How do you manage the potentially copious volumes of blood and body fluid that can be generated during surgery? Older fluid waste disposal systems used suction canisters to collect liquid waste. Staff would then discard the waste either by opening the canisters and pouring the contents down the drain, or by using chemicals to solidify the liquid, and then having it hauled offsite for treatment and disposal as regulated medical waste. There's also a third and decidedly more high-tech and cleaner way to dispose of fluid waste: direct-to-drain systems that forgo both pouring and solidifying. As we'll discuss, they can provide significant benefits in costs, safety and environmental impact.

A lot to consider
Naturally, there are advantages and disadvantages to all systems, so having a grasp of a significant number of variables can help determine which system makes the most sense for your facility.

For example, how much floor space is available in the OR? Does space always seem to be at a premium? How complicated would it be to plumb into the fluid management system? Are you doing a lot of orthopedic surgeries? If so, which systems have the capacity to handle the large quantities of fluid involved in total knees, total hips and other orthopedic procedures?

Do you want a system that's stationary and hard-plumbed into the sanitary sewer, or do you want one that's portable? Some systems have reusable canisters that can be disinfected; others have closed integrated canister systems. Some use disposable canisters that you can place in regular trash after they're rinsed with enzymatic cleaners. (Those may be less expensive than other systems, but they can't accurately measure fluid loss, if that's a concern.)

Pour alternative
Systems that require OR staff to manually pour contents down the drain may require the smallest capital outlay, but there's no question that they're also the most dangerous. We can speak from experience. We know of a nurse who was removing the suction tubing from a suction canister that hadn't been fully disconnected. The sudden change in pressure ejected the contents into her eyes, nose and mouth. Luckily, she wasn't injured, but it's the kind of experience you wouldn't wish on your worst enemy.

The risk of occupational exposure can have an emotional impact as well as a physical one, and the literature is clear that nurses are most in harm's way when it comes to splashing, which is especially common around and on the head, face and eyes. We also know that exposures are greatly underreported. And even when no splashing is apparent, pouring also carries the risk that aerosolized particles will contaminate clothes and work surfaces.

Heavy concerns
Solidifying the waste and hauling it away generally eliminates the pouring hazard, but in a high-volume environment, its costs can add up quickly. And in addition to the cost of the red-bag waste disposal, there are costs associated with canisters, hard-shell outer containers, solidifying agents and labels. It's been estimated that up to 40% of hospital-regulated medical waste is related to suction canister disposal.

Another big problem is that solidified waste is heavy. It's not unusual for a single surgery to produce 3 or 4 3-liter containers that weigh 6 to 8 pounds each.

You may also waste precious OR time while you wait for solidifiers to work. Some manufacturers claim that their products need only 2 minutes to do the job, but reports call that into question, suggesting that some solidifiers can take up to 10 minutes to solidify completely.

You may even find yourself still dealing with some dangerous liquids, because solidifiers sometimes fail to fully solidify canisters that are filled to the brim (some facilities find upon investigation that staff are pouring more than one package of solidifying agent into each container because they feel that one package doesn't do the job). And of course there are significant environmental implications — not only with the solidifying agents themselves, which may contain powdered chlorine and powdered glutaraldehyde — but also with the disposal of the canisters, which become part of the regulated medical waste stream. If the waste goes into a landfill, the plastic takes hundreds of years to break down and may leave environmental toxins behind. If it's incinerated, some of the petrochemicals used in the plastics have the potential to create and release dioxins, which are very potent carcinogens.

Quick ROI?
Fortunately, our municipal water systems are designed to deal with biological hazards, which makes the direct-to-drain alternative that much more attractive. Still, it's important to do due diligence and check with state and local authorities. Some locales may not allow direct-to-drain disposal, in which case you'd have to dispose of waste offsite. (In those instances it might be worthwhile to bring stakeholders together and initiate a discussion about the reasons behind that regulation.)

Ultimately, a direct-to-drain system, where appropriate, can have a positive impact not only on safety and the environment, but also on the bottom line. The money saved by avoiding having to pay for disposable suction canisters, chemical solidifiers and waste disposal adds up quickly, often resulting in a quick return on investment. OSM

MD Technologies
Environ-mate DM6000 Series
mdtechnologiesinc.com
(800) 201-3060
Price: $4,500 to $9,000, including installation, hardware and vacuum regulators
FYI: The 3 Environ-mate DM6000 Series models connect to a suction source, an electrical outlet and a drain, and silently suction fluid waste and drain directly to the sewer, so there's no staff exposure and waste doesn't have to be transported for disposal. The models are compact and wall-mounted, so they don't take up OR floor space. The DM6000-2A has unlimited capacity for high-volume cases in arthroscopy and cystoscopy, the DM6000-2 (shown) models offer 2 independent suction inputs for endoscopy, and the DM6000 with a footswitch provides hands-free operation, making it convenient for reprocessing. Units can be retrofit to existing facilities.

Skyline Medical
The Streamway System
skylinemedical.com
(651) 389-4800
Price: not disclosed
FYI: Designed as an alternative to canisters, the Streamway System is an FDA-cleared, direct-to-drain waste fluid management system that connects directly to plumbing. That means there's no risk that staff will be exposed to potentially hazardous fluids, there are no procedure delays to change canisters and there's no hazardous waste going to landfills, all of which adds up to reduced supply and disposal costs. Unlike other systems, the Streamway System has unlimited capacity and takes up no floor space. A demonstration video and case studies are available on the company's website.

Stryker
Neptune 3
neptunewastemanagement.com
(800) 253-3210
Price: not disclosed
FYI: Along with being 48% quieter than the Neptune 2, Neptune 3 provides 3 layers of protection, locking away suctioned biohazards and making it a completely closed system. It features 24-liter capacity and a 4-liter lighted canister. The new model also has improved suction, raising the limit from 480 mm-Hg to a powerful 520 mm-Hg. Rotating washers provide multi-directional canister cleaning and the unit is backwards compatible with Neptune 2 manifolds, filters and docking stations. Patient-to-patient use requires only a manifold change. An integrated smoke evacuator has 10 speed settings and in "auto mode" detects surgical smoke and automatically adjusts flow.

Zimmer Biomet
IntelliCart System Duo Fluid Cart
zimmerbiomet.com
(800) 830-0970
Price: starts at $33,000
FYI: Zimmer Biomet's IntelliCart System features 34-liter fluid capacity, a redesigned and extremely quiet vacuum pump (47.5dB or 3.87 sones), clog-free suction manifolds and portable smoke evacuation. Its dual 17-liter lighted and tinted reservoirs selectively hide surgical fluids. It has an interactive, high-definition touchscreen display and a flexible docking system that simplifies processing in any dirty utility room. Its reusable reservoirs and recyclable manifolds reduce red bag waste by up to 70%, and its reservoir doors close when manifolds are removed. Advanced cleaning technology employs hot water, enzymatic and an EPA-approved disinfectant.