WORKHORSE Direct-to-drain systems limit the number of ancillary products you'll need to collect fluid runoff.

When it comes to fluid waste management, what if you could cut turnover times, make less mess, decrease your red bag trash costs and lower your staff's risks of slips, falls and exposures to biohazardous waste? Direct-to-drain systems make those benefits a reality. Here's a look at why capturing fluid at the surgical site and filtering it into a closed container is ideally suited for your orthopedic facility.

USER FRIENDLY Odds are your staff would prefer setting up a direct-to-drain unit before a procedure to lugging heavy canisters filled with fluid after it.

1. Exposure risks eliminated
Due to the risk of biohazards entering the local water system, a lot of local jurisdictions are now prohibiting the dumping of fluid waste into hoppers without it first being neutralized. Even if you solidify surgical fluid and dispose of it in red bag trash, handling those unwieldy canisters can result in spills, which could potentially expose staff to biohazardous waste.

When my facility bought a direct-to-drain system, the local municipality gave us the go-ahead for disposal into the sanitary sewer. This is because water dilutes the surgical fluid, and the detergent you have to run through the direct-to-drain unit is considered to clean and neutralize the waste. (We use about 1 case of this detergent per year, which costs us only about $400 annually.) The detergent cleans the chambers inside the machine, and housekeeping wipes down the outside of the unit after each case. Potential exposure to biohazardous waste is essentially eliminated. Bonus: Because the fluid goes directly into the sanitary sewer, it's part of your flat sewerage rate. The only item on a direct-to-drain system that you have to physically dispose of after a procedure is the manifold, and that can go into the clean trash.

2. Fewer staff injuries
A friend of mine recently slipped on fluid during an orthopedic case, fell and broke her nose. One wrong step is all it takes. Why not eliminate slip risks? A direct-to-drain system collects fluid before it hits the floor and keeps it secure until it's ready for disposal.

Keep in mind that canisters full of fluid waste are heavy, about 30 lbs. for a 15-liter vessel. An average shoulder arthroscopy will generate 6 15-liter canisters. That's 180 lbs. to push on a cart, or 30 to 60 lbs. at a time to carry manually. You run the risk of suffering a debilitating back injury every time you lift a canister full of fluid if hauling away surgical waste is part of your daily work routine.

Consider this: Paying out for even 1 staff injury would cost at least what you'd have spent on a direct-to-drain system in the first place.

3. Faster room turnovers
When you use canisters to collect surgical fluid, those filled vessels have to be replaced often during the case, then removed from the room, changed for the next case, bagged and disposed of. Nurses are the first to pick up a rag or mop and help out, but back-to-back shoulder cases can mean, easily, 1 hour of cleanup: Blankets are heavy if they're used to collect fluid spills, mats have to be disposed of in red bag trash, filled fluid canisters have to be moved and the fluid waste solidified. After we switched to a direct-to-drain system, many of those tasks were eliminated and we cut at least 15 minutes off room turnover times. The less time nurses spend on cleaning up, the more time they'll devote to patient care. For the boost to manpower alone, direct-to-drain is worth it.

4. Lower costs
I'm a big proponent of making surgical fluid waste as easy and safe to dispose of as possible. But I'm also a big fan of saving time and maximizing my purchasing dollars. Even a small facility can rack up the savings and make direct-to-drain pay for itself (see "Why Direct-to-Drain Makes Financial Sense").

If you're doing any volume of orthopedic surgery (or urology and cystoscopy cases for that matter), purchasing a direct-to-drain system is a good financial investment. My small hospital is high-volume for its size — we perform about 750 ortho cases annually. The facility is part of a larger health network that has a heavy purchasing footprint with the direct-to-drain manufacturer we ended up choosing. Lucky for us, and partly because we played a couple manufacturers off one another, we got the system for free. We pay only for the disposables used during each case.

But even if you're lacking purchasing power, there are lots of ways to make direct-to-drain affordable. Obviously, there's price negotiation. Negotiate a payment plan with the manufacturer that builds the price of the capital equipment into disposable usage for a period; after that period, disposable supply prices are reduced, and you own the system.

COST COMPARISON

Why Direct-to-Drain Makes Financial Sense

SAFETY CHECK In addition to routine maintenance and care, C-arm upkeep requires periodic radiological safety inspections.

Let's look at the kinds of savings you can reap after adding direct-to-drain technology to manage fluid waste by examining what you'll need to spend and the expenses you'll avoid.

• Disposables. Last year my hospital spent only $150 more on disposables than we used to before adding direct-to-drain systems. One direct-to-drain manifold (which gets the white-bag treatment) costs $20 per patient. But 15-liter canisters cost about $12 to $15 apiece, depending on your buying power, and using 3 of those canisters for a shoulder scope — which is certainly possible — puts you in the same cost category as direct-to-drain fluid management.
• Solidifier. Surgical fluid collected in canisters has to be solidified (solidifier is another line item that can run between $5 and $30), and then you pay to dispose of those solidified pounds in red bag waste (at approximately $0.28 per pound). Multiply that out by the number of procedures you're doing a year and red bag disposal costs quickly add up. In fact, our annual red bag costs have been reduced by thousands of dollars since we added direct-to-drain technology.
• Blankets. Don't forget the cost of blankets if you're still using them to sop up excess fluid. First, you have to buy them. Second, when they become soaked through, you pay by the pound to have them laundered (and they're weighed when the linen supply company receives them).
• Floor-suction devices. If you use suction canisters, you'll likely use more ancillary products in attempts to keep the surgical field dry. Absorbent mats cost about $6 each, and we used to use 5 or 6 per surgery. That's another $30 added to the case cost. Those heavy, fluid-logged mats then have to be disposed of in red-bag waste. With direct-to-drain, on the other hand, we generally place a floor-suction device within the sterile field and have surgeons stand on a single suction mat while operating.

— Holly Sousa, RN, BSN, MS, CNOR

5. Staff satisfaction
My previous experience with direct-to-drain technology was at my previous job at a larger hospital, and I knew there was no going back to the days of suction canisters that nurses emptied into the hopper when I arrived at my current position. If your facility performs orthopedic cases, you know how much fluid waste is generated — a routine shoulder scope can produce 50 or more liters. That's a lot, and it's not just heavy and expensive to dispose of, it's a safety hazard for your staff. And once your staff experiences the ease with which fluid waste can be disposed of with a direct-to-drain system, none of them — from housekeepers to surgeons — will want to go back to using suction canisters.