There's a Smarter Way To Handle Fluid Waste

Orthopedics

By: Adam Taylor

Published: 8/1/2019

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Closed systems take the risk, expense and frustration out of keeping OR floors dry.


Last month, surgeons performed 28 fluid-spewing orthopedic cases in a single day at the 3-OR Boston Out-Patient Surgical Suites in Waltham, Mass. Had that many procedures been performed when the facility opened in 2004, fluid waste management would have been an aggravating and messy part of the day. Nurses would have been lugging dozens of heavy, fluid-filled canisters out of the ORs, and would have been exposed to splashback when they poured the contaminated contents down the hopper. Surgeons wouldn't have liked all the time it took nurses to manually dispose of the fluid waste, and the surgical team would have had to shuffle along on slick OR floors so they didn't slip and fall.

None of that happened on that recent July day because the surgery center had decided years ago to invest in a closed fluid waste management system.

"I didn't think about fluid management at all," says Greg DeConciliis, PA-C, CASC, administrator at Boston Out-Patient Surgical Suites. "We didn't have any issues."

In that way, good fluid waste management systems are like refs at a well-officiated basketball game: When they're doing their job, you barely notice that they're there. There are 2 main options of closed collection systems, and the right choice for your facility depends on your budget and case mix (see "Time for a Fluid Waste Management Upgrade?").

  • Wall-mounted removal. Fluid- collection canisters are positioned next to the OR table on a mobile cart. When the canisters are filled, nurses or surgical techs roll the unit to a wall-mounted disposal system, remove the filled canisters and place them in the system, which automatically flush the canisters.
  • Mobile collection. These mobile units have large internal reservoirs with the capacity to collect runoff during several fluid-heavy cases. Staff wheel a cart into the OR and attach its ports to arthroscopy pumps, surgical drapes or floor wicking devices. When the cart's reservoirs are filled, staff roll the cart to a dedicated docking station, which automatically empties the cart's contents into the sewer system.

"We decided to invest in a mobile closed system after realizing that the disposal costs, storage issues, staff complaints and potential for employee injury all meant that buying a closed system was worth the expense," says Mr. DeConciliis.

Time for a Fluid Waste Management Upgrade?
ON THE MOVE Staff appreciate the convenience and versatility of mobile cart fluid collection systems.   |  Pamela Bevelhymer, RN, BSN, CNOR

When shopping for fluid waste management systems, getting the right device for your facility at the best price is important. Here are factors to keep in mind once you've decided to make a purchase.

1. Assess your needs
Consider the kinds of cases you perform. The amount of fluid your top procedures produce will guide you to what kind of system to buy. And put more weight into how much fluid you produce over how many ORs you have.

"Large arthroscopy and endoscopy centers with high volumes of fluid waste are perfect candidates for a closed system, even if there is only one OR," says Greg DeConciliis, PA-C, CASC, administrator at the Boston Out-Patient Surgical Suites in Waltham, Mass.

If you're a facility that performs lower-volume procedures, you can save money by not buying the top-of-the-line model, points out Pamela Borello-Barnett, BS, RN, CNOR, CSSM, the clinical nurse manager at Ascension Macomb-Oakland Hospital in Madison Heights, Mich. "You really don't need all the bells and whistles on the latest models," she adds.

2. Trial before you buy
Mr. DeConciliis suggests talking to other facilities and to the sales reps from the device manufacturers. Compare the size and function of the different options. How easy are they to move? How easy are they to use overall? Make sure you'll not only have room for units in ORs, but also that you'll have room to store them when they're not in use. Do you need to invest in a costly mobile cart system, or would a more affordable wall-mounted unit handle your facility's needs? Make sure to ask vendor reps about potential ongoing costs, such as filter replacements, disinfecting solution and the preventive maintenance contract.

3. Look for creative financing
Ask manufacturers if you'd get a break on the sticker price if you purchase the machine outright, or if there's an option to refinance down the road if needed. Determine if financing or leasing makes more sense for you. Ask if there is a fee-per-disposal agreement option, where you'd pay an added premium for canisters in order to pay less for the unit itself. Figure out if buying a certified demo model or a refurbished unit for less makes sense for your facility. Ask about end-of-year or end-of-quarter sales. You might be able to hold out a little longer to wait for the better price.

4. Get a service contract
Having a preventive maintenance contract makes sure the devices are constantly cleaned and functional, often on a quarterly basis. As long as the service plan is reasonably priced, it's worth it.

"Not having a service contract is a corner you shouldn't cut," says Mr. DeConciliis. "It's definitely not a place to roll the dice to try to achieve cost savings."

5. Involve staff
Get input from the OR staff about the user-friendliness of the options you're considering, from how easy they are to set up before cases to the practicality of the fluid disposal process.

Listen and involve everyone, but be prepared to make the final call. Staff might think more about ease of use than the other host of benefits improved fluid waste management provides, and surgeons might look at a new fluid-capture method as one more disruption they have to deal with during surgery.

"You'll get it from all directions," says Ms. Borello-Barnett. "That's just the way it is."

— Adam Taylor

Taking the plunge

TOUGH JO\B
Pamela Bevelhymer, RN, BSN, CNOR
TOUGH JOB Staff who manually empty suction canisters are at risk of exposure and on-the-job injuries.

There are several benefits to adding a closed fluid waste management system.

