Are Regulatory Agencies Dropping the Ball When It Comes to Hospital Mattress Disinfection?

Edmond Hooker, MD, DrPH, professor, Health Services Administration at Xavier University, and emergency physician at the University of Cincinnati, explains how regulatory agencies are “turning a blind eye” to an important issue experienced in hospitals everywhere.

Interview Transcript (modified slightly for readability):

“The issue is, the regulatory agencies have done nothing; they have unfortunately turned a blind eye to this. The US Food and Drug Administration, the US Environmental Protection Agency, and the Centers for Disease Control and Prevention (CDC)—great organizations, wonderful people working there—but they just haven’t done anything. The CDC has not updated their guidance since 2008 on the cleaning of mattresses, and the 2008 guidance didn’t really change much from the 2003 guidance. The CDC could say, ‘Effective immediately: clean these beds to a high level every single time,” but, instead, they call it a noncritical surface; they say it’s noncritical because it doesn’t touch non-intact skin. The last time I checked, every single patient has non-intact skin; they’ve got an intravenous line in; they’ve got dermatitis; they’ve got a pressure ulcer; they just had an operation on their hip—that’s non-intact skin. And yet, we lay the patient on the mattress as if they’re being laid on a perfectly clean space and it's not clean. They put it in the noncritical category which means that you can use low-level disinfection. You don’t have to use high-level disinfection; you don’t have to remove Clostridium difficile, and this is just crazy.

There’s now a big outbreak of a new Candida species—Candida auris—that’s occurring in Europe and it has already hit the United States, and, again, you don’t know which beds have it. Well, if you don’t know which beds have it, you need to clean every single bed the same way, every time—high-level disinfection. But the CDC says, ‘Nope. Non-critical.’ The EPA says, ‘Oh, use the chemicals we’ve got.’ Oh, by the way, you can’t. Every chemical that’s in the hospital today says on the side label that it's ‘for non-porous hard surfaces.’ How can you clean the mattress with a chemical that says, ‘don’t do that?’ And that’s what’s done every day. Even bleach, even the bleach manufacturers, and I love bleach. Bleach is fantastic; it kills some of the meanest, nastiest bugs on this planet, and we need bleach. Please—we need to keep using bleach. The problem is, it says right on the side of the bottle that it's ‘for non-porous, hard surfaces.’ And then Clorox came out with a notice saying, ‘Oh, by the way, our bleach products are really not compatible with polyurethane mattresses.’ Oops—that’s what they’re all made of now. We need to use it, but it’s not compatible.

Mattresses really have to be rinsed; this is that multistep process. And so, the recommendation is becoming to remove all of the poop off first. Then, to remove all of the microbiome off. When that’s done, you need to rinse, because if you use a disinfectant, it’s not compatible with the bleach; they work against each other. I can tell you right now, there’s not a hospital on the planet rinsing after they clean, then disinfecting, and then rinsing again. Nobody’s doing that; it would take them an hour just to clean the bed. They would be tied up for an hour, and that hospital has patients coming out of the operating room, patients down in the emergency room. I had 50 patients, in-patients, being held in my emergency room last week. Fifty.

And so, the pressure on the Environmental Services people is to get the bed turned immediately. The EVS people are wonderful and I get so angry when I hear them blamed because they didn’t clean well enough. They’ve been given an impossible task. You can’t ask somebody to clean a room in 20 minutes; it needs to be an hour, an hour and a half at least. You want to clean every crevice. I, personally, as a patient or as a doctor, want to see a really clean room every time, and we have just kind of turned a blind eye to this. The hospitals, they’re under extreme financial pressure, margins are so close, and now, I’m asking them to triple their EVS staff.”