Foam surface safety: The forgotten vector for patient risk

Updated on February 4, 2025

Three steps for understanding and addressing the risks associated with foam support surfaces degradation 

Foam support surfaces in healthcare facilities are essential to patient care, comfort and recovery. But they can also be an overlooked source of infection risk for patients. 

While high-use support surfaces are often expected to last at least five years, research shows they can wear out more quickly. In fact, 50% of acute care support surfaces are compromised within 3.8 years, with failure odds increasing 67.6% for each additional year. And those that are compromised have a 5.83 times greater risk for cross-contamination.  

It is standard practice to change the linens and clean foam support surfaces between patient use, but knowing the condition of the foam underneath can be a blind spot – leaving the layers below prone to the buildup of bacteria and harmful pathogens if the surface is damaged. Foam support surface materials, construction and integrity are vital, and it is important to understand how these support surfaces degrade, the risks of damaged surfaces to patients, and how to help prevent them. 

The breakdown of support surfaces

Due to their frequent use in patient care, foam support surfaces can rip, tear and break down. A 2021 Cambridge University study of surfaces in use at four U.S. hospitals revealed 72% had damage: 47% needed top cover replacements, while 25% required complete replacement. 

Because of their frequent use in patient care, top covers are prone to damage such as rips, holes and tears. Once damaged, fluids can seep in and compromise the internal components of the surface. This fluid ingress damages the hidden layers and may expose patients to others’ bodily fluids. Over time, the use of harsh cleaning chemicals can further erode the top cover and the surface. The result of this damage and degradation is that patients may unknowingly be resting on a compromised surface. The FDA recommends regular inspection of all layers of foam support surfaces and replacing damaged covers and surfaces to reduce infection risk. 

How damaged support surfaces impact patients

Continued use of damaged foam support surfaces can increase patient risk due to cross-contamination. While the damage may seem as simple as a small tear, bacteria trapped between surface layers can be transferred from one patient to another. Another Cambridge University study found exposure to a previous bed occupant with infection contributes to a 5 to 6x increase in the odds of an infection in the next patient. 

How hospitals can protect their patients and their surfaces 

Preserving hospital mattresses’ integrity helps prevent not only infections but unnecessary spend for hospitals. Due to the impact of damaged foam support surfaces on patient safety, agencies such as the FDA and The Joint Commission have heightened their focus on these risks. Protecting patients and extending surfaces’ lifespan starts with conducting regular audits. 

To effectively audit, every layer of the surface must be inspected for damage. Something as small as a cut in the top cover, a broken zipper or a compromised fire barrier must be noted. The FDA, CDC and mattress manufacturers recommend replacing damaged mattresses or covers. Though costly, replacing foam support surfaces when needed can help prevent future patient injuries or infections, and improve patient outcomes.

In addition to completing regular audits of their support surfaces, hospitals should develop and follow clear policies and procedures for support surface assessment and monitoring. It is important to plan for ongoing replacements to cycle out impacted surfaces before significant damage occurs. When warranted, hospitals should refer to their audit results and look for specific materials and construction details when selecting the best replacements for their facility. 

New technology and materials such as specially formulated, chemically resistant top cover fabrics and RF-welded seams that permanently bond materials together have been shown to increase surface durability and longevity, resulting in less damage, fluid ingress – and less risk for patients. As evidence of this, an Agiliti study evaluated a total of 849 surfaces across 76 facilities and found that none of the 103 foam support surfaces that included a welded-shield required full replacement. Of the 743 surfaces evaluated that did not include a welded-shield, 75% sustained internal damage and required full surface replacement. 

Foam support surfaces see more use than almost any other piece of medical equipment – wear and tear is inevitable. But by assessing their foam support surfaces and taking precautionary steps, hospitals and facilities can expand the lifecycle of their surfaces and save money, all while protecting patients. 

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Tim McCarty
General Manager of Beds and Therapeutic Support Surfaces at 

Tim McCarty is General Manager of Beds and Therapeutic Support Surfaces atAgiliti, where he oversees the design and manufacturing ofAgilitibranded products as well as a diverse rental fleet of bed frames and surfaces.

Previously, he spent nearly 30 years withSizewise– a rental and capital provider of specialty beds, mobility aids and support surfaces – which was acquired byAgilitiin 2021. McCarty launched and ledSizewisethrough a period of rapid expansion, managing the acute care rental and capital sales teams, VA/Government team and National account team, while working extensively with design and manufacturing teams on new product development.