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Poster Series:

Unique Support Surface Construction Materials Influence Fluid Ingress, Longevity and Return on Investment

Neil Craney BSN, RN; Megan Hermann PT, DPT, CSPHA; Sarah Novotny PT, DPT, CWS, CLT-LANA, CFPS; Mikal Sanders PT, DPT; Stephanie Stoker BSN, RN; Kristen Thurman PT, MPT, CWS, CFPS
Surface replacement chart

Surfaces from other market leading manufacturers (B, C, D)

Surfaces with unique construction from Manufacturer A


Fifty percent of acute care support surfaces are compromised within 3.8 years with an increase in failure odds of 67.6% with each additional year of age.1 The FDA recommends regular inspection of the top cover and internal components for fluid ingress and damage and replacing damaged covers and surfaces to reduce the risk of infection to patients.2,3,4,5  


Risk for cross-contamination from compromised surfaces was shown to be 5.83 times that of controls.5 Replacing surfaces is costly. Preserving their integrity prevents not only infections but also unnecessary spend. 


Surfaces were inspected to observe top cover and internal component damage/staining.3 A top cover with holes/tears or internal staining is recommended for replacement.3 Once the top cover was removed, internal components were inspected for damage/staining/compression and recommended for replacement if observed. Various surfaces were selected to understand how different constructions impacted surface longevity.


A unique surface construction was assessed to understand if construction materials/methods decreased fluid ingress/cross-contamination and improved surface lifespan. 

Significant Differences Between Typical and Unique Construction:

Typical Construction

No Welded-Shield Layer
Sewn Seams
Standard Top Cover Fabric

Major Acute Care Support Surface Manufacturers top cover immersed in bleach for 5 days resulting in full delamination

Unique Construction

Welded-Shield Layer
RF-Welded Seams
Specially Formulated Top Cover Fabric (4-Way Stretch, Breathable, Waterproof)

Manufacturer A’s top cover immersed in bleach for 10 days resulting in no delamination

Support Surface Construction
No Welded-Shield Layer
Support Surface Construction
Sewn Seams
Support Surface Construction
Standard Top Cover Fabric

Major Acute Care Support Surface Manufacturers top cover immersed in bleach for 5 days resulting in full delamination


Support Surface Construction
Welded-Shield Layer
Support Surface Construction
RF-Welded Seams
Specially Formulated Top Cover Fabric
Specially Formulated Top Cover Fabric (4-Way Stretch, Breathable, Waterproof)

Manufacturer A’s top cover immersed in bleach for 10 days resulting in no delamination


Across 24 facilities, 422 surfaces from various manufacturers with an average age of 6 years were inspected:

  • Thirty-seven (37) surfaces (average age 5 years) contained a welded shield* to prevent fluid ingress if the top cover was damaged
    • None of these surfaces required full replacement, and
    • only 8% (3) required new top covers
  • Of the remaining 374 without a welded shield, 85% (318) sustained internal damage requiring full surface replacement

Frequent Damage Seen With Other Leading Manufacturers

Eroded Top Cover Frequent Damage

Construction: Top cover material is eroded by harsh chemical cleansers

Result: Degraded waterproofing material allows for fluid ingress

Sewn Seams

Construction: Sewn seams create thousands of holes in cover

Result: Holes allow fluid to permeate the interior components

Construction: Fiberglass fire barrier breaks down over time and is chemically treated

Result: No longer offers fire protection

Construction: Unprotected interior components

Result: Fluid ingress and contamination of interior components, requires full replacement of the surface for patient safety

Damage Prevented With Unique Support Surface Construction

Top cover unique Support Surface

Construction: Specially formulated top cover fabric

Result: No delamination of waterproofing, maintains integrity, and no fluid ingress

RF Welded Seams

Construction: RF-welded seams permanently bond the material on a molecular level

Result: Avoiding holes to join fabric prevents fluid intrusion

Fiberglass free barrier

Construction: Fiberglass-free fire barrier

Result: Remains intact over time ensuring adequate fire protection

welded shield protected damage

Construction: Welded shield protected interior components

Result: The welded shield prevents fluid ingress to interior components if top cover would get damaged, further preventing full replacement

Implications for Practice

Unique materials and construction prevented fluid ingress and contamination of surfaces preserving longevity of costly assets:

  • Previous studies have shown that most surfaces sustain internal damage triggering replacement in less than five years
  • None of the surfaces in this study with a welded shield required full replacement—only three top covers (~$1,300 less than cost of a new surface)

Taking this analysis further, the cost of replacing 318 surfaces would be ~$477,000—where replacing 8% of top covers only would be ~$6,000.

  • Surfaces with a welded-shield construction yield significant cost savings
  • Considering at 5 years the surfaces with welded shields did not require replacement, inspection of these surfaces beyond 5 years is warranted to understand total useful life

Additional Spend Required for Patient Safety
In a 400 Bed Hospital by Year 5

*Assuming $1,500 surface replacement cost

A= Agiliti®
B-D = Other market leading surface manufacturers
*Core Shield™ by Agiliti

Learn More

View our Resources page to learn more or contact Agiliti to learn strategies to help you better achieve your goals.

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Agiliti stands behind the authenticity of this data. Poster Presentation at the National Pressure Injury Advisory Panel (NPIAP) published on February 15, 2024


  1. Koshy T, Manista G, Nicholson L, Ikpeze T, Todd J, Black J. The state of support surface integrity in acute healthcare facilities. Poster presented at: NPIAP 2023 Annual Conference. March 17-19, 2023. San Diego, CA.
  2. “Safety Communications – Damaged or Worn Covers for Medical Bed Mattresses Pose Risk of Contamination and Patient Infection: FDA Safety Communication.” FDA Archive, Center for Devices and Radiological Health, Accessed 5 Sept. 2023.
  3. Center for Devices and Radiological Health. Covers for hospital bed mattresses – keep them safe. U.S. Food and Drug Administration. Accessed September 27, 2023.
  4. Creamer E, Humphreys H. Journal of Hospital Infection. The contribution of beds to healthcare-associated infection: the importance of adequate decontamination.
  5. Sivek A, Davis J. How Wet Is Your Patient’s Bed? Blood, Urine, and Microbiological Contamination of Mattresses and Mattress Covers. Patient Safety Advisory. 2018;15(4).