As a Clinical Consultant for a company that provides therapeutic support surfaces, I am frequently asked the question, “When should a support surface be replaced?” When is a surface “too old” to be of benefit to the patient? All mattresses have a finite life; therefore, determining when the life of the mattress has transitioned into risk for its occupants is paramount.
The financial and litigation risks to hospitals utilizing mattresses whose performance life has been exceeded are immense. This is due to the Centers for Medicare & Medicaid (CMS) policy on reimbursement for patients who experience a “never event.” Therefore, it is imperative for facilities to regularly assess surfaces for wear, proper support, tears and stains and replace surfaces when needed.
The National Pressure Ulcer Advisory Panel (NPUAP) Clinical Practice Guideline recommends verification that the support surface is used within its functional life span, as indicated by the manufacturer’s recommended test method (or other industry recognized test method) before use of the support surface.1 What exactly does that mean? Many manufacturers provide warranties that are frequently associated with the life expectancy of their support surfaces. It is much more than that though, as there are many points to consider when determining the life expectancy of a support surface in a facility, as highlighted below:
Design/Construction — Each support surface has a different mode of operation, construction and component parts. This provides a range of different clinical features to the clinician, and as a result of these differences, there are differing service-life periods.
Usage — Hospitals obtain and utilize their products in different manners. For example, rented support surfaces are subject to greater transportation and handling and, therefore, have different demands and life expectancy than a facility-owned product.
Storage and Aging Considerations — Support surfaces may be subject to a wide range of temperatures and humidity levels that can result in differing aging effects on different parts of the mattresses. One of the most widely known is the aging characteristic related to foam materials (used internally in many surfaces); the foam becomes less resilient or “springy” over time (even without use), so the support provided by the surface becomes less with increasing age. Another issue, perhaps even closer to the patient, relates to the cover. There is an aging/shelf-life effect where the actual chemical composition of the mattress cover material changes over time (typically due to hydrolysis in the cover material resulting from the moisture that is in the normal environment). The effect of this is that the surface can degrade though a change in performance over time (i.e., stretch characteristics decrease) and the sealing effectiveness (i.e., avoiding the ingress of liquids) can vary as a result.
Cleaning Effects — The process of cleaning and laundering the cover and the wiping of other parts may have an effect on the surface, particularly on the top cover. There is a wide range of cleaning materials used by hospitals that may include harsher materials outside of those recommended by the manufacturer.
Visual “End of Life” — Some foam-based mattresses are at the end of life as the foam has taken a “compression set,” and it is visible that it has deteriorated. There is an obvious dip in the mattress, and the foam does not compress. Other air-based mattresses do not show this aspect but, instead, do show the effect of inflatable cell damage/fatigue and leaks. Mattress covers with damage or a strikethrough are another obvious example.
Based on the above, it is difficult to say when a therapeutic support surface is “too old.” Patient safety risks are hard to argue against if a pressure injury does occur on an old mattress. It is widely accepted that the health economic assessment of the costs of a pressure injury are clear: Prevention costs less than treatment. Other products and patient safety items in a hospital are replaced routinely (e.g., smoke detectors, fire extinguishers, expiry-dated products, etc.). As a result, the replacement of other “older” products in a hospital is both well-understood and covered by facility guidelines. Many times, only financial limitations prevent the timely replacement of surfaces. Always keep the best interests of the patients in mind in order to provide optimal therapeutic benefits of support surfaces.
At Arjo, we are committed to improving the everyday lives of people affected by reduced mobility and age-related health challenges. So we encourage you to explore our broad portfolio of highly specialized therapeutic beds, mattress replacement systems, and range of other support surfaces.
- National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily Haesler (Ed.). Cambridge Media: Perth, Australia; 2014.