THE CARE OF HOSPITAL MATTRESSES

Assurance Statement This policy aims to ensure that Suffolk Mental Health Partnership NHS Trust complies with the requirements of the Code of Practice for Health and Adult Social Care on the prevention and control of infections and related guidance. (CQC Regulation 12)

SMHPT Policy Approved by Clinical Policy Board Review date Implementation date Director responsible for monitoring and reviewing policy Freedom of Information category

IC03/04/10 April 2010 April 2014 April 2010 Director of Nursing Policies

This policy has been disseminated in line with Suffolk Mental Health Partnership NHS Trusts policy for the management and format of policies and procedures.

SMHPT Care of Hospital Mattress Policy (IC03) Approved: April 2010

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SUFFOLK MENTAL HEALTH PARTNERSHIP NHS TRUST THE CARE OF HOSPITAL MATTRESSES POLICY

CONTENTS: 1.0 2.0 3.0 Introduction Definitions Static Mattress Testing and Care 3.1 Turning and rotation of static mattresses 3.2 Static mattress testing 3.3 Bottoming out of mattress 3.4 Contamination of the foam 3.5 General inspection of the cover a) Excessive Staining b) Hydrolysis c) Mechanical damage d) Wear and Tear Decontaminating Mattresses and Bed Frames 4.1 Cleaning Frequency (bed frames) 4.2 Cleaning Frequency (mattresses) 4.3 Equipment Required 4.4 Method of cleaning static mattresses plus bed frame 4.5 Method of cleaning dynamic mattress Condemning a Mattress or Cover Acquiring Mattress or Cover Role and Responsibilities of people involved Dynamic Mattresses 8.1 Introduction 8.2 Mattress testing and care 8.3 Decontamination 8.4 Acquiring a REPOSE mattress 8.5 Returning a REPOSE mattress 8.6 Decision to condemn a REPOSE mattress

4.0

5.0 6.0 7.0 8.0

Appendix 1 Mattress Condemnation Form

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SUFFOLK MENTAL HEALTH PARTNERSHIP NHS TRUST THE CARE OF HOSPITAL MATTRESSES POLICY 1.0 Introduction

The aims of this policy are to: Clearly identify the care that is required to maintain a hospital cover/mattress ensuring patient care is not compromised. Identify the degree to which many hospital departments are involved and state the lines of responsibilities necessary to deliver a high standard of inter-departmental communication. Promote the ongoing audit of mattress acquisition and condemnation working within clinical governance guidelines. Clearly identify the key roles of Health Care Support Workers within the hospital that will take a lead in maintaining the high standards of care necessary to implement this policy.

Presently, we recognise one style of static mattress to meet patient need, the Link Nurse Esprit, however older style mattresses are still in circulation and therefore at risk of greater deterioration i.e. Standard NHS mattress (marbled pattern cover) and the Link Nurse mattress. Summary of Key Statements arising from Care of Hospital Mattresses Policy Healthcare Support Workers will take the lead in ensuring this policy is implemented. Static mattresses will be turned and/or rotated once a week or between every patient episode. 6 simple tests will be used to assess the condition of static mattress covers and foam. Cleaning of bed frames should occur on patient discharge, prior to operation department transfer and by hospital cleaning contractor. Mattresses will be cleaned in between patients, before removal from ward to central store, on receipt from central store and when a mattress is condemned. To acquire or condemn a static mattress or mattress cover SMARTLINE on 01473 329755 (extension 3755). To acquire or condemn a dynamic mattress contact SMARTLINE. Page 3 of 15

SMHPT Care of Hospital Mattress Policy (IC03) Approved: April 2010

2.0

Definition

Cleaning: The physical removal of soil and contaminants. Disinfection: The destruction of micro-organisms to a level that is not harmful. Static Mattress: frame. Foam filled mattress with removable cover, fitting a NHS bed

Dynamic Mattress: Mechanical air distributing overlay or replacement mattress. For use of patients who require more advanced pressure relief than that provided by a static mattress. Hydrolysis: Disintegration of the polyurethane coating of a static mattress cover. 3.0 3.1 Static Mattress Testing and Care Turning and rotation of static mattresses Rationale: A systematic regimen for turning a mattress is required to maximise all usable surfaces and reduce the effects of long-term wear and tear. Frequent turning allows for a high standard of mattress testing/assessment and increases the longevity of the cover. All new Link Nurse Esprit covers are marked 1, 2, 3, 4 at either end. Method: 1. Every static mattress will be rotated once a week or in between each patient episode. 2. Using the numbers printed on the Esprit cover, turn or rotate the mattress so the following number appears at the foot e.g. 1 2, 2 3, 3 4, 4 1 etc.

