There are 3 basic ways to dispose of the blood, saline solution and other types of fluid waste generated during surgery: dump it, solidify it or use a closed fluid waste management system that does much of the work for you. When making a decision on which method to use, you'll need to weigh the costs, benefits and practicality of each system against the needs of your facility. Here's an overview of the 3 methods and how to safely execute them.

1. Dump it.
How it works: Staff manually transport filled suction canisters from the OR to a utility sink and pour the contents down the drain into a municipal sewer system, where the waste is treated.

Pros: The simplest, most low-tech and inexpensive option, dumping may make the most sense if you do a very low volume of procedures generating fluid waste at your facility, as long as your state and local laws permit the dumping of infectious waste in this manner.

Cons: Transporting and emptying canisters filled with fluid waste exposes workers to the greatest potential risk from splashing and aerosolization of infectious waste. In addition to the contamination risk, fluid spills on the floor can also lead to slips and falls.

How to do it safely: Don't overfill canisters, as that increases the risk of them leaking or breaking. Place caps firmly on all ports to avoid leaks or spills. Canisters being transported to a utility sink or hopper for disposal are at the greatest risk for spills and should be transported on a washable cart — not by hand — to ensure that they remain upright. Canisters that aren't immediately emptied should be clearly labeled as infectious medical waste.

Be sure to designate a sink specifically for waste disposal; staff should never dispose of fluid waste in a general-use sink where employees wash their hands or clean instruments and supplies. Consider installing a shield over the sink that would help protect staff from splashing that may occur while pouring fluid down the drain. Once the fluid is emptied, either discard the canisters or clean and disinfect them according to the manufacturer's specifications before reusing them for the next case.

2. Solidify it.
How it works: Staff add a solidifying agent to the waste while it's contained in suction canisters, turning the fluid into a gel-like substance. Both the waste and the canisters are then discarded. Solidified waste is still considered infectious waste and therefore requires red-bag disposal. However, some solidifiers contain antimicrobial agents that, when added to the waste, sanitize it to a degree that makes it suitable for clear-bag disposal.

Pros: This method contributes to operating efficiency, since rather than transporting canisters to a separate area for disposal, staff can begin solidifying and disposing of fluid waste as soon as suction is completed during the case. Solidifying fluid waste before you dispose of it helps protect workers from the risk of splashing, and since you don't have to transport the canisters, you can contain any potential spills or leaks to one room or area.

Cons: The added cost of the solidifying agent and the added weight of the red-bag waste disposal mean solidifying fluid waste is a more expensive option than simply dumping it. And even though the risk of splashing is reduced, there is still a manual element to this process — staff must open the canisters to pour in the solidifying agent — so there is some risk of exposure.

How to do it safely: The solidifying agent comes in a tube or packet corresponding to a particular canister size. Be sure to match the correct amount of solidifying agent to the amount of fluid in the canister. You must also allow time for the solidifying agent to thoroughly mix with the liquid and solidify it — it may take several seconds to minutes to complete this process. Follow the instructions on the label of the solidifier to get the best results for the product you are using.

Canisters of solidified waste can be placed in garbage bags for disposal and may be sent to a sanitary landfill or for incineration. Check with your state and local regulations to ensure you're safely and properly disposing of solidified fluid waste, and educate staff about those regulations and the products you're using. If antimicrobial agents are added to the waste during the solidifying process, rendering it non-infectious, don't dispose of the canisters in areas designated for infectious waste only, as that will cause confusion and increase your red-bag waste costs. Similarly, always place solidified waste that hasn't been sanitized in red-bag waste to prevent contamination. If a full canister doesn't immediately go into a red bag, clearly label it as infectious medical waste. Finally, limit the number of canisters per bag. If the bag is overloaded and breaks, the canisters can break open, creating a spill of the gelled waste.

3. Use a closed system.
How it works: With these more advanced systems, staff never have to open filled canisters and handle fluid waste manually. Instead, canisters are plugged into a docking station connected to a drain in the decontamination room or directly in the OR, and the fluid is automatically drained out of them to the sewer system. Some systems use canisters that are either disposable or disinfected and reused between cases, while others combine both suction and disposal in one system, without the need for canisters. These systems can either be mounted on the wall in the OR and connected directly to drains from there, or housed on mobile devices that can be wheeled in and out of the OR and docked to a drainage station located in the decontamination room.

Pros: The fastest and easiest method for dealing with large volumes of fluid waste, closed systems make the most sense for facilities that do a lot of fluid-waste-generating procedures. Since canisters of fluid waste remain closed throughout the process, this method greatly reduces the risk of exposure. It also contributes to OR efficiency by automating more of the fluid waste collection and disposal processes.

Cons: Closed systems are the most expensive option and may require capital purchases and renovations to your facility to add the docking area and dedicated plumbing and drainage for it.

How to do it safely: Just wheel closed systems in and out of the OR, hook them up to the proper suction and drainage channels, push some buttons and let the device take care of the dirty work.

Systems with reusable canisters often have a feature whereby the canisters are automatically washed and disinfected between cases. If you don't have an automated system, your staff will have to manually clean and disinfect the canisters according to manufacturers' specifications. Or, to better prevent cross-contamination, you may choose a system that uses disposable canisters or liners rather than reusable ones.

Safety first
What's the best way to dispose of infectious fluid waste? To answer that question, you'll need to consider your case mix, staff competency and comfort level with the different types of systems and, of course, your budget. Ultimately, the key to safe fluid waste disposal lies not in what tools you use, but in how you use them.