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Protecting your team doesn't end when the case does. Here's advice on safely disposing of the medical waste and fluid that collects in the sterile field and on the OR floor.
Define it. OSHA defines regulated waste as liquid or semi-liquid blood or other potentially infectious material (OPIM), items contaminated with blood or OPIM that would release these substances in a liquid or semi-liquid state if compressed, items that are caked with dried blood or OPIM and are capable of releasing these materials during handling, contaminated sharps, and pathological and microbiological wastes containing blood or OPIM.
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Fluid Waste Tips |
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As a medical waste management consultant, I spend lots of time in soiled utility rooms observing how people dispose of canisters of fluid waste. I also note if they're wearing the proper personal protective equipment: gloves, gowns, masks, goggles and even plastic face shields that extend beneath the chin. And whether those who pour fluid waste into a flush sink wipe down the sink afterwards (some do not). You have three options for collecting, containing and disposing of irrigants, blood and other surgical and bodily fluids that amass during surgery:
How do these rate from a staff safety standpoint? Simply stated, the fewer waste containers and collection devices your staff has to handle, the better. Transporting suction canisters and flushing their contents down a drain can expose staff to splashing and leaks, not to mention slips and falls. Anything you can do to reduce or eliminate the human element will minimize your staff's exposure to hepatitis C, HIV and other bloodborne pathogens that fluid waste may contain. Closed suction systems that automatically flush fluid waste into a sanitary sewer drain are best at minimizing staff exposure. Portable units that you can wheel over to the wall-mounted flusher are also a safer alternative to using a flush sink or solidifying and red-bagging fluid waste. Direct-connect systems also appear to be more efficient, both economically (not having to buy more containers and paying for their disposal) and environmentally (less plastic reduces your carbon footprint). There may be installation and supply costs to consider. Does the discharge connection plug into a drain in the soiled utility room like a fire hose, or does it need an engineered fitting? Will the system require dedicated plumbing? Much of the cost of fluid management lies in the canisters the systems use. Some systems involve reusable canisters but consumable lids. If you're not going to use an automated disposal system, here are things your staff can do to dump or solidify fluid waste safely:
More on using a case cart: Avoid the practice of throwing suction canisters into red bags and dragging them down the corridor to the flush sink. The canisters can leak, creating both a breach in infection control and slip-and-fall hazards. If your goal is to reduce injuries and free-flowing liquid, solidifying liquid waste is a decent alternative to pouring it down a sink. — Edward Krisiunas, MT (ASCP), MPH, CIC Mr. Krisiunas ([email protected]) is president of WNWN (Waste Not, Want Not), a Burlington, Conn.-based consulting firm specializing in the areas of medical waste management, infection control and occupational safety. |
OSHA says it's your responsibility to determine the existence of regulated waste, based not on the actual volume of blood, but rather on the waste's potential to release blood.
For example, regulated medical waste could be defined as disposable items that would release infectious fluid if compressed. Items at risk of being hazardous to your staff — including those who haul the trash — must go in red bag waste. Trash that isn't a risk to haulers can be placed in clear bag waste. That's not to say that all trash placed in clear bags is not infectious; it's just not at risk of infecting those who handle the trash. Staff can carefully roll or fold an impervious gown containing only a spot of blood before placing the gown in a clear bag to eliminate the chance of exposing staff and waste haulers to that blood.
OSHA says regulated medical waste must be placed in labeled, closable containers constructed to contain all contents and prevent leakage of fluids during handling, storage, transport or shipping. The containers must be closed before removal to prevent spillage or protrusion of contents during handling, storage, transport or shipping.
Control fluid. Disposable liners and open canisters certainly have a role in today's OR, but in my opinion nothing protects staff more than closed fluid disposal systems. Direct-to-drain delivery of fluid waste greatly reduces staff's exposure to infectious waste. Closed systems also help reduce red bag waste expenses by eliminating the disposal of full fluid canisters as regulated medical waste. Those canisters add significant weight, and therefore expense, to red bag hauling.
Closed systems may cost more than disposable canisters or fluid mats, but they minimize exposure risks by limiting hands-on elimination of fluid waste, making them invaluable tools to promote staff safety. The return on investment you'll realize by keeping your staff safe is difficult to fully measure if you look only at your capital equipment budget's bottom line when shopping for a closed system.
Put up barriers. The same personal protection precautions taken by staff should be maintained during cleanup and room turnovers. Keeping masks and gloves on when disposing of medical waste is likely a given in your ORs. But what about donning eye protection? Your staff might not be as vigilant in wearing eye shields during the handling of medical waste. They should be. I've been hit in the face when disposing of fluid waste. It's a frightening — and dangerous — experience, one that reinforced in my mind the importance of using the correct devices and following proper protocols when disposing of medical waste. You need to impart the same urgency to your staff, but without a traumatic experience serving as the spark of course.
Listen to and involve the experts. Involve staff in the decision-making process when trialing fluid disposal systems or sharps containers. Better yet, designate a staff member to drive this process among peers. Our surgical tech, Jeff Loper, CST, with help from OR product specialist Mary Gardner, worked with our frontline staff to trial new safety scalpels. Finding high-quality blades that also protected the OR team during passing was only part of the trial's goals. We also wanted products that were safe to dispose of after use. Eventually we found one, a device that removes blades from scalpels before automatically dropping them into a closed container.
The staff that trialed the device astutely commented that a strip of double-sided tape on its bottom would secure the frame to a tabletop while staff disengaged the blade. That simple alteration, one we're working with the manufacturer to make, will let staff operate the device single-handedly, eliminating the need to place a hand in harms way while the blade is removed from the scalpel's handle.
Expect initial resistance to changes in your disposal practices or new safety product introductions. Listen to staff's objections and acknowledge their concerns. Your frontline employees have the most interest in protecting themselves and are often the best sources for improving safety practices. Support proposed practice and product changes with rationale and education. We all can improve our practice, and as professionals, we should view these proposed changes as opportunities to do just that.
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