BIOSECURITY IN PRACTICE — Cleaning and Sanitizing Hospital Beds
Practical Guide for Conservation, Biosecurity, and Procedure Standardization
Objective of this Guide
To guide healthcare professionals on best practices for cleaning and sanitizing hospital beds, integrating biosecurity, equipment conservation, and operational standardization — contributing to the prevention of cross-transmission of microorganisms, extending equipment lifespan, and improving the quality of care.
Introduction
The hospital bed is among the most used equipment in any healthcare service. Throughout its useful life, it can accommodate hundreds or even thousands of patients, being continuously employed in hospitals, clinics, urgent care units, long-term care facilities for the elderly (LTCFs), rehabilitation centers, and home care services.
Due to prolonged and direct contact with the patient, the equipment is constantly exposed to sweat, secretions, body fluids, organic residues, and microorganisms originating from both the patient and the care environment. Furthermore, various components are repeatedly handled by healthcare professionals, companions, and support teams, making them high-touch surfaces and requiring rigorous cleaning and disinfection procedures.
In this context, hospital bed sanitization represents one of the main measures to reduce the risk of cross-transmission of microorganisms, preserve equipment integrity, and contribute to patient safety and the quality of care provided.
However, correctly sanitizing a hospital bed goes far beyond the simple application of a sanitizing agent. The equipment brings together different materials — such as carbon steel with electrostatic paint, stainless steel, aluminum, engineering polymers, mattresses covered in PVC or polyurethane, rubber components, electronic controls, and electric actuators — each with specific characteristics and different levels of chemical compatibility with the products used in cleaning and disinfection.
At the same time, infection prevention and control protocols require these procedures to be executed in a standardized manner, respecting the guidelines of the Hospital Infection Control Committee (HICC), the recommendations of the National Health Surveillance Agency (Anvisa), and the instructions provided by equipment manufacturers and sanitizing agents used in routine care.
For this reason, this guide was developed to integrate two objectives that must permanently go hand in hand:
- Preserve the lifespan of the hospital bed;
- Adopt procedures compatible with good biosecurity practices.
Throughout this article, the main concepts related to hospital bed sanitization, the different types of cleaning performed in healthcare services, the components that require greater attention, the Dental Access Technical Matrix of Product and Material Compatibility, operational flowcharts, a Standard Operating Procedure (SOP) model, audit checklists, and practical guidelines for implementing standardized sanitization routines will be presented.
Illustration 1 – Functional Anatomy of the Hospital Bed
Objective of the illustration
Visually present the main components of the hospital bed mentioned throughout the article, facilitating their identification during cleaning and sanitization procedures.
Elements identified in the illustration
- Side rails
- Headboard
- Footboard
- Hospital mattress
- Electrical controls
- Remote control
- Side structure
- Casters
- Pedals
- IV pole
- Patient call bell
The numerical identification allows components to be easily recognized throughout the article, avoiding descriptive repetitions and favoring future translations.
Why is Hospital Bed Sanitization so Important?
Among all the equipment in a care environment, few remain in contact with the patient for as long as the hospital bed. During hospitalization, almost all care activities occur on or around it: the patient rests, eats, receives medication, undergoes procedures, and is examined by different professionals — often remaining hospitalized for days or weeks on the same equipment.
In addition to the patient, the bed is continuously handled by nurses, nursing technicians, doctors, physical therapists, hospital hospitality teams, cleaning professionals, companions, and visitors. This intense use transforms various components into high-touch surfaces, requiring rigorous cleaning and disinfection routines.
Main high-touch surfaces
| Component | Contact level |
|---|---|
| Side rails | Very high |
| Electrical controls | Very high |
| Remote control | Very high |
| Headboard | High |
| Footboard | High |
| Hospital mattress | Very high |
| Patient call bell | Very high |
| Overbed table | Very high |
| Bedside table | High |
| IV pole (adjustment area) | High |
Hospital Bed or Patient Unit?
Although frequently used as synonyms, hospital bed and patient unit represent distinct concepts.
The hospital bed refers exclusively to the equipment used for patient accommodation, including its structure, mattress, side rails, headboards, controls, and other components that make up the bed.
The patient unit, on the other hand, corresponds to the set formed by the hospital bed and all the elements that accompany it during hospitalization.
