CLOSED COLLECTOR A portable fluid waste suction device is practically the gold standard for arthroscopy cleanup.

The steady stream of irrigation fluid used to distend the joint space during arthroscopic procedures has to go somewhere. Whether it ends up pooling under the feet of your surgical team or effectively contained in a closed collection system is up to you. For the sake of your staff's safety and efficient room turnovers, the following advice can help stem the tide in your ORs.

1 Take preemptive action
Contaminants on the floor are the leading cause of slip, trip and fall incidents in healthcare facilities, according to the Centers for Disease Control and Prevention's National Institute for Occupational Safety and Health. Falls make up the No. 1 workplace injury that nurses and techs suffer, according to the organization's report on Slip, Trip and Fall Prevention for Healthcare Workers (osmag.net/9EKkrT). The lesson is clear, says NIOSH: Employees who are properly trained and properly equipped to clean up spills as soon as they're discovered will protect themselves from harm.

"Be proactive when using large volumes of irrigation — don't wait until you have wet floors to start collecting runoff," says Dianna Wilson, MSN, RN, CNOR, assistant director of operative services at Alamance Regional Medical Center in Burlington, N.C. "In cases where you have large volumes of fluid waste and take early action to collect it, you don't see slip-and-fall accidents, as opposed to when you don't take precautions and should have."

Ms. Wilson takes a "best defense is a good offense" view and recommends investing in an efficient in-line arthroscopy pump system that automatically reacts to internal pressure changes within the joint and adjusts fluid delivery to limit runoff, even during high-volume cases. "It measures the fluid going in and coming out, so you should have very little excess to deal with," she says.

2 Automate the process
Ask anyone working in an OR that sees more than a moderate volume of minimally invasive orthopedic fixes, and they'll tell you how much automated fluid waste management systems lighten the load. Whether it's a mobile collection unit that's drained through a fixed docking station, a wall-mounted system that provides more power than room suction or a rapid-action canister-emptying device, automation brings convenience to fluid waste management.

"On a heavy ortho day, we have 4 rooms going at the same time, so we handle a lot of fluid," says Jimmy Henderson, materials manager at the Outpatient Surgery Center of Jonesboro (Ark.). The only way to keep up with the fluid, he says, is to station a wheeled suction unit in every room. "You need to get a portable system that's easy to maintain and use," he adds. "It may cost more on the front end, but you will save in the long run."

Mobility is an advantage in a busy OR, but any automated collection and disposal method offers safety with its efficiency, says Pam Skipper, RN, administrator of the Carolina Bone and Joint Surgery Center in Myrtle Beach, S.C. "Staff safety is the main reason to go with an automated, direct-to-drain system," she says. "These closed systems are compliant with OSHA regulations, which don't necessarily condone dumping out full canisters by hand."

BLOODY MESS The safest, most efficient and most economical fluid disposal method depends on a facility's case volume.

3 Use multiple methods
An automated, closed system isn't your only option for fluid collection and disposal. Depending on the types of cases you schedule and the volume of fluid they might generate, perhaps it shouldn't be. "If you want to stay ahead of the flow of fluid, a multipronged approach is best," says Mr. Henderson.

Besides portable, high-capacity collection equipment, he notes, it may be necessary to enlist the assistance of floor-based suction devices, disposable absorbent mats, surgical drapes with collection pouches or even lined kick buckets. "There's really no single option," says Mr. Henderson. "Probably the best choice is to use the many options in tandem."

Shortly after he began working at the Outpatient Surgery Center of Jonesboro, he noticed that using multiple fluid waste collection solutions sped OR cleaning between procedures. It became obvious to Mr. Henderson that efficient fluid waste management pays off. "The way you bank dollars is through improving turnover times," he says.

4 Focus on efficiency and safety
The key to getting the best results out of fluid waste management is to match the methods to the needs of the case. "Various collection devices work best for different procedures," says Ms. Wilson. Given the advance notice afforded by elective surgery, it should be possible to know which procedures are likely to be the messiest and what'll be needed to clean up during each one.

"Think about the length and severity of the case and how invasive it's going to be when you decide what you need as far as fluid management is concerned," says Mr. Henderson. "What would be most efficient and effective? Everybody would love a mobile collection unit, but does everybody need it? Is it overkill?"

Take, for instance, a knee arthroscopy. The use of a tourniquet keeps the blood in check, so lower pump pressure and less fluid is needed in the joint space. Single-use absorbent pads are a practical solution, although they get very heavy when they're filled with fluid. For quick scopes, disposable Chux pads or a floor-based suction device that you can easily move with your foot to where fluid is collecting might fit the bill.

In contrast, shoulder or hip repairs are longer, bloodier procedures that tend to need a lot of pressure. A hip takes up to 15 3,000 mL bags for 1 case, according to Mr. Henderson. Devices that collect fluid on the floor clearly won't be sufficient to keep ORs dry during those procedures.

It's also important to promote staff safety by limiting the surgical team's exposure to fluid waste and heavy lifting. "In the old days, we worked with 16 liter disposable containers," says Ms. Skipper. "Somebody had to dump those out. How many times did people get splashed?" Taking into account the bad ergonomics of carrying full canisters, and the time spent suiting up in personal protective equipment to pour their contents down the drain, automated systems seem a bargain at whatever the cost.

Don't let your fluid waste management solution create other ground-level problems. Mr. Henderson points out that some fluid-suctioning floor mats don't extend to the full length of the OR table, and some have a lip at the edge. "That can be a trip hazard," he says, "and when moving equipment close to the mat, you end up having to fight with it."

FLUID SITUATION Fluid on the floor may be inevitable, but it's not unmanageable.

5 Consider costs
Implementing any fluid waste management method comes at a cost, whether it's the canisters that must be continually purchased and discarded, the solidifying agent that makes your red bag waste more expensive to ship out, or the plumbing renovations and disposable filters needed for direct-to-drain suction. But preparing for fluid waste collection and disposal also carries considerable cost benefits. "Let's say someone slips and falls, and lands on her knee, breaking her patella — she's going to be out of work for 8 weeks," says Ms. Wilson. "That'll cost you more than preventive measures for a whole year."

In the long-term view, making a decision on fluid collection and disposal comes down to a few key questions. What, given your facility's volume of messy orthopedic cases, is the most economically efficient option? What tasks do you want to pay nurses to do? And what is it worth to keep your surgical teams on safe footing?

In Ms. Wilson's healthcare network, equipment purchases are conducted through research and value analysis, but it's clear, she says, what's above the bottom line, especially when it involves case cleanup. "The facility I work for is very safety conscious," she says. "We're urged to put our own well-being ahead of the cost. If surgeons, nurses and techs know you're looking out for their safety, you'll have a happier surgical team, and then you'll have happier patients, too." OSM