Bill Klaproth (Host): Welcome to the ASHRM Podcast made possible by the American Society for Healthcare Risk Management to support efforts to advance, safe and trusted healthcare through enterprise risk management. You can visit ashrm.org/membership to learn more and to become an ASHRM member. I'm Bill Klaproth. And with me is Kristen Thurman, Vice President of Product Management for Agility Health, as we discuss what's hiding in your hospital mattress. Oh my! Kristen, welcome.

Kristen Thurman: Thanks, Bill. Thanks for having me.

Host: This could be one of my most interesting interviews ever. I just have a feeling. I'm just saying right at the top. I just have a feeling. So, Kristen, could you elaborate on what exactly is hiding in hospital mattresses that poses a risk?

Kristen Thurman: Sure, Bill. Unfortunately, when patients are cared for on top of hospital mattresses, they're not healthy. That's why they come to the hospital. Things like bodily fluid, blood, unfortunately, are seeping through top covers, which leave those contaminants: blood, bodily fluids, bacteria, things that we're hoping not to transmit to other patients within that mattress and are now actually being seen as the cause of healthcare-associated infections today.

Host: Okay, that makes a lot of sense. And I never really thought about that. So, bodily fluids, of course, blood, all of that is bacteria, and it can seep into the mattress and then possibly get on the next person that's using that bed. Wow. Yeah, that really makes a lot of sense. So then, Kristen, how do compromise support services contribute to increased risks of cross-contamination in healthcare-associated infections? Explain that a little bit more on how this happens then.

Kristen Thurman: You bet, Bill. So when we look at support surface contamination, it's actually been identified as one of the causative sources of hospital-associated infection outbreaks. Many studies, and now actually, unfortunately, for at least a decade or more have shown this. So, what we're finding is most top covers, right? When you walk into a hospital and you look at a mattress, most of those top covers and mattresses appear to be intact. So, at quick glance, you don't really see any holes or anything that would indicate that anything's getting through them, right? They're manufactured with a waterproof top layer so that exactly those things we talked about, blood, bodily fluids can't actually seep into them.

What we're finding is when we actually unzip that cover, or take a towel or anything else and press into that, fluids are actually getting through that top cover and passing into the inner components of that mattress. So, many mattresses are made of foam. Lots foam mattresses out there. It's comfortable. It allows for a patient to immerse into the surface and prevents other things like pressure injuries, but that foam can also absorb, unfortunately, those bodily fluid than bacteria once it passes through that top cover. One study actually showed that patients were almost six times more likely to contract a hospital-associated infection if the previous occupant of their hospital bed had an infection. Yikes!

Host: Oof. Oof.

Kristen Thurman: Yeah. It doesn't make you feel good, does it, at all?

Host: So, it's in the mattress, but the patient leaves, the sheets are changed. How does it get through the sheet? It just kind of comes up back through the sheet to the next patient?

Kristen Thurman: Yeah. So, this is what's really interesting. So hospitals, and especially even thinking to COVID, right? Hospitals are trying their best, I mean, absolute best to wipe down and clean, right? Wash, clean, sterilize everything that they can to make sure that all of these infectious materials are removed from the room so it can't recontaminate the same patient, or can't contaminate the next patient that's going to occupy that space.

What we've actually found is those chemicals are harsh, very harsh. They're usually used on things like the floor and the bed frame, to get rid of all of that bacteria. The mattress is actually a soft surface, right? I mean, you go to the hospital as a patient, you don't want to lay there on a hard surface, right? And you can get more pressure injuries or not be comfortable. These soft surface materials are breaking down with these harsh chemicals. So in fact, exactly what the hospital is trying to do is to kill all of these bacteria, but yet the harsh chemicals that they're using to kill the bacteria are actually breaking down the top cover of these mattresses and allowing then these contaminants to actually enter the inside of the mattress.

Host: So, it's damaging that protective layer.

Kristen Thurman: Yep. It sure is.

Host: So then, that would allow the infection to be passed along to the next patient. So from your experience then, Kristen, what steps can hospitals take to ensure their mattress and support services are not neglected in infection control?

Kristen Thurman: Right. So, the FDA actually put out some recommendations recently. The very first thing that you really want to do as a hospital is audit your mattresses. So, it's the number one thing and the longest thing that a patient is in contact with when they're there during their stay. And to not just do a quick inspection, like you said earlier, remove the sheet, wipe down the mattress, put the next sheet on for the next patient, which is often what we do fast. Instead, taking the time to look at that mattress cover, first and foremost, is there visibly a hole or rip, a tear? It happens when you're caring for patients or putting equipment on a bed, we're trying to move a patient. And if we see a hole or rip or a tear, then obviously, number one, we need to look further, right? We need to unzip that mattress and see if something's made it inside, because we know that's the actual cause of some of these infections that are happening today.

But then, even more so, hospitals can establish an audit timeline. So whether that's yearly, bi-yearly, the FDA doesn't give a recommendation to how often we actually look our mattresses. But in looking at them to make sure that we are inspecting them, not just on the outside, but unzipping and looking under the top cover, and really seeing what's getting to the inside.

