PLAN B? Recalls and regulatory action involving a leading waste management system have complicated the practice of fluid collection and disposal.

In the wake of Stryker's voluntary recall of the Neptune 1 Silver and Neptune 2 Waste Manage-ment Systems, Outpatient Surgery surveyed facilities hosting orthopedic cases about their preferred fluid disposal options. More than half (57.4%) of our respondents say they predominantly use portable suction units that roll to docking stations for closed and automated direct-to-drain disposal of fluid runoff. Not surprisingly, most of these respondents cite safety as the main factor driving their purchasing decisions. Effective suction, they say, can prevent slips, falls and injuries on slick, puddled OR floors. "Keep the floors dry at all cost, for the safety of the staff in the room," says Rebecca Vitillo, RN, BSN, LNC, MSJ, administrator and director of nursing at the Meadows Surgery Center in Rutherford, N.J.

Suction with closed disposal shields surgical personnel from exposure to potentially infectious materials in fluid waste, says Janice Stewart, RN, BSN, nurse administrator for the SurgCenter of Bel Air in Maryland. "It is important for the safety of staff members to have a closed system where contaminated fluid is not handled directly," she says, adding that besides safety, the system offers yet another benefit. "It also cuts down on turnover time in the room to have an efficient waste management process."

In contrast, the one-third (34%) who solidify fluid in suction canisters for disposal with biohazardous "red-bag" waste or manually dump canisters' contents into utility sinks say that the simplicity or economy of the solutions influence their choices. Depending on the volume of your high-fluid-volume cases, direct-to-drain equipment and plumbing might unnecessarily burden your budget.

"One must marry convenience, cost and safety to be successful," notes Susan J. Stuckey, RN, CNOR, MSN/MHA, MBA, administrative director of Carlisle (Pa.) Outpatient Surgery Center, where staff solidify fluid. "If it's not convenient, the staff will not use the system. If it's not cost-effective, the CFO will not approve. Safety must be viewed from both a patient as well as a staff perspective: No backflow for the patient, and no risk of contamination for the staff."

FLUID FACTORS Solidifying the contents of suction canisters can be safer, but more expensive, than manually dumping them down the drain.

Ruler of the waters
Clinical directors and OR managers have long sworn by the Neptune for fluid collection and disposal. In September 2012, however, the company announced a voluntary recall (tinyurl.com/98q6mff) of certain Neptune models. The Neptune 1 Silver and Neptune 2 units had never obtained the federal Food and Drug Administration's 510(k) approval for U.S. sale. This notification expanded on an earlier recall. In June 2012, Stryker recalled its instructions for the Neptune 1 Gold, Silver and Bronze and Neptune 2 units after receiving 2 reports that improper use of the suction devices had caused tissue damage in surgical patients, including 1 fatality. Stryker issued revised instructions and warning labels to its customers.

The FDA advised Neptune 1 Silver and Neptune 2 owners not to use the units, since without the agency's approval they lack thorough safety assurances. Facilities without alternative fluid management options were given a limited amount of time to submit certificates of medical necessity to Stryker. With certification, they could continue to use the recalled units, provided they undertook the following 3 steps:

• They trained their staff in the proper use and potential hazards of the unit.

• A surgical staff member completed a 2-page pre-use checklist (tinyurl.com/cwjo4bh) before each procedure in which the unit was used.

• The staffer consulted the FDA's most recent safety communication on the unit before each use.

Stryker has said it plans to end production of and withdraw support for the Neptune 1 Silver by March 2014.

While the checklist required for continued use adds several pre-op steps, including safety verifications, technical testing and staffing documentation, the equipment is apparently just too useful to give up. "I like the Stryker Neptune system. It's efficient and safe if used within company guidelines," says Adam Andro, BSN, the OR supervisor at Stateline Surgery Center in Galena, Kan.

Of the 85% who still use their recalled Neptunes — and comply with the manufacturer's new rules — only a handful are considering a move to another fluid management option. Most of those who've switched have adopted other Neptune models. "We've acquired Neptune systems not affected by the recall," says Amy Hartman, RN, BSN, clinical manager at the Surgi-Center of Winchester in Virginia. Writes another manager, "[Our hospital] is storing our Neptunes off-site, and they provided us with an older version."

AT YOUR DISPOSAL
The Preferred Fluid Management Methods

Portable, large-capacity suction units that dock to drain:	57.4%
Fluid solidified in suction canisters, discarded with red bag waste:	19.1%
Suction canisters manually dumped into sink:	14.9%
Closed, direct-to-drain room suction systems:	6.4%
Canisters emptied via stationary direct-to-drain system:	2.1%

Source: Outpatient Surgery Magazine reader survey, October 2013 (n=47)

After all, they reason, the other (simpler) options aren't without risks and complications of their own. Carrying full suction canisters out of the OR and manually splashing them down the drain presents ergonomic and infection risks, unless staffers are taking time to don personal protective gear each time. "If possible, avoid having to dump full canisters," says Ms. Hartman. On the other hand, while pouring chemical solidifying agents into full canisters limits staff exposure to the fluids inside, the weight of the resulting refuse can drive up your by-the-pound red-bag waste costs.

These options may be suitable when schedules are full of low-fluid cases, but nothing replaces the efficiency of a large-capacity, closed-drainage system when arthroscopies threaten to flood your OR. "I feel the closed drainage and disposal system is the best for employee safety," says Sara McCallum, RN, MBA, LHRM, the CEO of Bonita Community Health Center in Bonita Springs, Fla.

Keep in mind, though, that clean and contact-free fluid management options, whether they're portable units or stationary room suction systems, may also include disposable components and are likely to require an investment in plumbing renovations to provide a direct-to-drain route for collected runoff.

The last drop
Regardless of their collection methods at the sterile field, most facilities also supplement their fluid management with floor-based options. About half of respondents (51.2%) throw down towels, blankets or linens, and about half (51.2%) have also purchased disposable suction mats or strips. Floor aspirators that connect to suction are also a popular choice, used by 44.2%, but there always seems to be some cleanup needed after ortho cases. "The perfect floor collection device has yet to be invented," says Robert Eisenberg, RN, MBA, CASC, administrator of Greenspring Surgery Center in Baltimore, Md. "The current offerings all have drawbacks."