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The evolution of sleep surface fabrics: selection guidelines.

Today's nursing home has a wide variety of sleep surface fabrics to choose from. Unfortunately, there is little information available to assist in evaluating and selecting sleep surface coverings. This results, in part, from lack of knowledge of how they have evolved over recent years toward more effective (and therefore cost-effective) resident care.

The ideal sleep surface fabric is fluid-proof, bacteria- and stain-resistant, durable, easy to maintain and comfortable. It is sufficiently pliable to conform to and allow the inner construction of a specialized mattress to perform its intended function.

Of course, all improvements come at a cost. Newer sleep fabrics are at least double the price of the standard "green vinyl" fabric found in the industry for the past two decades. Secondly, mattresses manufactured to reduce the incidence of pressure ulcers range in price from $150 to $2,000. Therefore, if a nursing home were interested in replacing all of their standard ($75) inner spring mattresses with their modem equivalents, one could anticipate a two-fold cost increase.

But the real issue is not one of initial outlay, but of long-term savings and cost-effectiveness. As healthcare professionals and patient advocates, it is our responsibility to employ products that provide patient comfort and ease of use, while effectively reducing real treatment costs. Given the multi-billion dollar expense of pressure ulcer treatment, the newer products can ultimately prove to be a very economical investment.

The selection process involves investigating all aspects of the sleep surface, rather than limiting evaluation to the inner construction alone. Applying the following questions to the various products available will aid in this process:

* Is the fabric fluid-proof against contamination from liquids and body fluids?

* Is the fabric bacteria-resistant against common organisms such as E coli, Staphyloccus aureus (inclusive of methicillin-resistant strains), etc.?

* Is the fabric stain-resistant and easily and properly cleaned with the germicidal cleanser used by the facility?

* Is the fabric fire-resistant according to published standards?

* Is the fabric conformable/pliable to complement the inner construction of the support surface?

* Is the fabric comfortable?

Establishing priorities (what does your facility truly need?) is key to the selection process, as is comparing the advantages and disadvantages of each fabric. A poor choice of fabric covering can negate the benefits of the best mattress and sleep surface design.

"Green vinyl," a three-ply vinyl laminate, continues to serve as a well-accepted mattress ticking fabric. It is bacteria- and stain-resistant, fluid-proof, easily maintained, and durable. However, when the decision is made to purchase specially designed pressure management mattresses, the selection process becomes more complex.

There are some potential problems that the end user may encounter. For example, the "green vinyl" fabric falls short as an acceptable product for pressure management mattresses since it is stiff by nature. Also, poor heat conductivity can lead to increased perspiration and maceration, and a lack of pliability makes the fabric difficult to fit to many specialty support surfaces, including those intended to reduce pressure.

Much more pliable and far softer to the touch is a coated nylon fabric originally developed for use in the apparel industry. The non-coated side is usually placed next to the skin, making the fabric feel cooler and more comfortable. Unfortunately, the noncoated side makes the fabric a haven for bacterial growth. Debris and bacteria collect in the fabric bundles of the woven material, and the weave itself may trap bacteria and prevent their removal with general housekeeping cleansers and procedures. The soft surface is also more easily stained and tends to be slippery when residents attempt to sit up in bed.

One of the newest ticking fabrics is a two-ply laminate knit (staphCHEK Comfort |R~, from Herculite Products, Inc.) The surface is smooth and easily cleaned and maintained. The fabric is highly resistant to both staining and bacterial growth. The fabric's knit construction makes it soft and pliable, and the two-ply laminate conforms easily to any mattress. Combining this fabric with a pressure-reducing mattress or under-structure is proven effective in reducing the incidence of pressure ulcers.

In short, this is yet another example from the nursing home field of how close attention to residents' problems and their needs is resulting in new generations of highly effective products, often working in synergy with one another.

Cathy Thomas Hess, RN, BSN, CETN, is Director of Clinical and Professional Services at Signature Health Services, Inc. in Exton, PA. She is author/narrator of the video/workbook Fundamentals of Successful Wound Healing: An Educational Approach for the Quality Caregiver.
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Title Annotation:Nursing Home Technology
Author:Hess, Cathy Thomas
Publication:Nursing Homes
Date:May 1, 1994
Previous Article:Preparing the nursing staff for the unexpected.
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