DIRECT TO DRAIN Portable units capture fluid runoff without exposing staff to infectious material.

Marlene Brunswick, RN, CNOR, swears by using portable direct-to-drain units to help keep fluid off the floors during shoulder scopes and knee arthroscopies. "It's the best decision I've made in decades," says the director of perioperative services at Mercy St. Vincent Medical Center in Toledo, Ohio. Two-thirds of the 188 facility leaders who responded to our recent survey about managing fluid waste agree that closed, high-capacity mobile units are best for protecting staff from exposure to infectious material, speeding room turnovers between messy cases and keeping the lid on your fluid waste management budget.

The method of choice
Solidifying and disposing of fluid waste remained a manual process at Ms. Brunswick's hospital until she had the opportunity to add mobile units to each of her 22 ORs in exchange for the per-case cost of replaceable manifolds (approximately $15), which prevent cross-contamination by stopping the backflow of fluid already captured in the machine. She also had to invest a small amount of capital into plumbing and construction to add a docking station for the portable units to the hospital's utility room.

To Ms. Brunswick, the investments have been worth every penny. However, her staff took a while to share in the enthusiasm. "They were hesitant to move away from solidifying waste manually," says Ms. Brunswick. "But if I did away with the portable units now, I'd have a mutiny on my hands."

The advantages that swayed her staff are numerous, says Ms. Brunswick:

• eliminating their exposure to infectious waste;
• he high-capacity mobile units never run out of space, even during procedures when fluid flows freely; and
• clean-up at the end of cases is a snap.

"You roll the unit to the docking station, plug it in and pick up an empty unit for the return trip to the OR," says Ms. Brunswick. "It's a simple process."

One facility administrator warns of a potential drawback to adding mobile direct-to-drain units. "Don't make the investment unless you have enormous OR space," says Cyndy Harting, MS, RN, CNOR, interim director of surgical services at MetroSouth Medical Center in Blue Island, Ill. "They take up a lot of room for the purpose they serve." She instead backs the use of wall-mounted systems that evacuate suction containers and empty the contents directly to a drain.

Ms. Brunswick's portable units can accommodate up to 4 tubes connected to various fluid-capture devices, such as the collection pouch at the surgical site, the arthroscopic shaver, floor-wicking devices or floor suction mats. One-third of the survey's respondents use floor-aspirating devices and one-half use disposable suction mats and strips to capture fluid that flows off the drapes. Floor collection devices work well, but only if they're placed exactly where fluid pools, according to Ms. Brunswick.

That can be tricky to determine — or to accomplish, says Diane Gress, RN, the OR and PACU manager at Memorial Hospital and Health Care Center in Jasper, Ind. Her staff places fluid capture rings on the floor near surgeons, who often kick them out from underneath their feet. Like half of the responders to our survey, her nurses must then resort to laying blankets on the floor to sop up excess fluid. That's a reality of working fluid-heavy cases, but it's also a definite departure from best practice.

"It's sometimes easier to create a dam made out of blankets," says Ms. Brunswick, "but that increases the per-pound cost of laundry, and hauling away the wet and heavy linens can be a safety hazard for the staff."

FLUID WASTE READER SURVEY
Nearly Two-Thirds Choose Portable Suction Units

Nearly two-thirds (64%) of the 188 surgical facilities leaders we surveyed last month are using automated fluid waste disposal systems. Our survey also found that the method you choose for fluid waste management is often driven by your budget, but staff safety impacts this choice more so than any other factor.

— Daniel Cook

Which fluid disposal method is used most often at your facility?

Portable suction unit, then docking to drain 64%

Solidifying, then discarding with red bag waste 17.5%

Manual dumping of suction canisters 9.5%

Stationary, direct-to-drain system 4%

Closed, direct-to-drain room suction system 5%

Which factor most influenced your primary fluid waste management method?

Staff safety 62%

Economy 14.5%

Ease of use 13%

Efficiency 9%

The environment 1.5%

Which floor-based fluid management options do you use?*

Suction mats and strips 51%

Towels, blankets or linens 47%

Floor aspiration devices 37%

* Respondents could select more than one option

Source: Outpatient Surgery Magazine online survey February 2016, n=188

Factors to consider
Like two-thirds of the survey's respondents, Ms. Gress converted to a direct-to-drain system because of concerns about her staff's well-being. Her nurses used to carry containers full of liquid waste to the hopper for disposal, during which they were at risk of exposure to splashing fluid and back injury.

Only 9% of the survey's respondents say improved efficiency is the factor that most influences their primary method of fluid waste management. Perhaps they should see what Randy Huffman, RN, MSA, CMPE, the administrator of the Weston (Fla.) Outpatient Surgical Center, has been able to accomplish since adding portable disposable units a year ago to each of his 6 ORs. His staff shaved 8 minutes off room turnover times — from 20 to 8 minutes — following fluid-heavy cases. "When you host 40 cases a day, that really adds up," he says.

So much so that Mr. Huffman has been able to compress the schedule on most days, meaning surgeons who used to operate until 5:30 p.m. are finishing up between 2:30 p.m. and 3:00 p.m. "That means another surgeon can start operating at 3:30 p.m. and be done by 6:30 p.m.," he says. "We're able to fill up time slots on the back end of the day that we didn't have available before."

Ms. Brunswick's investment in portable disposal units coincided with her hospital's recent initiative to reduce its environmental footprint. Although only 1.5% of the respondents say environmental concerns factor into which fluid waste management method they use, going green was a significant element of Ms. Brunswick's decision-making process. She wanted to reduce the amount of plastic canisters the hospital bought and filled. Mission accomplished. The hospital's use of suction canisters went from 11,000 to less than 1,000 in the year since the mobile units starting roving the ORs.

GROUND GAME Floor wicking devices are effective if they're placed where the fluid flows.

Fluid investment
Mr. Huffman believes many centers don't consider the sometimes hidden costs associated with fluid waste management. Before switching to the direct-to-drain system, surgeons wore rubber boots that cost $15 a pair and nurses threw blankets on the floor to soak up pooled fluid. "It struck a chord when I watched a nurse open a 10-pack of blankets and use them to mop up fluid," says Mr. Huffman. "I pay $1.50 for each blanket to be laundered. If she does that regularly, she's adding $15 to per-case costs." When you consider the costs of rubber boots and a healthcare laundry service, the $14 he pays for single-use manifolds used in his facility's portable units seems like a bargain.

Although Mr. Huffman's facility spends close to $50,000 a year on disposable manifolds and reusable floor-wicking devices, he says the staffing costs associated with solidifying fluid waste and the cost that the solidified waste adds to red bag disposal would be much more than that.

The direct-to-drain solution has also let his facility hit the trifecta of surgical satisfaction: Nurses appreciate disposing of fluid waste without being exposed to it, and faster room turnovers mean surgeons are heading home sooner and patients aren't informed that their cases are delayed. "I haven't had that conversation once since we added the units, and I know we're doing things right when I don't hear from surgeons," says Mr. Huffman. "They've been going home earlier, and happier." OSM