Infection Control Pillows

It is no surprise that mattresses and pillows are at high risk for transmitting infections because patients are in constant contact with these objects. There are currently no CDC/HICPAC guidelines for cleaning mattresses or pillows. Contamination may occur during bed making or when large surgical sites or broken areas of skin are being dressed. The media has been very vocal on transmission of bacteria and viruses due to inanimate objects (stethoscopes/ties) but few address pillowcases, which are in constant contact with the patient.

Reusable pillows are potential sources of bacterial contamination and nosocomial infections. These pillows may become contaminated with skin scales, body fluids (urine and feces), or wound drainage. These fabrics are potential reservoirs of microorganisms that may be able to survive on surfaces for periods ranging from a few minutes to several months. Patient exposure could be due to spores, hyphae, or fungal degradation. pillows and pillowcases are the most commonly contaminated items.

Under the Microscope
The Barts and The London NHS Trust in the U.K. found 30 types of infections in a sample of hospital pillows including MRSA, E.coli, and even leprosy. Most common 3 fungal species in pillow swatches were Aspergillus fumigatus (recognized allergenic fungus), Aureobasidium pullulans (yeast like fungus), and yeast Rhodotorula mucilaginosa. When 100 disinfected pillows were cultured, 38% were found to harbor infection causing pathogens including MRSA, VRE, Enterococcus faecalis, E.coli, Yeast, Staphylococci, Klebsiella pneumonia, Bacillus species, Gram-positive coci, and diptheroids.1

The American Hospital Association and the Medicare Cost Report of 2004 estimated that an occurrence of hospital acquired infection increases the hospital care cost of a patient by $10,375 and increases the length of stay by 3.3 days. They conclude that reliable cost estimates show a cost of $16.6 billion.2

Separate Head and Body Pillows
Not all hospitals are able to purchase disposable pillows, and this would not solve the problem with cross-contamination among the same patient. Therefore the simple solution is to have a dedicated pillow that will be used only to position the patients head. This pillow will not be interchanged with other pillows used to position any other parts of the body. This pillow will be easily identified from the other ones because it will have a colored pillow case versus a regular white pillow case. This can be a cost neutral solution since most facilities already use colored pillowcases in the OR and PACU.

Joint Commissions’ Patient Safety Goal #7 is to reduce risk of health care associated infections. Patients in the hospital setting are acquiring infections not directly related to their admission diagnoses at a disturbing rate. At the James A. Haley Veterans Hospital, prevention strategies must be customized to fit our special population. It has been identified that the same pillow used to support the patient’s head, could be used to support their back, legs, etc. This creates a breeding ground for microorganisms to spread and contaminate surgical sites, intravenous and central line sites, as well as wound sites. By implementing a designated head pillow, it provides an opportunity to aid in the reduction of infections that could be essentially related to contaminated pillows and therefore optimize care.

Once in practice, the “head” pillow and “body” pillows can be swabbed to determine if any significant differences exists. Positive patient outcomes directly correlate with patient safety practices. There have been many patient safety practices implemented (simulators, bar coding medication, and computerized patient records) to improve health care outcomes but there are countless opportunities for further research.

Reducing Risk
Nursing has been concerned with patient safety long before the emphasis on quality improvement. Hospital acquired infection prevention is beneficial to the patient and the hospital. Studies show that hospital acquired infections will increase the cost of hospitalizations by at least $10,000 per patient. Nursing plays a vital role in promoting positive patient outcomes as well as positive financial outcomes for the institution. The simple act of a dedicated head pillow has the potential to attain these positive outcomes as well as improve patient satisfaction.


1. Collins, N. Hospital pillows riddled with infection. The Telegraph. June 22, 2011.
2. Hassan, M. et. al. Cost of hospital-acquired infection. Hospital Topics. 2010 Jul-Sep; 88(3):82-9

Lisa Guillen is assistant nurse manager, CICU and Shelevia Dawson is a patient safety specialist at James A. Haley Veterans Hospital in Tampa, Fla.

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