  • Improved efficiencies. Mobile carts used at Boston Out-Patient Surgical Suites don't fill up until after 2 or 3 procedures. Staff used to empty numerous standalone suction canisters after each case, a task that delayed room turnover and slowed down the schedule.
    The ORs at Ascension Macomb-Oakland Hospital in Madison Heights, Mich., can be turned over in 10 or 15 minutes, in part because the hospital now uses a closed fluid management system to capture fluid before it hits the floor, says Pamela Borello-Barnett, BS, RN, CNOR, CSSM, the facility's clinical nurse manager.
  • Going green. Surgery generates large amounts of waste. In some hospitals, ORs account for 20% to 33% of the facility's total waste, and as much as 60% of it is regulated medical waste, according to Practice Greenhealth, an organization that works to reduce healthcare's environmental footprint.
    Closed fluid waste management systems greatly reduce how much regulated medical waste is generated by an OR, says Kaeleigh Sheehan, the manager of Practice Greenhealth's Green the OR Initiative. Consider you'll no longer dispose of thousands of single-use fluid collection canisters and the residual materials from chemical solidifying agents in red bag waste. By eliminating fluid through the sewer system, you send less medical waste to landfills and incinerators.
  • Cost savings. While there's a significant upfront cost to purchasing a new fluid management device — the cart-based units at Boston Out-Patient range from $10,000 to $15,000 — Ms. Sheehan says closed disposal systems are generally paid off in 2 years or less.
    How? You'll spend less on disposable canisters, solidifying agents and red bag waste disposal. Costly employee injuries will be averted, and less staff time will go toward cleaning ORs. Also, Practice Greenhealth says installing closed systems can save a facility $3,600 a year per OR.
  • Employee benefits. Converting to a closed disposal system benefits your staff as well: fewer heavy fluid canisters to lift, less exposure to bloodborne pathogens and greatly reduced risk of slipping on wet OR floors.
    Ms. Barnett says the old fluid collection device used at Ascension had a fluid collection canister made of glass. It didn't catch all of the fluid, so slipping hazards were ever present.
    "It could break and was very difficult to empty," she says. "The old way was not the safest method of disposal for our staff. The new way is nice and clean, and much safer."

Acceptance is fluid

Your staff will love to work with a closed fluid waste management system, even if they don't realize it at first, says Ms. Borello-Barnett. Her hospital bought its closed system about 2 years ago, but didn't put the old one out to pasture until just a few weeks ago.

"Every time you introduce something new, it's going to change the staff's practice," she says. "We've been selective in introducing it."

Her cajoling of staff to get on board with using the closed system was ultimately successful, except for a surgeon who has been performing sinus surgeries for 40 years and who didn't have any interest in changing his ways. The nursing staff recently asked him to try the closed system one time. He liked it, it turns out, and now uses it regularly.

"He was my last nut to crack," says Ms. Borello-Barnett, "but we did it." OSM

Taking the plunge
TOUGH JOB Staff who manually empty suction canisters are at risk of exposure and on-the-job injuries.   |  Pamela Bevelhymer, RN, BSN, CNOR

There are several benefits to adding a closed fluid waste management system.

  • Improved efficiencies. Mobile carts used at Boston Out-Patient Surgical Suites don't fill up until after 2 or 3 procedures. Staff used to empty numerous standalone suction canisters after each case, a task that delayed room turnover and slowed down the schedule.
    The ORs at Ascension Macomb-Oakland Hospital in Madison Heights, Mich., can be turned over in 10 or 15 minutes, in part because the hospital now uses a closed fluid management system to capture fluid before it hits the floor, says Pamela Borello-Barnett, BS, RN, CNOR, CSSM, the facility's clinical nurse manager.
  • Going green. Surgery generates large amounts of waste. In some hospitals, ORs account for 20% to 33% of the facility's total waste, and as much as 60% of it is regulated medical waste, according to Practice Greenhealth, an organization that works to reduce healthcare's environmental footprint.
    Closed fluid waste management systems greatly reduce how much regulated medical waste is generated by an OR, says Kaeleigh Sheehan, the manager of Practice Greenhealth's Green the OR Initiative. Consider you'll no longer dispose of thousands of single-use fluid collection canisters and the residual materials from chemical solidifying agents in red bag waste. By eliminating fluid through the sewer system, you send less medical waste to landfills and incinerators.
  • Cost savings. While there's a significant upfront cost to purchasing a new fluid management device — the cart-based units at Boston Out-Patient range from $10,000 to $15,000 — Ms. Sheehan says closed disposal systems are generally paid off in 2 years or less.
    How? You'll spend less on disposable canisters, solidifying agents and red bag waste disposal. Costly employee injuries will be averted, and less staff time will go toward cleaning ORs. Also, Practice Greenhealth says installing closed systems can save a facility $3,600 a year per OR.
  • Employee benefits. Converting to a closed disposal system benefits your staff as well: fewer heavy fluid canisters to lift, less exposure to bloodborne pathogens and greatly reduced risk of slipping on wet OR floors.
    Ms. Barnett says the old fluid collection device used at Ascension had a fluid collection canister made of glass. It didn't catch all of the fluid, so slipping hazards were ever present.
    "It could break and was very difficult to empty," she says. "The old way was not the safest method of disposal for our staff. The new way is nice and clean, and much safer."
Acceptance is fluid

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