NHS Regulations Infection Prevention and Control of Mattresses

Transcription

1 Policy Document Control Page Title Title: Mattress Maintenance Policy Version: 3 Reference Number: CL86 Supersedes Supersedes: Version 2 Description of Amendment(s): Paragraph re disposal of mattress Paragraph re responsibility for cleaning and checking of mattresses provided to community patients for use in their own homes Originator Originated By: Infection Prevention & Control Team Designation: Infection Prevention & Control Nurse Equality Impact Assessment (EIA) Process Equality Relevance Assessment Undertaken by: N/A ERA undertaken on: N/A ERA approved by EIA Work group on: N/A Where policy deemed relevant to equality- YES ERA undertaken by: Laura Birch EIA undertaken on: 2 nd April 2014 EIA approved by EIA work group on: 2 nd April 2014 CL86 Mattress Maintenance Policy V3 1

2 Executive Directors Referred for approval by: Laura Birch Date of Referral: 11 th April 2014 Approved by: Infection Prevention and Control Committee Approval Date: 11 th April 2014 Date Ratified at Executive Directors Meeting: 28 th April 2014 Executive Director Lead: Medical Director Circulation Issue Date: 1 st May 2014 Circulated by: Performance and Information Issued to: An e-copy of this policy is sent to all wards and departments Policy to be uploaded to the Trust s External Website? YES Review Review Date: 11 th April 2016 Responsibility of: Laura Birch Designation: Infection Prevention & Control Nurse This policy is to be disseminated to all relevant staff. This policy must be posted on the Intranet. Date Posted: 1 st May 2014 CL86 Mattress Maintenance Policy V3 2

3 CONTENTS Page 1 Introduction 2 Scope of the Policy 3 Purpose of the Policy 4 Duties and Responsibilities 5 Purchase and Procurement 6 Care of Mattresses 7 Disposal and Replacement 8 Specialised Pressure Relieving Mattresses 9 Audit and Monitoring 10 References Appendices: Appendix 1 Hand Compression Assessment & Water penetration Test Appendix 2 Mattress Audit Form 12 CL86 Mattress Maintenance Policy V3 3

4 1. Introduction The Health & Social Act 2008 Code of Practice for the Prevention and Control of Health Care Associated Infections sets out criteria by which NHS organisations must ensure that the risk of Health Care Associated Infection is kept as low as possible and patients are cared for in a clean environment. Compliance with this code is a statutory requirement including the duty to adhere to policies and protocols applicable to infection prevention and control (IP&C) Poor maintenance of foam mattresses and their covers may lead to staining of the foam or inner surfaces of the mattress covers. Recent research highlights that different types of trauma to the mattress cover can result in damage which is not visible to the naked eye, but which can allow fluid to enter the mattress (Russell 2001). The first outbreak of hospital acquired infection attributed to mattresses was reported by Stead Several studies have subsequently replicated these findings, demonstrating that damaged mattresses can harbour micro organisms and be a potential cause of cross infection. (Moore, 1991; Ndwala, 1991). Foam mattresses have a relatively short life expectancy and if used for longer periods will experience core fatigue. This can result in the patient sinking through the foam and being supported by the underlying bed base (Dunford 1994). Proper care, maintenance and cleaning of mattresses and covers can minimise the risk. 2. Scope of the Policy This policy is aimed at all staff employed by Pennine Care NHS Foundation (PCFT) Trust working within inpatient facilities in the Trust. 3. Purpose of the Policy To ensure appropriate mattresses are purchased To provide advice on the cleaning and maintenance of mattresses To reduce the risk of healthcare acquired infections related to hospital mattresses To ensure that mattresses are replaced as soon as they become damaged / contaminated CL86 Mattress Maintenance Policy V3 4

5 4. Duties and Responsibilities 4.1 Chief Executive The Chief Executive has overall responsibility for the strategic and operational management of the Trust, including ensuring that Trust policies, such as the Policy for Cleaning, Maintenance, Audit and Replacement of Mattresses in Pennine NHS Foundation Trust Care comply with all legal, statutory and good practice guidance requirements. 4.2 The Director of Infection Prevention and Control The Director of Infection Prevention and Control (IPC) oversees development and implementation of infection prevention and control policies in accordance with the Infection Control Strategy. The Director of Infection Prevention and Control chairs the Infection Control Committee, which will formally review and approve this policy and reports to the Integrated Governance Group. 4.3 Directors All Directors are responsible for the implementation of this policy into practice and taking appropriate action should any breach of policy arise. 4.4 Modern Matrons/ Unit Mangers Modern Matrons and Unit Managers are responsible for: Supporting the operational implementation of this policy Providing clinical leadership with the policy implementation Improving and spreading best practice 4.5 Service Managers and Ward Managers Service Managers and Ward Managers are responsible for: The operational implementation of this policy Ensuring that staff are aware of their responsibilities, including the requirement to undertake IP&C Training Taking appropriate action should any breach of this policy arise Yearly audit of the policy and monitoring its effectiveness during routine clinical activities and planned audit programmes as agreed by the Infection Prevention and Control Committee CL86 Mattress Maintenance Policy V3 5

