Hospital-Onset C Difficile Infections Decreased with Launderable Mattress Barrier

Edmond Hooker, DrPH

Hospital-onset Clostridium difficile infections add another meaning to checking under the bed for monsters. As an infectious disease that is easily transmitted via resistant spores, C diff can be both directly and indirectly hospital-acquired via neglected surfaces, such as those underneath hospital beds.

Although health care systems and reimbursement bodies have directed attention to hospital-onset C diff infection, the bacterium still exists as a major source of morbidity and mortality. However, Edmond Hooker, DrPH, professor Xavier University, has helped create a launderable mattress cover that is showing it can help with the scary situation.

“The problem in the United States is that hospitals are being cleaned with chemicals that do not work,” Hooker told MD Magazine®. “When you have a bacteria or a lot of bacteria on a hospital mattress, you’re trying to remove bacteria before the next patient. [However], none of the things that people are using routinely, whether that’s quaternary ammonium, bleach, UV light, phenolics, peracetic acid, [completely eliminate C diff]. All those things only decrease the bacteria—in the real world—by about log 1, which [is about] a 90% decrease. That means 10% of the bacteria is all over the mattress and ready for the next patient to be exposed.”

To see if the use of a launderable bed barrier could help, Hooker and his team conducted a retrospective pre- and post-bed barrier study at an acute care hospital in Kentucky. From September 2014 through March 2016, the pre-bed barrier period served as the baseline for establishing the rate of hospital-onset C diff infection. In April 2016, the bed barrier was brought to beds in the hospital; September 2018 ended the post-period for the study.

Although the bed barrier was used on 97% of all beds, when calculating the C diff infection rates, all hospital-onset C diff infections during the post bed barrier were included in the study.

The actual number of hospital-onset C diff infection divided by the number of patient days each month served as the value from which the rate of hospital-onset C diff infection was calculated. To control for confounding, data on handwashing compliance, length-of-stay, case mix index, and average age of patients were collected.

To assess the difference in hospital-onset C diff during the pre-/post-periods, the team used Poisson regression models. No covariates were included in the first model, but all covariates were included in the second model.

In the preintervention period, there were 34 hospital-onset C diff infections and 42,672 patient days. In the postintervention period, there were 31 hospital-onset C diff infections and 65,882 patient days.

“This cover is unique in that it covers not just the mattress. It’s a bed protection system that [also] covers the bed deck,” Hooker added. “I challenge anyone, the next time they’re at a hospital, to lift the mattress up. You may find a lot of dirt and rust underneath that mattress. This [cover] protects everything. The bed deck, which is that metal part, and the mattress are both protected, and by mounting it to the bed deck, it actually articulates and works with the bed so it doesn’t come off. This bed protection system protects the bed from the patient, and the patient from the bed.”

During the pre- and post-periods, respectively, the average monthly count of hospital-onset C diff infection was 1.79 (SD 1.51) and 1.03 (SD .96). During the pre- and post-periods, the corresponding average monthly rate (per 10,000 patient-days) was 7.94 (SD 6.30) and 4.71 (SD 4.42).

In the first model, the bed barrier was associated with a 59% (95% CI 36-96%, P = .034) reduction, while the rate of hospital-onset C diff infection in the fully saturated mode, the bed barrier was associated with a the 59% (95% CI 36-99%, P< .05) reduction. While using the bed barrier, no statistically significant increase was present in stage 2 or deep ulcers.

From their results, Hooker and his team concluded that a statistically and clinically significant reduction in hospital-onset C diff in the acute care hospital setting was associated with a launderable bed barrier.

“[The cover] basically allows the hospitals to do a couple of things. One, it [allows the hospitals] to ensure that the bed and bed deck are cleaned, which they aren’t doing today. Two, it allows them turn the room over quickly, yet still cleaned. Even though you pay for the cover and have to launder the cover, it ends up being cheaper because you prevent a lot of infections, and you get the bedrooms turned over quicker.”

This abstract “Use of a Launderable Mattress Barrier to Decrease Hospital Onset Clostridium difficile Infections in an Acute Care Hospital: A Retrospective Pre/Post Study,” was presented at the 6th International C diff Awareness Conference and Health EXPO in Philadelphia, Pennsylvania.