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What's at Your Disposal?
Flushing Out the Essentials of Fluid Disposal Systems
Daniel Cook
Publish Date: October 10, 2007   |  Tags:   Waste Management

Before Barnes-Jewish Hospital in St. Louis could open its 28 new ORs in January, Diane Desmond, RN, had to figure out where all the fluid waste from an estimated 16,000 surgeries would go after it was sucked, soaked or swept from the surgical field.

She looked at safety issues and the cost of the products available to judge whether her hospital could implement and support the system on a facility-wide basis. With a growing wad of red tape wrapped around red bag waste, she also considered government regulations (see "Government Rule" on page 80) and ecological concerns of filling up landfills with processed suction canisters.

Ultimately, Ms. Desmond decided to purchase a closed system that disposes of fluid waste into the sewer with little or no employee-exposure risks. That was the right decision for her hospital, she says, but the choices available to you are plenty. Here's what to keep in mind when deciding on the best fluid disposal system for your facility.

New thinking in fluid disposal
"Disposing of fluid waste is a cradle-to-grave industry," says Lindy Radaszewski, a safety product specialist for Microtek Medical. She says the fluid waste collected in the OR remains a facility's responsibility until it's completely disposed of, whether that ultimately occurs in a landfill or the sewer.

Even properly disposed-of canisters are now scrutinized. Once a canister is wrapped and dropped in red bag waste, the bag is taken to an off-site autoclave for sterilization before it reaches a landfill. The California Department of Health Services has determined suction canisters never reach the temperature required for proper sterilization; as a result, the agency has prohibited the use of solidifying agents in suction canisters if they can't be processed in one of the state's few remaining medical waste incinerators.

The EPA, meanwhile, mandates that incinerators be shut down if they're not upgraded to meet strict emission standards. As a result, most of the nation's 2,600 hospital incinerators are now inactive, according to James L. Dunn, RN, vice president of product development and regulatory affairs for Dornoch Medical Systems. Gone are the days of tossing all waste in a bag and burning it. You now need to look for alternative measures for handling fluid waste on-site.

Medical waste treatment and disposal is regulated by states individually. In rare cases, counties have regulations as well. "Keep in mind that no matter what a state or county may say about the product or the waste it treats, the landfill and the waste hauler have a right to refuse any waste," says Ms. Radaszewski.

Many waste haulers and landfills have their customers fill out a waste profile sheet when the facility wants to implement a new treatment technology before determining if the waste is acceptable for disposal. "I suggest that administrators contact their waste hauler when implementing new fluid disposal technologies," says Ms. Radaszewski.

Fluid-disposal Roundup

Here are, in alphabetical order, the latest fluid-disposal products and systems. List prices are not final; contact manufacturers to determine your price.

- Compiled by Daniel Cook

AVEC Scientific Design
Black Hole Flash
(800) 944-2525
List Price: $12 each
Key Features: This front-end suction device wicks - instead of sucks - fluid off OR floors without emitting distracting slurping noises. It is ideal for keeping the OR dry and safe during orthopedic cases, and offers a durable and cost-effective alternative to traditional absorbent floor mats, says the company.

Bemis Health Care
(800) 558-7651
List Price: $4,000
Key Features: The system reduces exposure to splattering and spilling of infectious waste fluids. Bottom-draining ports on Vac-U-Port disposable canisters open with a pull of the Vac-U-Station handle, draining 250cc of fluid per second, says the company. Infectious waste empties directly into the sanitary sewage system.

Cardinal Health
SAF-T Pump
(800) 234-8701
List Price: $8,000
Key Features: The SAF-T Pump is an alternate-waste disposal system that quickly and safely drains liquid medical waste into the sanitary sewer with no pouring required, thus minimizing your staff's exposure to this infectious waste, says the company. The SAF-T Pump doesn't require electricity and is small in size, simple to operate, and economical to install and use, as it reduces red bag waste disposal costs, adds Cardinal.

