Strikethrough is a term being heard more often in healthcare these days. The term is applied to soft surfaces and textiles, and the fluids and micro-organisms that can cross a barrier surface, or strike through it. In hospitals, this term is used in relation to such things as surgical drapes, surgeon gowns, wound dressings and mattress surfaces.

There is more widespread risk of infection associated with the loss of barrier integrity of hospital mattress surfaces than any other strikethrough compromised surface in healthcare. Strikethrough, in this case, goes in both directions, sending pathogenic contamination into the mattress substrates from the invasion of body fluids, skin cells and organisms of an infected patient lying on the mattress.

Whatever goes into the mattress substrate is sent out by the application of pressure (sitting, lying down, etc.). These fluids exiting the mattress through rips, tears, surface deterioration and pin holes are potentially infectious bioburden to an unsuspecting patient. Strikethrough can be either visible or invisible. The damaged mattress must either be replaced or fitted with a new cover, costing anywhere between $250 to $3,000. Fitted sheets offer no barrier between the compromised surface and the patient’s skin.

Then there’s the second lie beneath the sheets: the issue with the mattress Manufacturer’s Instructions for Use (IFUs). IFUs commonly don’t allow disinfectant to pool on the support surface, but this does not take into account dwell time. They also state to wipe each product with clean water and thoroughly dry each product after cleaning because some cleaning agents are corrosive and may cause damage if used improperly.

A mattress surface becomes compromised when manufacturers’ IFUs aren’t followed. Chances are good that the disinfectant being used to perform between case or terminal disinfection of mattresses is an off-label use of an EPA-registered disinfectant, which voids the manufacturer’s IFU.

Disinfecting Alternatives

Since environmental service departments can’t disinfect soft surfaces, some facilities are switching to disposable items when possible. Disposable privacy curtains and blood pressure cuffs can be easily and quickly changed between patients.

Laundering with hot water and bleach is another option for some soft surfaces, such as privacy curtains and certain mattress covers.

Steam vapor equipment uses heat to effectively disinfect both soft and hard surfaces. Steam can penetrate the porous surfaces of fabric found in chairs, privacy curtains and mattresses. Studies have shown that steam can kill viruses and antibiotic-resistant bacteria in five seconds.

Jan/san distributors can offer these alternatives for disinfecting to their hospital clients. Unfortunately, one thing they can’t provide is additional time. Cleaning personnel aren’t given adequate time to disinfect both hard and soft surfaces. However, distributors can work together with their customers to continually improve the situation with the resources they currently have.

J. Darrel Hicks, BA, CHESP, MRE is the author of “Infection Prevention For Dummies.” He can reached at or visit for more information.

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The Problem With Sanitizing Soft Surfaces