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Sinks and sewers, splashes and splatters. Yes, fluid waste disposal is the dirty job that somebody's got to do. The most basic options for getting rid of fluids are the manual, open methods of dumping and solidifying. But as you'll see in this comparative report, closed disposal systems that send fluid waste directly to the sewer are much more efficient and safer.
Dumping down the drain
Dumping suction canisters entails transporting covered containers by hand or on a cart to a utility sink or hopper, then pouring the contents down the drain. The discharge of fluid medical waste into a municipal sewer system for eventual treatment has been deemed an appropriate disposal method by the EPA as well as the Centers for Disease Control and Prevention. It requires no specialized equipment and, as long as your state's laws allow it, it is perhaps the simplest method but it's by no means carefree. In order to protect themselves against the threat of bloodborne pathogens, surgical personnel must don gloves, gowns, masks and goggles or face shields before emptying canisters. Installing a hood over the sink can also help to cut down on fluid backsplash, spatter and aerosolization.
"Even with personal protective equipment, it still presents a risk of exposure," says Brenda Yates, RN, BSN, MBA, CNOR, a perioperative clinician for surgical services at Gwinnett Medical Center Duluth in Duluth, Ga. Plus, pouring large quantities of fluid means there's always a chance you'll get the floor wet and risk slips and falls.
Solidifying fluid waste
Solidifying a suction canister's contents would seem to remove much of the potential mess from the disposal process, but this method has its own tradeoffs. The addition of an agent into the fluid converts it to a gel; some products even offer disinfection. The entire canister is then discarded with the facility's infectious waste for incineration. (If incineration is taking place off-site, the canister must be packaged for transport in accordance with regulators' and haulers' guidelines.)
However, there still may be the risk of exposure, since the canister must be opened in order to add the solidifying agent. "A pressure buildup inside can cause the fluid to pop or splash out," says Ms. Yates. Some products, formulated to be poured into the canister before its use, offer a way around this concern.
Also, she says, "It's not an inexpensive way to dispose of fluid." Besides the cost of the solidifying agent — about $2 or $3 per use — full canisters add substantial weight to the red bag waste you're shipping out. De-pending on how many canisters your ORs go through in a day, this can add up.
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Canister Waste Considered |
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Besides the spent saline and bodily fluids, there's still another waste management issue to consider: the canisters themselves. Unless you're using a canister-less closed suction system, it's likely that your canisters wind up in red bag waste bins. Research conducted by the University of Minnesota's Technical Assistance Program has shown that single-use suction canisters make up 40% of the infectious waste that surgical suites generate. The study (available at www.mntap.umn.edu/health/91-canister.htm) recommends closed suction systems and reusable canisters as economical and environmental alternatives. Closed suction can represent a significant investment. You'll pay a premium for reusable canisters, perhaps more than $100 each as compared to the couple of dollars spent on each single-use canister, says Mitch Birchfield, MBA, CHESP, the environmental services director and hazardous materials manager at Seattle Children's Hospital in Seattle, Wash. For high-volume users, though, the more durable containers offering years of reuse can cut thousands of dollars from purchasing and waste disposal budgets. His department has calculated that the hospital's 15 ORs use and discard an estimated 26,000 suction canisters — about 12,000 pounds of plastic — each year. "At the end of the day, what you're looking at is an insidiously large amount of plastic, just from the OR area," he says. He and other hospital stakeholders, including surgical services, central sterile, purchasing and facility maintenance personnel, are studying the feasibility of installing reusable-canister suction equipment throughout the facility. Their review is part of a hospital-wide program that's linked environmental aims with financial benefits. Given the extra expense of infectious waste hauling over the cost of solid waste disposal, an examination of what got red-bagged was a priority. After identifying and diverting the non-medical waste, says Mr. Birchfield, what they were left with, other than blood- and fluid-saturated items, was blue wrap and suction canisters, both of which they're seeking recycling solutions for. "Some may say those types of waste are the cost of doing business, but we could be doing a much better job," he says. — David Bernard |
The risks and costs associated with these 2 manual disposal methods make them more suited to cleaning up after procedures that don't produce much fluid. For facilities that don't host many fluid-intensive procedures, they may be the only methods needed.
Closed solutions
When larger amounts of fluid are involved, such as in complex orthopedic procedures, more efficient disposal methods are necessary. Saline irrigation flows freely during many orthopedic fixes. Rotator cuff repairs and anterior cruciate ligament reconstructions demand a lot of fluid quickly, which results in a lot of runoff. With new techniques shortening procedure times, open disposal was hampering workflow and room turnovers at the Boston Out-Patient Surgical Suites in Waltham, Mass., where some of the facility's surgeons were able to complete ACLs in 25 to 30 minutes.
"We'd fill canisters and hope the nurses could keep up with it," says Administrator Greg De-Conciliis, PA-C, CASC. "Finally the nurses said, this isn't a great solution." Besides the possibility of infectious exposure, the full and heavy 3-liter canisters that stacked up in the corner of the OR presented ergonomic lifting and carrying risks, he says.
Closed disposal systems send fluid waste to the sewer with less risk of exposure for the user. There are 2 ways to do this: closed drainage systems and closed suction systems.
- Closed drainage systems. You transport suction canisters to the decontamination room or other designated disposal area and plug them into a stationary, often wall-mounted device that empties the collected fluid into a sewer drain without removing the canisters' lids. You then either discard the canisters as infectious waste or, if they're reusable, disinfect them for continued use.
- Closed suction systems. This combines collection and disposal by skipping the canisters. A portable unit with the capacity of several suction canisters and multiple suction ports can connect to the surgeon's instruments, the drape's fluid capture pouch and the floor vacuum, then be wheeled to the decontamination room and docked with a drain for discharge when necessary. Or a stationary, wall-mounted unit offers suction direct to the sewer line without even transporting equipment.
With closed suction, you must change the single-use filter, which shields the intake against contamination from previously collected fluid and costs about $10 to $14 each, between each case. And all closed disposal methods require installation of dedicated plumbing for drainage functions, the cost of which will depend on how much renovation such plumbing demands.
Tight budget? Discuss creative financial options with the vendor's rep, as Mr. DeConciliis's facility did for a portable closed suction unit. His deal works like this: Rather than paying for the machine, they estimated the number of cases they'd use it for and made a commitment to buy a certain number of the filters every month, he says. The vendor let the surgery center use the machine at no cost and added a dollar or so to the cost of each filter, which paid for the equipment over time.
Between the equipment purchase, the plumbing installation and the regular orders for disposable items, closed fluid waste disposal can run your facility tens of thousands of dollars, a daunting investment that may lead some to reconsider the riskier, but perhaps cheaper, manual methods. But think of it this way: In addition to the employee safety advantages, you're also buying time and a more efficient staff. "People don't realize how much more time it's going to give their nurses," says Ms. Yates, "and any efficiency that nurses can gain in the room is an asset."
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