Guidelines for the Refurbishment of Flo-tech, Essential, and Propad cushions in Preparation for Re-use.

Purchasing

It is recommended that the reuse of cushions be considered at the point of purchase to ensure longevity of cushion stock. Features to consider include:

Wipedown cover – Two way stretch PU vapour permeable outer cover with zip flange to reduce the risk of fluid ingress through the zip. Premier cover flap greater protection.

Black Smooth Ingress Resistant cover – Two way stretch vapour permeable cover treated with a fluorocarbon-based fluid repellent finish which allows fluid to “roll off” the cover. A welded zip flap is fitted as standard to reduce the risk of fluid ingress through the zip. Ingress resistant material can be identified by two blue flashes on the Flo-tech label on the side of the cushion (see Fig. 1).

Platillon Liner – Clear two way stretch inner cover that provides an additional layer of moisture protection.

Cushion Use

To prevent accidental cover damage, do not place hypodermic needles, venflons, scalpels or other similarly sharp objects onto the cushion. In domestic settings pets should be discouraged from sleeping on the cushion as clawing can puncture the cushion cover, allowing fluid ingress.

Cleaning the Covers

(removal of contaminants such as dust and organic matter)

It is recommended that a solution of neutral detergent and hot water using a single use wipe is used to clean Invacare Cushions. Ensure that the cover is rinsed with clean water using a damp single use wipe, and thoroughly dried.

The removable outer cover for Pro-pad, Flo-tech and Essential cushions can be laundered at 80 oC using a dilute detergent solution. The Aero-tech cushion and its cover should be machine washed to up to 60 oC only.

N.B. After laundering of the Black Smooth Ingress Resistant cover, it is necessary to re-activate the fluorocarbon finish by tumble drying on a low heat setting. Other types of cushion cover should not be tumble dried.

Disinfecting the covers (reduction of the number of micro-organisms to a level not harmful to health).

Ensure that any residual detergent has been removed prior to disinfection. The cover can be wipedown with a 0.1% Chloride Solution (1,000 ppm). Alternatively, where required, a 1% Chloride Solution (10,000 ppm) can be used. Ensure that the cover is rinsed with clean water using a damp single use wipe, and thoroughly dried.

Where combined cleaning and disinfection products are used, ensure that the cover is rinsed with clean water using a damp single use wipe, and thoroughly dried.

The Aero-tech cushion can be decontaminated using the same procedure described above. It is recommended the cover be replaced.

N.B. An intact water resistant outer cover and platilon liner should protect the cushion foam, gel or air sac on the Pro-pad, Flo-tech and Essential cushion ranges from contamination and therefore it should not be necessary to separately disinfect cushion foams. Chloride Solution may discolour the foam surface, and will not adequately disinfect areas inside the foam core. Contaminated cushion foams should not be reissued.

Do not use phenol’s, alcohols or bleaches. Do not iron.

Cushion Inspection

Check the label on the cushion matches the cushion type
The cushions name label should be on the front left hand side of the cushion cover. Check that this matches the name of the cushion printed onto the back of the cushion foam.

Check for cover damage
Check the cushion thoroughly for signs of damage…

  • Check the surface of wipedown covers for a matt sheen or cracked areas that may indicate delamination from aging, the use of incorrect cleaning fluids or abrasive cleaning techniques. If unsure compare to a new cover or cover material swatch.
  • Rips, tears, punctures or burns. If unsure, stretch the material and hold up to the light.
  • Check stitching and welded seams are intact, especially around the zip area.
  • Check for staining to the inside of the outer cover as this indicates ingress. Invacare cushions that are designed specifically for hospital use, i.e. Flotech range with coloured covers and Propad cushion covers, have a light coloured underside to the cover making it easier to identify fluid ingress.
  • If concern remains regarding the integrity of the cushion cover, a water test can be carried out. Place a paper towel under the cover and pour a small amount of water onto the top surface of the cushion (e.g. using a medicine tot or similar receptacle). Using another couple of paper towels press down onto the top surface of the cover to absorb the water. Inspect the paper towel on the inside of the cushion cover. If dampening is present, ingress has occurred.

Check platilon liner for evidence of rips, tears, punctures and burns.

N.B. Small manufacturing holes are normal and allow air to escape from the cushion when in use.

Check date of manufacture
On foam cushions, this should be printed on the back edge of the cushion foams and most cover label. Take care not to confuse this with the fire standard compliance date.

N.B. It should be noted that Invacare cushions carry the following warranties…

Flo-tech - 3 Years

Aero-tech - 2 Years

Essential 3” - 2 Years

Essential 2” - 1 Year

Propad - 1 Year

Under normal conditions a 5+ year lifespan is expected on Flo-tech and Areo-tech cushions, and 3+ years on Essential and Propad cushions. Although actual cushion life-spans vary from user to user.

Check gel/air sack

Any gel (or air sack) should be inspected for signs of leakage or flattening (loss of gel volume). Leaked silicon gel will appear white and sticky.

To check the Aero-tech cushion for punctures and leaks, over inflate so that the cushion begins to arch and lock off the valve. Leave over night and then inspect for any deflation. If punctures are suspected, over inflate the cushion until the cushion begins to arch, lock off the valve and submerge in a bowl or water. Punctures and leaks should be evident by a series of small bubbles being released from one point on the cushion. Punctures can be repaired using the puncture repair kit supplied with the cushion. After repair, the cushion should be re-tested for punctures and leaks before re-issue.

Check foam

  • Inspect the foam for any dampness or offensive smells which indicate contamination. Contaminated cushions should not be reused.
  • Check the cushion continues to maintain its original shape. If unsure check a new cushion as a benchmark. There should be no dips in the surface of cushions that are manufactured to be flat.
  • Check the foam is still serviceable. PU Foam that has a low resistance and only slowly regains its original shape after deformation is considered to be “dead” foam. To check this, you can carry out the fist test (see Fig. 5). This subjective test is intended to simulate the bony prominence of a light user, commonly used in mattress audits
  • Make sure the top of the cushion is level with the tester’s greater trochanter;
  • Link hands to form a fist, keep elbows straight
  • Lean forward and push the fist into the cushion foam, using a similar amount of force as that used in CPR.

You should feel some resistance from the foam, and when you release the foam should spring quickly back into shape. A slow return to shape is normal for visco-elastic type foam (memory foam), however they should return to shape within a couple of minutes of release. This test is only suitable for testing foam and is not intended to test gel or air.

After cleaning and inspecting the cushion, ensure that the cover is replaced the correct way around…

Propad (Castellated Foam) - The Castellation should be on the top surface.

Flo-tech (Anatomically Shaped Foam) – The shaped surface should be on the top surface with the thigh troughs at the front. The printed edge of the foam should be at the rear of the cushion (see Fig. 3)

Essential Visco and Pro-pad Visco (Layered Foam) - The white visco-elastic foam layer should be face up. On the Pro-pad Visco the curved shape of the foam should be positioned to the front and back.

Aerotech (Air Cells). The Air cells should be on the top surface.

All cushion cover name labels should be placed text upwards, with the zip positioned towards the back of the cushion. N.B. on the Flo-tech Solution Xtra where there is a label clearly indicating the back of the cushion and the zip runs across the front and sides of the cushion.


References

Department of Health Circular. Decontamination of Equipment Prior to Inspection, Service or Repair. DoH HSG (93)26. June 1993.

MHRA - DB2006(05) Managing Medical Devices