Discussion

Mattresses arguably represent the single highest-touch element for a hospitalized patient, and damaged mattresses pose a potential patient safety risk. The current study showed that most beds (72%) in a hospital system in the midwestern United States had damage. This research is the first to demonstrate that many of the failed mattresses were <4 years old and that the prevalence of rust on the bed decks was substantial.

The higher rate of damage noted in the present study may be attributable to the inspection process, which included the entire interior of the mattress and use of an LED light. In the current study, we identified obvious failure in 49% of mattresses and small punctate defects in 23%. Examining only obvious failures, the results did not appear qualitatively different than those of prior reported studies, which have reported failure rates between 27% and 33%. ^{Reference Bradbury, Mack, Crofts and Ellison7,Reference Marks, de Haas, Abboud, Lam and Datta8} In the study by Bradbury, ^{Reference Bradbury, Mack, Crofts and Ellison7} 27% of the mattresses had interior damage from leaking, which was similar to our study, in which 24% had large stains (>15.25 cm). Bradbury did not report on damaged covers without staining. Identification of small punctate defects is important because they can lead to mattress failure. In our study, 62 of the 174 mattresses with large interior staining only had small punctate defects in the cover. The Centers for Disease Control and Prevention (CDC), the US Food and Drug Administration (FDA), and mattress manufacturers recommend replacement of damaged mattresses and covers due to infection risk. ^{Reference Sehulster and Chinn4}

The American Hospital Association states that the depreciable life of the mattress is 5 years, and mattress manufacturers state that the expected life of the mattress is only 1–3 years. ^5,6,9 In this study, the most mattress failures (52%) were in mattresses that had been in service for <4 years. At a minimum, these results indicate that routine inspections of all mattresses, even recently purchased ones, is necessary to minimize patient safety risks.

The bed deck is expected to last 5–10 years according to manufacturers. ^5,6,9 The current study is the first to report on the percentage of rust found on the bed decks. We detected rust on 24% of the beds, and 9% of all beds had widespread rust, which makes cleaning and disinfection difficult. To properly repair these rusted beds, they must be sent out for sandblasting and powder coating.

The current study must be interpreted in light of a few limitations. First, although 4 hospitals were involved in the study, they were all part of a single healthcare system. Second, the beds and mattresses where primarily from a single manufacturer. Third, only 300 (41%) of the 727 mattresses evaluated had a tag identifying the date of manufacture. Despite these limitations, our findings, coupled with prior studies, support the need for routine inspections of beds and mattresses to minimize infection risk.

In conclusion, these findings confirm that damaged mattresses are common in hospitals, which potentially places patients at increased risk for infection. The rate of failure was higher in this study than those reported in previous studies, which may be attributable to enhanced visual inspections and interior inspections. Most of these failed mattresses were <4 years old, and many of the bed decks had rust, indicating that even relatively new beds and mattresses require routine inspection for damage.