The Problem With Sanitizing Soft Surfaces

Environmental service departments are right to think they don’t have the tools needed to disinfect the soft surfaces found in patient rooms because these surfaces can’t be disinfected. Proof of that fact is found on the product label. Just read the label on the EPA-registered disinfectant and it will state that the chemical is to be used on “hard, nonporous surfaces.”

A few disinfectant manufacturers market disinfectants with a claim for “soft surfaces.” However, upon further inspection, this is not a disinfectant claim; it is a sanitizing claim only. There is a substantial difference between sanitizing and disinfecting.

A sanitizer kills 99.99 percent of pathogens. Although that sounds pretty good, consider that a disinfectant kills 99.9999 percent. So if there were 1 million pathogens on a surface, after sanitizing there would still be 10,000 left that would quickly replicate and contaminate the area again. However, after disinfecting, only 100 pathogens would remain.

When soft surfaces are defined on the product label, the sanitizing claim is for privacy curtains, in-room couches, bedside chairs, cots, drapes and linens. One soft surface in the patient hot zone missing from these sanitizing claims is the bed mattress.

Many of the bacteria that cause 80 percent of hospital acquired infections are found on mattresses, including S. Aureus, Enterococcus, Escherichia-coli, Coagulase-negative staph and more.

The U.S. Environmental Protection Agency (EPA), the Joint Commission, the U.S. Food and Drug Administration (FDA) and manufacturers are still struggling to come to an agreement on the most effective process to disinfect mattresses. It’s nearly impossible to disinfect mattresses since there are no chemical disinfectants with a soft surface claim — not even UV-C light has a soft surface claim.

Environmental services professionals currently are using hard surface disinfectants to wipe down mattresses with terminal cleaning. This constitutes an “off label” use of the disinfectant and the EPA is aware of this practice, but chooses not to enforce the federal law.

EPA-registered, hospital-grade, hard surface disinfectants destroy the integrity of the soft mattress surface over time, which causes damage, leaks and voids the manufacturer’s warranty.

In intensive care units, high-tech beds — sometimes costing tens of thousands of dollars — are used. These beds and mattresses are classified as “reusable medical devices” by the FDA and fall under their reprocessing guidance.

Reprocessing includes a pre-cleaning and rinsing step to remove all soils prior to disinfection, followed by a wipe down with properly mixed disinfectant solutions and specific dwell times. Then there is a rinse removing the disinfectant. However, even if these steps are followed in reprocessing mattresses, 99.9999 percent microbe removal is not guaranteed because the disinfectants are not validated for use on soft surfaces. Compounding this problem is the fact that most cleaning teams are not given adequate time to clean the bed according to the required steps.