Colby Manufacturing Corporation
(800) 969-3718
List Price: $17 to $23
Key Features: The WaterBug Quiet Floor Suction System maneuvers effortlessly without ever sticking, efficiently suctioning blood and other bodily fluid spills to promote a drier and safer floor area around the operative field, says the company. The WaterBug has the unique ability to capture fluid from the top as well as from the bottom, maximizing fluid containment efficiency, says Colby.

Dornoch Medical Systems
High Fluid Cart
(888) 466-6633
List Price: $8,000
Key Features: The High Fluid Cart collects up to 48,000cc of surgical fluid without the need to tandem multiple suction canisters, says the company. When connected to a main vacuum source, the cart collects fluid from as many as four sites in two reservoirs. After the procedure, all fluid collection devices are reusable, says Dornoch.

Aqua Box
(800) 251-9864
List Price: $3,900 to $9,900
Key Features: The Aqua-Box is a stand-alone, wall-mounted unit that optionally adds a disinfectant before discarding waste fluid down facility sewer lines. The device empties and discards fluid from any suction canister, liner, collection back, kick bucket or any other fluid collection source. The company says the Aqua-Box can empty a standard suction canister in less than 30 seconds.

Think safety first
The highly regulated fluid disposal industry was a factor in Ms. Desmond's decision to install a closed system in her hospital's ORs. While she knows that solidifying liquid waste lets you bypass the most prohibitive regulations on fluid disposal practices, when Ms. Desmond considered the additional weight costs associated with placing canisters in red bags and the number of canisters her 28 ORs would produce, "it made sense for us to dispose of our engineered waste in the sewer."

One of the byproducts of surgery is the biohazard risk for the staff involved. Dealing with fluid waste is at the forefront of this risk.When staff empty open suction canisters, they're at risk of getting splashed with infectious waste in the eyes, nose or mouth, regardless of the amount of protection they wear.

"Anytime liquid is moved, you can breathe in tiny aerosolized particles without even knowing it," says Stephanie Lipp, the director of marketing, fluid management, for Cardinal Health. Ms. Lipp says the difficulty in realizing when an exposure takes place makes tracking such incidences nearly impossible, unlike the high level of documentation that occurs after a needlestick. "We don't know how much of a risk dealing with infectious waste truly is," she says.

Healthcare workers take a special interest in products that enhance workplace safety, and implementing them in your facility will show employees you put their safety at the forefront.

"The system I chose disposes of fluid waste without the need to pop a lid or open a canister," says Ms. Desmond. "I wanted to keep staff exposure to an absolute minimum because that sounded like the right thing to do. I believe the staff appreciates that effort."

Wasteful spending?
While safety should be your primary concern, the expense of fluid waste disposal is a close second. Ms. Desmond did a cost analysis based on the amount and type of procedures her hospital performs. "We do a great deal of orthopedic and urology cases, both of which are high-volume procedures that often fill numerous standard-size canisters," she says.

Government Rule

Federal, state and industry regulations play a large factor in how facilities dispose of fluid waste. Here's a rundown of the mandates you need to be aware of when deciding what to do with a canister full of infectious liquid.

  • OSHA. You should perform all procedures involving blood or other potentially infectious material in such a manner as to minimize splashing, splattering and generation of droplets of these substances.
  • CDC. You may carefully pour bulk blood, suctioned fluids, excretions and secretions down a drain connected to a sanitary sewer.
  • EPA. You may discharge blood and blood products directly to the sanitary sewer for treatment in the municipal sewer system, provided that secondary treatment is available.
  • AORN. The Association of Perioperative Registered Nurses states that it is the healthcare worker's responsibility to participate in the evaluation of work practices and engineering controls. The association recommends that you dispose of blood, body fluid, disinfectant solutions and other hazardous materials in accordance with local, state and federal recommendations and with concern for the environment.
  • FDOT. The Federal Department of Transportation defines infectious fluid waste packaging as the receptacle and any other components or materials necessary to perform the containing function. Suction canisters are not designed to perform packaging functions for transportation, and therefore special wrapping requirements are necessary when placing suction canisters in red bag waste. In short, you must wrap every suction canister containing fluid waste with material sufficient to absorb the entire contents of the canister before placing the canister in a rigid, watertight non-bulk outer packaging.
  • EPA and AHA. The Environmental Protection Agency and American Hospital Association issued a Memorandum of Understanding, calling for the reduction of the overall volume of waste (both regulated and non-regulated) by 33 percent by 2005 and by 50 percent by 2010.