Components of the Patient Unit
| Element | Part of the Patient Unit |
|---|---|
| Hospital bed | ✓ |
| Mattress | ✓ |
| Pillow | ✓ |
| Overbed table | ✓ |
| Bedside table | ✓ |
| IV pole | ✓ |
| Call bell | ✓ |
| Companion chair | ✓ |
| Armchair | ✓ |
| Bedside monitoring equipment | ✓ |
Illustration 2 – Patient Unit
Objective of the illustration
To demonstrate, in a single image, the difference between the hospital bed and the patient unit, identifying all the elements that normally make up this care environment.
This representation facilitates the understanding of protocols that cover only the hospital bed and those that involve the entire patient unit.
Conservation and Biosecurity: Two Inseparable Objectives
A relatively common misconception is to believe that hospital bed sanitization should exclusively prioritize the elimination of microorganisms. While this is an essential objective, it cannot be achieved at the expense of degrading the materials that make up the equipment. Likewise, limiting oneself to the bed manufacturer's recommendations, ignoring infection prevention and control protocols, also does not meet the demands of a care environment.
For this reason, this guide adopts the principle of Dual Compliance, according to which a sanitization procedure is only considered adequate when it simultaneously meets the requirements of equipment conservation and good biosecurity practices.
Principle of Dual Compliance
| Equipment Conservation | Biosecurity | Integrated Best Practice |
|---|---|---|
| Preserve the lifespan of the hospital bed. | Reduce the risk of cross-transmission of microorganisms. | Integrate patient safety and asset conservation. |
| Avoid corrosion, wear, and warranty loss. | Standardize cleaning and disinfection according to institutional protocols. | Select products compatible with the materials and the purpose of the procedure. |
| Maintain safe operation of mechanical and electrical components. | Promote a safer care environment for patients and professionals. | Simultaneously follow the recommendations of the bed manufacturer and the sanitizing agent used. |
PART 2 — Dental Access Technical Matrix of Product and Material Compatibility
The selection of the sanitizing agent used in hospital bed sanitization must simultaneously consider its microbiological efficacy and its compatibility with the materials present in the equipment. A product suitable for a given surface can cause degradation, loss of finish, drying out of polymeric components, metallic corrosion, or damage to electronic systems when applied improperly.
For this reason, it is recommended that product selection be based on technical criteria, taking into account the type of material, frequency of use, level of surface contamination, and guidelines provided by the hospital bed manufacturers and the sanitizing agents used.
The Dental Access Technical Matrix was developed as a practical quick reference tool, allowing for the assessment of compatibility between the main materials found in hospital beds and the products most commonly used in cleaning and disinfection routines. It does not replace manufacturers' recommendations but assists in standardizing procedures and reducing operational failures.
How to interpret the Technical Matrix
Each intersection between material and product represents a technical recommendation for use.
| Classification | Meaning |
|---|---|
| Recommended | Compatible product for routine use when applied according to manufacturer's instructions. |
| Use with restrictions | Can be used in specific situations, respecting contact time, concentration, and application frequency. |
| Not recommended | Possibility of damage to the material, reduction of useful life, or loss of original equipment characteristics. |
The matrix analysis should always consider:
- purpose of cleaning;
- degree of soiling;
- presence of organic matter;
- biological risk involved;
- surface material;
- current institutional protocol.
Dental Access Technical Matrix — Compatibility between Products and Hospital Bed Materials
| Product / Material | Painted steel | Stainless steel | Aluminum | Plastics | Rubbers | PVC/PU-coated mattress | Electronic components* |
|---|---|---|---|---|---|---|---|
| Water and neutral detergent | ✔ Recommended | ✔ | ✔ | ✔ | ✔ | ✔ | Controlled use |
| Enzymatic detergent | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Do not apply directly |
| 70% alcohol | Moderate use | ✔ | ✔ | Occasional use | May dry out | Occasional use | Do not apply directly |
| Sodium hypochlorite | Restricted | Restricted | Not recommended | Restricted | Not recommended | Restricted | Forbidden |
| Quaternary ammonium compounds | ✔ | ✔ | ✔ | ✔ | ✔ | ✔ | Indirect application |
| Hydrogen peroxide | As per manufacturer | ✔ | As per manufacturer | As per manufacturer | As per manufacturer | As per manufacturer | Indirect application |
Cleaning of electronic components must strictly follow the equipment manufacturer's recommendations, avoiding direct spraying and excessive moisture.
Hospital Bed Components and Specific Care
Although perceived as a single piece of equipment, the hospital bed is composed of various components with distinct construction characteristics. Each presents different levels of exposure, forms of contamination, and specific sanitization needs.
