You know who the messy surgeons are in your facility. They're the ones who pump joints full of fluid and have surgical team members wishing they had slipped on rain boots instead of shoe covers as they splash around the OR. You can capture a surgeon's sloppy runoff in open containers and toss the solidified contents into red bag waste, but direct-to-drain options are better ways to keep fluid off the floor. Wall-mounted ports that suck fluid directly into the sewage line or mobile units that collect large amounts of fluid and dispose of it through docking stations will have staff singing your praises instead of feeling like they're singin' in the rain.

Significant savings

Staff are no longer splashing around the OR at Iowa City VA Medical Center in Iowa City now that the hospital is soaking up the benefits of its recent reassessment and revamping how it collects fluid waste. Staff at the medical center had been collecting fluid runoff in standard disposable canisters and then adding a solidifier.

"We were spending a lot of time moving canisters back and forth," says Ann Polking, RN, the facility's OR clinical manager. "Each time we replaced a full canister with an empty one, it took time to move them because the canisters were heavy."

Before diving right in and purchasing mobile direct-to-drain systems for all of its ORs, the medical center trialed a few units in a couple suites.

"We retrofitted the facility to accommodate the docking stations and started using them for different orthopedic procedures," says Martin Jones, the facility's director of green environmental management services. "It didn't take very long before it was very clear that there were clear benefits associated with their use. Orthopedics is a fluid-intensive specialty, so never stop looking for new and better ways to dispose of fluid waste."

Direct-to-drain closed or wall-mounted systems are more expensive than traditional open-canister disposal methods, yet their proven ability to reduce staff exposure and to decrease the cost of medical waste disposal make them worth the investment. Plus, as Mr. Jones points out, disposable canisters are a direct cost in your OR budget. You need to consider the purchase price for each canister and the expenses associated with delivery, storage and disposal in regulated red bag waste, which costs 20 ? to 50 ? per pound to have removed.

Iowa City VA Medical Center purchased direct-to-drain mobile collection units for each of its 6 main ORs, its cystoscopy room and for its 17-OR ASC. The facility paid $16,000 per unit and $12,500 per docking station. The systems save the medical center about $25,000 a year in costs related to the manpower and time it takes to collect and dispose of fluid waste, and to store disposable canisters, according to Mr. Jones, who says the units will pay for themselves in just a few years.

Atlantic Health System's Overlook Medical Center, which also reassessed its method of disposing of fluid waste a few years ago, reports similar financial benefits. In 2017, the 504-bed facility located in Summit, N.J., saved close to $400,000 in annual fluid waste management costs after installing a direct-to-drain fluid management system, says Brian Wechsler, RN, CNOR, the facility's clinical coordinator for orthopedics and podiatry.

"The savings include avoided waste (tonnage), avoided waste disposal fees from disposable canisters and the avoided purchase cost of disposable canisters," he says.

Safer and more efficient

Collecting fluid runoff in disposable suction canisters puts staff at risk of workplace injury as they transport filled containers to disposal areas and to exposure of potentially infectious waste should they pour the contents down the drain or solidify the fluid for disposal.

Closed mobile units and wall-mounted direct-to-drain disposable systems lessen the health risks associated with the fluid disposal process. "The risk of exposure is limited by the decreased risk of potential spills," says Mr. Wechsler. Ms. Polking points out that a dryer OR is a safer OR. "There is less chance for someone to slip," she says. "And staff don't have to lift heavy canisters."

The mobile collection units in use at Iowa City VA Medical Center have 2 internal canisters; the upper canister holds up to 4 liters and the lower one holds up to 20 liters. Depending on the procedures scheduled, the unit does not need to be emptied between each case. "Our old disposable canisters held 3 liters each and the circulating nurse had to move the suction tube from one canister to the next when they would fill up," says Mr. Jones.

"Never stop looking for new and better ways to dispose of fluid waste."
— Martin Jones

The new mobile collection system is "a huge timesaver," says Ms. Polking. "You can keep the units in the OR and dispose of the fluid waste between cases with a single trip to the docking station," she says. "Staff spend less time replacing filled canisters with empty ones during cases. That makes their jobs much easier."

Going green

The upgrades Iowa City VA and Overlook Medical Center made to their fluid collection practices has caught the attention of Practice Greenhealth, an organization that recognizes healthcare facilities for their efforts to make their working operations greener. Both facilities received the organization's 2018 Environmental Excellence Award for keeping countless containers of solidified waste from reaching local landfills.

Mr. Wechsler emphasizes that his facility's focus on improving fluid waste collection practices centered on ways to protect staff and surgeons. "We originally converted to using mobile collection units to increase the safety to our surgical team," he says. "That the system helped us go green was a welcome secondary benefit that further enhanced our hospital-wide commitment to environmental sustainability." OSM