Jun 18, 2018

How Clean are the Pillows in Your Hospital?


When patients are admitted into a hospital room that has been prepared for a new patient, they anticipate the room has been properly disinfected and is free from harmful pathogens known to cause healthcare-associated infections (HAIs). As practitioners in infection control and prevention, we know that despite the use of strong disinfectants and rigid protocols for cleaning and disinfection; oftentimes, pathogens are left behind on surfaces.


From -



The study team at Promise Hospital includes (from left) Victor R. Lange, infection preventionist; Joseph Baran Jr., MD, infectious diseases; and Peter C. Juan Jr., director of laboratory services. By Victor Lange, MSPH, CRC, ICP, JD(c) When patients are admitted into a hospital room that has been prepared for a new patient, they anticipate the room has been properly disinfected and is free from harmful pathogens known to cause healthcare-associated infections (HAIs).  As practitioners in infection control and prevention, we know that despite the use of strong disinfectants and rigid protocols for cleaning and disinfection; oftentimes, pathogens are left behind on surfaces.


HAIs are a major cause of patient morbidity and mortality. Often the main source of these pathogens is the patient's own endogenous flora. Yet, researchers have projected that approximately 20 percent to 40 percent of HAIs are associated with cross -ontamination by way of contact contamination from the hands of healthcare personnel who have touched contaminated patients or contaminated environmental surfaces.1 Several studies discuss the strong role environmental contamination plays in the transmission of methicillin-resistant Staphylococcus aureus and Vancomycin-resistant Enterococcus species.(1)


Nosocomial transmission of norovirus, Clostridium difficile, and Acinetobacter spp can come from environmental contamination.(1) These pathogens can survive on environmental surfaces for long periods of time. The hospital environment is well recognized as an increasingly important source of healthcare-associated infection; yet the environment in which the patient spends the most time, the hospital bed and pillow, are often overlooked when it comes to finding the source. So, at our facility, we decided to investigate patient pillows.


Over a five-week period, swab cultures (n=100) were obtained from  reusable vinyl covered pillows to determine if pathogens remained on the pillow post environmental services disinfection with a commonly used quaternary ammonium solution. The vinyl surface of the pillow was swabbed with a sterile, polyester-tipped applicator and placed in a sterile tube of sodium chloride solution. The tube was vortexed and swab discarded. Soybean-Casein Digest Agar plates were inoculated with 100 microliters of the eluate and incubated at 360 degrees C for 72 hours. Pathogens were identified according to established industry practices.


We found that the patient-ready, decontaminated reusable vinyl covered pillows in use at our hospital were in fact contaminated with pathogenic bacteria. Thirty eight (38 percent) of the 100 disinfected patient ready pillows cultured were contaminated with infection causing pathogens including  methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), Enterococcus faecalis (E faecalis), Escherichia coli (E coli), Providencia stuartii (P stuartii), Yeast, Coagulase-negative Staphylococci (CNS), Klebsiella pneumoniae (K pneumoniae), Bacillus species, Gram-positive Cocci and Diptheroids (95 percent CI, P < .016). Three pillows were found to harbor more than three pathogens on each pillow and 15 pillows had more than two pathogens on each pillow.


Reusable patient pillows pose a cross-contamination risk. Variability in disinfection technique, pillow condition, and the effectiveness of disinfectant make it difficult to completely clean and disinfect the pillow. Cross-contamination may occur from the pillow to the patient, from the pillow to the healthcare worker to patient, and from the patient to the pillow. Clear and rigorous guidelines should be established for decontamination of patient beds and pillows. Outbreak investigations should include assessment of pillows and mattresses. At our institution, this finding led us to make a temporary switch to disposable pillows. We are currently reviewing other options such as a barrier pillow cover with and without antimicrobial protection.


Victor Lange, MSPH, CRC, ICP, JD(c), is director of infection control at Promise Hospital in San Diego.

Reference: 1. Weber D, Rutala W, Miller M, Huslage K, Sickbert-Bennet E. Role of hospital surfaces in the transmission of emerging healthcare-associated pathogens; norovirus, Clostridium difficile, and Acinetobacter species. American Journal of Infection Control, 2010 Jun; 35 (5 Suppl 1) S25-33.

