From manually dumping open canisters of blood and body fluids down the drain to high-tech suction units that dock directly to a drain, there's a fluid waste disposal option that's perfect for every OR. Question is, which is the best for your facility? Here are the most popular options you might want to consider.

Manually dumping suction canisters

Many facilities still manually transport filled suction canisters from the field to a utility sink and pour the contents down the drain, leading to a municipal sewer system that treats waste. It's simple, low-tech and inexpensive. And, if your facility handles mostly low-fluid volume procedures and your state and local laws allow it, it's even better.

The downside is risk of contamination and slips and falls. Transporting and emptying canisters that are packed with fluid can expose workers to infectious waste through splash back and aerosolization. Every time a staff member pours fluid from an open canister into the drain, they can be exposed to airborne contaminants and possible splash back — especially if the waste disposal handler isn't wearing a face shield, gloves and glasses (these should be worn at all times when dealing with waste). And if any fluid spills on the floor, it now becomes a slip-and-fall risk.

One way to keep your staff members safe: Have them transport the canisters on a washable cart rather than by hand. Staff will be able to keep canisters upright, reducing the risk of a spill. You might also designate a sink just for waste disposal — preferably away from a general-use sink where employees wash their hands or clean supplies.

Solidify and red bag

Want to cut back on the risk of contamination even more? Solidifying suction canisters' contents is a way to do just that. When you add a solidifying agent to the canister, the fluid turns into a gel-like substance. Then canisters get discarded with red bag waste. The canister doesn't get moved when it's in liquid form, so the risk of splash back is minimal.

In terms of cost, there are a few things to consider. The cost of canisters, solidifying agents and red-bag disposal can be expensive. However, some solidifying agents contain antimicrobial agents that sanitize the waste, which make the canisters acceptable for clear-bag disposal, cutting back on costs.

The costs to be environmentally friendly can be considerable. For example, if municipal laws prevent you from pouring bodily fluids down the hopper, you'll have to solidify your fluid waste. "We have to solidify everything," says Michelle Ruhnke, RN, administrator of the The Methodist Ambula-tory Surgery Center-Medical Center in San Antonio, Tex. For every canister they solidify, it takes a 4-ounce bottle of solidifier, which costs $1.15, says Ms. Ruhnke.

That can add up quickly, not to mention red-bag removal costs. Then there's the risk of contamination. Canisters of solidified waste awaiting disposal can leak or smell. There's also the chance of exposure from the chemicals in the solidifying agent itself. Some contain chlorine and glutaraldehyde, which can be problematic for staff. Glutaraldehyde can cause throat and lung irritation, nosebleeds, burning eyes, wheezing, nausea and more.

For these reasons and others, the Methodist ASC-MC is considering abandoning solidifying fluid waste and switching to a large-capacity suction unit, says Ms. Ruhnke.

One tip for your staff: Put the solidifier in before the procedure. Of course, they'll have to estimate how much fluid the procedure will produce and add the appropriate amount of agent. But at least they won't run the risk of coming in contact with any biohazardous fluids.

Direct-to-drain systems

Take your waste disposal system up a notch by emptying canisters into a direct-to-drain system. Just put the closed canister in and the system empties it directly into a sanitary sewer system, saving time in patient and room turnover. The system takes care of emptying and cleaning the canister in a closed system.

It's environmentally and budget friendly, since it cuts back on the cost of red bag waste and solidifiers. Plus, it keeps the disposal process contained to a single area, so it meets EPA, CDC and OSHA guidelines.

Dock-to-drain suction unit

If you've ever slopped around in puddles and pools of fluid waste, then you'll appreciate a large-capacity suction unit that docks and empties directly to a drain. Since staff members don't have to empty and manually change out the suction canisters, you'll improve OR turnover time. You can position the portable units anywhere in the OR to accommodate the procedure. It's easy to roll these units from one OR to another, or straight to the docking station, where it empties, rinses and cleans itself within a few minutes.

Some units provide up to 8 lines of suction, with low, medium and high settings, and have a built-in smoke evacuator. It's great for cases with large volumes of fluid and, because it can hold such a high volume it doesn't need to be changed between each case. You only need to change out the manifold — the part that goes from patient to machine.

The benefits are plentiful. They eliminate red bag waste costs and handling of biohazardous fluids. Some units track all cleaning and purging cycles, providing information and alerts when filters or services are needed. Some also give you a digital reading of how much fluid is in each canister.

Chunks of debris in addition to fluid? Not a problem for some units. Bone fragments or pieces of skin that go through the tube stop in the manifold, so they don't get sucked into the fluid collecting in the canister. The tube will adapt to the size of the debris, so it won't get clogged or backed up.

The cost is what deters a lot of facilities from dock-to-drain suction units. They can run tens of thousands of dollars. However, when you consider the cost of canisters, solidifiers, tubing and exposure to staff, many of our readers say it pays for itself.

From an infection point of view, a closed, direct-to-drain suction system is ideal because no one comes close to the fluid. The system takes fluid straight from point A — the patient — to point B — the drain. There's no mobile unit getting in the way. Instead, it's suction tubing that connects to the wall or ceiling. The fluid doesn't even have a chance to hit the floor.

It completely confines liquid waste, eliminating splash and airborne risks. Problem is, unless your facility was built with one, it can be expensive to add it. It involves reconstruction and plumbing, which means closing the OR for a period — not something your facility might have time for.

Closed, direct-to-drain suction systems aren't without flaw, though. The suction can get weak when the tubing is pulled or when multiple lines are hooked up to it. OSM