Which bed to choose?
A hospital bed is not only for sleeping, but also functions as medical equipment meant to aid the patient’s recovery and, also, streamline the work of the medical staff. There are many models of beds – and even more technical solutions used to enhance them. Therefore, selecting a suitable bed is a matter of utmost importance and, at the same time, of some difficulty. Several issues need to be taken into account such as the patient’s condition, fitness and mobility, the nature of medical procedures applied and the type of the medical department.
The most important formal requirements (legal basis)In terms of safety, hospital beds are usually classified as medical devices ranked “class I”. Hospital beds with a built-in scale can be classified as “class I – measuring”. The beds are classified according to criteria outlined in Annex IX of the Council Directive 93/42/EEC of June 1993 concerning medical devices (OJ L 169, 12.7.1993). The beds which fulfill that criteria are given a CE mark. Beds regulated electrically are verified by rule 12, while manually-operated beds – by rule 1. The verification of beds ranked “class I” is usually conducted by the manufacturer. Beds ranked as “class I – measuring” are verified by Notified Bodies.
The beds are supervised – similarly to all medical devices manufactured, holding or given a marketing authorization, in current use or awaiting verification in Poland – by the President of the Office for Registration of Medicinal Products, Medical Devices and Biocidal Products, who also controls the executory proceedings in accordance with law.
A survey of the solutions on the market
Bed structure: column and frame structure
The structure of a modern hospital bed can be based on a frame or on columns. A column--structured bed can only be electrically--regulated. Frame structure allows for the regulation through the electric actuator or other various non-electric mechanisms (various methods of regulating a bed’s section or height will be described in detail further on). The lower part of the frame can be additionally encased with a plastic cover, which aids in keeping it clean. The flaws of this solution include: susceptibility to mechanical damage and lower clearance between the floor and the frame of the bed, which may obstruct entering the elevator or crossing over thresholds.
Kinetic functions of the bedHospital beds can be regulated electrically or manually. Obviously, electrically-regulated beds have more uses; unfortunately infrastructure and low budget do not always allow for this type of purchase. Interestingly, modern hydraulic machinery is often of equal cost to electrical mechanisms. That is due to higher component prices and a longer period of installation of hydraulic pumps than electric linear actuators.
Automatic contour mechanism
The function of automatic contour mechanism is possible thanks to an additional fixed panel which allows to distribute body weight more evenly and helps prevent bedsores. The function of automatic contour is switched on with one press of a button, which lifts segments below the head and legs at the same time.
The CPR function (cardiopulmonary resuscitation function) enables a quick leveling of the bed in case of emergency resuscitation by simply pressing a single button or pulling a special lever. Lower-cost beds also have that function, but with the bed regulated manually using a screw and a raster mechanism (so-called ratchets).
Electrical functions of the bed can be controlled using a wired control (patients), control panels on both side rails (patients and staff) and nurses’ panel (staff). This panel is usually placed or built-in on the foot of the bed. The option of disabling the patient’s control system can be switched on using this panel, which is necessary in case of certain medical conditions – it is also convenient for the staff. The wired control is illuminated, which makes it well-suited for hospital rooms at night-time – switching on the light in the room is unnecessary to adjust the position of the bed.
Electrically-regulated beds can be equipped with emergency batteries. The batteries do not replace the permanent power source (therefore do not enable to use the electrical bed if the conditions in the hospital do not allow it), but allow to control the bed during an emergency.
Emergency power generators
Hydraulic pump and gas spring
The merit of this solution is that the height of the bed can be regulated manually, yet without the use of strength. The patient can adjust the position of the segment supporting the back. The flaws include: hard to predict abrupt and jerky movements in some types of gas springs during regulation as well as liquid leaks from hydraulic pumps. High costs of both purchase and long-term upkeep are also its negative aspects.
When using a ratchet, strength must be used to lift the patient. In this process, rasters may be damaged, especially in a psychiatric ward, where, at times, interventions must take place. On the positive note, ratchets are rather cheap both at purchase and in long-term use.
ScrewA screw enables a precise and gentle adjustment of the patient’s position; moreover, it is more durable than other possible solutions. The screw mechanism requires the use of strength to regulate height – however, it is not necessary when adjusting the position of the head or legs.
Screw mechanism is controlled through a folding crank built-in by the foot of the bed. Hydraulic pump is controlled by leg power (a pedal situated on the side of the bed). The gas spring is controlled by a handle positioned within the patient’s reach.
Types of bed segment and top fillings
- a screen made of steel wires welded to the frame
- beams, usually made of metal positioned crosswise (double-C beams)
- a perforated steel sheet
- perforated removable plastic panels
- translucent sheets made of Bakelite or carbon fiber.
Perforated steel sheets are the most durable solution, as they are permanently attached to the bed. Plastic panels are slightly less sturdy, yet they enable the easiest clean-up. Panels can be removed and sterilized, and their removal enables the clean-up of the remaining parts. Bakelite sheets are only used on intensive care units, when the patient needs to remain on the bed during an X-ray. It is most commonly used to fill in the panels in the upper section of the bed – to enable chest X-rays.
Headboards are made up of plastic panels or steel tubes filled with permanently-attached MDF fiberboard. Fiberboards are used rarely, as they cannot be removed, e.g. to resuscitate. Plastic panels are easier to clean and, unlike MDF fiberboards, cannot be broken down by the patient. Easily removable headboards should be protected from uncontrolled detachment, e.g. during transport. They should be hinged, to prevent from accidental removal. For safety reasons, headboards used on psychiatric wards should be permanently attached to beds.
Rails are often the most important part of the bed – they can considerably improve or hinder the staff’s work. There are two types of rails – folding under the bed frame or along the bed frame.
Types of side rails
Two matters need to be taken into consideration to ensure the patient’s safety: how the rail is folded and if it can be folded single-handedly by one person. The assembly of the rail is also important – a rail that is permanently attached to the bed platform is the most stable. Admittedly, there are solutions where the rail is attached to the platform with a clamp, without the necessity of drilling holes into the frame, but this type of assembly does not guarantee sufficient resistance. In case of electrically-regulated beds the non-compulsory standard EN 60601-2-52 Medical Electrical Equipment (part 2-52: Particular requirements for the basic safety and essential performance of medical beds) is a good point of reference.
This standard determines, amongst other things, the length of the bed unprotected by the side rail, which prevents the patient from getting stuck or blocked. According to the standard, the unprotected length should be either shorter than 2.4 inches or longer than 12.5 inches. The first solution leaves no doubts as to the patient’s comfort and safety; the second one is widely debated – especially in cases of conditions where the patient is prohibited from willfully leaving the bed. Long unprotected lengths increase the risk of patients leaving on their own (e.g. those connected to medical equipment) and often force the staff to use straps, which makes the functioning of a ward more difficult.
In principle, Polish law requires the patient to be secure in a horizontally-positioned bed during sleep. However, the rails that move together with the segments and protect the patient when the bed is positioned otherwise are the more optimal solution.