It's not an overstatement to say that automated fluid waste disposal systems have revolutionized case cleanup and room turnover after minimally invasive orthopedic fixes and other procedures in which fluid flows freely. But which system is right for you?

Clearly the choice of fluid waste management technology encompasses a range of practical considerations. As any experienced surgical administrator or materials manager will tell you, though, the best place to begin an equipment purchasing decision is in discussions with your professional peers at facilities that use the equipment. We asked 4 managers what sold them on the systems they use, and what they'd change about them.

'A toilet for canisters on the wall'

FYI: The Quick-Drain system connects to existing plumbing and its operation requires no electricity. Staff transport Bemis suction canisters or liners to the installed system and it drains the containers, flushing the fluid waste into the sanitary sewer system with water. A built-in rinsing feature washes out the canisters for disposal with non-biohazardous waste.

User's view: "You want your surgical suites to look and smell clean," says Carolina Madrid, RN, nurse manager at the Digestive Health Endoscopy Center in Fayetteville, N.C. "Fluid suctioned from the colon and flushed down the hopper doesn't look or smell good. We needed something that was more contained and safer."

She and her colleagues observed the Quick-Drain in action during a site visit to another facility. They were impressed by its simplicity. "First of all, the size was very small. It fits in the corner of our utility room," says Ms. Madrid. "Also, maintenance is easy. There aren't that many moving parts that can break down. It's a simple device, basically a toilet for canisters on the wall.

"You put the container in, it's easy to flush, it goes straight down the drain. No splash, no smell, no exposure," she says. "No chemicals or fumes, the less the better with that."

Perhaps the only drawback, she concedes, is that the single-use canisters represent a continuing expense. "And you can only use Bemis Quick-Fit containers. You don't have the option to use any other type of canister with QuickDrain except for Quick-Fit exclusively."

Silently suctions and drains fluid waste

FYI: The Environ-mate DM6000 series are compact, wall-mounted systems that occupy no OR floor space and don't require staff to transport suction canisters to waste disposal sites. The system silently suctions and drains fluid waste directly to the sewer line, isolating staff from exposure. The DM6000 model can be equipped with a footswitch, while the DM6000-2 model (shown) offers 2 independent suction inputs and the DM-6000-2A has an unlimited capacity.

User's view: "It's such an easy system to use," says Peg Ferguson, RN, BSN, director of nursing at the West Chester (Pa.) Endoscopy Center. "With the Environ-mate, there's no emptying of canisters, which decreases the issue of staff exposure to infectious waste, and the cost savings could be thousands of dollars. We just hook new tubing to the machine and to the scopes."

The low-maintenance system provides consistently strong suction as long as it is thoroughly cleaned at the end of each day by flushing through a solution of bleach and water, she says. Also, if specimens are retrieved by suctioning them through a scope, a single-use trap will need to be attached to catch it.

Installation can take some planning, she notes. "If you're not new construction, if you're an existing center, you'll need the assistance of a plumber, an electrician, a construction contractor to put it in," says Ms. Ferguson, keeping in mind the location of the utilities as well as the other equipment and available space in the room. "That represents an up-front cost, but you make up for it in not having to purchase canisters. That cost can be dissolved in 6 months or so."

Continuous collection and disposal

FYI: The wall-mounted, direct-to-drain Streamway System delivers unlimited capacity for continuous collection and disposal, eliminating the need for suction canisters and, with them, staff's risk of exposure to fluid waste. An illuminated touchscreen panel controls suction levels and displays volume measurements, and an automated cleaning cycle makes turnover simple.

User's view: Frances Hahn, RN, BSN, CNOR, clinical coordinator at the Blue Bell (Pa.) Surgery Center, used the Streamway System for fluid waste management at her previous facility, and often wishes she still had one on hand.

"We had a three-port model, and it maintained suction no matter how many ports we used," she says. "The scope, the shaver and the Puddle Guppy were all hooked up to it and suction wasn't affected, so the surgeon kept good visualization."

It wasn't just the physicians who preferred it. "The nurses were thrilled they didn't have to empty canisters or switch over to the next one," she says. "If nurses are watching and moving canisters, they're not paying attention to the patient. And taking time away from the patient is a safety issue.

