Are your mattresses putting patients at risk? You need to know now

Learn the telltale signs that your mattresses need replacing and why it’s important.

Medline clinicians conducted assessments of more than 25,000 support surfaces in 300 facilities, and nearly 60 percent of them were deemed high risk, mostly for holes or tears, and improper pressure redistribution properties.1 This breakdown in support can lead to serious breakdown in skin integrity for your patients, putting them at risk for facility-acquired infection and pressure injuries.

Wondering if your mattresses could pose a risk to patients? A professional assessment is a valuable practice, but it’s also important for healthcare staff to know how to recognize a support surface that could prove unsafe.”Regular evaluation of existing surfaces is just as important as choosing the right surface for a pressure injury prevention and treatment program,” says Medline National Clinical Specialist Jackie Todd, MBA, BS, BSN, CWCN, DAPWCA.2 The US Food and Drug Administration also reminds facilities to check the manufacturer’s expected lifespan for the cover and mattress.3

“Regular evaluation of existing surfaces is just as important as choosing the right surface for a pressure injury prevention and treatment program.”2
— Jackie Todd, Medline National Clinical Education Specialist, MBA, BS, BSN, RN, CWCN, DAPWCA.

Here, we discuss two key areas of mattress assessment that help you spot mattress failure and lower patient risk:

1. Cover condition

  • Wearing or thinning
  • Tears
  • Contamination

Clues on cover condition
In its flyer, “Keeping Patients Safe from Contaminated Mattresses,” the US Food and Drug Administration stresses the role of the mattress cover and cautions, “Worn or damaged covers can let fluids inside the mattress, posing a risk of infection to patients.”3

Learn to spot extensive wear or thinning of the mattress cover, which could allow fluids to leak into the surface, Todd notes.2 Besides the infection risk, Todd explains, “Once foam gets wet, it loses its resiliency and ability to bounce back, making it unable to adequately provide pressure redistribution.”

Remember to check the corners of the mattress cover, where worn or frayed material could indicate broken seams that may leak. Todd says even the smallest punctures from medical devices or needles can be cause for concern. She also advises close inspection of any zippers, “as a dysfunctional zipper can lead to moisture damage of the mattress as well as infection control issues.”

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If the cover is undamaged, then make time for maintenance. The FDA recommends cleaning and disinfecting it, being sure to take note of the cleaner manufacturer’s proper process and sporicidal kill time. After waiting the appropriate time, follow up by rinsing off the cleaner residue with clear water and a clean cloth.

Key signs your mattress needs replacing:

2. Internal integrity

  • Bottoming out
  • Condition of internal structures
  • Failure with articulation

What’s going on inside?
Maintaining internal structural integrity is essential for proper support. If internal components are compromised, Todd says, “then their ability to provide adequate support, meaning weight distribution, no longer exists, and bottoming-out can occur.” This bottoming-out effect means there’s more direct pressure on bony prominences and other tissues, Todd explains. “Sustained pressure on bony prominences for prolonged periods of time will lead to capillary compromise, ischemia and tissue death, resulting in pressure injury formation,” she says.

In addition, improper weight redistribution and positioning can further increase the risk of potential injury due to friction and shear forces. “Remember,” Todd stresses, “a small amount of pressure over a long period of time can do as much damage as a large amount of pressure in a short period of time.”

In order to determine the condition of the mattress, the FDA advises assessment of the cover and, if indicated, the internal components. Many covers are dark in color and could camouflage stains and subtle evidence of damage or contamination, so careful examination is important. Depending on the condition of the cover, it may be necessary to remove it and evaluate the inside of the cover as well as the internal components for contamination, moisture and odor.3

As you look at the mattress itself, take notes on what you see.
  • For foam surfaces, does it flatten out or completely compress with weight applied, and does it bounce back readily or is the bounce back slow or nothing at all?
  • Are there gaps or separations in the internal foam either with or without weight applied?
  • Does the foam bunch up in areas?
  • If there are tubing or connectors as part of the internal components, are connections intact between each of the internal components or are they disconnected, cracked, broken or torn?

Getting a mattress assessment and ensuring your facility has the right support surfaces in place are the foundation to pressure injury prevention protocol and reduction of cross contamination. Learn more about the many Skin Health Solutions available to you.


  1. Medline Industries, LP Data on File
  2. Todd, Jackie, “Understanding Support Surface Terminology,” and “Pressure Ulcer Etiology and Support Surface Selection.” Medline Industries, LP Data on File.
  3. (Accessed March 1)