Ever since the first healthcare facility opened its doors, wheelchair cleaning has been an unwelcome job. Avoidance behavior is the norm when it comes to cleaning the devices. Consider what’s involved in your typical wheelchair: 3,000 inches of tubes, grit, food, body wastes, plastic, metal, fabric and germs in a complex blend of hundreds of parts.

Considering what’s in a typical wheelchair, quality cleaning is therefore a labor intensive, time consuming, inefficient, manual process that can take 20 to 45 minutes for one wheelchair. To clean and sanitize wheelchairs in a fast, focused and standardized quality procedure with manual methods is almost impossible, and is a constant challenge for healthcare facility managers.

The absence of an infection control process between patients using equipment can lead to cross contamination where contagious diseases are spread from surfaces to hands and mouth particularly evident in group settings. Thorough cleaning followed by an infection control application using the correct dilution and the required contact time for the chemical to be effective is far from standard operating procedure.

Current methods are typically subjecting equipment to excessive hot water and/or blasting away with a pressure washer. That only leads to saturated upholstery, displaced lubricants, increased corrosion and fabric fatigue. Furthermore, these methods are often inconvenient leading to infrequent cleaning schedules. So, it’s not surprising that automated cleaning and infection control systems for wheelchairs and other durable medical equipment have entered the market. Healthcare facilities and equipment providers are purchasing systems or contracting cleaning and infection control services through service businesses using this automated technology.

Automated cleaning and infection control systems could be described as a "mini-carwash on wheels." Rotational spray systems with strategically placed spray nozzles reach specific hard-to-clean equipment areas. Spray pressures operate close to equipment surfaces providing effective but not destructive spray pressure.

Automated functions include: cleaning, sanitizing, disinfecting, cleaning time, under-spraying, parts cleaning, chemical dispensing, low chemical sensors and a host of functions to minimize manual labor intervention. Programmable micro-processors control, monitor and provide diagnostics on electro-mechanical devices. Software offers the advantages of updating when new regulatory requirements are introduced.

Installation requires a water supply and drain. A common utility sink will do. One hose connects to the faucet for standard hot water while a second hose empties into the drain. A power cord connects to a wall outlet.

Then it’s just a case of rolling the wheelchair into the enclosure, closing the door and pressing the start button. When finished, typically in about 5 minutes, the operator opens the door and rolls the equipment out to wipe off fabric material. Drying agents dispensed in the cycle quickly dry equipment surfaces for immediate use.

Here are the benefits you should expect from automated systems:

• Significant time savings – up to 70%

• Substantial labor cost savings – up to 30 to 50%

• Consistent quality cleaning

• Consistent process for infection control

• Reduced chemical costs

• Environmental improvement

• Improved ergonomics

To achieve the expected benefits, there are basic system design parameters that determine outcome: chemistry, agitation, temperature, time, location, environment and ergonomics.

Chemistry

Cleaning detergents should be safe for repeated cleanings on a wide variety of surface material such as: plastics, rubber, soft metals, new composites, painted surfaces and fabrics. PH levels between 7 and 9 will minimize corrosion and drying out of material, and is appropriate for drainage throughout the facility’s drain systems.

Rinsing/drying agents eliminate spotting and remove most of the water remaining on surfaces for quick drying. Rust inhibitors reduce corrosion when wheelchairs are cleaned. Metal tubular construction invites rust formation as experienced by steam cleaners and pressure washers.

Hospital grade infection control chemicals should be EPA registered. Dilution ratios and contact time should be programmed to meet industry standards for cleaning and infection control labeling claims by the manufacturer. Chemical effectiveness and cost savings are achieved through computer controlled measurement of chemicals dispensed for cleaning and infection prevention. Industry statistics cite savings of 30% with chemical dispensing measurement usage.

Agitation

Agitation or spray pressure is the mechanical action (the elbow grease). High spray pressures can overkill – causing lubricant displacement and fabric fatigue. Low spray pressure may not be effective for surfaces having tenacious substances. Spray pressures of between 30 and 60 psi per nozzle, less than 15 inches from equipment surfaces, deliver effective cleaning. Rotational spray systems minimize saturation of fabric and allow the operator to return equipment to the user quickly.

Water temperature

Adjusting water temperature for cleaning has a similar impact as agitation. Excessive hot water accelerates staining and corrosion, and may dissolve lubricants on wheel bearings. Energy costs and worker hazards increase with higher temperatures. Low water temperature may not break down food wastes and other contaminates on surfaces. A desirable water temperature for maximum accessibility in multiple locations is regulated water temperature in the range of 90 to 115 degrees.

Time

An automated system for cleaning can only make economic sense when there is minimal labor intervention for re-cleaning equipment and the system accommodates multiple types of equipment. Any additional labor time to re-clean equipment adds to the overall purchase costs and on-going cost. Total time for cleaning should be measured when equipment is taken from its location of use to the cleaning location, cleaned, sanitized/disinfected, dried and returned, for an accurate assessment of labor time.

Location

Cleaning location is a big time saver. Transporting equipment for cleaning to a central location, different floor level or another wing adds considerable time/labor cost for each piece of equipment. The closer equipment is to the cleaning location, the less time it takes. Cleaning is convenient for more equipment with increased frequency. In the event of any emergency where wheelchairs are needed quickly, localized cleaning insures quick access.

Environmental

Automated cleaning systems bring a positive change for our environment. Self-contained systems connected to a facility’s utility sink eliminate environmental issues of leaving waste and chemical residue on driveways, parking lots and other inappropriate locations. Outside cleaning with chemicals using non-controlled sewer systems is prohibited.

Ergonomics

While not so obvious, manual methods of cleaning can be a strenuous task. Constant back bending, repetitive movement and lifting, leads to back and muscle strain, having potential for lost work time.

Summary

The potential rewards from automated cleaning systems are tremendous. Healthcare facilities are improving quality outcomes while reducing labor time and costs. While costs savings are significant, there are many other important benefits.

• Fast, focused and standardized cleaning procedure

• Capacity for large volumes without increasing staff

• Avoidance behavior minimal to clean equipment

• Improved self-esteem and employee morale

• Better utilization of resources

• Less staffing

• Definite plus for Accreditation requirements

• System ready for cleaning anytime by anyone

• Equipment turns faster for less risk to patients

Automated cleaning systems can be purchased, leased, rented, or used through service businesses.

Karl Soderquist is president of the HUBSCRUB Company, a Manchester, NH based manufacturer of portable automated cleaning systems for healthcare facilities, equipment providers and service businesses. HPN

Cost Comparison

Costs are compared for actual cleaning and does not include costs for transporting equipment to and from the cleaning location.

The wheelchair is rolled into the unit. The automated process is completed in an average of 5 minutes. Actual time to load and wipe down equipment is about 5 minutes.

For the same 25 wheelchairs, worker time is 5 min. per wheelchair or 2 hrs. per week.

Wage: $13/hr x 2 hrs. = $26/week or $104/mo.

Monthly lease approx.: $300*

Labor: $104 + equipment $300 = $404/mo

Monthly dollar savings = $168/month

   (Manual $572 – Equipment & worker $404)

Time savings = additional 9 hrs./wk. for other work.