Ouida Klock, MSN, RN, CNOR, estimates that switching from suction canisters to collect and transport patient fluids to a liquid waste disposal system has saved her ortho-pedically-focused surgery center (see "Site Visit" on page 83) more than $100,000 a year in disposal costs alone. As an added benefit, the complete fluid management system that her facility purchased reduces turnover time between cases and prevents the staff from having to come into contact with contaminated waste that could expose them to dangerous bloodborne pathogens, including HIV and Hepatitis C.

"We wanted to find a fluid management system that would protect our staff and at the same time reduce our fluid waste expenses," says Ms. Klock, administrator of the Mountain Empire Surgery Center in Johnson City, Tenn.

Why a complete system made sense
When Mountain Empire opened in April 2000, the center used suction canisters to collect and transport patient fluids. The staff isolized the fluids and disposed of them in red bag waste. They spent five to 10 minutes between cases replacing canisters and setting up more for the next procedure. "Being a new facility without much negotiating power," says Ms. Klock, "we were paying more than a dollar a pound for red bag waste disposal." (Typically, red bag waste costs about 30' to 50' per pound, according to Ms. Klock and several industry sources.) With 60 percent of the center's cases involving scopes, Ms. Klock determined that Mountain Empire was pouring nearly $100,000 a year into fluid management expenses, including labor, supplies and disposal. Even if she paid a more reasonable 50' per pound in disposal costs, she estimated the surgery center would still be paying almost $60,000 a year.

With this in mind, the center invested in a complete fluid management system (the Neptune Stryker). Although the initial investment is significant (many start above $20,000), these systems handle patient fluids from collection to disposal. Most of these units connect to your plumbing and release the collected fluids at a closed disposal station into the sanitary sewer system. Some systems also treat the fluid with either bleach or enzymatic solution, breaking down fatty components in the waste, before flushing it away.

Canisters: easy to use and economical
Canister use is still very common. They are easy to use and their cost is minimal; disposable canisters and canister liners cost around $1.50 to $2. Becky Swan, RN, MSN, administrator for the Southern Surgery Center in Hattiesburg, Miss., uses canisters and believes they meet the needs of her orthopedic facility. She uses a tandem system, which holds four 3-liter canisters. When one canister is full, the system automatically starts filling the next canister. But she says most regular cases only require a single 3,000-cc canister. For big procedures like ACLs, her facility uses a larger 16-liter canister. Her staff dispose of the canisters in their red bag waste.

To avoid the expenses of red bag disposal, some facilities pour their fluid wastes into a "hopper" (an open sink with water in the bottom, much like a toilet, usually found in a substerile room). While this can be a great cost savings, it may put your staff at a greater risk of exposure. "When employees pour patient fluids into open sinks, it can splash back or aerosolize, and they can breathe in the materials," says Mr. Shelver. To prevent exposure, he says employees should wear personal protective equipment, including a face shield and apron.

Regulatory compliance
When it comes to fluid waste management, administrators must also consider regulations covering everything from employee safety, transportation and disposal of fluids.

• Employee safety. OSHA's Bloodborne Pathogens Directive (writeOutLink("www.osha.gov/SLTC/bloodbornepathogens","1")) requires employers to minimize employees' exposure to bloodborne pathogens. To comply with the directive, facilities must purchase fluid management products designed to reduce the risk of spills, leaks, splashing, and aerosolization of infectious fluids.
• Disposal. The EPA and CDC regulate the disposal of infectious fluids. According to EPA estimates, more than 90 percent of infectious medical wastes were incinerated before 1997. Since then, the EPA has cracked down on incineration, making this alternative increasingly expensive. Red bag waste treatment, disposal services and flushing fluids into the sanitary sewer system are now the common methods of disposal. Both the EPA and CDC have approved the disposal of blood into the sewer system as long as secondary wastewater treatment is available.

Laws governing medical waste disposal also vary from state to state. Mr. Shelver formerly worked at a Lubbock, Tex.-based hospital that was not allowed to flush blood or bloody fluids directly into the sewer without paying a city fine. He advises you "consult state and local codes and ordinances to be sure your town allows medical-waste flushing."

Finding what's right for you
From collection to disposal, fluid management poses regulatory and financial challenges, but finding the right system for your facility makes all the difference.