Introduction

Although the phrase ‘high specification foam mattress’ has been common in the industry for several decades, its continued use today is now a cause for concern.

The first ‘high specification foam mattresses’ were introduced around the 1990s. These incorporated multiple construct layers of different foams, some of which might be castellated and/or shaped, and then enveloped in stretch covers to provide improved pressure reducing properties when compared with the then, ‘standard hospital mattress’, which was essentially a single rectangular block of foam protected by a non-stretch cover. Over time these more advanced, complicated multi-layer constructs have themselves now become the norm, completely replacing the old product in most modern hospitals.

Continued use of the ‘high specification’ terminology creates the risk of confusion and allows manufacturers to lay claim to providing a ‘high specification foam mattress’ without an agreed benchmark against which to justify this claim. The continued use of this phrase also takes the focus away from the principles of holistic care and the correct risk assessment leading hopefully to the selection of the mattress that will most likely deliver the desired outcome depending on the needs of the patient.

Looking at the different clinical requirements and physical properties for foam mattresses, different properties and their values come into play depending on the identified needs. A single property that might be considered ‘high’ specification or highly desirable in relation to one patient or healthcare environment could well be deemed ‘low’ or somewhat unimportant when considered against the needs of the next patient in a different environment. Ultimately, it is the performance of the mattress as a whole, within its environment, rather than any individual component part of it, that is important.

Understanding the characteristics of foam can help inform and potentially aid in the choice when several products are available. However, it is the performance of the complete product, based on the individual’s assessed needs, which is critical to ensure optimal patient care.

Without knowing the current (and often evolving) clinical needs of every particular user, it is not possible to define clearly a nominal or minimal/maximal performance specification that needs to be met or surpassed by the final product.

Additional safety standards, such as fire resistance at a component and/or final product level, exist in relation to the foam product addressed in this document. The minimum level of resistance legally required potentially differs depending on the application environment, for example domestic versus hospital use. The flammability requirements and test methods used currently differ depending on the country or state of use.

The manufacturer is required to explain and corroborate any claims made concerning the important features of their product and how these features assure the clinical efficiency of their product over its expected lifetime.

Based on this information and/or local, national or international requirements, it remains, however, the responsibility of the user to determine if the foam proposed provides merely adequate behaviour or exceeds by a significant amount the performance required.

Not all of the proposed tests need to be carried out to give an indication of a foam's performance and some of the proposed tests will not be considered relevant for some types of foam.

These test methods can be used to identify differing performance characteristics between products thus indicating the potential superior performance of one foam over another.

It is emphasized that the test methods specified in this document do not necessarily simulate conditions of use in practice. The use of resulting data is therefore restricted to a broad comparative assessment between different foam products.

It is recommended that no single result be taken in isolation. The clinical efficiency of the final product will also be the result of many different contributory factors, a large number of which will not be related to the foam’s physical properties.

The type of cover (fabric or other) used on the APTI can have a significant effect on overall clinical performance of the final product. An incorrectly fitted cover, or changing the cover to a product other than that specified by the manufacturer, will possibly affect product safety, performance and durability.

Continued use of a damaged cover can result in penetration of liquids into the foam, not only potentially affecting its performance, but also increasing the risk of cross contamination.

The type of bedframe, or support, onto which the APTI is placed potentially affects the performance of the final product. Overall product dimensions need to be taken into account not only to ensure that the APTI can function correctly, but also to ensure that no entrapment hazards are created between the frame and the APTI.

PD ISO/TR 20342-7:2021

Assistive products for tissue integrity when lying down - Foam properties, characteristics and performance

Current

Published:

31 Aug 2021