DISPOSAL When it come to fluid waste disposal, consider not just capital investments and per-case costs, but also staff safety and convenience.

My facility has disposed of fluid waste in just about every way imaginable. We've dumped it down the drain. Solidified it and tossed it into red bag waste. And we're currently trialing a fluid suction and collection cart on wheels.

We also considered a direct-to-drain system, but it would have required more renovations to our OR plumbing system than we wanted to do. Staff safety and convenience count, yes, but when looking at your fluid waste-disposal options, it's best to consider the hard and soft costs of the 3 main options: dumping, solidifying and closed systems.

Dump it down the drain
The cheapest way to get rid of fluid waste is to take the canister after a procedure and have a staff member dump it down the drain via a sink or hopper. To dump the fluid waste down the drain, a staff member must transport suction canisters by hand or by wheeling a cart to the sink or hopper, where she then must open the canister and dump it.

While cheapest in hard costs — because all you'll have to pay for besides the suction equipment and canisters is a sewer bill — this method poses the biggest infection and staff safety risks by far.

To start, canisters are fairly heavy — the average weight is about 8 pounds. When a staff member needs to dump the canisters, she then has to do so in a hopper or sink, which means the possibly infectious fluid could splash or aerosolize, endangering the person doing the dumping. It's a dirty job, and can put staff at risk. Even if employees are wearing gowns, masks and goggles, as required, they can still be exposed.

Costs can skyrocket when you start to add how much it would harm your facility if an employee was exposed to a bloodborne pathogen. Practice Greenhealth cites a study that says the cost to initially treat an exposed employee is between $500 and $3,000, while OSHA warns that when you include long-term costs of medications, lab work, lost wages and disability payments, it could be more than a million dollars. The human costs for these exposures are immeasurable. That's why my facility went away from drain-dumping several years ago.

It's also important to remember that while the EPA considers dumping fluid waste into the sewer system satisfactory, you may have to meet local and state laws before you can consider doing this practice, and often you need a special permit to do so. Plus, some say that this method brings an added risk of citations, with some interpreting dumping fluid waste as a violation of OSHA's Bloodborne Pathogens Standard. Many facilities have moved away from this in recent years and several national organizations discourage the practice.

SOLIDIFYING WASTE Disposing of fluid waste by using a solidifier is a "middle-ground" in terms of cost and risk to staff.

The middle ground: solidifying
Solidifying fluid waste is often considered the middle ground. It's a good option for facilities that don't have a large number of fluid-heavy cases, as it's safer than dumping down the drain but requires less in capital costs.

Solidifying comes with problems and costs of its own. Fluid is not light. Basically, you're taking what you threw away for free in the drain (minus the sewer bill) and throwing it away in red bag waste at a higher cost, both to your facility and the environment — but with the advantage that the fluid will be less likely to splash and infect a staff member.

The major cost to consider is the price to dispose of the fluid in regulated medical waste. A typical 3-liter canister, when filled, could weigh as much as 8 pounds. Regulated medical waste costs on average 28 cents per pound to dispose of, so switching to this option will likely increase your red bag costs. According to Practice Greenhealth, solidifiers usually cost between $5 and $30 per case, so for a facility performing 7,000 surgeries per year, the use of solidifiers could be equivalent to $35,280 in red bag waste charges and another $105,000 for additional supply costs for the solidifiers.

Some solidifiers contain chemicals that are meant to disinfect the gel so you can throw it away as normal solid waste. However, state laws vary whether this is acceptable, and these solidifiers often contain chemicals that have been linked to such negative health effects as respiratory problems and eye and throat irritation.

While the risk is lessened using solidifiers, it's not completely eradicated. Surgical staff usually must still open the container to pour in the powder to the fluid waste, which risks the fluid splashing. Some solidifiers aim to remove this risk by letting you pour them into the canisters before the procedure. There is also the risk that canisters could drop or break during transport, or leak if not properly solidified.

At my facility, we will likely continue to use solidifiers for cases that aren't as fluid heavy and wouldn't require the new closed system. We're planning on implementing a policy that solidifiers will be used for procedures with up to 100 cc of irrigation, while cases above that will use the automated system. On a per-case basis, this made the most sense economically and ergonomically for us.

FLUID DISPOSAL The staff at West Virginia University Hospitals currently use solidifiers for fluid waste disposal, but the facility is considering making a move to automated systems.

Closed systems
At our hospital, we recently completed a trial of a closed system for fluid waste disposal. These systems are the safest option for your staff, as they won't have to open canisters at all during the process, but require you to make a fairly large investment.

There are 2 types of these systems. In a closed drainage system, suction canisters are taken to stationary, (usually) wall-mounted port that empties the contents of the canister without removing the lid. The canister, if disposable, is either thrown out with red bag waste or cleaned with enzymatic solution and thrown in regular solid waste. Reusable ones are another option and can reduce waste, but come at a higher cost.

In a closed suction system, there are no canisters. Instead, a portable unit that has the capacity of several canisters is used to store fluid from procedures. After the unit is full, it can be taken to a drain system that will release the fluid waste into the sewer system. There are also stationary, wall units that suction the fluid directly from the patient to the drain.

While the safest option for staff, they aren't cheap. The average cost for these systems is around $25,000, and many times there are additional costs to renovate the plumbing to connect the system up to the sewer, which usually is added on top of the capital cost for the machine. Plus, the systems also come with a per-case cost that can be between $15 and $20 for disposable manifolds or filters.

Vendors have options for you when it comes to how you purchase these systems. Many will let you pay just a few dollars more per case in addition to the cost of the manifolds until the full price is reached. Others let you have the unit for free, but require that you pay higher costs for manifolds and filters. If we choose to go with the closed system, we're planning on taking advantage of one of these options to pay for the machine over time, rather than all at once. Keep in mind that these systems often make room turnover times faster, which can recoup costs. When looking into closed systems, keep in mind the amount of fluid you need to dispose of on average. For my facility, we're planning on using a closed system for our fluid-heavy procedures, like arthroscopies, cystoscopies and trauma cases, to ease the burden on staff and reduce red-bag waste costs.

Other factors
While costs to purchase the equipment and staff safety are the big things to consider when looking at new fluid management systems, other factors can affect your decision. In my experience, staff notices right away any space and noise issues, and is the first to bring up any problems. Talk to your team members ahead of time to gather their input on what works best for them and take that into consideration. Plus, you'll have to train them on the new system, which can factor into total costs. Finally, some of the closed systems also can function as smoke evacuators, so you may be saving money on other equipment. Take a look at all of your options, your caseload and your budget before deciding, and try your options to see what works best for your facility.