IN TANDEM Using fluid-collecting drapes and floor mats in combination can help keep floors dry and employees safe.

Nothing creates a potential flood in the OR like a long arthroscopy case. If you don't safely and efficiently keep up with the flow while your surgeons are scoping knees, hips, shoulders and elbows, you can find yourself up to your ankles in no time. Fortunately, closed direct-to-drain systems and floor suction devices can handle the large volumes of fluid waste generated during arthroscopy procedures and help limit staff exposure to dangerous waste. They can also help reduce turnover times and potential red bag trash costs, as well as mitigating the ever-present risk that a staff member could go slip slidin' away, right into a serious injury or a workers' compensation claim.

Direct collection
"What goes in must come out," is how Matt Cooper, BSN, RN, CNOR, RNFA, director of surgical services at the Spencer (Iowa) Hospital, sums up the challenge. "So the question becomes, as it comes out, how do we deal with it?"

Mr. Cooper has been around long enough to remember what it was like dealing with arthroscopic fluid waste before today's high-tech options were available. "We used to capture it in suction buckets and then empty the fluid into another pail," he says. "At the end of the case, we'd be carrying out a couple of buckets of fluid, putting ourselves at risk of exposure after exposure after exposure."

Not exactly the good old days.

Mr. Cooper decided he needed to protect himself and his staff from the biohazardous waste that pours off patients' joints. The advent of floor suction devices helped, and still does, "but inevitably we would also end up throwing blankets on the floor," he recalls. "And we'd end up with tons of saturated blankets. You can imagine the expense of dealing with that. We were charged by the pound to get them cleaned, so we weren't just paying for the linens, we were also paying for pounds and pounds of water in the linens."

DRAINING CHORE There's a busy caseload of arthroscopic procedures at the Outpatient Center of Jonesboro (Ark.), where the docking station can handle 4 portable large-capacity units.

These days, Mr. Cooper swears by the portable suction units that capture fluid runoff before it hits the floor and are drained at docking stations. They can be wheeled from OR to OR and have more than enough capacity to handle the vast majority of arthroscopy cases.

"Ours holds up to 24 liters total," says Mr. Cooper. "On a couple of occasions, we've had to pull in a second one to finish a case, but it doesn't happen very often. You need a long and complicated case to reach that kind of volume."

How rare is the arthroscopic case that exceeds that capacity?

"I've yet to see one fill up before the case is over," says Jimmy Henderson, the materials manager at the Outpatient Center of Jonesboro (Ark.), also a fan of the closed portable large-capacity suction devices. "We have 4 of them, and we keep them pretty busy. We just did 12 arthroscopy cases today."

If there's a drawback, it's that the devices are large enough to intensify the crowded feeling in smaller operating rooms. But their convenience and the peace of mind they provide generally draw rave reviews. The fluid goes directly into it, so you never have to worry about dumping those fluids. Plus, it's hooked up to evacuate through the plumbing, so you never have to worry about being splashed or exposed to bodily fluids.

Direct-to-drain options also include wall-mounted systems that automatically collect surgical fluids and dispose of them directly into your facility's plumbing system. They have unlimited capacity, so they're never full and there's never a need to change canisters. They also free up space in crowded ORs and can minimize traffic in and out, because they don't need to be removed from the room to be emptied.

In addition to being more convenient, both kinds of direct-to-drain systems are also more environmentally friendly. The most common alternative — solidifying the liquid and having it hauled away — means that both the waste and the canisters that contain the solid waste end up in a landfill.

Direct-to-drain systems can also reduce room turnover times by eliminating or shortening many of the cleanup tasks that result from using less efficient means of fluid collection. Mr. Cooper and his team must be thrilled those sopping wet towels that had to be picked up and hauled away are no longer needed.

EXPOSURE THREAT Closed direct-to-drain fluid-waste systems keep staff from having to handle biohazardous waste.

Backup solutions
Of course, no solution can catch every drop before it hits the floor, so it makes sense to augment direct-to-drain systems with other tools, like drapes that have fluid pouches built into them. Those are great at catching any extra fluid, says Mr. Cooper. An alternative is drapes with adhesive backing that can be attached to regular drapes, and folded or melded around the extremity to capture the additional runoff. Both products have suction ports that can be drained into a closed system.

Of course, they're useful only as long as the surgeon makes sure the fluid is always running into the pouch. Surgeons are sometimes too busy to care, and if the fluid doesn't run into the pouch, they're not concerned, because somebody else ends up having to clean it up.

If surgeons are oblivious, that, too, creates both a hassle and a potential hazard for staff members, who not only have to do extra cleaning, but who also face a greater slip-and-fall hazard. All it takes is a few drops to send someone skidding and reeling.

At Mr. Cooper's hospital, in addition to the suction device and the drapes, they use a floor suction mat to try to catch every stray drop. "I don't know if that need will ever go away entirely," he says. "We once had a circulator slip and fall because there was some fluid on the floor and it got very slippery," he adds. Fortunately she wasn't seriously hurt. "I think her pride was damaged more than anything else," says Mr. Cooper.

Pride aside, such accidents can be serious. So it makes sense to pull out all the stops to keep the OR floor dry and safe.

At the Rye (N.Y.) Ambulatory Surgery Center, the anti-slip-and-fall arsenal includes not only a portable high-capacity suction unit, but also drapes with a collection bag, and floor mats that are positioned around the perimeter of the operating room table, just in case. "That combination usually contains everything, so we've had no trouble with falls," says Maureen Simpson, RN, CNOR, the center's OR and PACU manager. "We've been fortunate in that regard."

Fortunate, but also diligent and well prepared to catch every drop of liquid that could threaten the health and wellbeing of her staff. OSM