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Must-Haves for Orthopedic ORs
Direct-to-drain systems are a safe, cost-effective and eco-friendly way to manage fluid waste.
Dan Cook | Editor-in-Chief
Publish Date: September 21, 2021   |  Tags:   Waste Management Staff Safety Orthopedics
Direct to Drain
IN THE FLOW Capturing fluid runoff in closed mobile units helps staff turn over rooms between cases quickly and easily.   |   Pamela Bevelhymer

Julie Moyle, RN, MSN, remembers the case well, even though it occurred more than 35 years ago. At the start of the AIDS epidemic, she was a surgical nurse at a hospital in Florida. While cleaning up after a major oral maxillofacial case, she disconnected the suction line attached to a canister full of fluid waste. The canister’s ports were uncapped, and the sudden loss of vacuum ejected its contents directly into her face. “That type of high-risk exposure simply can’t happen,” says Ms. Moyle, now the sustainability manager at Practice Greenhealth, a non-profit organization in Reston, Va., that provides green solutions for healthcare facilities and professionals.

Ms. Moyle thankfully was not exposed to an infectious disease, but the experience stuck with her. It’s part of the reason she believes surgical teams should consider better alternatives to disposable suction canisters for collecting hazardous runoff and dumping the contents down the hopper or solidifying the fluid for deposit in red bag receptacles. “Collecting fluid waste in a closed, direct-to-drain management system is the far better option — for several reasons,” she says.

Improved safety. As Ms. Moyle can clearly attest, staff are at risk of exposure to fluid collected in disposal canisters when they’re removing them from the surgical field and as they’re pouring the contents down the hopper. Solidifying fluid in a suction canister reduces the risk of splashback in theory, but Ms. Moyle says solidifying agents aren’t always 100% effective; if staff don’t add enough of the agent to penetrate the amount of fluid in the canister, the risk of spills and splashes might not be eliminated. Additionally, staff who lift and move fluid-filled canisters might suffer muscle strains or more serious injuries. Removing suction canisters from ORs eliminates these risks.

Ms. Moyle points out that OSHA requires employers to mitigate risks to their workforce through a hierarchy of engineering controls. “It’s incumbent upon surgical leaders to reduce or eliminate exposure to blood and bodily fluids,” she says. “That’s where closed fluid management solutions come into play. They mitigate exposure to fluid waste that occurs any time a suction canister’s port is opened.”

Cost savings. A full three-liter suction canister weights about seven pounds and costs about $2 to dispose of in regulated medical waste, according to Kaeleigh Sheehan, manager of Practice Greenhealth’s Greening the OR Initiative. A couple bucks might not seem like much in isolation, but Ms. Sheehan says the costs can add up, especially when you consider surgical fluids can comprise up to 40% of regulated medical waste produced in facilities that solidify fluid in disposable suction canisters.  

Adding a mobile fluid management unit requires a significant upfront cost, but Ms. Sheehan says eliminating the expense of single-use suction canisters and lowering the amount of regulated medical waste that needs to be disposed of enables facilities to achieve a return on investment in about two years.

“The payback on mobile units can be accelerated if they’re used during high-volume, heavy fluid-producing procedures such as joint arthroscopies,” says Ms. Moyle. More important than a return on investment, according to Ms. Sheehan, are the intangible cost savings associated with eliminating staff exposure to fluid waste and adding a technology that will protect them from potential harm. “Treating a single infection that results from an exposure to bodily fluids is expensive, not to mention the cost of the overall impact on human health,” she says.

Greater efficiencies. Mobile collection units keep fluid off OR floors, a benefit that eliminates slipping hazards and speeds up room turnovers. Faster room turnovers might not show up on financial spreadsheets, but consider the soft assets of improved staff satisfaction and improved between-case cleaning during busy days of surgery when every minute counts.  

“After mobile units reach full capacity — a process that can take several cases — a staff member simply wheels the cart to a docking station, which automatically empties the contents and cleans the reservoir,” says Ms. Moyle. “The cart is ready to return to service in minutes. It’s a much faster and much easier process than using suction canisters.”

Green benefits. Facilities that track the amount of fluid waste they collect in direct-to-drain units avoid processing 12 tons of regulated medical waste each year, according to Ms. Sheehan, who says the figure is a conservative estimate. She also points out that eliminating the disposal of single-use suction canisters has a significant environmental impact.

Ms. Moyle says incinerating fluid-filled plastic canisters releases petrochemicals into the environment. “Polyvinyl chloride can convert, combust or compound into dioxins and mercury, which gets emitted atmospherically and settles in area soils and bodies of water,” she explains. “Moving away from single-use plastics has tremendous upstream and downstream environmental benefits.”

For many compelling reasons, it makes sense to throw away disposable suction canisters for good. Says Ms. Moyle, “Whenever facilities want to reduce their amount of regulated medical waste, implementation of a closed fluid waste management system is one of the first strategies we discuss.” OSM