"Also, it was the biggest convenience not to have to pull a big unit out of a room at the end of a long day and dock it," says Ms. Hahn. "All you had to do was attach a bottle of disinfectant and turn it on. It was clean in 4 minutes, and that was easy to do between cases."

As with most direct-to-drain systems, installation involved "going into the wall and plumbing to the sewer system," she says. "But that took just a couple of hours. The one thing I would like to see different is if the device were more flush to the wall. The tubes hanging down may be a minor issue, but even if you're cramped for space, you still have a 12-inch rule around the sterile field."

'Cleans and docks seamlessly'

FYI: The Neptune 2 features hands-free operation and no open canister access points to prevent staff exposure to waste fluid. Its SealShut technology securely locks away suctioned biohazards during cases, manifold changes, docking and transport to allow safe patient-to-patient use. Its high-volume capacity enables workflow efficiency and quick turnovers.

User's view: "When the Neptune was introduced in 2001, the first self-contained suction device on the market, my opinion at the time — and I've been in OR nursing for decades — was that it was probably the best piece of equipment for surgical staff, ever," says Meg Wiebel, RN, CNOR, CASC, administrative director of Crow Valley Surgery Center in Bettendorf, Iowa.

Its chief appeal was the safety it brought to the OR workplace, she says. "It let nurses work unexposed to biohazards. It not only minimized but erased exposure to surgical waste. The company is nimble and flexible about financing, and yet the safety outweighed any financial considerations."

Safety isn't the Neptune's only benefit, though, says Ms. Wiebel, who had a say in purchasing when her surgery center opened a few years ago, and when there were more fluid waste management options. "We looked at other systems. The ease of use was important to us, the way it cleans and docks seamlessly, with no leaks," she says. "It has a built-in smoke evacuator and powered IV poles, those are useful in ortho cases, that retract when it's turned off. It's not heavy to push, and it's low-profile."

Ms. Wiebel credits the manufacturer's responsiveness to customer concerns for the system's practical utility. Earlier models "used to be pretty loud," she says. "We told them, you're going to have to work on minimizing that. When we upgraded, we were thinking, if it's going to be that noisy, it doesn't make sense to go with Neptune again. But they've fixed that. They've improved a very good product."

COST JUSTIFY
Should You Invest In an Automated Fluid Waste Disposal System?

ON YOUR FEET Today's fluid waste management options make the job of collecting runoff safer and easier.

The benefits of collecting and disposing of runoff waste with a closed-suction system are many-fold over manually dumping suction canisters or solidifying their contents for the biohazard bin.

• It's safer for your staff. Not only does direct-to-drain minimize or eliminate OR employees' exposure to potentially infectious materials, its use can also prevent the slip-and-fall risk of splashed or spattered floors.
• It's a more efficient process. Changing out and dumping full canisters — not to mention suiting up in personal protective equipment to handle the task — takes time and distracts attention away from the surgery at hand.
• It's better for your budget. If you're scheduling a high volume of high-fluid cases, the expense of an automated system is likely more economical than laundering the linens absorbing fluid on the floor, weighing down your red-bag waste with full canisters, or paying nurse salaries for canister maintenance.
• It's environmentally sound. Fluid waste is medical waste, no two ways about it, but some disposal systems don't add single-use canisters to the accumulated refuse.

Still, an automated fluid waste disposal system is a considerable purchasing decision. While once there was only one automated fluid waste management option available, rival technologies have since entered the market. The choices range from portable suction units that drain through docking stations, to stationary wall-mounted suction systems, to closed-canister emptying devices.

In addition to a system's ability to protect providers from direct contact with fluid and its ease and efficiency of use, cost is often a leading factor in the choice. Not just the capital outlay or financing arrangement to acquire the equipment, but any plumbing renovations that may be necessary for its operation or the continuing expense of filters or other disposable components.

There are also questions of functionality. For example, how powerful is the system's suction? Does it have the capacity to serve an entire day's schedule of cases? What maintenance is necessary between uses or at day's end, and how long does it take? What are its power requirements? How loud is it when it's in use? How much space does it occupy? Will it accommodate multiple instruments or attachments?

— David Bernard