Head
2

Head
1

Head
4

Head
3

1
Foot
3.

2
Foot

3
Foot

4
Foot

The cover and foam should be inspected during turning for signs of deterioration (see section 3.2 - 3.5).

NB. There are patient groups for whom weekly mattress rotation is inappropriate e.g. prolonged bedrest, traction, spinal fractures undergoing SMHPT Care of Hospital Mattress Policy (IC03) Approved: April 2010 Page 4 of 15

conservative treatment. When linen is changed the covers and where possible foam should still be assessed for deterioration. 3.2 Static Mattress Testing Rationale: Testing is required to avoid increasing clinical risk for the patient. It ensures the equipment in service is safe and fit for purpose. Methods to test a static mattress: The information is split into 2 sections Foam and Cover each giving details of the test or observation. However, they are not set out in order of priority and should be carried out as a complete procedure using all components. FOAM 3.3 Bottoming Out Of The Mattress All foam will eventually lose its density and so flattening the mattress causing the patient to sit on a much harder surface (the bed frame). The mattresses must be tested once a week or between each patient episode to check if this has occurred. How to test for bottoming out: 1. Stand beside the middle of the bed with your knees touching the side, adjusting the bed height to accommodate this. 2. Link your hands and keeping your elbows straight, lean forward into the centre of the mattress. 3. Use your weight to push down with your clasped hands, if you can feel the base of the mattress then the foam has lost its integrity and the mattress is said to have bottomed out and should be CONDEMNED 4. Repeat this in different central areas of the mattress. 3.4 Contamination of the Foam In order to check the suitability of the foam, unzip the outer cover. Once the foam is exposed check for obvious damage, broken or crumbling foam and staining or dampness. If any of these are present the foam should be CONDEMNED. COVER 3.5 General Cover Inspection The integrity of the cover can be compromised in a number of ways: Excessive Staining Hydrolysis Mechanical Damage Wear and Tear

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a.

Excessive Staining If the mattress is stained and all reasonable efforts have been made to remove the discolouration it should be CONDEMNED. The Gold Standard here is would you lie on it? Hydrolysis Rationale: The mattress cover is made in such a way as to allow twoway stretching thus preventing a hammock-effect, which can increase direct pressure on the patients skin. Hydrolysis is when the polyurethane coating of the mattress cover disintegrates. Method to test for Hydrolysis: Stretch the mattress cover between both hands. If the polyurethane coating breaks up and is not seen as a complete covering, hydrolysis has occurred. Visually, the coating has a webbing effect through which the material underneath becomes visible. The integrity of the cover is compromised therefore no longer waterproof and must be CONDEMNED.

b.

c.

Mechanical Damage The cover must be inspected for evidence of accidental damage. Often small splits can be identified having been caused by a sharp object or rubbing off of the polyurethane coating. In both cases, the integrity of the covering is compromised exposing the foam to a high risk of contamination and should be CONDEMNED. Wear and Tear A general inspection of the mattress cover will reveal any evidence of seams that are coming undone or zips that are jammed or broken. These mattresses are not fit for purpose due to the uncertainty of their reliability in protecting the inner foam and must be CONDEMNED.

d.

