This document provides guidelines for cleaning, disinfecting, and sterilizing rehabilitation equipment to prevent healthcare-associated infections. It outlines procedures for various equipment including therapeutic pools, hydrotherapy units, hydrocollators, paraffin wax treatment rooms, gymnasiums/exercise rooms, and cleaning of specific equipment. Proper disinfection and cleaning is crucial as rehabilitation patients often have impairments or conditions that increase infection risk. Staff should follow the manual's cleaning guidelines and manufacturers' instructions for each piece of equipment.

1. ١
KING KHALID HOSPITAL
INFECTION PREVENTION
AND
CONTROL MANUAL
REHABILITATION / PHYSIOTHERAPY
Dr. Nahla Abdel Kader, MD, PhD.
Infection Control Consultant, MOH
Infection Control CBAHI Surveyor
Infection Prevention Control Director
KKH.

2. ٢
DEFINITION
To provide clear guidelines on appropriate cleaning, disinfection
and sterilization of rehabilitation equipment, to prevent
transmission of healthcare associated infections.
COMMENTS
1. The rehabilitation patient may have one or more impairments or
disabilities at the time of admission that increase the risk of infection.
2. Factors such as incontinence, skin breakdown, co-morbidity,
immobility, and age are all associated with increased risk of infection in
the rehabilitation population.
3. References to specific equipment are applicable where these exist. Each
facility should refer to the user manual in its rehabilitation department
for specific instructions regarding cleaning disinfecting and preventive
maintenance of its equipment

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PROCEDURE
A. Therapeutic Pool:
1. Pools are generally designed to be used by many
individuals concurrently and sequentially. They may
become contaminated with organic matter (feces,
urine, wound drainage) between cleaning. Therefore
to reduce contaminant in the pool water certain
measures must be taken.
a. Maintain proper level of chlorine/bromine/other
disinfectant to the equivalent of 1.5 to 2.0 ppm free
chlorine at a pH of 7.5 to 7.8 to control organic load.
b. Sample kits for testing should be available in the
pool area.
c. Ideal water temperature is 30.5o – 34o C [ 87o - 93o
F ] ( maximum 35o – 39 o C [ 96o - 102o F ] )

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d. To reduce contamination of pool consider scheduling
modifications or activity limitations for patients with:
a. Exposed sub-epidermal tissue or blisters.
b. Open wounds, skin lesions, skin rashes.
c. Bowel or bladder function incontinence.
d. Patients with invasive devices i.e., external fixation,
tracheostomy, IV lines.
e. Patients with infectious or communicable diseases.
2. The pool should be drained every 2 weeks for scrubbing of
sides and bottom and then refilled. Accessory equipment
should be wiped with an approved hospital disinfectant, i.e.,
a quaternary ammonium compound, and rinsed between
patients and at the end of the working day.

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3. The procedure to follow when pool is grossly contaminated
with patients blood or body fluid:
a. Wear the appropriate PPE.
b. Remove visible debris from the pool.
c. Raise the level of chlorine to 10 ppm, or drain pool and
scrub sides and bottom.
d. Test the level of chlorine and pH hourly until they return
to acceptable ranges.
e. Resume patient treatment in the pool when chlorine and
pH have returned to acceptable ranges. (1.5 to 2.0 ppm)
B. Hydrotherapy Units:
1. There are 3 treatment tanks in use on patients with nonintact skin as follows:
a. Rinse thoroughly and wipe dry

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C. Hydrocollators:
1. Hot packs: drain unit once per month or if visibly soiled.
Water may be drained through drain valve located at rear
bottom of unit.
a. Clean unit with a mild non-abrasive stainless steel
cleanser, and rinse thoroughly. Hot packs can be washed
with mild soap and water, however, the simplest method of
cleaning is to keep them immersed in the hydrocollator at a
preset temperature of 160 0 F (71 0 C).
b. Hot packs which leak or become visibly thinner should be
replaced. Hot packs have an expected use period of
approximately one year.
c. Towels not in direct patient contact for wrapping hot
packs should be laundered once per week or when visibly
soiled.
d. Towels in direct patient contact for wrapping hot packs
are single use only and are laundered between patients.

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2. Cold packs: drain unit once per month, or if visibly soiled, or if
there is excessive frost build-up. Water may be drained through
drain valve located at rear bottom of unit. Wash down using
warm water only.
a. Cold packs may be cleaned with mild soap and water or
disinfected with 70% alcohol if soiled with blood or body fluid.
b. Cold packs which are leaking should be repaired or discarded.
c. Towels in direct patient contact for wrapping cold packs are
single use only and are laundered between patients.
d. Dust and lint in the condenser fins should be cleaned once per
month. The condenser can be reached by removing the rear
access panel.
D. Paraffin Wax Treatment Room:
1. Wax treatments should only be used on patients with intact
skin. All skin surfaces to be treated should be washed with an
antibacterial soap and rinsed prior to placement in the paraffin
bath.

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2. The wax bath should be sterilized at the end of each working day by
turning the timer switch on for the full 55 minutes. The wax bath
temperature should rise to 212 o F (100 o C) and then should return
to normal working temperature automatically when the 55 minutes
is complete. For visible sediment at the bottom of the tank, the
following procedure should be done:
a. Drain paraffin into a container using the hollow drain rings (this
filters wax).
b. Disconnect electrical outlet and remove drain ring - the sediment
and sludge can then be drained.
c. Clean the bottom of the wax holder and slats with a mild hospital
approved detergent and rinse thoroughly.
d. Return clean paraffin to the container. Reconnect electrical outlet.
e. This cleaning method usually removes approximately 1 to 3 pounds
of paraffin which should be added to the cleaned bath.
f. Process for reusing wax:
i. Allow wax to harden and sediment to filter to bottom
ii. Cut off sediment
iii. Return clean wax to container for reuse

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E. Gymnasium/Exercise Rooms:
1. All equipment and toys should be made of materials which are
easily disinfected. If this is not possible it should have a cover
which can be laundered when visibly soiled. i.e., weights.
2. Whenever possible and if the information is available, follow
manufacturer’s instructions for cleaning equipment to avoid
injury to patient or damage to equipment, or interference with
function, i.e., laser, electrotherapy.
3. Equipment which is frayed, cracked, or otherwise damaged,
should be replaced or repaired.
4. Non-critical reusable items such as scissors should be wiped
with 70% alcohol between patients.
5. Although difficult to control, children should not place toys in
their mouths. Toys should be washed with a hospital approved
disinfectant, and then rinsed with water.
6. The plinth table should be wiped off with an approved hospital
disinfectant, i.e., a quaternary ammonium compound and
rinsed between patients if there is visible blood or body fluid. It
should also be covered with a sheet which is changed between
patients.

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7. Only patients with intact skin should use hand putty.
Appropriate hand hygiene techniques should be used prior to
using the putty. Putty that is visibly soiled should be discarded.
F. Cleaning of specific equipment:
1. Clean equipment daily or if visibly soiled.
2. Follow manufacturer’s recommendations.
G. Patients with communicable
diseases/epidemiological significant organisms:
1. Seek infection control advice for individual assessment of these
patients

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