6 4.6 Infection Prevention and Control Team It is the responsibility of the Infection Prevention and Control Team to ensure that this policy is updated as required. The team will: Support Service Heads in providing advice and training, as required, assisting with the implementation of the policy Review the policy in light of the outcome of periodic audits undertaken and monitor it s effectiveness during routine clinical activities and planned audit programmes as agreed by the Infection Prevention and Control Committee 4.7 The Employee All staff employed by PCFT are responsible for adhering to this policy, regardless of role, band, discipline or service area. Employees are also responsible for ensuring that clinical staff has a responsibility towards the safer working practices of colleagues and co-workers, such as students, trainees under their supervision. In addition, it is the employee s responsibility to: Perform a risk assessment when handling mattresses and use standard precautions see personal protective equipment policy CL76 and hand hygiene policy CL69 Handle mattresses in a responsible manner Ensure mattresses are decontaminated between patient uses according to Pennine Care Decontamination Policy CL92 & Cleaning Policy CO69. Receive/obtain training from the Ward Manager within the Trust on induction to the ward/unit 5. Purchase and Procurement A replacement programme should be established to replace condemned mattresses On delivery to the hospital the mattress should be marked with the date of purchase in indelible pen or a written record kept on the unit so that ongoing monitoring can take place. If a written record is kept this must be made available at all times for inspection purposes. This will permit the life of the mattress to be audited. Mattresses must be purchased through NHS supplies and a recognised supplier used. (See Medical Devices Policy CO16). CL86 Mattress Maintenance Policy V3 6

7 . When planning to dispose of mattresses, the ward/unit manager needs to work closely with the Estates Department to co-ordinate collection of old mattresses and the delivery of new ones. Mattresses should be placed in a yellow sack. Rolled up and place in the yellow clinical waste bin and not left on the floor. All mattresses to display contamination status form. 6. Care of Mattress 6.1 Turning Mattresses that require turning will have this marked on the cover. The instructions on the mattress should be followed. This should occur when the mattress is being cleaned on the patient s discharge it should be turned monthly and checked when making the patient s bed the correct month should be displayed in the bottom left corner. 6.2 Cleaning All mattresses should be cleaned between patients. The way in which the mattress is cleaned depends upon the nature of the contamination and the susceptibility of the patient (Viant1992). However the user should also consult the manufacturer s recommendations before cleaning the mattress cover Alcohol wipes/solutions/sprays and chlorhexidine should not be used as it can cause breakdown of the waterproof cover. In the absence of gross contamination of the cover or unusual risk, the removal of dirt and spillages with clean, warm water, neutral detergent and manual dexterity should be sufficient (Viant1992). In cases of contamination the mattress cover should be cleaned first with detergent and water then with a 1000 parts per million sodium hypochlorite solution, (e.g. Actichlor Plus). Ensure adequate ventilation. Disposable gloves and aprons should be worn, following the Personal Protective Equipment policy CL76. Ensure mattress cover is thoroughly dried before remaking the bed. Inspect the inner and outer surfaces of covers and their zip fasteners regularly for signs of damage. If the cover is stained, soiled or torn, the foam core should be examined. Damaged/soiled covers and mattresses should be reported to the ward/department manager. If the CL86 Mattress Maintenance Policy V3 7

8 core of the mattress is wet or badly stained, the mattress should be withdrawn from service. If a cover is damaged and the foam core not stained the cover should be replaced on the patients discharge. Covers must be checked after each patient discharge, the mattress must be unzipped. If the mattress is without a zip then a hand compression and water test should be performed.(see Appendix 1) NB: bed frames must be cleaned in between each patient use. 7. Disposal and Replacement Mattresses for disposal must be reported to Estates. A new mattress should be ordered by the ward staff. When there is more than one mattress for disposal there needs to be a co-ordinated approach between the ward manager and estates so that arrangements can be made for collection of the old mattresses and this does incur a charge. Please check with Estates regarding current charges at any given time. 8. Specialised Pressure Relieving Mattresses It is recommended that all specialised pressure relieving mattresses/beds within the hospital/unit are cleaned following manufacturer recommendations where applicable. 8.1 a) After each patient use If the mattress has not been used in an infectious environment or contaminated with blood or body fluids. Switch off the pump and disconnect the power source. Disposable apron and non-sterile gloves should be worn. A solution of mild, neutral detergent and warm water should be used. The solution should be applied with disposable cloths and dried using paper towels. It is recommended that cleaning is undertaken as follows: - Pump, hanging bracket, tubing, mains lead, mattress sides, mattress cover. Ensure that all surfaces are thoroughly cleaned and dried. 8.2 b) After each patient use If the mattress has been used in an infectious environment. Switch off the pump and disconnect the power source. Always wash hands before and after cleaning the equipment. CL86 Mattress Maintenance Policy V3 8

