The importance of cleaning your wheelchair cushion

Are wheelchair cushions a paradise for microorganisms? Which factors and cushion properties influence this?

There are 5 key characteristics of effective wheelchair cushion design 1, but expert opinions and 90% of wheelchair users found that at least 3 other key characteristics are missing, namely microclimate, ease of use and washability. Washability is particularly important as proper cleaning of a cushion should lead to a reduction in bacterial load. With the introduction of COVID-19 and the emergence of multidrug-resistant bacteria, ensuring proper cleaning and disinfection of reusable medical devices has become increasingly important. Adequate cleaning can also extend the lifespan of a cushion, improve skin health, and control odour. Therefore a literature review is conducted to explore the significance of cleaning and disinfecting wheelchair cushions and to identify factors and cushion properties that influence this process.

Multiple studies have found that wheelchair use increases the likelihood of microbial colonisation of the user 2-4 therefore appropriate cleaning is important. To classify medical equipment Spaulding created criteria in 1970. Medical equipment used on patients is classified into three levels based on infection transmission risk, each requiring specific disinfection methods 5 & 6:

Non-critical items: these items only come into contact with intact skin, such as stethoscopes, blood pressure cuffs, wheelchairs, and patient beds. Although non-critical items have the lowest classification within the Spaulding Classification, these items play a crucial role in patient care, and research has demonstrated their involvement in pathogen transmission 7.

Semi-critical items: are any items that touch mucous membranes or broken skin, such as endotracheal tubes and laryngoscopes.

Critical items: are items that are going to enter vasculature or sterile tissue, including catheters and surgical instruments.

 

Corresponding with the Spaulding criteria there are 3 different levels of disinfection:

High-level disinfection: This level kills all microorganisms except large numbers of bacterial spores.

Intermediate-level disinfection: This level kills mycobacteria, vegetative bacteria, most viruses, and most fungi, but may not necessarily kill bacterial spores.

Low-level disinfection (LLD): This level kills most vegetative bacteria, some fungi, and certain viruses.

 

Before disinfection, it is crucial to clean medical equipment because pathogens are more likely to survive on soiled surfaces where the soil acts as a protective barrier 8 & 9. According to the Spaulding criteria, wheelchair cushions are categorised as non-critical devices requiring LLD 6.

Non-critical medical devices need cleaning, followed by LLD. Examples of LLD’s include phenolics and iodophors, such as wescodyne, bactergent, hy-sine, ioprep, providone, Hil-Phene, LpH se, Metar, Vesphene, Decon-cycle.

Mohapatra defines disinfection as the process of killing harmful vegetative bacteria and viruses on surfaces and objects, excluding bacterial spores.

They recommend achieving at least a 99.9% reduction in microorganisms (log 3 reduction). However, achieving this can be challenging in some care facilities due to a lack of knowledge about medical device cleaning, tracking systems, and guidelines, which impacts the cleaning 10.

Cleaning the cushion can also be difficult due to the material compositions of the cushion 11-16 (see table 1 on the last page). Foam cushions can not be submerged in water, and therefore can only be wiped with warm water and soap.

Vicair O2 wheelchair cushions are the only wheelchair cushions that are easy machine washable at 60C and can be subsequently sprayed with a disinfectant, without causing any negative consequences.

 

for the cushion performance. Agidens demonstrated that washing Vicair cushions at 60°C reduces the bacterial load by 99.99% 17. This reduction in bacterial load achieved through washing is equivalent to the reduction required for disinfection according to Mohapatra 18, this is achieved without the use of a LLD. (More about the research of Agidens can be found in the one-pager “How effective is washing your Vicair wheelchair cushion?”)

Thus, considering a Vicair O2 cushion is recommended when confronted with (bacterial) soiling, repeated use, or other factors that impact the hygiene and cleanliness of the wheelchair cushion.