- Stephanie Lipp

After factoring in the capital outlay for the closed-system she bought and the reusable canisters - she purchased enough to have 39 sterilized canisters ready to go at the start of each day - the hospital didn't save any money. "The cost involved was a wash when compared to the expense of placing disposable canisters in red bag waste," she says.

As Mr. Dunn points out, it might cost you $2.50 just to throw away a canister, when you consider that the national per-pound average cost of red bag waste is 30' and a full suction canister weighs about 8 pounds.

The cheapest practice of fluid waste disposal continues to be pouring infectious waste down the hopper, a large sink located in the soiled utility room. Facilities that pour waste must use engineering controls - such as a shield or a closed disposal system to protect employees from cross contamination - in addition to any Personal Protection Equipment (PPE), according to Ms. Radaszewski. "A sanitary sewer provides secondary treatment so it is safe to pour into the sewer, providing that PPE and engineering controls are used," she says.

Industry experts can't agree on the number of facilities still pouring - Mr. Dunn says one-fourth of you pour while Ms. Lipp believes the number is closer to two-thirds. Most concur, however, that pouring without the use of engineering controls puts staff at unnecessary risk. "Administrators always want to save money," says Mr. Dunn, "but there are some things you should save money on and on some things safety concerns should come first."

More to come
Instead of a cost-savings investment, Ms. Desmond's decision to buy her fluid disposal system was based on cost-avoidance; she hopes to see the financial benefits in year two when the facility no longer has to purchase disposable canisters. Ms. Desmond is also encouraged by the staff's reduced anxiety about dealing with fluid waste and she already has plans to implement the fluid disposal system in 11 ORs set to open on her hospital's south campus.

Fluid-disposal Roundup

Here are, in alphabetical order, the latest fluid-disposal products and systems. List prices are not final; contact manufacturers to determine your price.

- Compiled by Daniel Cook

MD Technologies
(815) 598-3143
List Price: $2,300 to $7,000
Key Features: The compact DM6000-2A, specifically designed for endoscopy, has an unlimited fluid capacity and features two independent suction field connections to accommodate EGD, ERCP and bronchoscopy procedures, says the company. For typical colonoscopies and other single-field procedures, the DM6000-2 provides a back-up suction source. An optional fluid totalizer records fluid volume aspirated, says MD Technologies.

Medline Industries
(800) 633-5463
List Price: $256 for a case of 16.
Key Features: You add SafeSorb to a suction canister before you start a procedure, thereby maintaining the integrity of a closed suction system. Pre-loading SafeSorb solidifies fluid waste while avoiding the need to open the pour spout or suction tube port on the suction canister lid, says the company.

Microtek Medical
Isolyser LTS-Plus
(800) 886-8795
List Price: $180 to $257
Key Features: LTS-Plus is a solidifier and sanitizer that treats liquid waste at the point of generation, thereby allowing surgical facilities in most states to dispose of their suctions canisters into the white bag waste stream, says the company. The product employs a closed system SAF-T-TOP that helps prevent powder spills, aerosolizing and infectious splashes, says Microtek.

Promethean Medical Technologies
Fluid Control Island
(800) 588-8861
List Price: $18 to $32
Key Features: The Promethean Fluid Control Island is a proactive device designed to capture and contain fluids lost from the patient and instrumentation during scope procedures, says the company. It is a combination drape and collection vessel that rests on the floor, uses existing facility wall suction and immediately evacuates fluids for measurement before they hit the floor.

Stryker Instruments
Neptune Waste Management System
(800) 253-3210
List Price: $15,700 for the Rover; $12,600 for the Docking Station.
Key Features: The Neptune offers fluid waste management and smoke evacuation in one unit. The system collects and transports waste fluid within a totally closed system, then disposes of it with little human intervention, reducing operator exposure, says the company. Other system features: A 20-liter collection reservoir for multiple procedures, a three-minute self-cleaning cycle, independent suction capability and accurate fluid measurement.