4.0

Decontaminating Mattresses and Bed Frames

Rationale: To make bed frames, mattresses and other allied equipment safe for reuse in order to provide a safe environment for the patient. 4.1 Cleaning Frequency of Bed Frames: On discharge of patient. Bed frames should be checked as clean prior to patients going to the Operating Department. The cleaning contractor should keep bed frames dust free. Cleaning Frequency of All Mattresses: In between patients. When a mattress is removed from the clinical area to be stored. When a new mattress is requested and delivered to the clinical area from central store. When a mattress is condemned. Page 6 of 15

4.2

SMHPT Care of Hospital Mattress Policy (IC03) Approved: April 2010

N.B. Disinfection: Nursing Staff are responsible for ensuring that spills of body fluids are cleaned immediately. Blood spillages should be disinfected with a 1% solution of hypochlorite (1 tablet of Achtichlor in 100mls of water) prior to cleaning (See Section 5.4 policy for dealing with spillages of blood and blood stained body fluids in Infection Control Manual). 4.3 Equipment Required: Use either detergent wipes or a freshly prepared solution of household detergent and water. Any solutions should be made up to Manufacturers instruction in a bowl kept solely for cleaning beds and stored on the ward. Disposable cloths for either cleaning or drying Protective clothing (gloves and apron) Linen skip For disinfecting after a patient is in isolation (i.e. MRSA) a 0.1% solution is required (1 tablet of Achtichlor in 1000mls of water) Cleaning blood see NB above Method for Cleaning Static Mattresses and Bed Frames (Cot sides, IV stands etc., need to be included if part of the bed assembly). The general principle is to work from the least contaminated area towards those such as the base and legs which harbour skin scales and therefore micro organisms: 1. 2. Collect equipment. Wash hands and don protective clothing Raise the bed to a level that will allow access to the bed surface. Avoid excessive stretching or twisting. Ideally two people should be involved in this procedure but one person moving around the bed to work from each side can do it safely. Strip bed carefully to avoid dispersal of microorganisms. Discard used linen into appropriate coloured skip according to hospital policy. Clean the bed head then the uppermost surface of the mattress. Fold the head of the mattress back towards the foot and clean the top half of the base, the underside and sides of the mattress. Ensure that both surfaces are dry, to avoid moisture collection between the surfaces, before repeating the move in the opposite direction. Surfaces should be physically dried if there is no time for air-drying. N.B. Where one person is working alone the mattress should be weighted down with one or two plastic covered pillow to allow the operator to have both hands free. The pillow can be cleaned as part of the procedure. Clean foot board then raise bed to its maximum height and clean the rest of the frame working down from legs to wheels. If the bed is in an isolation room or has been soiled with body fluids, both frame and mattress should be wiped over with a freshly prepared solution of 0.1% hypochlorite (1 Achtichlor tablet in 1 litre of water made up in a clean container) and allowed to dry. Discard detergent wipes and disposable cloths as household waste. Wash the bowl, if used, and store dry on a shelf in the dirty utility room. Page 7 of 15

4.4

3. 4. 5. 6.

7. 8.

9.

SMHPT Care of Hospital Mattress Policy (IC03) Approved: April 2010

10. Remove gloves and aprons and wash hands. 4.5 Method for Cleaning Dynamic Mattresses Generally the same equipment and solutions are used for both the static and dynamic systems. Manufacturers instructions should be referred to if necessary. Follow steps 1 to 4 as above then proceed as follows: 1. Disconnect the electrical supply 2. If possible put the mattress onto transport mode and disconnect the pump or disconnect the pump and wait for mattress to deflate. 3. Clean the system in the following order: pump; tube set; top and sides of mattress. Fold the head of the mattress back towards the foot and clean the top half of the base, the underside and sides of the mattress. Ensure that both surfaces are dry, to avoid moisture collection between the surfaces, before repeating the move in the opposite direction. Surfaces should be physically dried if there is no time for air-drying. N.B. Where one person is working alone the mattress should be weighted down with one or two plastic covered pillow to allow the operator to have both hands free. The pillow can be cleaned as part of the procedure. 4. Clean foot board then raise bed to its maximum height and clean the rest of the frame working down from legs to wheels. 5. If the bed is in an isolation room or it is soiled with body fluids, both frame and mattress should be wiped over with a freshly prepared 0.1% solution of hypochlorite (1 Achtichlor tablet in 1000mls of water made up in a clean container) and allowed to dry. 6. Ensure all surfaces are dry. Completely deflate the mattress, roll and place into a plastic bag. Attach a tag confirming that the mattress assembly is clean and store on the ward. 7. Discard detergent wipes and disposable cloths as household waste. Wash the bowl, if used, and store dry on a shelf in the dirty utility room. 8. Remove gloves and aprons and wash hands. N.B. If the inner surface of the mattress has been contaminated specialist advice needs to be sought from the Infection Control Nurse. If it is necessary to return it to the manufacturer for special cleaning this should be done through the Procurement Department, having first cleaned the equipment as above. Any piece of equipment returned to the manufacturer should have a Decontamination Certificate. 5.0 Condemning a Static Mattress or Cover