 

References

1. Levy, A., Shoham, N., Kopplin, K., & Gefen, A. (2018). The Critical Characteristics of a Good Wheelchair Cushion. In Science and Practice of Pressure Ulcer Management (pp. 17–31). Springer London.

https://doi.org/10.1007/978-1-4471-7413-4_2

2. Martak, D., Gbaguidi-Haore, H., Meunier, A., Valot, B.,

Conzelmann, N., Eib, M., Autenrieth, I. B., Slekovec, C., Tacconelli, E., Bertrand, X., Peter, S., Hocquet, D., & Guther, J. (2022). High prevalence of Pseudomonas aeruginosa carriage in residents of French and German long-term care facilities. Clinical Microbiology and

Infection, 28(10), 1353–1358.

https://doi.org/10.1016/j.cmi.2022.05.004

3. Tu, M. G., Lin, C. C., Chiang, Y. T., Zhou, Z. L., Hsieh, L. Y., Chen, K. T., Chen, Y. Z., Cheng, W. C., & Lo, H. J. (2022). Distribution of Yeast Species and Risk Factors of Oral Colonization after Oral-Care Education among the Residents of Nursing Homes. Journal of Fungi, 8(3). https://doi.org/10.3390/jof8030310
4. Weppner, J., Gabet, J., Linsenmeyer, M., Yassin, M., & Galang, G. (2021). Clostridium difficile Infection Reservoirs Within an Acute Rehabilitation Environment. American Journal of Physical Medicine & Rehabilitation, 100(1), 44–47. https://doi.org/10.1097/PHM.0000000000001579
5. Rowan, N. J., Kremer, T., & McDonnell, G. (2023). A review of

Spaulding’s classification system for effective cleaning, disinfection and sterilization of reusable medical devices: Viewed through a modern-day lens that will inform and

enable future sustainability. Science of The Total Environment, 878, 1–18.

https://doi.org/10.1016/j.scitotenv.2023.162976

6. Spaulding, E. (1970). The role of chemical disinfection in the prevention of nosocomial infections. International Conference on Nosocomial Infections.
7. Klacik, S. (2019). ‘Noncritical’ OR items deserve due diligence in disinfection – OR Manager. International Association of Healthcare Central Service Materiel Management. https:// www.ormanager.com/noncritical-items-deserve-due-diligence-disinfection/
8. Ontario Agency for Health Protection and Promotion (Public Health Ontario), & Provincial Infectious Diseases Advisory Committee. (2013). Best practices for cleaning, disinfection and sterilization of medical equipment/devices in all health care settings (3rd ed.). Queen’s Printer for Ontario.
9. Werkgroep Infectie Preventie, de Bruyn, A. C. P., van Klingeren, B., & Severin, W. P. J. (2009). WIP richtlijn – Beleid reiniging desinfectie en sterilisatie. www.wip.nl
10. Gardner, P., Muller, M. P., Prior, B., So, K., Tooze, J., Eum, L., &

Kachur, O. (2014). Wheelchair cleaning and disinfection in Canadian health care facilities: ‘That’s wheelie gross!’ American Journal of Infection Control, 42(11), 1173–1177. https://doi.org/10.1016/j.ajic.2014.08.007

11. Cushioning Products by Supracor – User manual – Stimulite. (2018). www.supracor.com
12. Jay Foam Cushion Products User Instruction Manual & Warranty. (2021).
13. JAY J3 Cushion Owner’s Manual. (2017).
14. Jay Xtreme Active Owner’s Manual. (2018).
15. ROHO ® DRY FLOATATION ® Wheelchair Cushions Operation Manual. (2019).
16. Vicair Vector O2 User Manual. (2018).
17. Op De Beeck, J. (2023). Test Report Disinfection Wheelchair Cushion.
18. Mohapatra, S. (2017). Sterilization and Disinfection. In Essentials of Neuroanesthesia (pp. 929–944). Elsevier.

https://doi.org/10.1016/B978-0-12-805299-0.00059-2