stained the mattress should be withdrawn from service. Ensure mattress cover is thoroughly dried before making the bed. Remove Personal Protective Equipment. All PPE must be disposed of as clinical waste if the mattress has been contaminated with blood or bodily fluids On removal of PPE hands should be washed NB BED FRAMES SHOULD BE CLEANED BETWEEN PATIENT USE Procedures for Specialised Mattresses (Including overlays, bariatric and replacement mattresses) It is recommended that all pressure relieving mattresses and beds within the hospital and community are cleaned according to the manufacturer s instructions. A. AFTER EACH PATIENT USE If the mattress has not been used in an infectious environment or contaminated with blood or body fluids. It is the responsibility of the nurse in charge of the patient s care that day to ensure that checking and cleaning of the mattress is undertaken. Wash Hands Don PPE Switch off the pump and disconnect the power source A solution of neutral detergent and warm water should be used The solution should be applied with disposable cloths and dried using paper towels. It is recommended that cleaning is undertaken as follows: - Pump, hanging bracket, tubing, mains lead, mattress sides and mattress covers. Inspect the inner and outer surfaces of covers and their zip fasteners regularly for signs of damage. If the cover is torn, stained or soiled, the foam core should be examined. Damaged/soiled covers should be reported to ward manager. If the core of the mattress is wet or badly stained the mattress should be withdrawn from service. Ensure that all surfaces are thoroughly cleaned and dried Remove PPE. All PPE must be disposed of Wash Hands NB BED FRAMES SHOULD BE CLEANED BETWEEN PATIENT USE B. AFTER EACH PATIENT USE IF THE MATTRESS HAS BEEN USED IN AN INFECTIOUS ENVIRONMENT OR CONTAMINATED WITH BLOOD OR BODILY FLUIDS SAME AS ABOVE EXCEPT After first cleaning with a solution of neutral detergent and warm water, then disinfect as per NHS Shetland s protocol for the Management of Care Equipment 7
Ensure cleaning environment is well ventilated. Weekly cleaning of the mattress and bed frame should occur as this will reduce the number of microorganisms and make final cleaning of the system more effective HIBISCRUB SHOULD NOT BE USED ON ANY OF THE EQUIPMENT. Community Nursing In the community setting, mattresses and hospital beds are provided to support patients at home usually for a limited period of time e.g. when patients are in a palliative/end of life stage of their illness. Alternating pressure relieving mattresses are also provided to support pressure area care for those patients at risk of developing pressure ulcers. The care and cleaning of these mattresses and hospital beds adhere to the general principles outlined in this procedure. However, the following guidance is specific to the Community/ Home setting: Care and Cleaning of Static Mattresses and Hospital Bed Frames When it is no longer necessary to have a static Mattress and/or Community Nursing Profiling Bed frame in the home, the mattress and frame should be wiped down with a detergent wipe prior to it being transported back to the Independent Living Centre at Gremista. This is the responsibility of the district/community nurse/social Care staff. (Porters should be informed if Nursing/Social Care staff have been unable to access the premises prior to uplift to clean mattress, in order to allow porters to take appropriate precautions). Upon arrival at Independent Living Centre the Mattress and/or Community Nursing Profiling bed frame requires to be washed down with a fresh solution of neutral detergent in hand hot water and then dried using paper towels. Following drying the Mattress and Community Nursing Profiling bed frame should be stored until required for future use. This is the responsibility of the Community Health Care Support worker Care and Cleaning of Alternating Pressure Mattresses Alternating pressure mattresses should be wiped down with a detergent wipe prior to being dismantled and removed from a patient s home. The Mattress will then be transported back to the Independent Living Centre for cleaning. Staff at the Independent Living Centre will remove mattress cover and wash in washing machine 8
The Mattress base requires to be washed down with a fresh solution of neutral detergent in hand hot water and then dried using paper towels. Remove PPE All PPE must be disposed of Wash Hands The cleaned and dried pressure mattress should be placed in a Mattress bag for transport to the next patient s home. The care and cleaning is the responsibility of the Independent Living team Any staff member requiring further advice and guidance on the decontamination of mattresses and bed frames should contact their Clinical Team Leader, Chief Nurse (Community) or Infection Control Team member. Checking of Mattresses and Bed Frames This is part of the weekly bed space cleaning protocol. Disposal and Replacement of Mattresses If the mattress is not compliant then follow this procedure: Report to the nurse in charge immediately If the mattress is condemned remove immediately and place in a yellow disposal bag which is specifically designed for mattresses, the disposal bags are available from the porters, who will remove the mattress from the ward area; If it is a specialised mattress, under the care of medical physics then the Estates team will need to be contacted so that appropriate disposal can be organised and changes made to the asset register. Locate a replacement mattress; Mattress Purchasing NHS Shetland is moving towards the standardisation of mattresses and associated Equipment. The purchase of mattresses and associated equipment will be co-ordinated by Senior Nurses in conjunction with the Infection Control Team. Direct purchase of equipment is not permitted to ensure that we can continue to move towards standardisation of products in alignment with national contracts. 9