SEAL THE DEAL By using wall-mounted ports, you can pump fluids from your sealed canisters directly into sewage.

Not long ago, disposing of liquid waste was a most unpleasant task. You'd either have to pull off the tops of canisters and dump the liquid down a hopper, a crude method that carried with it the constant risk of splashback of blood and body fluids. Or you'd solidify the canisters of waste and dump them into red bags that a medical waste hauler who charged by the pound would later pick up. Pour down the drain or red-bag — neither option safe, efficient or economical.

But thanks to today's direct-to-drain units, we can empty canisters directly into a sanitary sewer system — a clean, safe no-pour solution to fluid waste disposal that not only reduces staff exposure to infectious fluid but also shaves minutes off of room cleanup and may in the long run lower waste disposal costs.

With a closed direct-to-drain system like ours, staff attach full containers to wall-mounted drainage units, which pump the waste directly into the sewer. We also considered direct-to-drain disposal with high-capacity roving units that collect fluid directly from the surgical site, suction mats or floor wicking devices. Staff simply wheel filled rovers to a docking station, hook them up and stand back as the contents are automatically emptied into the sewer.

Going direct-to-drain
Before we switched to a direct-to-drain suction canister system 5 years ago, we packaged untreated liners into red biohazard bags. But with the expense, the leaks and the constant risk of exposure to dangerous fluids, we knew we needed a change.

Cost was the most pressing concern we had with our red-bag system. Yes, we saved on reusable canisters, but we were spending a small fortune on waste removal. You'd be surprised how much container-based disposal methods can cost, so it's important to remember you're buying containers and paying more for red bag waste on a regular basis.

We considered dumping the unsealed canisters of fluids into a hopper. Simple, yes, but hardly safe. We couldn't expose staff members handling the disposal to splashback and contamination.

The main cost of installing a fluid-waste-disposal system right in our facility was installing the wall-mounted, built-in port to suction fluid from the canisters into sewage. However, by no longer having to pay a medical waste hauler, our system more or less paid for itself in 6 months.

We opted for single-use canisters over reusable ones, which require cost to reprocess, space in sterile processing and time to clean properly. With disposable, once we flush the canister, we toss it into regular trash. The expense of resupplying doesn't even come close to what we were spending on waste removal before, and by saving on time and effort, we've become more efficient. Plus, our system uses gravity to drain a canister, requiring no electric power, which adds to our savings.

Staff safety
In addition to cost, staff safety was an equally pressing concern for us. When were still using single-use liners in reusable canisters, our method allowed a number of exposure points along the way. From opening canisters, removing the fluid-filled liners, sealing them and packing them away in red bags, exposure was a big problem. And with the potential for breaks and leaks, the liners themselves simply weren't secure enough. We even had a few spills over the years, which, although rare and never causing any dangerous outbreaks, were frequent enough to raise concerns over contamination and disrupt all other operations.

Our new suction-canister system closes the gap on nearly all of the previous exposure points we had, and the same is true for fluid-cart and direct-to-drain systems. No matter what system you choose, you're connecting your waste to sewage and more or less sealing the process.

Such is the case when we connect our canisters to the built-in port. The only exposure points occur when we disconnect the canisters from the vacuum in the OR and when we snap them into the port in the waste closet, an isolated location that also benefits the system's safety protocol. Plus, by choosing single-use canisters, we've blocked them from spreading contaminants, too.

SANITARY SEWER SYSTEM
Your Direct-to-Drain Options

Direct-to-drain systems eliminate the need to red-bag liquid waste or pour it down the drain.

If you're thinking of upgrading to a fluid waste management system, here's a look at your 3 options.

Suction canister systems gather fluid during surgery into canisters (0.5-3 liters), just as it happens with the traditional canister method, only once the fluids are ready to be disposed, you take the canisters to a stationary built-in port, where the fluid is drawn directly into sanitary sewage. You can use single-use or reusable canisters with this method, depending on your preference and needs. This method is perfect for smaller outpatient facilities with a few ORs, which is why we chose it for our own upgrade.

Fluid cart systems involve mobile carts that hold large (20-52 liters) reservoirs onboard to collect fluid during operations. Once the procedure is complete and all the fluids have been gathered, the cart, like the canisters, is wheeled to a stationary dock that pumps the fluid from the cart directly into sewage. The added benefit of the cart-and-dock method is that the reservoirs are reprocessed within the same system, and the only single-use features are cleaning agents and solutions. Additionally, some systems include digital waste measurement as well as smoke evacuation. This option is best suited for facilities that do a lot of fluid-intense procedures.

Direct-to-drain systems directly suction fluid from an operation into a wall-mounted unit in the OR that draws all waste directly into sewage. This method bypasses the need for canisters or fluid carts, but it does require each OR to have an easy access to plumbing to support installation. Typically, direct-to-drain systems are best suited for hospitals with high volume and turnover because they eliminate the need for any additional transportation of fluid waste. They are, however, the most costly.

— Darlene Hinkle, MSN, RN, CNOR

Time and space
Along with cost and safety, red-bagging was making turnover longer than it needed to be. The simplicity of our suction canister system shrinks the amount of time we spend gathering fluid and transferring it from container to container, and now that we use disposable canisters as well, we don't spend time reprocessing. The collected fluid travels directly from the OR and into the sewage pump in one easy transfer. The less time our nurses spend on cleanup duty, the more time they'll devote to patient care. For the boost to manpower alone, direct-to-drain is worth it.

Fluid-cart and direct-to-drain systems would've improved our time management just as well, but the suction-canister approach was the way to go for our 6-OR facility. To go direct-to-drain, we would have had to install a system in each OR. When we opted for suction-canister, we installed our wall-mounted port in the waste disposal room, out of everyone's way, and the choice has let all other facility functions go unimpeded by the way we manage fluid waste.

Red waste goes green
Another benefit of converting to an integrated fluid-waste management system is improving your environmental impact. By tying our fluid waste directly into sanitary sewage, we reduce the amount of resources necessary to dispose of our waste along with the chance of the fluids leaking or becoming aerosolized in the process. Direct-to-drain and fluid-cart options are the most environmentally friendly of the 3 fluid-waste systems. Not only do they connect waste to sewage, they also eliminate disposable canisters and any other materials that would be used along the way.

Even though we use disposable canisters in our suction-canister system, we've reduced the amount of hazardous waste we produce— no more chemicals to solidify the fluid waste and no more cleaning agents to reprocess canisters.

Whatever option you choose, both your downstream disposal and upstream resource-use impact will improve, tacking on another benefit to fluid waste management systems. OSM