See all those canisters of fluid in this picture? There are nearly 30 of them. Believe it or not, they're from a single shoulder arthroscopy. Holly Sousa, RN, BSN, MS, CNOR, nurse manager of perioperative services at Beth Israel Deaconess Needham in Needham, Mass., sent this picture of the messy remains of a particularly difficult scope to her CEO to highlight the need for a direct-to-drain fluid management system. It worked.

Ms. Sousa attached some cold, hard facts to the photographic evidence. Since the hospital didn't want to solidify its fluid overflow for red bag disposal, it was paying for the removal of about 30 tons of boxed infectious waste each month. She also marched up to the corner office to hammer home her point with a little show-and-tell. She brought 2 15-liter canisters, one empty, the other filled to the brim with water. The CEO lifted both. Ms. Sousa then explained that the hospital paid by the pound to dispose of hazardous waste, and that each shoulder scope generated at least 3 15-liter canisters.

"Imagine the impact when he lifted the full canister," says Ms. Sousa. "We were approved for the fluid management system very shortly after that."

Safety first
Why go to such extremes over fluid waste? Two words: staff safety. "Every one of us has slipped on arthroscopy fluid, including myself," says Ms. Sousa. One of her nurses who slipped sustained a shoulder injury that sidelined her for 3 months.

Since her facility went direct to drain, Ms. Sousa reports that her staff couldn't be happier — and her OR floors are noticeably drier. "It's so much nicer now," she says of the dry floors. "No one is moving around like they're walking on eggshells. Even with our hands full, we're not afraid of falling. That peace of mind goes a long way."

Ms. Sousa says the capital needed to invest in a fluid management system isn't as much as you might think, especially when you factor in the savings you'll realize by eliminating heavy solidified fluid waste from your red bag disposal costs.

The monthly infectious waste disposal expense and the cost of the fluid management system were essentially a wash, says Ms. Sousa. While it's harder to quantify her staff's satisfaction, she says it's impossible to ignore how much easier it is for them to dispose of fluid waste.

A little more than half of the 61 facility managers we surveyed have no trouble keeping OR floors dry thanks to the fluid-capture devices they use. The rest of the respondents are frustrated by the chore and concerned about staff safety and cross-contamination risks.

Your staff is in serious danger when electrical cords around the sterile field sit in fluid runoff, says Pamela Barnett, RN, BS, CNOR, clinical nurse manager at St. John Macomb-Oakland, Oakland Center in Madison Heights, Mich. "I'm always concerned about someone getting electrocuted," she adds, pointing out that the likelihood of staff slipping and falling also increases when floors are slick.

The danger of letting fluid collect on the floor isn't contained within the walls of your ORs. Keep in mind that surgical team members who walk through runoff in the sterile field could potentially track contaminants throughout your facility as they move from room to room.

Ms. Barnett supposes she could stand outside of OR doors between cases, asking staff and surgeons to remove their shoe covers. "But I don't run a day care," she says, pausing before adding, "although sometimes I think I do."

Quick and easy cleanup
Staff safety and infection control concerns should be your top priorities, but don't ignore that the latest fluid control devices can help you shave a few minutes off of room turnovers, especially after particularly messy cases. Ms. Barnett says controlling fluid before it pools on the floor means her staff mops only once between cases instead of 2 or 3 times.

Sherry Butts, RN, BSN, the OR supervisor at the Albany (Ga.) Surgery Center, swears by the timesaving advantages offered by proactive fluid containment. Even though her single-OR facility hosts low fluid-producing procedures, capturing runoff from drapes in kick buckets before it hits the floor saves her staff 10 or 15 minutes between cases. That's how long it would take to mop around the surgical table and underneath the rubber mats her physicians stand on, then wait for the floor to dry before the next patient can enter the room.

Cleanup efficiency is especially important for smaller facilities hosting specialties that rely on high volumes to remain viable. "Slow turnovers are not at all good for us," says Ms. Butts, explaining that waiting for floors to dry in her single room grinds the surgical schedule to a halt. Since her 4 surgeons book cases in entire day blocks, they'd easily become frustrated if their assigned day at the center dragged on because Ms. Butts' staff was more focused on drying times instead of case throughput.

Less red bag waste, lower costs
Ms. Butts insists that fluid-absorbent dry pads be placed over rubber floor mats when notoriously messy physicians operate. The pads are an effective, if not ideal, solution to her facility's fluid-control needs. Ironically, the docs who need the pads the most are the ones frustrated with not being able to easily maneuver foot-pedal controls and kick buckets over them during cases.

Wouldn't suction mats be an ideal solution for her needs? "Sure," she says, "but we're a small center and not in position to buy them right now." Like any solution to any problem, you have to weigh costs against primary and secondary benefits.

A majority of our survey's respondents have invested up to $10,000 in equipment designed to ease fluid management burdens. Does it make sense to allocate capital dollars toward the purchase of suction mats, spill booms, floor-wicking devices, specialized drapes or even a direct-to-drain system — considered by many to be the Cadillac of fluid-capture options? It might when you consider the overall gains of reducing your red bag waste costs, increasing staff satisfaction, eliminating risks of slips and falls, and faster turnaround times.

Widespread benefits
Ms. Sousa's staff is happy now that fluid waste is contained soon after it leaves the surgical site. No one is slipping on slick floors and room turnovers are that much easier. She says her hospital's occupational health department is thrilled that back injury rates are down since staff no longer haul heavy suction canisters and fluid-absorbing drapes. Her infection control nurse, housekeeping manager and facilities director are also satisfied that the fluid management system has virtually eliminated the wet messes left behind after fluid-heavy procedures and staff's exposure risks to blood and bodily fluids. Considering the numerous departments that have been positively impacted by Ms. Sousa's efforts to better manage liquid waste, can you blame her for being unable to imagine when fluid flowed freely?