Study Finds Mattress Covers Cut Hospital CDI Rates in Half

Edmond Hooker, MD, DrPH, professor, Health Services Administration at Xavier University, and emergency physician at the University of Cincinnati, discusses a study that assessed the use of mattress covers in hospitals to cut down on CDI rates.

Interview Transcript (modified slightly for readability):

“For the study, we used the mattress cover in 2 long-term acute care hospitals that were having a Clostridium difficile (C. diff) problem. They had tried several things, such as antibiotic stewardship, proton pump inhibitor limitations, and handwashing compliance. They couldn’t solve the problem. They weren’t as bad as some hospitals. Some hospitals are running 30, 40, 50 CDIs per 10,000 patients; that’s ridiculous. They were running about 12 CDIs per 10,000 patients.

We put the cover on for 14 months and we cut their rates in half, in both hospitals. We prevented about 20 CDIs, so a value of about $600,000 at least, probably more than that. And so, this was huge; we were able to do it. We had no change in pressure ulcers; in fact, we actually decreased them a little bit but it wasn’t statistically significant, so we can’t take credit there. Also, we didn’t experience any problems with regular Environmental Services staff using it. And so, it worked. We really decreased the rates.

Now, we’ve put the mattress covers in another hospital in the northeast and they want to publish their own results, but what I can tell you is, they basically wiped their CDI rate out by putting it in the units they put it in. What they found was, they were doing everything in 5 different hospitals to try to decrease CDIs; they were doing all of the antibiotic stewardship. There was no change in rates anywhere expect in the units that had the cover; they wiped it out. The cover works.

We had another hospital that’s using the cover and they said, ‘We’re going to replace our mattresses. You’ve convinced us that we’ve probably got defective mattresses; they’ve probably got breaches and they probably have a microbiome on them. We’re just going to replace them all. We’re still going to buy your covers to protect them.’ And guess what happened. When they replaced all of the mattresses, they wiped out their CDI problem. Now, they bought the covers because they want to keep wiping it out. They know that the microbiome is going to restart and they know that they are going to destroy their mattresses because they’re using peracetic acid, which is not compatible at all with these mattress covers. It’s a good cleaner; it smells horrible, but it does clean.

There are more and more hospitals that are really seeing the value proposition here; it’s really clear. It’s so much of a return on your investments, that it’s just unbelievable. Even if you said, ‘I’m not going to prevent any CDIs,” which you will, you can prevent other infections, but what’s going to happen is, you’re also going to protect your bed asset. These mattresses cost $1500 to $3500 to replace, and the bed deck, when you get the rust there, you’re not supposed to keep that bed in service; that bed is supposed to come out of service. It costs $5000 to replace the bed deck. All you have to do is prevent a few damaged assets and you pay for the covers.

Your EVS workers will have quicker turns of the rooms. And so, if you need a quick turn to the room, but a clean room, you give them an hour, they put the cover on, and they actually clean everything to a high level—including the hand rails and everything—and all of a sudden, you have decreased your infection rates. I challenge any hospital to either clean better or put the cover on. They’re going to see a change.”