9 Disposable apron and gloves should be worn. If there is the possibility of facial splashing eye/face protection should be worn. After first cleaning with a solution of neutral, detergent and warm water, then disinfect using a solution of sodium hypochlorite 1,000 parts per million (eg Actichlor Plus). Ensure cleaning environment is well ventilated. The solutions should be applied with disposable cloths and dried using paper towels. It is recommended that the cleaning is undertaken as follows: - Pump, hanging bracket, tubing, mains lead, mattress sides, mattress cover. Ensure all surfaces are thoroughly cleaned and dried. PHENOLIC, STERICOL AND HIBISCRUB SHOULD NOT BE USED ON ANY OF THE EQUIPMENT. Weekly cleaning and documentation of equipment whilst in use will reduce the number of micro organisms and make final cleaning of the system more effective. 8.3 Hired Mattresses Cleaning and Maintaining the Mattress You must follow manufacturer instructions. The hired mattress needs to be cleaned prior to patient use, checked daily for cleanliness and cleaned weekly. The mattress must also be cleaned before returning it to the company and a decontamination certificate attached. A representative from the company must undertake training, with staff, regarding the safe use and care of the mattress before it is used. When pressure relieving mattresses are provided to community patients for use in their own homes the team responsible for providing the patients care eg District Nursing, should ensure the mattress is checked for soiling, staining and damage at each visit. The patient s family or carers should be advised to check the mattress on a daily basis. If the mattress is damaged in any way a replacement should be requested as soon as possible. All findings should be documented within the pts records. When the mattress is no longer required by the patient it should be returned to the equipment provider for decontamination. If there are any signs of wear and tear or the mattress are not functioning effectively the company from which the mattress is hired must be contacted immediately. The patient will need to be moved off the mattress until the company provides a replacement. CL86 Mattress Maintenance Policy V3 9

10 9. Audit and Monitoring Mattresses at PCFT will be audited annually. Currently a representative from a Mattress Company (currently ArjoHuntleigh ) will undertake an audit and return results via a report to IP&C nurses. In-patient areas can undertake mattress audits as per local policy. Mattress Audit reports will be discussed at the Infection Prevention & Control Committee and Divisional Integrated Governors Groups then disseminated to Service Leads. 10. References Department of health (2008) Health and Social Care Act. Dunford C (1994) Choosing a Mattress Research Findings Nursing Standard 8:20: Larcombe J (1998) One good turn deserves another Nursing Times 84:49, Loomes S (1998) Is it safe to lie down in hospital? Nursing Times 84:49, Moore E (1991) A Maternity outbreak of MRSA Journal of Hospital Infection 1991: 19, Ndwala E (1991) Mattresses as Reservoirs of Epidemic Methicillin Resistant Staphylococcus aureus Lancet Patel S (2005) Minimising cross infection risks associated with beds and mattresses. Nursing Times. Vol 101. issue 8 p52 Peto R (1996) An audit of mattresses in one teaching Professional Nurse 11:6, Russell L (2001) Strikethough: review of research on mattress cover performance British Journal of Nursing (Supplement) Vol 10 No Viant A (1992) Cleaning of hospital mattresses, nursing Standard 21, MDA 2010 (02) Alert for all types of mattresses January 2010 Medicines and Healthcare products Regulatory Agency (MHRA) MDA 2004 (014) Medical Device ALERT (2004): Replacement mattresses for hospital beds used in hospitals and in the community, Medicines and Healthcare products Regulatory Agency (MHRA), March 2004 CL86 Mattress Maintenance Policy V3 10

11 Appendix 1 Hand Compression Assessment 1. Adjust the height of bed so that it is at the same level as the tester s head of trochanter (hip). 2. Link hand to form a fist and place them on the mattress. 3. Keep elbows straight and lean forward, applying the full body weight to the mattress 4. Repeat the hand compression along the entire length of the mattress. 5. Note any variation in the density of the foam including whether the base of the bed can be felt through the foam. 6. The mattress should be condemned if it is found to bottom out or if the foam is found to be stained, damp or odorous. (Dunford, 1994). Water Penetration Test 1. Undo the zip and place a sheet of absorbent tissue between the cover and the foam. 2. Using the fist, indent the mattress to form a shallow well and pour tap water (20-30mls) into the well. 3. Agitate the surface with the fist for one minute to increase contact and then mop up water. 4. Inspect tissue for water marking. 5. Repeat procedure on reverse side of the mattress. 6. The cover should be replaced if it is found to fail the above test or it is damaged (Patel, 2005). CL86 Mattress Maintenance Policy V3 11

12 Appendix 2 Mattress Audit After examination of each mattress complete the section below. Answer yes/no or N/A to each question. Ward/unit:. Date:. Name of auditor: Is it fitted with a mattress cover? Is the cover free from stains? Is the cover free from tears? Are the zip fasteners in a good state of repair? Is the mattress free from stains? Is the mattress intact? Has the mattress passed the Hand Compression Assessment Has the mattress passed the Water Penetration Test Number of mattresses checked Number of mattresses condemned (if applicable).. CL86 Mattress Maintenance Policy V3 12