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How Do You Keep Your OR Floor Dry?
Your colleagues share their best tips for containing fluid.
Kent Steinriede
Publish Date: December 14, 2007   |  Tags:   Staff Safety

As surgical procedures become less invasive, one of the side effects is that many procedures, especially arthroscopy, generate more fluid waste. The result of today's wetter ORs is an increased risk of infection, greater chances of slips and falls, and more time needed to clean the room, which increases turnover time. On top of all this, most of the fluid is saline solution, which corrodes IV poles and wrecks shoes.

Dry Floor Survey Results

What type of personal protective equipment does your staff use for fluids?

Knee-high boot covers

66.7%

Impervious gowns

78.4%

Goggles

84.3%

Non-skid shoe covers

70.6%

Shoes without covers worn only in the facility

54.9%

Which type of fluid waste management system do you use?

Closed suction system

78.8%

Red bags

50%

Suction mats

32.7%

Drapes

36.5%

Wicking devices

28.8%

Special collection drapes

44.2%

Linens

30.8%

Are your surgeons compliant and helpful when it comes to controlling the amount of fluid that ends up on the floor?

Yes

78.8%

No

21.2%

Do you use special drapes for collecting fluid?

Yes

68.6%

No

31.4%

If you do use drapes, how do you feel that they work?

Very well

15.6%

Fairly well

60%

Not well at all

2.2%

Do you empty fluid waste directly into a sewage drain?

Yes

62.7%

No

37.3%

Do you solidify and red-bag your fluid waste?

Yes

48.1%

No

51.9%

How much fluid waste do you deal with each day?

0 - 10 gallons

54%

11 - 20 gallons

14%

21 - 30 gallons

10%

31 - 40 gallons

8%

41 - 50 gallons

4%

More than 50 gallons

10%

What is your annual expense for fluid management and disposal?

Less than $25,000

72.1%

$25,001 - $50,000

18.6%

$50,001 - $75,000

7%

More than $75,000

2.3%

How much have you invested in capital equipment for fluid management in the last two years?

Less than $10,000

70.5%

$10,001 - $20,000

11.4%

$20,001 - $30,000

4.5%

More than $30,000

13.6%

SOURCE: Outpatient Surgery Magazine Reader Survey, November 2007, n=53

"All of us are looking to see what is out there to help contain fluid. And most of us have tried everything on the market," says Nichole Hawkins, RN, CNOR, BSN, clinical coordinator at Emory Eastside Medical Center in Snellville, Ga.

We surveyed our readers to find out how they're staying ahead of this rising tide of fluid in the OR. We received 53 responses to our online survey (see "Dry Floor Survey Results" on page 59). When we asked for the most important reason to control fluids on the floor, more than 94 percent of respondents cited safety issues. Less than 6 percent cited infection control. When we asked OR managers if they'd had any injuries directly related to standing fluids on the floors, nearly 20 percent said yes. Here are six tips from your colleagues to help you reduce the amount of fluid that ends up on the floor.

1 Control the flow with the right drape
Managing the flow of body and irrigation fluids during a procedure isn't that different from dealing with water runoff in your backyard. It's a matter of channeling it to go where you want it. With various types of draping, you can create a path to control the flood. Over the years, drapes have gained better adhesives, become more absorbent and impervious and even included antimicrobial agents. They have also been adapted for specific procedures. About 37 percent of the survey respondents said that they use special collection drapes.

At Naples Day Surgery North in Naples, Fla., arthroscopic shoulder procedures are mainstays among the multi-specialty caseload. Drapes designed for shoulder surgery, which have a pouch for capturing fluid, are used for these procedures. The pouch can be attached to a suction device. With this setup, even procedures that require six 3,000ml canisters of saline generate very little fluid on the floor, says M.J. Balun, RN, CNOR, director of clinical operations at Naples Day Surgery North.

2 Properly position suction mats
Pouches and suction are not going to catch all the fluid. Depending on the type of procedure, fluid may run down the drapes and on to the floor, creating dangerous puddles that may cause someone to slip. Suction mats with absorbent batting capture the fluid, even large amounts, and remove it by way of a wall-mounted portable suction device.

About 32 percent of our survey respondents use suction floor mats. They work well, "except when you don't position them correctly," says Brian Lewis, clinical director at the Bone & Joint Clinic in Franklin, Tenn. Make sure you place the mat so that the fluid running off the drapes flows onto the mat, not on the bare floor. To do this you might need to adjust the drapes as well, says Mr. Lewis.

3 Switch to King Cotton
The Surgery Center, a multi-specialty facility in Oxford, Ala., had a problem with employees slipping, especially after mopping. The center did two things to fix the problem, says Renea Goode, RN, BSN, the center's director of nursing. First, Ms. Goode told the company that waxed the floors about the problem. The maintenance company changed the type of polish on the floor to one that was less slippery. The center also switched from a disposable rayon mop to a disposable cotton mop. "They weren't absorbent enough," says Ms. Goode of the rayon heads. Most of our survey respondents, 78 percent, use cotton mop heads and 86 percent use non-disposable mops.

4 Go from red to green
Adding a solidifier to a canister of fluid makes it easy to transport because the gel doesn't splash and can be disposed of as red bag waste. However, because of its weight, solidified fluid can be expensive when it comes to disposal. Because of the high cost of regulated medical waste, healthcare facilities across the country have been trying to keep as much as possible out of the red bags. Fewer red bags means less waste in the landfill. "It's safer for the environment," says Andrea Halkiotis, RN, BS, CNOR, the clinical manager for the 15 operating rooms at the Jewish Hospital in Cincinnati.

5 Fluid waste management systems
One way of reducing red bag waste is to use a fluid waste management system. These can be wall-mounted or portable. Some are completely closed systems while others are open vacuum systems that suction fluid into canisters. About 79 percent of survey respondents use a closed suction system. Naples Day Surgery North has a portable closed system with no canisters to open. "We don't have to worry about touching any of that nasty fluid," says Ms. Balun.

With a closed system, there's no need to change or empty canisters during a procedure, which is one less task that nurses and techs have to worry about during a procedure. At the end of the procedure, the fluid can be dumped directly into the drain or treated with a disinfectant and then pumped into the drain.

6 Keep trialing
New products are always coming on the market. Don't pooh-pooh anything until you've trialed it. Niki Moman, RD, MS, director of surgical services at Midwest City Regional Hospital in Midwest City, Okla., is always open to trying products. When she hears of something with promise, she contacts the manufacturer and asks for enough samples to run a trial for two or three weeks. During and after the trial she solicits feedback from as many people as possible. Even after a product gets the thumbs-up and is incorporated into the OR, it is still on trial, says Ms. Moman. "Sometimes they don't work as well after a while."

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