The daily schedule at my busy multi-specialty surgery center is loaded with fluid-intensive orthopedic cases. We'd still be sloshing around the ORs if it weren't for the specialty drapes, suction mats and strips, floor suction devices and closed-fluid disposal systems that keep our floors bone dry during even the messiest ortho cases.

Lots of fluid, lots of options
Standing in a pool of water and surgical fluid waste isn't just uncomfortable; the potential dangers to staff and surgeons are many. Staff can slip and fall on slick wet floors; they can get electrocuted if power cords sit in pools of water; and infection prevention efforts are jeopardized when staff track fluid out of sterile ORs and across non-sterile halls.

During meniscus repairs, the most fluid-intensive procedures we host, our surgeons run through as many as 23 3L bags of fluid. Emptying 12 to 20 bags during shoulder procedures or ACL repairs is more the norm. Either way, that's a lot of fluid, which more often than not ends up on the floor during a case.

Long gone are the kick-bucket and 3L suction canisters we used to use to help keep fluid off our floors. Today we have a wide array of fluid-control devices at our disposal, including:

• Fluid-capture drapes. Specially designed drapes with fluid-collection pouches serve as our first line of defense. Many of the suction devices used by surgeons connect directly to the pouches, which helps prevent fluid runoff from ever reaching the floor. While one of our surgeons balked at using the drapes because of concerns he had over having captured fluid sitting close to the patient — he felt it harbored bacteria in the pouches — most docs welcomed the drapes' fluid-capturing potential.
• Suction mats. When fluid escapes capture in a customized drape, suction mats placed at the surgeon's feet collect the overflow. Fluid that falls onto the mat seeps through small holes in the surface before pooling in a series of channels that connect via suction tubing to our closed fluid management system.

After trialing the options on the market, we opted for a reusable model instead of a disposable option. In addition to being more eco-friendly — we host 300-plus cases a year that require suction mats — the reusable mats were less bulky and more comfortable for surgeons to stand on for long stretches of time. While reusable mats need to be cleaned between cases, using them actually helps speed room turnovers. Instead of having to mop up water that would collect on the floor if the mats were not used, staff simply clean the mat's surface and place it for the next case.

The multi-use mats cost between $200 and $300 each, compared to $22 to $30 for the disposable models. We purchased 2 multi-use mats for our 3-OR facility — rarely are all 3 rooms filled with messy cases at the same time. Spending a couple hundred dollars more to capture excess fluid might seem excessive, but consider how quickly expenses would mount if we dropped upwards of $30 on each of the more than 300 cases that demand the use of a mat. When you look at the purchasing decision that way, spending a little extra on suction mats is justifiable.

• Floor suction devices. When drapes and suction mats fail to contain fluid runoff, our staff grabs floor aspirators to finish the job. These single-use mobile suction devices, which cost about $7, work like the wet vacs you'd use to clean a flooded basement. They're not needed for every case — we use ours about 2 or 3 times a week — but they're invaluable to have on hand when fluid-intensive cases make a mess of the OR.
• Spill booms. We'll wrap these long, sock-like devices around the base of the OR table at the start of cases known to produce large amounts of fluid or before fluid-happy surgeons make their first cut (see "Get With the Flow"). The spill booms are 4 feet long and 6 inches in diameter, cost about $6 a piece and absorb up to 5L of fluid. The devices are infinitely more effective at collecting excess fluid that drips down the OR table than the blankets or towels you might be using in your facility.
• Closed fluid management system. Our fluid-control program revolves around this workhorse. The mobile system connects directly to our drapes, surgical instruments, suction floor mats and floor suction devices to capture fluid in a contained unit. Once filled, staff simply rolls the unit to a docking station in the decontamination room for emptying directly into the sewer. The system eliminates staff having to lift fluid-filled canisters and protects them from the contamination risks they face when dumping waste from open canisters into the hopper.

We didn't pay for the unit outright. Instead, the manufacturer supplies the machine free of charge; we're responsible for purchasing single-use, $30 proprietary filters for each case. It's a price we're willing to pay, especially compared to the (many) $18 fluid canisters we'd fill during ortho cases. Paying for the filter is even more reasonable, even for our budget-conscious physician-owners, when you factor in the potential expenses we'd incur if a staff member suffered a back injury while lifting heavy suction canisters, missed time because of the injury and filed a workers' compensation case.

No more slips
Since we've started capturing fluid before it makes a mess of our OR floors, surgical efficiencies have improved. Instead of wasting time by laying down towels or blankets to sop up excess fluid — which is hardly effective — and having to mop up after each case, our staff simply cleans the suction mat, tosses away the single-use boom and floor suction device, and empties the closed fluid management system.

More importantly, we work in a safer environment. I've seen plenty of nurses slip on slick OR floors as they've rushed to help a co-worker or grab a piece of equipment. That's something I'll likely never have to witness again, thanks to the emphasis we've put on controlling fluid in the OR and the investment we've made in the devices that make it possible.