Nienke is the Clinical Research Coordinator at WheelAir. She holds a BSc in Medicine and an MRes in Clinical Epidemiology.

Poster Presentations (Research category) at The Society of Tissue Viability 2022 Conference

Development of a risk matrix tool incorporating symptoms of an adverse microclimate for wheelchair users

Abstract

Introduction: Temperature, humidity and airflow at the skin surface combine to create a microclimate (Borzdynski et al., 2021). An adverse microclimate increases the risk of pressure ulcer development and Moisture-Associated Skin Damage (MASD)(Lumbers, 2018). Increased temperature and humidity weaken the structure and function of the skin and underlying soft tissues undermining its integrity (Kottner et al., 2018).
When skin temperature exceeds 33°C, several problems occur simultaneously, each exacerbating the risk of skin breakdown. Local perspiration increases markedly leading to skin maceration; this accelerates trans epidermal water loss that reduces skin resilience (Lachenbruch, 2005). In these circumstances, the coefficient of friction of the skin rises furthering the likelihood of skin breakdown (Greasley, 2018).
Wheelchair users (WU) need to consider several factors undermining skin integrity including their ability to alleviate sitting pressure by lifting off the seat. This action simultaneously provides airflow, reducing temperature and relative humidity at the seat surface. Development of a risk matrix tool incorporating symptoms of an adverse microclimate with other factors highlight the complexity of risk these symptoms generate.

Methods: A comprehensive literature review was conducted to establish evidence identifying a matrix of risks that WU need to manage to prevent pressure ulcers and MASD. These include heat, moisture, need for postural support, use of medication known to disrupt thermoregulation, and in-chair mobility.
A 6-point Likert scale using shading to provide a visual indicator of severity enables generation of an overall score. Higher scores indicate greater risk. The initial risk matrix has been distributed to clinicians and WU and their feedback sought to clarify how to improve this tool.

Results: Wheelchair users and clinicians subjectively reported the matrix is helpful in identifying an individual’s complexity of risk. Further investigation to establish whether the tool is clinically valid and reliable is required.

Conclusion: This tool identifies risks caused by an adverse microclimate in exacerbating other factors known to cause pressure ulcers and MASD.

Reducing skin temperature and humidity using a wheelchair cushion microclimate cover with active airflow

Abstract

Introduction: Temperature, humidity and airflow at the skin surface combine to create a microclimate (Borzdynski et al., 2021). An adverse microclimate increases the risk of pressure ulcer development, and Moisture-Associated Skin Damage (MASD)(Lumbers, 2018). Increased temperature and humidity weaken the structure and function of the skin and underlying soft tissues undermining its integrity (Kottner et al., 2018). When skin temperature exceeds 33°C, several problems occur simultaneously, each exacerbating the risk of skin breakdown.
Local perspiration increases markedly leading to skin maceration; this accelerates trans epidermal loss that reduces skin resilience (Lachenbruch, 2005) In these circumstances the coefficient of friction of the skin rises furthering the likelihood of skin breakdown (Greasley, 2018). There is a lack of research and available solutions regarding microclimate management for wheelchair users. This paper reports an investigation testing the extent a microclimate cushion cover with active airflow (WA CC) is effective in reducing the impact of an adverse microclimate at the skin/seat interface (Bogard et al., 2021). The aim is to assist wheelchair users manage their risks of skin microclimate more effectively.

Method: Using a modified ISO 16840-11 testing standard, the WA CC was tested on 8 different commercially available wheelchair cushions, and on 1 customised cushion. The test measured temperature and relative humidity levels for each cushion over a two-hour period. The test was repeated on each cushion cover issued with the wheelchair cushion.

Results: These tests demonstrate the WA CC is effective; reducing both relative humidity (mean reduction of 12.3%) and temperature (mean reduction of 2.3°C) significantly (p<0.05). This was sustained over a period of two hours for eight out of nine cushion models tested. The non-permeable inflatable air cell cushion did not demonstrate a reduction in temperature and relative humidity with the WA CC (mean increase of 1°C and 4.5%).

Implications for practice/conclusion: The results indicate the WA CC can make a positive contribution by reducing humidity, and temperature at the skin-seat interface of wheelchair users. Good microclimate is essential for the management of the risk of skin breakdown.