So if that mattress and that foam is getting contaminated, then the recommendation is to remove that mattress and replace it with another one or if it something like a top cover that can be cleaned or just the top cover can be replaced and we can salvage the rest of the mattress, then to do that as well. But those are really the steps then that can help protect from that fluid and bacteria ingress into the mattress, keeping mattresses safe and obviously keeping patients safer.

Host: So, do a mattress audit. That's what it sounds like.

Kristen Thurman: Correct.

Host: And know what's in your mattress, basically.

Kristen Thurman: Know what's in your mattress. Yep.

Host: Okay. So, talk about this study. Can you share insights from this study involving-- I don't even know if I want to know the answer to this-- over 1022 services across 89 facilities. Tell us about that and what were the most surprising findings.

Kristen Thurman: Yeah. So obviously, the FDA recommendations that came out prompted this study. And working for Agility, we have customers across the country that took a hard look at this and said, "Ooh, we probably need to look, you know, a little bit more into the mattresses that we have and really see what's inside."

So, we actually went in like you said, 89 facilities across the U.S. from coast to coast, literally just took a random audit. So, customers came in and said, "Hey, can you help us unzip our top covers? See if there's fluid inside our mattresses. Look at how our top covers are doing. Are there holes? Are there microholes?" So, we really took the audit seriously. We took teams in to do this process. So when patients were not in bed, uncovered the mattress, looked at both the top and the bottom of the cover. And then, obviously, it's unfortunate or fortunate, however you look at it, not hard to see when fluid and bodily fluids, and what we call ooey-gooeys have gotten to the inside of the mattress.

So in doing so, what we actually found was there were four different manufacturers of mattresses that we saw throughout all 89 hospitals, some within the same hospital. So even knowing that different mattresses were still being cleaned and disinfected the same way, so those harsh chemicals that we talked about were being used a across all different manufacturing types. So, ended up being kind of four of the top manufacturers that have the largest market share across the country. And we found some pretty big differences just between the construction differences of the mattresses.

So, the unfortunate part that you're probably scared to hear is three out of four of those manufacturers had over 80% of their top covers damaged. So, it had holes, rips, tears. The waterproofing that they put on there was starting to degrade and peel off from those harsh chemicals. So now, obviously, when that waterproofing is no longer on the top of the mattress, those bodily fluids can get in. And probably even more disturbing, what you can't clean is 70% of those showed visible signs of fluid or contaminant ingress into the inside of the mattress. So, let it sink in for a minute. You go to a hospital. And there is over a 70% chance right now that you will lay on a contaminated mattress if it's from three of the leading top manufacturers of hospital mattresses.

Host: Oh my. And when you said let it sink in, pun intended.

Kristen Thurman: Yeah, it kind of was.

Host: Oh, so four different mattress manufacturers basically that were tested in this, and those were the results you found. Oh my goodness.

Kristen Thurman: So, the shocking part-- I know you asked about the shocking part-- the shocking part was there was a fourth manufacturer that stood out where 17% of their top covers were still damaged. And that happens over time, especially when you look at two, three, four, five-year mattresses, it's Not uncommon to see damage of a top cover, but only 17% not 80% of their top covers were damaged and 0% of them had fluid ingress.

So Bill, which one do you want to lay on when you go to a hospital?

Host: I want that one, I want that one.

Kristen Thurman: Me too.

Host: Made of some kind of a different material. So when it was wiped down with the harsh cleaners, it didn't damage it as much as the others then.

Kristen Thurman: You got it. So if you look at the differences between that manufacturer and the other three, the top cover was definitely made of a different material.

Host: Okay. So, speaking of that mattress, and we were talking about it, it must be made of some kind of different material, can you talk about emerging materials or design trends since you know this space very well that could further improve patient care and hospital efficiency?

Kristen Thurman: Absolutely, Bill. So, there is a push, and as a product management leader in the market, I feel like we should be designing products that our customers need and can withstand the environment that they're used in. So, we know from a hospital standpoint, they're going to use harsh chemicals because that's what they use on everything else in the hospital room to kill contaminants, to kill bacteria, viruses. So, there's been a lot of research and interest in looking at, first and foremost, top cover materials. So, knowing that the way that we're waterproofing these fabrics may need to change based off of the chemicals that are used on them, the material makeup itself of the fabric, how the fabric layers go together, need more research so that when we're using these top covers, those harsh chemicals can still be utilized. And we're not degrading the waterproof layer, we're not breaking down the material and letting fluid go through it.

So, one of the things that we did find within this study is all of those mattresses, and there were different types of them, but they all had the same top cover material. So, there was a consistent theme there with using this same top cover material that 17% of damage was considerably less than the 80% of all of the other top cover materials that we saw out there.

Host: So, that's the key, that internally, the mattresses can be different. But as long as that top cover is on there, the one that we've been talking about, that's the one you want because that's going to protect the inner mattress, the most from any bodily fluids, the ingress from bodily fluids, those types of things. Is that right? Do I have that right?

