Best practices for managing such contaminated disposable items as suction containers and tubing necessitate disposal after each surgical or invasive procedure. Do your ORs meet this standard or do you dispose of tubing and canisters on an as-needed basis, citing cost and convenience as reasons why you're less than vigilant when it comes to medical liquid waste management?
Time for a change?
To find out how often facilities change their suction canisters and tubing, Janet Hannah, RN, CGRN, GTS, a staff nurse and education nurse at Inova Loudoun Ambulatory Surgery Center in Leesburg, Va., developed a survey to find out:
- what type of suction system the facility used;
- how often suction canisters were changed;
- how often the tubing was changed; and
- what the reasons were for these practices.
She handed these questionnaires to attendants at the 2006 Society of Gastroenterology Nurses and Associates meeting and got 101 responses. Of these, 12 were from freestanding surgery centers, four were from office-based centers and five were from ambulatory surgery centers with GI services. The other 80 were from hospitals.
The canister-changing habits of the surveyed freestanding centers that used disposable suction systems were all over the board. Five changed the suction canister after each case; three changed it at the end of the day; one changed the canister when it was full; one changed it when the canister was full or at the end of the day; one did it at the nurse's discretion; and one participant didn't respond. When asked about suction tubing, eight of the centers changed it after each patient while four waited until the end of the day.
As for the office-based centers, only one reported changing the suction canisters with each patient; another changed it at the end of the day and the other two changed it when full or at the end of the day. Three of these centers changed the tubing with each patient; one did this at the end of the day.
Two of the respondents from freestanding GI centers reported that they changed their canister with each patient, one only when full, one at the end of the day and one when it was full or at the end of the day. Three of these centers changed their tubing with each patient, while two changed the tubing at the end of the day.
The hospitals were less likely to use the same canister or tubing for multiple patients. Close to 60 percent reported that they changed canisters for each patient and a higher percent, ranging from 70 percent of the community hospitals to almost 80 percent of the trauma/teaching hospitals reported changing the tubing with each case.
When asked for the reasons for their policies and practices, the survey respondents cited the following influences:
- policy and procedures of the facility (32);
- infection control issues (28);
- cost factors (10);
- unknown reasons (3);
- no answer (13); and
- other (15). These reasons included "We based it on a magazine article," "It was the way when I came here," "Common sense" and "We called a neighboring unit to see what they were doing."
What the authorities say
So with all these options, how can you know how often you should change your canisters? And more importantly, what will the regulators say about your technique? Here's what AORN and the Joint Commission recommend.
AORN. The AORN's 2007 "Recommended Practices (RP) for Environmental Cleaning in the Surgical Practice Setting" in its Standards, Recommended Practices and Guidelines (551-558) states: "Operating rooms should be cleaned before and after each surgical procedure and at the end of each day. Cleaning also may be necessary during any surgical procedure." The rationale for this statement is based on infection control principles related to decreasing the presence of contamination within the perioperative environment to reduce the number of microbial flora and ultimately lowering the incidence of surgical wound contamination, says Sharon Giarrizzo-Wilson, RN, BSN/MS, CNOR, perioperative nurse specialist at the AORN's Center for Nursing Practice.
The RP continues on to state, "Contaminated disposable patient care items should be discarded in leak-proof, tear-resistant, labeled containers to prevent exposure of personnel to items potentially contaminated with infectious microorganisms and to prevent contamination of the surgical environment."
How contaminated patient care items are disposed is of utmost concern, says Ms. Giarrizzo-Wilson. "Disposal is a process that requires forethought and conscientious efforts to protect the healthcare worker from exposure to microbial contamination and the patient from harm related to surgical site infection," she says.
Joint Commission. While the Joint Commission doesn't specifically say how often you should change your waste canisters, it says in Standard IC 4.10 Element of Performance 1 that you should incorporate relevant guidelines for preventing infections. That means following the guidelines from the CDC, Joint Commission rules (Leadership Standard LD.1.30) or your local environmental services guidelines. "Whichever one you choose, be sure to tell your surveyor about it," says Louise Kuhny, RN, MPH, MBA, CIC, associate director of standards interpretation for the Joint Commission.
For example, if you're going by the CDC guidelines as outlined in its "Guidelines for Environmental Infection Control in Healthcare Facilities," your plans for canister disposal would need to prove that you do the following:
- Dispose of the waste regularly to avoid accumulation.
- Keep the waste in a well-ventilated area where pests can't get to it.
- Know if there is a state-imposed limit to how much fluid waste from the canisters you can dump into the sewer. If you seal and dispose of used canisters, have a system in place to be sure they are properly labeled and arrive at their intended destination.
- Create a regulated plan to show you are in compliance with all federal, state and local health and environmental regulations.
So if you're thinking about why you dispose of your canisters, however often you do it, and can't come up with an answer, this may be a good time to establish guidelines to use for your facility's protocol. If cost is a concern, you may want to look at common hidden expenses to be sure you're not wasting money on medical waste.
"Most facilities look at their canister disposal systems from a worker's safety standpoint and when looking at the types of equipment they do a cost-evaluation," says Jack McGurk, president of the Fair Oaks, Calif.-based consulting firm Systems Improvement Initiators and former chief of the Environmental Management Branch of the California Department of Health. "But to get the best system, they need to look at what they're doing in the facility.
"For example, if a facility is doing a lot of arthroscopy cases, they're going to need a cart or a big container. You can hook up a bunch of small canisters to do that, but it will take your staffers time to change those so you really should go to something bigger."
To set up the best system for your facility, Mr. McGurk says, you need to take a big-picture approach. "The accounting department may not be a part of your team to improve waste disposal, but they have the data on how much you're paying and how much your contracts with outside companies for medical waste removal are," he says to offer an example. "By getting information like this, you end up with all departments participating in your disposal process."
One of the biggest hidden costs you may uncover, says Mr. McGurk, is in the way you dispose of the fluids. "Some facilities just cap it and send it off as medical waste and that's an expensive way of doing it," he says, noting that waste disposal companies often charge by the pound and that a canister filled with fluid is two or three pounds heavier than its usual weight.
You can reduce what you throw away by dumping the fluids and cleaning out the canister, but Mr. McGurk says you need to be sure this practice actually is efficient in terms of cost and safety. "If you're putting the canisters into an autoclave, you should test the canister afterwards to be sure you're killing everything inside it because the canister itself could act as a barrier," he says. "You also have to account for the capital costs of equipment and maintenance of the autoclave and what you're paying for the time your staff needs to run a cycle."
Getting Your Staff On Board
Once your fluid waste program is designed or redesigned, you need to teach your staff about what you want them to do. Try a multimodal approach to make it as interesting as possible, says Louise Kuhny, RN, MPH, MBA, CIC, associate director of standards interpretation for the Joint Commission. "Some possible ways of achieving compliance are by using videos, PowerPoint, motivational campaigns and other measures to get the staff thinking about the rules," she says.