Side Rails
Side rails are among the highest-contact surfaces during hospitalization, being continuously handled by patients, companions, and healthcare professionals. Therefore, they require frequent and careful cleaning.
Special attention:
- top hand-support area;
- locking mechanisms;
- articulations;
- inner corners;
- hard-to-reach spots.
After cleaning, the proper functioning of the rail locking and movement system must be verified.
Headboard and Footboard
These components receive frequent contact during patient movement and care procedures.
Cleaning should include:
- external surfaces;
- internal surfaces;
- fittings;
- handles;
- attachment points.
During visual inspection, the following should be observed:
- cracks;
- breaks;
- looseness;
- deformations;
- loss of surface finish.
Hospital Mattress
The mattress represents one of the critical surfaces of the patient unit, as it remains in direct and continuous contact with the body throughout hospitalization.
Sanitization should include:
- top surface;
- bottom surface;
- sides;
- seams;
- zippers (if any);
- areas near valves or coating joints.
During inspection, the following should be observed:
- perforations;
- tears;
- delamination;
- coating wear;
- liquid infiltration;
- loss of impermeability.
Casters
Casters accumulate residues from the floor and can compromise both mobility and equipment safety.
The sanitization routine should include:
- hair removal;
- thread removal;
- removal of solid residues;
- cleaning of the rolling system;
- cleaning of the brake mechanism.
During inspection, check for:
- locking;
- wear;
- difficulty in turning;
- looseness;
- structural damage.
Electrical Controls and Remote Control
These components require specific care due to the presence of electronic circuits.
Cleaning should be done with a lightly dampened cloth, avoiding:
- direct spraying;
- excess liquid;
- immersion;
- incompatible products.
After cleaning, it is recommended to test:
- all controls;
- lighting (if any);
- motor movement;
- general operation of the equipment.
Operational Flowchart for Cleaning and Disinfection
Material preparation
│
▼
Team gowning
│
▼
Initial equipment inspection
│
▼
Waste removal
│
▼
Cleaning
│
▼
Disinfection (when indicated)
│
▼
Final inspection
│
▼
Bed release for useRecommended Sequence for Concurrent Cleaning
Concurrent cleaning is performed while the patient is hospitalized and aims to reduce the microbial load and maintain a clean environment during care.
Operational sequence
- Hand hygiene.
- Use indicated PPE.
- Prepare materials.
- Remove visible waste.
- Clean from less contaminated to more contaminated areas.
- Respect the contact time of the sanitizing agent.
- Perform visual inspection.
- Record non-conformities when identified.
Recommended Sequence for Terminal Cleaning
Terminal cleaning is performed after discharge, transfer, death, or definitive bed vacancy.
Steps
- Remove linens and materials from the bed.
- Remove organic matter.
- Perform complete cleaning of all components.
- Perform disinfection according to institutional protocol.
- Visually inspect the entire bed.
- Test movable mechanisms.
- Check electrical function.
- Release the equipment for a new patient.
Cleaning is Also a Tool for Preventive Inspection
In addition to removing dirt and reducing microbial load, cleaning and disinfection represent a valuable opportunity to identify early structural and functional failures of the hospital bed.
During each procedure, the team can observe signs of wear, corrosion, cracks, looseness, damage to coatings, problems with casters, failures in side rails, and irregularities in electrical components. Recording these occurrences allows for timely referral for maintenance, contributing to patient safety, continuity of care, and preservation of institutional assets.
PART 3 — Preventive Inspection During Cleaning and Disinfection
Cleaning and disinfection of hospital beds should not be seen merely as a cleaning procedure. Each intervention also represents an opportunity to assess the general condition of the equipment, identify early signs of wear, and record non-conformities before they compromise patient safety or lead to bed unavailability.
In routine care, minor changes may go unnoticed when attention is focused exclusively on dirt removal. During cleaning, however, various components are exposed, allowing for quick and efficient visual inspection without a significant increase in operational time.
What should be inspected?
Metal structure
Check:
- presence of corrosion;
- oxidation spots;
- damaged paint;
- structural deformations;
- compromised welds;
- loose or missing screws.
Side rails
Observe:
- functionality of locking mechanisms;
- ease of movement;
- looseness;
- bending;
- cracks;
- broken components.
Mattress
Carefully inspect:
- tears;
- perforations;
- wear of the covering;
- liquid infiltration;
- loss of impermeability;
- open seams;
- delamination of the material.
Casters
Evaluate:
- free rotation;
- brake function;
- accumulation of debris;
- wheel wear;
- looseness;
- locking mechanisms.
