FLUID DYNAMICS A single surgery can fill several containers with fluids bound for disposal.

Safety, cost and simplicity: All are essential considerations in the world of surgery, but which one wears the crown in your OR? Your answer just might determine if you need to adjust how you manage the disposal of the potentially infectious byproducts of surgery — namely, blood and other forms of fluid waste.

You could dump fluids manually, which is likely the simplest and most economical option, but it may also expose staff to infection and ergonomic hazards. Or you could invest in solidifying and decontaminating agents that may help you to trim the amount of red-bag waste that has to be hauled off at a premium. Or, for the ultimate in staff safety — and capital costs — you could opt for a stationary direct-to-drain system that is hard-plumbed into the sanitary sewer, or a portable system on a cart that employs a docking station for automated drainage to the sanitary sewer. We talked to 3 surgical facility leaders about why they altered their approaches to fluid-waste management.

Spend a little, save a lot
The unpleasant odor, or lack thereof — that's what Rebecca Rhodes, CST, notices most since her surgery center shifted its approach to handling fluid waste. She's not the only one who detects a change in the air.

"We're a small facility, so the biohazard room is close to PACU," says Ms. Rhodes, materials manager for Wesmark Surgery Center in Sumter, S.C. "When that room would get smelly, patients had to deal with it. Now, I never once smell it. It's much more pleasant for patients, and the nurses, too, especially when you're at the nurses station all day."

It's a matter of then versus now. When it first opened, the surgery center did mostly urological procedures. It has since grown to include orthopedics, ENT, podiatric procedures and "lots of GI," says Ms. Rhodes. In all, it's doing about 600 cases per month, meaning the amount of fluid waste that's being generated has gone up exponentially.

LIQUID TO SOLID Powdered solidifying agents can help to reduce red-bag waste. NO CANISTERS TO DUMP A docking station automatically empties the liquid waste closed systems suction and collect during surgery. DOWN THE HOPPER Manually opening plastic canisters and pouring the contents down the drain can pose a significant risk of splashing or aerosolization of bloodborne pathogens for OR staff.

Once upon a time, the facility red-binned its untreated fluid waste. As the waste piled up in periods of high volume, the odor would intensify till the waste-removal vendor came to retrieve it. Then, about 2 years ago, the facility changed course by solidifying and decontaminating the contents of reusable suction canisters and then bagging the waste. Ms. Rhodes says the "new way" is a marked improvement.

"Sometimes the waste would pour out of the red bins; it was very unsanitary," she says. "The way we do it now, most of it is appropriate for white bag; all we have to do is label it with a sticker that says it's treated solid medical waste."

Ms. Rhodes says the change has helped the facility "save a ton of money" on waste-disposal costs. She estimates the facility was spending $3,000 per month on red-bag waste pickup — a number that has been slashed to $1,000 a month. In comparison, the cost of the solidifying and disinfecting agent runs about $400 per month. "You look to save anywhere you can," she says. "Every little bit helps, especially when you're physician-owned."

Investments in ancillary systems, like absorbent floor mats and disposable floor aspirators, have contributed to process efficiencies and a dip in overall costs. The mats and aspirators work in concert to soak up any fluid that might reach the floor during a case. The benefits, according to Ms. Rhodes: improved OR safety and quicker room turnover.

Safety first
Likewise, Skeet Todd, RN, BSN, CNOR, CPAN, RNFA, says an adjustment to fluid-waste management has produced dividends for her surgery center. Portable, large-capacity suction units that dock to a drain have been a boon to safety, she says, because they protect staff from potential infection, reduce ergonomic concerns and mitigate other risks, like injuries from slip-and-fall accidents.

"When I first came here, in 2003, they were using big, fluid-filled containers and literally putting 3,000-cc containers full of liquid in the trash," says Ms. Todd, director of outpatient perioperative services for Texas Spine and Joint Hospital in Tyler. "They were heavy, and they could be punctured, so leaks were a source of concern."

The facility then moved to the same kind of solidifying agent used at Ms. Rhodes's facility. It was an improvement, but still an imperfect solution.

"The bags were still heavy — 45 to 50 pounds, in some cases — and there was the possibility the top [of the container] could come off," she says. "If there was a spill, it wasn't fluid, but it was a gelatinous mess."

Now, with the closed system, there's nothing to handle, no mess to mop up. Ms. Todd admits cost can be an issue — she says the dollars spent on the disposable manifolds add up quickly, plus there's the $20,000 to $25,000 in capital cost per system, according to Practice Greenhealth estimates (osmag.net/Y7sFGj) — but she considers it a worthwhile investment. Besides the protections a closed system affords, some units double as smoke evacuators.

"You have to weigh the costs over the possibility of a workers' comp injury," she says. "If you prevent someone from getting hurt with a back injury, it's a wash. It will more than offset the cost of the manifolds."

Ms. Todd thinks the capital cost will be less of an issue going forward. Vendors may be willing to negotiate on the cost of the equipment — even providing them for free, in some cases — in exchange for a purchase commitment on X number of disposables.

"For someone who doesn't have a big capital budget, that can be a huge deal," she says.

Environmentally friendly
Emerald Coast Surgery Center in Fort Walton Beach, Fla., used to red bag just about every drop of fluid waste coming from its 5 ORs and 2 GI suites. Now most of it gets solidified and disinfected, sitting for 12 hours before getting earmarked for the trash bin. Jeniffer Ferrell, RN, the multispecialty surgery center's pre-op/PACU nurse manager, believes this solution offers safety and simplicity at an acceptable cost.

"The waste from GI procedures used to go down the hopper, and we'd red bag everything else," she says. "Now we're not red bagging anything but blood."

That's led to significant cost savings, though Ms. Ferrell can't offer a precise number. She sees another important benefit of this approach: All the fluid that once went down the drain is no longer flowing directly into the environment. OSM