Rationale: to identify static covers and mattresses that no longer meet safe standards for patient use and dispose of this equipment safely. Method: 1. 2.

Undertake the tests in section 3.0 and if either the cover or mattress fails it must be condemned. Clean the cover/mattress (see section 4.4).

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3. 4. 5.

6.

7. 8.

The word CONDEMNED will be written across the cover and on the foam inside the zip. Store in a safe place. Complete a Mattress Condemnation Form (see appendix 1) even if it is the cover that has failed. The form can be printed from the intranet site (Infection Control webpage) and send in the internal post to the Head of Procurement. Contact the SMARTLINE (ext: 3755) to request removal from the clinical area and inform them of storage site. You must obtain a job number for future reference. SMARTLINE will contact the Hotel Services that will attend the ward and remove. The porter will dispose of the condemned mattress safely. N.B. In the extreme event that a static mattress is contaminated with body fluids beyond that, which can be removed by decontamination methods, one large mattress bag is kept by Infection Control Team and must be used to encase the mattress before transportation to the hospital incinerator.

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Static Cover / Mattress Fails Tests (see 3.0) Decision to Condemn

Clean cover/mattress

Contact SMARTLINE ext: 3755 Obtain Job Number

Write Condemned on cover/mattress

Hotel Services mobilised to collect Mattress from Ward

Place in safe storage

Safe transportation of mattress to disposal point

Complete Mattress Condemnation Form

Send form to auditor

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6.0

Acquiring a Static Mattress or Cover

Rationale: A new cover or mattress may be required to replace one that is condemned. Method: 1. Contact SMARTLINE (ext: 3755) to acquire a replacement cover or static mattress. You must obtain a job number for future reference. 2. Helpline will mobilise portering service to collect a cover/mattress from central stores and transport it safely to clinical area. 3. On arrival the mattress will be cleaned (see section 4.4) and placed on bed frame. 4. A replacement cover will be new and not require cleaning. 5. The cover will be placed over the foam in the clinical area and the complete mattress returned to the bed frame.

Acquiring a Cover/Static Mattress from Central Store

Contact SMARLINE ext: 3755 Obtain Job Number

Hotel Services contacted by SMARTLINE

Hotel Services collects cover/mattress from central store

Safe transportation of Cover/mattress to ward

Clean cover/mattress and placed on bed frame

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7.0

Roles and Responsibilities of people involved

HCA/NN, TAs and Nursing/Midwifery Staff It is their responsibility to ensure this policy is implemented and any situation when it cannot be document on a risk management form, It is important that if a cover or mattress is condemned a condemnation form is completed and sent to the auditor. Hotel Services To ensure the transportation of static mattresses to and from the central store and the transport of dynamic mattresses out of hours is safe and does not put undue wear and tear on t he mattresses by dragging or transporting them in a cage. Head of Procurement Maintain the central store and supply of static mattresses and covers. SMARTLINE To liaise with ward staff and portering service to ensure prompt transportation of mattresses to and from the Central Store. Administrator to Head of Procurement (Estates & Facilities) Maintains the static mattress audit database and produces an annual report of mattress acquisition and condemnation for the Estates and Facilities Manager. Infection Control Team & Infection Control Nurse To annually review the policy and respond to staff requests. 8.0 8.1 Dynamic Mattresses Introduction This section clarifies the differences in care required of dynamic mattresses. The following points must be implemented: Dynamic mattresses will be stored in the Procurement Department facility with other electrical equipment i.e. syringe drivers etc and maintained by the Head of Procurement. This is separate to static mattresses storage. When the mattress is no longer required it will be returned to the Procurement Department and not stored or kept locally in the clinical area. This is for several reasons: 1. 2. 3. 4. 5. All patients must have equal access to a dynamic mattress. Appropriate storage facilities are not available in ward areas. Risks such as contamination and accidental damage are greater in the clinical area when compared to the Central Equipment Store. Damaged mattresses that remain in the clinical areas are likely to be reused causing obvious hazards to patients and staff. Use and general wear and tear of dynamic mattresses must be monitored centrally ensuring timely maintenance is carried out and replacement if necessary. Page 12 of 15