New Posts
  • Admin
    Jun 12, 2018

    AND a 38% decrease in direct costs This independent research was just released at the APIC2018 Conference in Minneapolis. The study involved SleepAngel pillows in an ICU environment in the Kingdom of Saudi Arabia. I will update the post with the link to the study and the poster when I have a public link to share: What is the impact of introducing barrier pillows into a tertiary care hospital in Saudi Arabia? Bassel Molaeb, MPH, CIC, FAPIC - Infection Control Director, Al-Moosa Specialist Hospital Background: There is substantial evidence indicating that pillows contribute to the cross-transmission of pathogens and this is attributed to the variability in disinfection technique and the pillow condition and construction. On the other hand, the costs of pillow laundry and replacement are always overlooked. This study discusses the impact of introducing barrier pillows into a tertiary care hospital in Saudi Arabia on cost and incidence density of multidrug-resistant Acinetobacter baumannii (MDR-ACB) in the intensive care unit (ICU). Methods: Barrier pillows were introduced to replace regular pillows in the hospital. The differences in purchase cost in addition to laundry costs in the pre-intervention (November 2016 to April 2017) versus the post-intervention (May 2017 to October 2017) phases were compared. All infection prevention practices were maintained the same in ICU and the incidence density of MDR-ACB was reviewed and analyzed during the study period. The overall cost savings and the decrease in MDR-ACB incidence density in ICU were analyzed using Z-test and p-value of less than 0.05 was considered statistically significant. Results: The intervention resulted in 38% cost reduction (p-value<0.05) with the elimination of laundry costs. In addition, a significant 58% decrease in the MDR-ACB incidence density was observed during the post-intervention phase as compared to the pre-intervention phase. Conclusions: Substantial cost savings are achieved by introducing barrier pillows since they are reusable and require standard surface cleaning only thus making laundry obsolete. Barrier pillows reduce replacement frequency because they are durable and decrease infection risks since no fluids and contaminants can enter the inner of the pillow due to the barrier filter protection and presence of a completely welded seam. The decrease in the MDR-ACB incidence is noted after introducing the barrier pillows although there were no major changes in the infection prevention practices in ICU during the post intervention phase. Keywords: Barrier pillows, cost reduction, incidence density
  • Admin
    Jun 12, 2018

    - By David Woolfson - Founder   My daughter Eve suffered with allergies from a young age. She would have restless nights  and wake up with her eyes red and streaming and complexion blotchy. It used to upset us to see her like that because she is a girl who so loves to enjoy life. We resolved to do something and began by trying the anti-allergy and wellness pillows that were on the market – none of them worked; no benefit whatsoever despite all the wild and wonderful claims that they made.  Eve told me that she thought I was clever and that I would come up with a solution and whilst we so often think that a child’s motivation to succeed is to impress their parents it is surely also true in the other direction. I began to research and it quickly became evident that there was an untold health problem from bedding. The evidence made it clear that it relates to all bedding, in fact everywhere we sleep – in the hospital, hotel and in the home. Put simply, micro-contaminants, for example – dust mites and their allergens and various pathogens can get into and out of our pillows and mattresses through the fabric and the stitching holes. To make matters worse, we might not like to think about it but we humans shed at night – we shed dead skin, we shed sweat and all this enters our pillows and mattresses and mixes in there forming mould and bacteria. Then when we compress our pillow or mattress by lying on them, these things are pushed out into our intimate-environment and right where we are most vulnerable – the eyes, the mouth, the ears and nose. Indeed our skin is our great hygienic protector. It is actually an organ – the largest of the human organs – and when it is breached like when we get a cut or through our intimate-environment, that is when problems occur. In the hospital, this can be very serious indeed as bedding can act as a reservoir and vector for infections including superbugs. In the hotel, your intimate environment can be made up of whatever the previous guests were suffering from or “shed”. In fact I’ll always remember the time we visited hVIVO in London – a global leader in the prevention and treatment of viruses – and the founder, Professor John Oxford, told us that they had just identified that the flu virus can live in a pillow for up to 24 hours “so if the guest in the hotel before you had the flu, the chances are you are going to get it too”. In our homes the problems posed by contaminated bedding are different but can really affect our quality of sleep and quality of life like in Eve’s case, but also we can all suffer in terms of skincare or from inflamed sinuses from inhaling contaminants. There are many people who have no problems breathing in fresh air in the daytime but soon after they get into bed they are feeling “stuffed-up” and their breathing is impaired. So why do the anti-allergy and “healthy” and “wellness” pillows and mattresses not work? Because they are getting breached all the time. Allergens and microbes are far smaller than fabric pores and stitching holes.  Even if the seams are sealed they have to have a way for air to get in and out to function and so if a zipper is used, the bugs are way smaller than the gaps between the zipper teeth and if a vent is used well that is the worst of all worlds as the vent acts like an aerosol. My thinking kept coming back to how clever our skin is – preventing unsavoury things getting inside but breathing all the time, keeping us comfortable. Pillows and mattresses should do the same. They should be made with  materials that perform in the same way – materials that filter the air going in and coming out. I knew that new technical/performance textiles would work for the cover because they are vapour-permeable so they allow heat and moisture to dissipate; the challenge was to design a filter medium that would act like a synthetic skin with enhanced breathability.   Enter Dr Bain – Dr Duncan Bain is the leading biomedical engineer in the field of “support surface technology” and a good friend of mine. How he became a good friend is a funny story for another day. Duncan and I worked together and eventually came up with what is known today as PneumaPure Filter technology (PPt). PPt works because it is a 100% proven barrier to the ingress and egress of allergens, mould  and even the smallest pathogens including flu virus, norovirus, SARS, and MRSA. But crucially the PPt filter means that the only thing that can get into and out of your pillow is clean pure air. It has been proven in independent laboratory testing and clinical trials around the world but more than anything it is proven because it has made an  important improvement for people.  It has been adopted by leading hospitals around the world (by the way hVIVO now use PPt products in their rooms), the hotel range is about to launch and people are benefitting  in their  homes in over 30 countries. And that brings us nicely back to my home where we all sleep on SleepAngel bedding and where Eve always goes to bed too late and always gets up too late but she sleeps well and wakes up perfect. - David Woolfson

© 2018 by SaluSleep Inc. Canada

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