Sunday, 27 April 2008

And so to bed ...

The contribution of beds to healthcare-associated infection: the importance of adequate decontamination
E. Creamer and H. Humphrey
Journal of Hospital Infection
Volume 69, Issue 1, May 2008, Pages 8-23
The hospital bed is comprised of different components, which pose a potential risk of infection for the patient if not adequately decontaminated. In the literature there are a number of descriptions of outbreaks or experimental investigations involving meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Acinetobacter spp., and other pathogens. Often only the bedrail has been sampled during investigation of outbreaks, rather than more important potential reservoirs of infection, such as mattresses and pillows, which are in direct contact with patients. It is essential that these items and other bed components are adequately decontaminated to minimise the risk of cross-infection, but detailed advice on this aspect is often lacking in reports and official documents. The ideal would be to decontaminate the bed by thermal disinfection between patients. Institutions, especially acute hospitals with endemic MRSA and VRE, should consider investing in this type of equipment or at least endeavour to ensure that the critical components, e.g. mattresses and pillows, are processed in a thermal disinfection unit. Other technology such as hydrogen peroxide should be studied further to determine its role for routine use as well as during outbreaks. Clear guidelines should be formulated for bed decontamination and systems established, such as labelling, to indicate when a bed has undergone decontamination. Pillows and mattresses should be made of materials that are easily washed, dried and decontaminated, and have the lowest potential to harbour organisms. The regular replacement of mattress and pillows should be included in hospital budgets. While all equipment and environmental aspects in contact with the patient can cause infection, and therefore require appropriate decontamination, priority should be given to mattresses and pillows, due to their greater degree of contact with the patient.