A Closer Look at Soft-Surface Contamination & Aerosolization
Soft surfaces – such as pillows and mattresses – pose a significant risk for the spread of infection within hospitals. In fact, ECRI Institute listed soft surfaces second on their list of Top Health Technology Hazards, stating: “Blood and other body fluids that remain on, or within, mattresses or mattress covers after cleaning can contact subsequent patients, posing an infection risk.”
While the COVID-19 pandemic has helped raise awareness around the transmission of pathogens via aerosolization, there is still a knowledge gap and lack of dialogue around the aerosolization of pathogens via soft surfaces.
Defining Soft Surfaces
All surfaces – whether they’re classified as hard or soft – are fomites, and can be defined as “objects or materials which are likely to carry infection, such as clothes, utensils, and furniture.” The term “soft surface” pertains specifically to items that can be compressed, allowing air to flow in and out of their interiors. Common objects that would be classified as “soft surfaces” in this category include: pillows, mattresses, OR pads and stretcher pads – all of which are in direct contact with the patient.
By design, soft surfaces pose a unique risk of contamination through the aerosolization of pathogens. These surfaces are traditionally made with stitched seams, surface perforations and porous materials, which allow harmful microbes to penetrate, proliferate and become aerosolized with each use. These soft surfaces also allow microbes to avoid disinfection agents, since most can only be disinfected topically.
More information about this issue is available in the HSI On-Demand Webinar: Challenges of Disinfection of Soft Porous Surfaces in Healthcare Environments
Soft Surfaces Pose a Significant Risk to Patients and Caregivers
In the healthcare setting, patients are in direct contact with soft surfaces for prolonged periods of time. Traditional hospital pillows – regardless of whether they’re considered disposable or reusable – absorb and expel pathogens with every movement or readjustment of the patient. Not only is this hazardous to the patients in direct contact with the pillows and mattresses, but also the caregivers, guests and hospital staff in the surrounding area.
Traditional hospital pillows are a known source of human respiratory pathogens. Adenoviruses, fungi, and bacteria have been detected at substantial loads on the surfaces (Russell et al., 2006; Woodcock et al., 2005), seams and possibly filling materials (Yacht et al., 2020) of used pillows. And despite their inability to be effectively disinfected, hospital pillows often migrate throughout the hospital and are used under multiple patients before being discarded – increasing the risk of cross contamination.
By taking a closer look at the novel coronavirus (COVID-19) as it pertains to soft surface contamination, we can understand the overall risk of soft surface aerosolization within healthcare facilities.
SARS-CoV-2 causes infections in the human respiratory tract and spreads through breathing, talking, coughing, sneezing, and drooling (Yoon and Yoon, 2020). Undoubtedly, pillows are in close contact with a patient’s mouth and nose for several hours a day (CDC, 2017). And while people are advised to wear masks / face coverings to prevent community transmission, it becomes a challenge to maintain full coverage of patients, especially during sleep. As a result, pillows are exposed to droplets exhaled from mouth and nose as well as saliva, making them a potential reservoir where SARS-CoV-2 could reside, accumulate, and aerosolize into the surrounding environment.
Preparing for a Cleaner, Safer Future in Healthcare
Soft surfaces must be considered a top priority when it comes to infection prevention. While the ultimate goal is to have a system-wide mandate that requires surface disinfectant compatibility and strict material regulations, there are still steps that facilities can take to minimize soft surface contamination, such as:
- Avoid products with stitched seams, which allow for pathogen ingress/egress
- Use products made with non-porous materials to prevent the absorption of fluids and pathogens
- Implement new technologies that block pathogen absorption without compromising product breathability, such as Spry Therapeutics’ patented filter technology that blocks up to .02 micron from entering soft surfaces.
In order to properly address the issue of soft surface contamination, the healthcare industry as a whole has a responsibility to:
- Fill in knowledge gaps surrounding surface contamination
- Address the risk of contaminated soft surfaces
- Adopt new technologies and set new protocols for infection prevention
- Commit to providing the safest possible care environment for patients, and the safest possible work environment for staff
As an industry, it is essential that we constantly re-evaluate our current practices to ensure the safety of our patients and staff. The COVID-19 pandemic has shed new light on the risks associated with the aerosolization of pathogens, and as such has created an opportunity for the healthcare industry to address aspects of infection control that were previously overlooked – including soft-surface contamination.