Electrical systems
For motorized models, check:
- functionality of controls;
- integrity of cables;
- connectors;
- remote control;
- movement of actuators.
Any identified abnormality must be communicated immediately according to the institutional maintenance flow.
Non-conformity Communication Flow
The identification of a non-conformity during cleaning and disinfection should result in a standardized action, preventing equipment with failures from returning to care use.
Recommended flow
Identification of non-conformity
│
▼
Recording of occurrence
│
▼
Communication to the responsible department
│
▼
Technical evaluation
│
▼
Corrective maintenance
│
▼
Functional test
│
▼
Release for useThis flow contributes to the traceability of occurrences, reduces the risk of using unsafe equipment, and facilitates the planning of preventive and corrective maintenance.
Benefits of Integrating Cleaning and Disinfection with Maintenance
When the cleaning and disinfection team also acts as a preventive inspection agent, several benefits can be observed:
- increased lifespan of the hospital bed;
- reduced costs with corrective maintenance;
- less bed unavailability;
- early identification of failures;
- greater safety for patients and professionals;
- standardization of maintenance records;
- improvement of care quality.
Recommended Frequency of Procedures
The frequency of cleaning and disinfection must follow institutional protocols, considering the care profile and the equipment's usage level.
Operational reference
| Procedure | Recommended frequency |
|---|---|
| Concurrent cleaning | During the patient's stay, according to institutional routine |
| Terminal cleaning | After discharge, transfer, death, or bed vacancy |
| Visual inspection | During every cleaning and disinfection |
| Functional test | Whenever applicable, before bed release |
| Preventive technical evaluation | According to the institution's maintenance schedule |
Compatibility with Manufacturer Recommendations
Each manufacturer may establish limitations regarding chemical products, application methods, contact time, and cleaning methods for their equipment.
For this reason, institutional protocols must always simultaneously consider:
- hospital bed manual;
- mattress manufacturer's instructions;
- sanitizing agent manufacturer's guidelines;
- Hospital Infection Control Committee (CCIH) protocols;
- internal institutional procedures.
The use of incompatible products can compromise coatings, metal components, plastic parts, and electrical systems — and may even result in the loss of the equipment's warranty.
Main Errors Observed in Cleaning and Disinfection
Among the most frequently observed non-conformities, the following stand out:
- use of incompatible products;
- incorrect dilutions;
- disregard for contact time;
- direct spraying on electrical components;
- excessive humidity;
- absence of visual inspection;
- inadequate reuse of cloths;
- failures in recording occurrences;
- equipment release without functional testing when necessary.
Standard Operating Procedure (SOP)
Objective
Standardize the cleaning and disinfection of hospital beds, promoting biosafety, equipment preservation, and patient safety.
Materials
- Indicated PPE;
- clean cloths;
- neutral detergent;
- sanitizing agent standardized by the institution;
- preparation containers;
- area signage when necessary.
Procedure
- Perform hand hygiene.
- Use PPE.
- Prepare materials.
- Visually inspect the bed.
- Remove waste.
- Perform cleaning.
- Perform disinfection when indicated.
- Respect the product's contact time.
- Perform final inspection.
- Record non-conformities.
- Release the bed for use.
Operational Checklist
Before releasing the hospital bed, check:
| Item | Checked |
|---|---|
| Clean structure | □ |
| Cleaned rails | □ |
| Clean headboard | □ |
| Clean footboard | □ |
| Intact mattress | □ |
| Clean casters | □ |
| Brakes working | □ |
| Clean controls | □ |
| Intact cables | □ |
| Absence of debris | □ |
| Non-conformities recorded | □ |
| Equipment released | □ |
Technical Basis, Norms, and References
The cleaning and disinfection of hospital beds are not procedures defined by a single specific standard. They are part of the set of infection prevention and control measures applicable to healthcare services and must be executed in accordance with biosafety best practices, institutional protocols, and the guidelines of equipment manufacturers and sanitizing agents used.
In addition to reducing the risk of cross-transmission of microorganisms, these procedures play a fundamental role in preserving hospital assets, patient safety, and standardizing care routines.
The professional must understand that the technical responsibility for hospital bed cleaning and disinfection is based on three pillars:
- compliance with sanitary legislation;
- use of regularized sanitizing products;
- observance of instructions provided by hospital bed manufacturers and products used in cleaning and disinfection.
