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What Lie’s Beneath


shutterstock_132572702 BHTA guidance to assist in choosing an appropriate healthcare polyurethane foam mattress

In April 2014, the National Institute for Health and Care Excellence (NICE) published a clinical guidance document (cg179)1 on prevention and management of pressure ulcers, superseding guidance issued in 2005 (cg29). Within the guidance, there are several references to ‘High Specification Foam Mattresses’ – terminology used in a number of studies – alongside recommendations for their use.

Members of the BHTA Beds and Support Surfaces Section have argued that the term should not be used as there is no grounds to use the words ‘High Specification’. There is also concern that the terminology unwittingly creates confusion and allows any manufacturer to lay claim to providing a ‘high specification foam mattress’ without a benchmark against which to make this claim. It takes the focus away from the principles of holistic clinical care and proper risk assessment, and their leading to selection of a mattress that will deliver the desired outcome for a patient.

Looking at the different clinical requirements and physical properties for foam mattresses, different properties and their values come into play depending on the needs identified. A single property that might be considered a “high” specification in relation to one patient could well be a “low” specification for the next.

Note 1. When cg179 was reviewed in 2018, NICE decided not to make any changes despite it being pointed out by the BHTA that there is shutterstock_335091281no universally accepted (see Note 2) definition of High Specification Foam.
Note 2. The Cochrane Review (CD001735)2 states “It should be emphasised, however, that there is no international definition of what constitutes a standard foam hospital mattress, and, indeed, this changes over time within countries, and even within hospitals.” However, in the Pan Pacific Clinical Practice Guideline for the Prevention and Management of Pressure Injury (2012)3, there is a table offering minimum recommendations for high specification foam mattresses. The recommendations are somewhat vague in places, and this material has not been validated elsewhere, see Table 6 Annex D.

Different healthcare environments have differing needs from their respective mattress options – for example, a mattress used in a surgical ward with 24/7 demands will generally have contrasting materials requirements than a less frequently used day care unit. Likewise, it would be perfectly feasible to have a mattress that could be described as being made of ‘high specification foam’ containing, say, high density foam with a non-stretch cover, but which would still not necessarily protect against the risk of developing pressure ulcers. It is the patient who is at ‘high risk’, not the product.

In the absence of suitable knowledge and guidance as to what a ‘high specification mattress’ should be, it is tempting for organisations to shutterstock_184925012purchase lower priced mattresses to try to reduce costs, but in doing so potentially sacrifice quality. This can lead to purchase of mattresses which fail prematurely, in turn leading to the cost of replacement often outweighing the original savings made.

In this document we describe the various features that contribute to the performance of a pressure re-distributing mattress and which, as such, should be considered when selecting one that is appropriate for the clinical setting in which it is to be used, in line with assessment of the care needed by the patient. It provides background information on key aspects to consider.

Foam density, hardness, cover fabric, and a number of other characteristics, all play a part, and claims about the performance of the final product should be supported by evidence from testing and clinical evaluation. No one factor should be taken in isolation, and it should be remembered that the mattress is a composite of foam and cover.

This guidance is intended to help clinical practitioners and procurement teams make an informed decision as to their choice of options available on the market.

Note 3. We have included signposting of appropriate standards where they exist. BS standards can be purchased from the British Standards Institute (BSI)4; ISO standards from BSI or from the International Organization for Standardization (ISO)5; and the DIN standard from Beuth6.

Note 4. Where values are expressed these are for guidance and understanding only. This document must not be taken as a ‘prescription’ for future product.

Note 5. This document relates only to foam mattresses, and does not apply to hybrid foam and air mattresses, nor to alternating pressure mattresses

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