Most surgical waste is liquid waste, infectious blood and bodily fluids that have been diverted during surgery. How do you collect and dispose of it? There's a good chance you're using a fluid management system that empties liquids directly into the sanitary sewer system, maybe one that's stationary and hard-plumbed into the sanitary sewer or perhaps one that's portable, on a cart that uses a docking station for automated drainage to the sanitary sewer. However you manage liquid waste, follow these 3 Golden Rules for suction canister disposal.

1Safeguard your staff.

Golden Rule No. 1 is more like a commandment: Thou shalt not let staff manually open the liquid-filled canisters and pour the contents down the hopper into the sanitary sewer system. The down-the-drain method can pose a significant risk of splashing or aerosolization of bloodborne pathogens for staff. Although it's hard to quantify the cost of treating an employee for exposure to bloodborne path-ogens like HIV and Hepatitis B and C, this practice can lead to OSHA citations regarding personal protective equipment practice, says Margaret Wasserman, BSN, RN, CNOR, senior analyst for peer review at Advocate Illinois Masonic Medical Center in Chicago, Ill.

"It only takes one contaminated worker to offset any potential savings you might anticipate," says Ms. Wasserman. Most facility managers readily agree that the mobile units are the best way to protect staff members from infectious materials, facilitate speedy turnovers between cases and keep fluid waste management costs in check.

"Do they save us money?" asks Lee Ann Puckett, the materials manager at the Evansville (Ind.) Surgery Center. "Probably not, unless you look at the cost of what's involved when somebody gets splashed with bloody fluid, and then having to go through all the protocols with workers' comp."

Direct to drain can be economical, too. Some systems use reusable canisters that are disinfected and reused, while others use an integrated canister system that is completely closed. Still others use disposable canisters that are able to be placed in regular trash after a rinse with an enzymatic cleaner.

"These systems, while requiring an upfront capital investment, often pay for themselves within the first few years of use," says Ms. Wasserman.

2What constitutes red bag waste?

Does everyone on your staff always know the difference? They should, but the fact is that tons of unregulated medical waste ends up in red bags every day — including device packaging, urine cups, test strips and gauze.

You should only be red-bagging waste that contains enough blood or other potentially infectious materials to spread bloodborne pathogens. So, if the gauze is blood-soaked, yes, it should be red-bagged. But if it isn't, it shouldn't be. The same goes for gloves, sharps or any other contaminated item.

Whether you're paying by the pound or by the container, red bag waste is expensive.

"So you need to make sure that the things you're putting in red bags belong in red bags," says Jimmy Henderson, materials manager at the Outpatient Surgery Center of Jonesboro (Ark.). "We've had to stop people from throwing everything in red bags. They were throwing away empty fluid bags, disposable wrappers and a lot of other items that should go into the regular trash."

The solution: "We put up signs in each room," says Mr. Henderson. "There's a list of red bag items, and a list of what goes in the trash."

Dan Good, the materials coordinator at Copper Ridge Surgery Center in Traverse City, Mich., says he got tired of hearing complaints from his facility's waste management company. So he asked the company for a poster, which he modified slightly and hung up in both the "dirty room," where all waste is stored until it's picked up, and the "clean room," where the empty bins are kept. When people were getting it wrong, it was both expensive and hazardous, he says: "The poster explains the waste stream flow and the proper containers to use. We've greatly reduced our mistakes with medical and hazardous waste."

Adding a chemical solidifier to a canister of fluid waste turns the liquid contents into a gelatinous substance. Once the solidifier has made the canister contents immovable, you can place the canister in the regulated waste stream ("red bag"), says Ms. Wasserman. However, some solidifiers also contain a disinfectant that can render the suction canister contents sanitized. In that case, you can dispose of the canisters in the regular waste stream. "The caveat is that this is state regulated, so in some states it can be disposed of in the regular waste stream and in some states, it cannot," says Ms. Wasserman. "The benefit of either product, though, is that each minimizes the risk to staff of exposure to the bloodborne pathogens."

3Consider all options

What works best in one situation might fall short in another. Maureen Simpson, RN, CNOR, a clinical manager at the Rye (N.Y.) Surgical Center, had to experiment to accommodate the challenges posed by surgeons who frequently repositioned limbs during surgery, thereby redirecting fluid away from pre-positioned drapes and collection bags and onto the floor.

But floor suction mats turned out to be cumbersome, she says. "The last one we used, we were tripping over, because it was on the floor connected to the suction canisters." Add a potential tripping hazard to a slippery floor and you've doubled the chance that a serious mishap will occur.

Disposable floor mats made from a heavy cotton material turned out to be the better answer, she says. "We tape them down, so they don't move," says Ms. Simpson. "They do a good job of collecting fluid in that one area, instead of letting it spread out all over." OSM