It would be tough to find someone happier with the advances that have been made in the area of fluid management than Barbara Hersh, RN, BSN, CNOR. Ms. Hersh's last facility used bath blankets to sop up fluid waste. "Wouldn't you know it," she says, "I slipped in some fluid during a knee arthroscopy and broke my ankle." Her current facility, the Princess Anne Ambulatory Surgery Center in Virginia Beach, Va., features the very latest in fluid collection choices: direct-to-drain units, wicking pads, red bag solidifiers, wet mops and floor-suction devices.

The direct-to-drain advantage
Of these, the direct-to-drain unit is by far the safest, most efficient system for collecting and disposing of fluid, says Ms. Hersh. "None of the fluid has the potential to come in contact with the staff and its high-pressure suction allows for quick collection," she says. There are 4 ports on the manifold, so you can attach several suction tubings at once to the unit, she says. Depending on the procedure, staff typically attach 2 suction tubings from the sterile field — one from the pouch, and one from a floor suction mat.

You'll also find a portable closed drainage system at the Tucson (Ariz.) Orthopaedic Surgery Center. You can leave it in the room for the entire day and empty it at the end (or between cases if necessary), says administrator Stuart Katz, FACHE, CASC. He says it's easy to wheel the system to the janitor's closet, where the docking station is located, run the canisters through the cleaning cycle and have it back in place before the next patient is wheeled into the OR. Staff change the tubing and manifold for every case.

"There's no need to add solidifier concentrate, no need to increase red bag trash and, probably most important, the unit is not easily tipped over," says Mr. Katz. "The manifold weighs about 4 or 5 ounces — that's no typo — so there are no issues with picking up heavy canisters."

Those that use a closed drainage or closed suction (which combines collection and disposal by skipping the canisters) system can't imagine any other way to dispose of liquid infectious waste.

"Since we began using the [closed drainage] system, our staff response has been universally positive," says Jim Howard, RN, of Lake Regional Health System in Osage Beach, Mo. "Our fluid handling costs went up, but so did our fluid handling ability and safety."

Before placing fluid evacuation units in the ORs, Lake Regional used a washable canister system and a central vacuum from the wall to collect surgical fluid waste, says Mr. Howard. "During orthopedic scope procedures and cysto procedures, we often had system overload and liquid leaked onto the floor, which was controlled by floor wick devices, which also failed from time to time," he says. "We had a few accidents over the years."

The old-fashioned way
A direct-to-drain system is the preferred means to dispose of suction waste, but not every facility can afford one. A good fallback is solidifying fluid waste and disposing of it in the red bag, canister and all. Most often, you pour a powdered granular solidifying agent made of a super-absorbent polymer into a fluid-filled canister of infectious waste, says Theresa Criscitelli, MS, RN, CNOR, director of perioperative education at Winthrop Hospital in Mineola, N.Y. This creates a gelatinous substance within minutes.

"This method of disposal lends itself to efficiency, safety and economic impact," says Ms. Criscitelli. "The quick nature of the solidifying of blood and body fluids make it an efficient method to use in the fast-paced environment of an operating room. It in turn helps reduce surgical clean up time."

Unlike pouring fluids directly down the hopper, solidifying liquid waste is safe in that it protects staff from exposure to potentially hazardous fluids as a result of spilling, splashing and aerosolization that can be a by-product of other methods, says Ms. Crisci-telli. She adds that it's safer to transport a solid form of infectious waste than a liquid form.

"Given the choice, you'd opt for a newer closed disposal system," she says, "but the solidification method is a viable option that provides a safe, efficient, low-cost choice."

Above all, safety
Regulations for the disposal of medical waste differ depending on each city and state's laws. However, the risk of exposure to medical waste is a constant for healthcare workers, even though the field of disposal offers a variety of options, says Vangie Dennis, RN, BSN, CNOR, CMLSO, administrator of the Spivey Station Surgery Center in Jonesboro, Ga.

"Ultimately, the goal with all liquid waste products is to keep hazardous material from infecting anyone else before being properly destroyed," she says. 'This includes having efficient equipment to clean up a spill, place the liquid, dispose of the liquid and clean the canister."

You also have to take human aspects into consideration, says Ms. Dennis. For effective liquid waste disposal, the staffer working with the waste must be sufficiently covered with personal protective equipment. Where the disposal takes place is also an issue. You should designate and equip a non-patient area for disposal to eliminate any possibility of a patient becoming infected during the process, she says.

During a recent surprise visit from OSHA, Ms. Dennis says the surveyor asked a nurse to explain how she disposes of fluid directly from the suction field to the sewer, isolating staff from exposure. The surveyor also asked how they transport regulated medical waste from the operating room to the decontamination room, and whether it is labeled with a biohazardous sticker and covered with an impervious drape or container. "The surveyor even asked to see the contract of the company that disposes of the ASC's medical regulated waste as well as the times of pickup," says Ms. Dennis.