Kristen Thurman: Yep. Absolutely. You absolutely do. You got it. And then, secondarily, what we actually saw with the fourth manufacturer is they took it a step further, not just a top cover material, but they actually added a still breathable, but waterproof secondary internal cover to the foam cavity that actually gets contaminated by those fluids. So, knowing that that top cover is never going to be a hundred percent bulletproof when it comes to wear and tear, if fluid does start to get in, that secondary layer now actually protects the internal component and protects that foam, really protecting the asset. So, number one, if fluid makes it through, it's going to come right back out and actually get cleaned off during the cleaning process. And number two is protecting that foam asset. So when you do open it up, nothing's getting inside. If you have to replace a top cover, that's a lot cheaper to replace than an entire mattress.

Host: Right. So, there's some redundancy there, and it's actually protecting the mattress so you don't have to throw the whole mattress out then.

Kristen Thurman: Correct.

Host: Got it. Okay. So, that leads me right into my next question then. That's got to be a cost savings. If you're not throwing out mattresses after how many years, if you're able to keep them longer, what kind of cost savings can hospitals expect by switching to support services with, let's say, innovative construction?

Kristen Thurman: Right. We did a little math. And when you look at the average life, at least that hospitals budget for mattresses, it's usually between five and seven years. So hospital manufacturers, we really look at kind of the internal components and say, " We want enough pressure redistribution, we want the mattress to last at least five to seven years to get good outcomes." And typically, that's what hospitals budget for.

Interestingly enough, there was a, another study, a very large study that was just published this past year that showed they did audits of thousands of mattresses across the U.S. More even than the study that we talked about before. And what they found was just after a little over three years of use, over 50% of all mattresses were compromised.

So when you start looking at the math on that-- yeah, I know we're back to ooey-gooey-- but really from a cost standpoint, hospitals aren't budgeting to replace 50% or more of their fleet in three years. They're budgeting five to seven years to actually replace mattresses. And I can tell you they're certainly not budgeting to replace top covers as often as we see these go through.

There's layered costs in here, though. I mean, one is having to replace mattresses more often to keep patients safe is a huge one disruption to patient care and, two, a cost that isn't typically budgeted for in the hospital budget. But really, when you start thinking about infections, within a hospital, you're increasing your length of stay typically for your patients. Obviously, patient satisfaction is going to go down, they're not going to come back to your hospital. If they lay down and blood comes out around them on a mattress, that was an actual news story somewhere that has really gotten a lot of attention.

Yeah. There's really layer upon layer of costs here. Both hard from mattress replacement to all of the soft costs that goes along with the outcomes of less patient care when you're not really taking care of your mattresses or not using a mattress that has some more of these innovative features and protecting not only your mattress asset, but also your patients.

Host: Yeah. From the patient standpoint, less infections is always better. And infections are costly. So from the human standpoint, there's a cost savings as well. And even if, say, you budget five to seven years, even if you can get it to seven years instead of five over a 15-year period, if you're at five, you're replacing the mattresses three times. If you're at seven, you're really just replacing it twice, so that's got to be a huge cost savings right there.

Kristen Thurman: And Bill, I love how you think. We actually looked, the average age of the study of the mattresses that we saw was about five years. But within those mattresses that had a lot less fluid ingress, we had mattresses up to nine and 12 years old that were still no fluid ingress functioning appropriately. So, your point is very valid that with a longer lasting asset, your costs go way down.

Host: Yeah. If you're just getting it up to the maximum range of that five to seven, that's a cost savings, because you're going to be replacing less mattresses. And then if you do the mattress audit like you suggested, maybe there are some mattresses that are going eight years, nine years, et cetera. That's a cost savings too. So, that's really maximizing your assets of the hospital. And you said covers are a lot cheaper than mattresses, so that really plays into that. Kristen, this has really been fascinating. Thank you so much for your time today. Is there anything else you want to add?

Kristen Thurman: I think really just maybe to sum it up the bottom line, if I'm a hospital administrator, I would not only want to spend money wisely on proven mattresses that I know exactly what you just said are going to last not over only the expected life, but maybe even longer. But I think, more importantly, protect my patients from getting additional infections while being cared for in my facility. I think those are both really impactful items.

And I think mattress design and construction, what we saw in these studies can have a huge impact on both that financial burden and clinical outcomes for hospitals today. So, maybe pun intended, you know, get down and dirty with your mattresses, know the state that they're in, but then also know the construction of mattresses before making an investment. And I think that can really help keep both your budget and your patients safe.

Host: I think that's a really good thought. Kristen, thank you so much. This has really been fascinating. I appreciate your time today. Thank you again.

Kristen Thurman: Thank you. It's been great to be here.

Host: You bet. And that was Kristen Thurman. And this podcast is sponsored by Agility Health explore the latest research and tools on the impact of support surface construction at agilityhealth.com/betterdesign. So if you want to learn all about mattress covers and all of this technology that we've been talking about, agilityhealth.com/betterdesign.

And the ASHRM Podcast was made possible by the American Society for Healthcare Risk Management to support efforts to advance, safe, and trusted healthcare through enterprise risk management. You can visit ashrm.org/membership to learn more and to become a member. And if you found this podcast helpful, please share it on your social channels and make sure you check out our podcast library for all of the great topics of interest to you. I'm Bill Klaproth. Thanks for listening.