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Last month, we saw COVID-19 become a global pandemic, which prompted the Clinical Corner article, Cleaning Seating and Mobility Equipment Part One - Wheelchairs. The March article reviewed best practices for cleaning for infection prevention and control, medical devices and levels of disinfection, and considerations for cleaning and disinfecting wheelchairs. This month, Clinical Corner will look at the procedures to employ when cleaning/disinfecting wheelchair cushions, back supports and their covers.
Check Owner's Manual
The owner's manual for a seating product will have directions for cleaning and disinfecting the product. Check the owner's manual to follow specific directions for each product. For example, the owner's manual may say "do not use bleach". In addition, the owner's manual may include the maximum temperature at which to launder the cover. The owner's manual should take precedence over this article, as what follows is general guidance on cleaning seating products.
Covers
Let's start with looking at cleaning the covers for wheelchair cushions and back supports. Some seating products have both an outer cover and an inner cover. The outer cover must be removed from either the cushion or the back support. Once the cover is removed, it should be turned inside-out and the zipper should be closed as much as possible to prevent any snagging. The outer cover should be machine washed in warm water. Once washed, the cover should drip dry or tumble dry on low heat to avoid shrinking and/or damaging the cover. The use of industrial washers and dryers is not recommended.
If a cushion has a dual cover system, the inner cover usually is an incontinence cover made of stretchable, wipeable material. There may also be features, such as an inverse coil zipper and anti-wicking thread, to prevent any fluids from entering the cushion material. If the inner cover has these design features, this type of cover can be wiped with warm water and soap or with a disinfectant wipe. It does not require laundering in a washing machine. The inner cover should air-dry completely before adding the outer cover.
Cushions
The optimal method for cleaning a cushion base will depend upon the material and construction of the cushion. Cushions can be manufactured from numerous materials, including foam, elastomer, gel, fluid, and air, and from combinations of materials. (See Skin Protection and Cushion Materials for more information.) A closed-cell foam cushion base will be cleaned differently than an open-cell foam cushion base because of the properties of the materials. Because closed-cell foam is non-porous, it can be sprayed with a cleaner or wiped with a disinfectant wipe; whereas an open-cell foam base must be wiped lightly with a damp cloth. The use of soap is not recommended directly on open-cell foam. In addition, an open-cell foam base must not be submerged in water as it is porous. A cushion constructed with open-cell foam usually has an inner incontinence cover to protect the porous foam. A foam base should be air-dried completely before the cushion is re-assembled.
If a cushion has a removable insert, such as a fluid or air insert, the insert should be removed from the cushion to be washed separately. A fluid pad can be wiped with warm water and soap; rinsed with a clean, damp cloth; and then wiped dry with a clean cloth. To clean an air insert, the air cells should be deflated and the valve(s) should be closed. Each air cell and the spaces between the air cells should be wiped clean.
While the cover is removed from the cushion, it is a good time to look for signs of wear in the base of the cushion. For a review on signs of wear in wheelchair cushions, refer to this Clinical Corner article: Wear in Wheelchair Cushions 2.0
Back Supports
Once the cover has been removed from the back shell, make note of the placement of any postural support components, as these will need to be returned to their original position after cleaning the back shell. The aluminum shell can be cleaned with soap and water or a disinfecting wipe. Positioning components that are manufactured from closed-cell foam also can be cleaned with soap and water or a disinfectant wipe.
Reassembling Cushion/Back Support
To reassemble a cushion after washing the cover and the base, refit the cover onto the cushion and ensure that the back of the cover matches up to the back of the foam base. Some cushion bases and their corresponding covers will have the words "front" and "back" printed on them to ensure correct placement of the cushion into the cover. Ensure that any seams on the cushion cover are aligned in the correct position relative to the cushion base.
For a cushion that has an open-cell foam base with either a fluid or air insert, the insert will be placed on top of the inner incontinence cover (as shown in the photograph below). The Velcro® strips on the inner incontinence cover should align with the Velcro strips on the bottom of the air or fluid insert. This will ensure the correct positioning of the insert onto the cushion. Next, the foam base/inner cover assembly is inserted into the outer cover. Again, ensure that the zipper is at the rear of the foam base where the pelvic loading area is located.
To re-assemble a back support, replace any postural support components into their original position. Re-insert the foam into the cover, ensuring the correct placement for front to back and for top to bottom and with correct alignment of the foam in the cover, and zip the cover closed. Affix the covered foam to the aluminum shell with the Velcro on the product.
Summary
Cleaning wheelchair cushions and back supports involves removing the cover and washing the cover and the components separately. When re-assembling the cushion or the back support, ensure the proper placement of the seating into the cover, and pay particular attention to the placement of positioning components if these have been removed for cleaning.
Sheilagh Sherman, BA, BHScOT, MHM, OT Reg. (Ont.)
Clinical Education Manager
Sunrise Medical Canada
Note: The content of this article is not meant to be prescriptive; rather, it is meant as a general resource for clinicians to then use clinical reasoning skills to determine optimal solutions for individual clients. Sheilagh is unable to answer questions from members of the general public. Members of the general public are directed to their own therapists or other health care professionals to ask questions regarding needs.
This article is © Sunrise Medical, Inc., 2020 and cannot be copied, distributed, or otherwise reproduced in whole or in part without the express written permission of Sunrise Medical Canada.