One by-product of minimally invasive procedures such as arthroscopy and endoscopy is the fluid waste they generate. Cleaning up and discarding irrigants, blood and other surgical and bodily fluids between procedures can add time to your turnovers, but it's essential given the safety risks they present — most notably, infection and fall risks. Closed suction systems are one option for collecting, containing and disposing of fluid waste into a sanitary sewer. Here's some advice on choosing one that will meet your OR's needs.

Present vs. possible
When you're considering the purchase of a fluid waste disposal system, as when you're considering the purchase of almost any medical equipment, it may be helpful to start by taking a sheet of paper and dividing it into two columns.

The left-hand column is for your current system. How are you handling fluid waste right now? Talk to your staff about the process and break down all the steps they have to take on. What size canisters do you use: one, two, four liters or larger? Do surgical personnel have to transport them to a flush sink or hopper? Does the sink have a "salad bar"-type shield over it? Does your staff don personal protective equipment when they pour the fluid down the drain? Or do you use solidifiers and dispose of the canisters with your red bag waste? In short, what's it take to do what you're doing now? And, more to the point, what is the cost to do what you're doing now? Enumerating the details of your current fluid waste management process will give you a clear understanding of its costs in time and supply expenses.

In the right-hand column, then, you'll list the steps involved in the system you're considering installing, in order to develop a point-by-point comparison. You'll need to do your due diligence for this. You're looking to determine not only what the new equipment's going to cost you, but what you stand to gain in the tradeoff. What aspects of your staff's workflow would a new fluid management method alleviate? How much time would you save, for instance? Is there anything you'd be giving up in the switch? How does your staff feel about the possibility of adding a new system?

Considering the candidates
It's reasonable to start your examination of individual products on the market with an assessment of their vendors. How many years have they been in the business? How many fluid waste disposal systems have they installed? What kind of warranty and service do they offer? While the size of a company's client base and its standing in terms of market share will give you a sense of its reputation for quality and service, it will also reassure you that you're not going to be just a beta test site for a newly developed product.

Cost is, of course, a major factor in any equipment purchase. But when you're evaluating fluid waste disposal systems, you'll have to think about costs on perhaps three different timelines.

• First, there's the initial cost of the system's components.
• Second, there may be installation costs to consider. Does the discharge connection plug into a drain in the soiled utility room like a firehose, or does it need an engineered fitting? Will the system require dedicated plumbing? What's it going to take to get from delivery and installation to training and use? Don't overlook these setup expenses.
• Third, what's the system's continued operation going to cost you in disposable supplies? It's been said that much of the cost of fluid management is the canisters the systems use. Some systems involve reusable canisters but consumable lids. Keep in mind that single-use components mean that you must calculate costs over the long term.

Permits and performance
Another important factor you'll want to look into before you make a decision is whether you'll need the approval of your state or another local or regional government authority to install and operate a fluid disposal system. If the system you're considering doesn't claim to treat the fluid waste it drains into a sanitary sewer system, you might not require a special discharge permit or license. If the system involves a disinfectant, sanitizer or other agent added to the waste before it's discharged, however, permitting might be required. Ask your engineering staff, who'll have up-to-date knowledge on your local waste water regulations.

At the same time, be sure to obtain independently confirmed data that the manufacturer's claims are valid: that an additive the system uses is effective, that no bioaerosols are released during use, that users don't come in contact with fluids, or any other safety, infection control, operational or management claims that are raised, are addressed. Avoid the marketing preceding the science, because everything sounds great on paper.

Since issues of plumbing and installation may prevent you from trialing some systems in your own facilities, you owe it to yourself to visit facilities that have installed the system you're considering. Ask the manufacturer for an extensive list of users and visit as many as you can — preferably ones that are similar to yours. During your site visits, don't just ask for a demonstration. Invest some time into watching the equipment in action over hours of use. Watch the staff members who use it and ask them about how it works. The actual end users will give you a good sense of how well it works.

Last, but not least, it will serve you well to measure in advance how fluid disposal equipment will fit into your ORs or procedure rooms. Some systems are stationary, wall-mounted fixtures and others are mobile consoles, but room space always seems to be at a premium in the surgical environment as personnel joust with equipment for a place at the table or on the floor. Keep your surgeons' and staff's concerns over "something else you've got to put in" in mind, especially since you've also got to be mindful of whether you'll need just one unit, or more than one as a backup measure in case the first breaks down.

Bemis Health Care
Quick-Drain
(800) 558-7651 x5252
www.quick-drain.com
Price: $6,995
FYI: Bemis's Quick-Drain provides safe and cost-effective disposal of liquid infectious waste, with fluid emptying into the sanitary sewer at a rate of 500cc per second, saving staff time, says the company. Quick-Drain saves money by reducing red-bag waste and by eliminating per-use disposal costs such as solidifiers. The system connects to existing plumbing and requires no electricity to operate.

Cardinal Health
SAF-T Pump
(800) 964-5227
www.cardinalhealth.com
Price: not disclosed
FYI: Cardinal Health's SAF-T Pump system quickly and safely disposes of liquid medical waste directly into the sanitary sewer with no pouring required, says the company. The SAF-T pump connects directly to existing plumbing, accommodates all Medi-Vac suction canisters and is more economical than disposing of full canisters, which results in more costly red bag waste.

DeRoyal
AquaBox
(888) 938-7828
www.deroyal.com
Price: $3,900 to $9,900, depending on model
FYI: DeRoyal's AquaBox offers a simple, quick, efficient and safe fluid waste elimination system, says the company. The compact, stand-alone, wall-mounted unit can empty fluid from suction canisters, liners, collection bags, kick buckets or any fluid collection source — it can evacuate a suction canister in less than 30 seconds — and safely dispose of it through existing sewer lines with an option of adding disinfectant solution, eliminating red bag expenses for fluid waste disposal.

Dornoch Medical Systems
Transposal Infectious Fluid Management System
(888) 466-6633
www.dornoch.com
Price: Complete 10-OR-suite fluid management system begins at $30,000
FYI: Dornoch's Transposal System is an integrated infectious fluid collection and disposal system with OR and facility-wide applications, says the company, which is also introducing a new line of fluid carts for 2008. The carts, which can remain in the OR for an entire surgical day, provide a sealed, cleaned and disinfected reservoir for each patient. All collected fluids are safely processed on site, minimizing exposure risks and dramatically reducing red bag waste.

MD Technologies
Environ-mate DM6000 and DM6000-2 Suction-Drain Systems
(800) 201-3060
www.mdtechnologiesinc.com
Price: From $3,000 per sterile processing room for DM6000 to $5,500 per endoscopy room for DM6000-2. List prices include budgeting for installation.
FYI: About 80 percent of the cost of conventional fluid management is spent on canisters, with the rest going to waste disposal, says MD Technologies. The company's compact, wall-mounted Environ-mate eliminates both costs, offering tremendous savings. While other systems require users to transport suctioned fluid to disposal sites, Environ-mate channels fluid directly from the suction field to the sanitary sewer, isolating staff from exposure. (Environ-mate requires the installation of a plumbing drain).

Stryker Instruments
Neptune 2 Waste Management System
(800) 253-3210
www.stryker.com
Price: not disclosed
FYI: Stryker's Neptune 2 Waste Management System minimizes risks to healthcare workers by virtually eliminating harmful exposure to fluids and smoke in the operating room, says the company. A totally closed, all-in-one unit, it collects and disposes of surgical waste without operator assistance to prevent contact with infectious fluids and surgical plumes. It's said to offer a greater range of suction, more volume capacity, highly visible fluid volume, an intuitive user interface and improved cleaning technology.