Main Norms and Technical Documents
1. ANVISA – Surface Processing in Healthcare Services
ANVISA's guidelines establish that surfaces in healthcare services must remain clean and, when indicated, disinfected, using regularized products, standardized techniques, and trained professionals.
These recommendations apply to hospitals, clinics, outpatient clinics, urgent care units, long-term care facilities, and other healthcare establishments.
Practical application: concurrent cleaning, terminal cleaning, use of regularized sanitizing agents, standardization of procedures, and continuous training of teams.
2. Manual for Surface Processing in Healthcare Services
This document compiles recommendations regarding cleaning methods, disinfection, frequency of procedures, indicated products, prevention of cross-contamination, and criteria for processing surfaces present in healthcare services.
Most of the best practices presented in this guide are aligned with the principles established in this manual.
3. Healthcare Waste Management Plan (PGRSS)
Disposable cloths, compresses, protective barriers, and other waste generated during cleaning and disinfection procedures must be segregated and disposed of according to the Healthcare Waste Management Plan adopted by the institution.
The correct management of this waste complements biosafety actions and reduces occupational and environmental risks.
4. Sanitizing Products
Only products intended for surface cleaning and disinfection that are duly regularized by ANVISA and used according to the instructions on their labels and technical data sheets should be used.
Among other aspects, the following must be observed:
- active ingredient;
- concentration or dilution;
- contact time;
- compatibility with hospital bed materials;
- correct application method.
Responsibility of the Technical Manager
It is the technical manager's responsibility to establish standardized procedures for hospital bed cleaning and disinfection, promote training for the involved teams, and continuously monitor compliance with institutional protocols.
Their main responsibilities include:
- defining authorized products for cleaning and disinfection;
- developing or approving Standard Operating Procedures (SOPs);
- supervising the execution of procedures;
- ensuring the availability of necessary materials;
- promoting periodic training for hygiene, nursing, and support teams;
- revising protocols whenever there are changes in products, equipment, or applicable norms;
- monitoring quality indicators related to equipment cleaning and maintenance.
Recommended Best Practices
Regardless of the hospital bed manufacturer, some measures are considered essential to ensure safety, preservation, and quality of care:
- perform concurrent cleaning according to institutional protocol;
- perform terminal cleaning after patient discharge, transfer, or death;
- use only products compatible with the equipment's materials;
- strictly observe the contact time of disinfectants;
- avoid direct spraying on controls, motors, and electrical components;
- previously remove all organic matter before disinfection;
- periodically inspect side rails, casters, mattress, controls, and movement systems;
- record and immediately communicate any non-conformities identified during cleaning and disinfection;
- integrate cleaning and disinfection routines with the institution's preventive maintenance programs.
Frequently Asked Questions (FAQ)
Should the hospital bed be disinfected after every cleaning?
The need for disinfection depends on the institutional protocol, the type of cleaning performed, and the patient's clinical condition.
Can any disinfectant be used?
No. Only products compatible with the hospital bed materials and approved by the institution should be used.
Can electrical components be sprayed directly?
No. Direct application of liquids on controls, connectors, and electrical systems should be avoided, always following the manufacturer's guidelines.
Does cleaning replace preventive inspection?
No. However, cleaning and disinfection represent an excellent opportunity to identify early failures and record non-conformities.
Conclusion
The cleaning and disinfection of hospital beds constitute an essential process for healthcare safety, contributing to the prevention of cross-transmission of microorganisms, the preservation of equipment, and the improvement of the quality of healthcare services.
When performed in a standardized manner — with compatible products, in compliance with institutional protocols, and incorporating preventive inspection into the operational routine — cleaning ceases to be merely a maintenance activity and becomes part of a comprehensive strategy for quality management, patient safety, and asset sustainability.
The adoption of standardized procedures, combined with staff training and continuous monitoring of routines, strengthens the biosafety culture and contributes to safer, more efficient care environments that are aligned with recommended best practices for healthcare services.
Technical References
- Brazilian Health Regulatory Agency (ANVISA). Patient Safety in Health Services: Surface Cleaning and Disinfection.
- Brazilian Health Regulatory Agency (ANVISA). Surface Processing in Health Services.
- Brazilian Health Regulatory Agency (ANVISA). Regulations applicable to sanitizing products for use in health services.
- Brazilian Association of Technical Standards (ABNT). Standards applicable to electromedical equipment, hospital furniture, and facilities in healthcare establishments.
- Operation, cleaning, and maintenance manuals from hospital bed manufacturers.
- Technical-scientific literature on hospital infection control, surface processing, hospital housekeeping, and biosafety.