SMHPT Care of Hospital Mattress Policy (IC03) Approved: April 2010

Summary of Key Statements regarding the care of Dynamic mattresses

There are many types of mattresses available however some are few in number. Dynamic mattresses are obtained via the Head of Procurement. Out of hours, equipment can be obtained via the bed/site team. Suitable pressure relieving equipment is determined by the assessment of the patient using the Waterlow Risk Assessment along with the sores a patient has. It is only in extreme circumstances that a dynamic mattress would be required out of hours. The Waterlow Assessment tool will advise staff of the severity of risk to patient care and therefore a high standard of patient repositioning and turning should take place throughout the night leaving the day staff to acquire a mattress. All dynamic mattresses will be cleaned as per policy before leaving the ward. Pressure Reliving Overlays and Mattresses

9.0

There are many types of support systems available and it is important that the correct one is chosen to meet the needs of individual patients. This brief descriptor should be used in conjunction with the Waterlow assessment score and the mattress guide outlined in section 10.0. 9.1 Fibre and Foam a) Fibre Systems: Spenco Permaflow Products in this category are pressure-reducing overlays. They look like thick duvets and are constructed from silicone hollow fibre that is divided into diagonal sections. Controversy exists with the effectiveness of these overlays following repeated washing. b) Foam Support Overlays: Modular Propad This overlay is pressure reducing and are usually 3-4 inches thick with a series of slashes across the surface forming squares, facilitating the distribution of weight across a large area and allowing the body to sink into the material thus reducing pressure. c) Foam Support Mattresses: Transfoam (low risk) Linknurse (low risk) Softfoam (high risk) SMHPT Care of Hospital Mattress Policy (IC03) Approved: April 2010 Page 13 of 15

Made up of several layers of foam of differing densities, but the principle is the same as with the overlays. 9.2 Air Support Systems a) Repose Overlay: A clear plastic air filled static overlay. b) Alternating Overlays: Alpha excel Auto excel These systems are divided into a number of cells, which inflate or deflate to a pre-determined sequence. They are placed on top of a mattress secured by putting the flap at the end of the overlay underneath the mattress. Failure to do this will result in the danger of the patient falling out of bed, as the overlay is not secured. It is advisable for these mattress overlays to be placed on a NHS mattress only. c) Dynamic Air Mattress: Nimbus 2 or 3 This is a more sophisticated version of the alternating air system. The cells are in the shape of a figure eight, and a sensor pad beneath them causes the cell pressure to be altered according to the patients weight. This is a complete mattress replacement and should not be placed on top of a static mattress. Must be secured with the straps provided. d) Airwave and Cairwave Mattress: Pegasus This model has two layers of cells, grouped into threes, working synchronously. These cells rhythmically inflate and deflate creating a wave effect. 10.0 10.1 Mattress Guide Mattress Testing & Care The Head of Procurement will undertake inspection of all dynamic mattresses. 10.2 Decontamination Cleaning a dynamic mattress see section 4.5. N.B. Dynamic mattress will not be removed from the clinical area unless cleaned.

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APPENDIX 1 MATTRESS CONDEMNATION FORM Todays Date

Ward/Clinical Area Type of Mattress or Cover Esprit Link Nurse NHS Marbled Other (please state) Tick Box:

Batch Number of Cover/Mattress (MUST BE COMPLETED)

Date of Manufacture

Reason of Condemnation

Print Name of person You are signing to confirm the following: 1. 2. The Mattress has been cleaned You have clearly identified the mattress/cover is to be condemned

This information is required for ongoing audit and this form should be sent to:

Head of Procurement

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