When talking trash in a surgical facility, you have to know your trash. Three points to remember:

• White-bag waste is cheapest. Get as much of your waste as possible into the Dumpster. Used sponges and lap pads are obviously biohazardous red-bag waste, but the wrappers they came in aren't. It's easy to toss waste into the nearest receptacle, but putting white-bag waste into red bags is expensive.
• Red bags are for regulated medical waste. This refuse has federal regulations on its packaging and handling for disposal. It is transported and incinerated by federally regulated companies. Because you pay by the pound for disposal, minimizing red-bag waste is the name of the game.
• You want to flush if you can. Look into a system that deposits fluid waste directly into the sanitary sewer system and compare it to the cost of solidifying liquid waste for disposal in red bags - you might be able to save money. Unless your center is consistently busy with the same type and number of cases, analyze this over a month or a quarter rather than a single week.

Of the three types of trash - white bag, red bag and liquid red bag - the third poses a unique and somewhat costly challenge because it's the most difficult to safely dispose of. With that in mind, here's a look at your options for doing it in the most cost-effective manner while maintaining good practice.

Turn liquid into solid
Physical disposal of the liquid waste and its container, in a liquid state, is getting more expensive than ever before because of more stringent federal Department of Transportation packing requirements for biohazardous liquids, published in the Aug. 14, 2002, Federal Register. That's where DOT-approved packaging for biohazardous liquids, such as those available from Stericycle, come in handy.

However, some biohazardous disposal companies will no longer take waste in a liquid state. To remedy this, you can solidify liquid waste with agents, commonly called gels, which turn the liquid waste into a solid state. If the agent is such that the solidified mass won't return to a liquid state, then the container and its contents qualify as solid red-bag waste. There are several solidifiers on the market, such as Colby Manufacturing's ViraSorb, with features including disinfecting agents and deodorizers.

Flush it
Safe disposal of liquid biohazardous waste into the city sewer system - if you're legally permitted to do it - is possible thanks to products that are continually being introduced to meet this unique challenge.

Bemis Health Care offers three devices for disposal of biohazardous liquids directly into the sanitary sewer system, each requiring use of different Bemis suction collectors. The Bemis Vac-U-Station uses Vac-U-Port suction canisters that are drained through a port on the bottom of the suction canister. The wall-mounted Bemis Quick-Drain Systems drain and rinse the suction collector. There are also two Quick-Drain systems, the HF model for rigid high-flow Bemis canisters and the QF model for Bemis Quick-Fit suction liners.

The advantages: Staff are not directly exposed to the waste fluid, and the emptied, rinsed container may be disposed of as white-bag waste (regular put-it-in-the-Dumpster trash.) At least usually this is the case. Check with your state's interpretation of the regulations. Some still require that the emptied container be handled as biohazardous solid waste.

In these instances, Dornoch's Transposal system - comprised of reusable clear plastic suction canisters, a disposable single-use lid for the canister, and a machine to wash and sanitize the used canisters - might be what you're looking for. The capped, used suction canisters are placed in a Transposal Safety Station, which automatically uncaps the canister, dumps its contents, washes the canister in a high-level disinfectant, rinses the container and then signals the operator. The operator places the sanitized containers on a drying rack and disposes of the single-use cap. Initial capital investment is around $25,000; Dornoch can analyze your costs for disposable suction containers, gel, red bags and biohazardous disposal compared to its system.

Another potentially good choice is Stryker Instruments' Neptune Waste Management System, which consists of a mobile rover that functions as a both a fluid waste and smoke evacuation system. When the unit is to be emptied, it attaches to a fixed plumbing docking unit that empties, washes and rinses the rover's 20-liter holding tank. Dornoch offers a similar system as part of its Transposal product line in 24-liter and 48-liter versions.

Exceptionally wet procedures
During surgery, you might sometimes have to suction a few milliliters of blood or irrigating solution out of a wound. Other times, you have to deal with a flood. It is the flood we'll address.

When you perform exceptionally wet procedures, cystoscopy or arthroscopy, for example, you could use literally dozens of liters of irrigating fluid. This is the appeal of large-volume, automated suction systems like Transposal or Neptune. Most facilities, though, still change one- or two-liter collection canisters throughout the procedure or use a monster-sized canister like the 16-liter Omni-Jug from DeRoyal. These disposable jugs can collect fluid from up to four separate suction lines and are sized and shaped to fit in a standard OR ring-basin stand. DeRoyal offers a siphon device to empty the jugs into a hopper sink.

You know you're in for a wet procedure when the surgeons show up wearing white knee-high rubber boots. Since most of the irrigation fluid winds up on the floor during these surgeries, the industry has responded with numerous devices to contain and collect this runoff.

Colby Manufacturing is best known for its WaterBug floor fluid-removal system. This unique disposable device comes with 12 feet of standard-sized suction tubing and scours the floor where the fluids are running, quietly vacuuming them into your collection method of choice. Other companies have disposable fluid-containment/damming systems coupled with fluid removal - think of a one-ring kids' inflatable swimming pool with a WaterBug in it.

Before the age of WaterBugs existed the era of "throw a bunch of cotton towels on the floor, then send them to the laundry." While effective, this method was costly, a hassle to clean up and a tripping hazard. Today, single-use absorbent floor pads are available in many sizes. These pads have a waterproof plastic back, a porous, water-conducting top and a filling of a hygroscopic cellulose compound - imagine a 3-feet-by-4-feet disposable diaper without the elastic. These pads absorb many times their weight in water, making the OR floor safer from slips. These absorbent pads come in varieties offering extra padding to reduce fatigue on the surgeon, extra tough to allow stools to roll over them without bunching or tearing, and basic varieties.

Trash talk
Little threat to patients comes from contained liquid waste, but the threat to your staff's health is a significant one. Simply emptying a container of liquid bioharzardous waste into a hopper sink and flushing it away exposes yourself and your staff to the risk of HIV or hepatitis - which makes it unacceptable from an infection control standpoint - and it's now prohibited by law in many jurisdictions.

For staff safety and infection control, the best practice is to altogether avoid direct contact with the waste fluids.