As with all equipment purchases in any industry, there is a tug-of-war between equipment effectiveness and cost. Such is also the case with fluid management and disposal systems in the OR. However, when it comes to the safety of healthcare workers and patients, and cost is stripped from the equation, what is the safest system to use?

Surgical Products interviewed several fluid waste management and disposal equipment suppliers to answer just that. Their answers are below.

For Cystoscopy, Urology, Arthroscopy and procedures requiring management of large fluid volumes, theDM6000-2A from MD Technologies inc. is designed for unlimited fluid volumes.

For Cystoscopy, Urology, Arthroscopy and procedures requiring management of large fluid volumes, theDM6000-2A from MD Technologies inc. is designed for unlimited fluid volumes.

Surgical Products: What kind of safety concerns do the management and disposal of surgical fluid waste pose in the OR?

Joyce Wasserman, Environmental Technologies Team, Cardinal Health: “In the OR, exposure to surgical fluid is always a concern. Clinicians need to avoid exposure to biohazardous waste.”

Bill Merkle, MD Technologies Inc.: “The two principal safety concerns related to fluid waste include slippery floors and presence of potentially infectious elements. Collecting spilled fluid from drapes or floors is an important safety consideration in preventing slips and falls, as well as minimizing risk of staff exposure. Fluid collection and disposal greatly reduce the possibility of slips and falls while removing potential sources of hospital-acquired infection.”

Bill Spence, Director of Sales, BioDrain Medical Inc.: “With transportation of fluids, you also add in safety risks of moving fluids around, pluspotential spills and injury from lifting the canisters of fluid.”

How should healthcare workers in the OR best avoid the associated risks with handling surgical fluid waste?

Wasserman: “Clinicians in the OR should avoid the risks associated with handling surgical fluid waste by ensuring that they always follow manufacturer recommendations for handling surgical waste containers, such as suction canisters. Avoiding pouring of surgical fluid into the hopper also helps reduce these risks. Wear the appropriate personal protective equipment.”

Merkle: “The OR should:

  1. Dispose of fluids as quickly as possible from the surgical field to minimize exposure to fluids.
  2. Employ fluid management technology that offers as much isolation from fluids as practical and affordable.
  3. Collect and dispose of spilled fluid as soon as possible.
  4. Exercise care and use protective equipment as necessary when handling potentially infectious fluid.”

Holly Bengel, Product Manager, Aspen Surgical: “In order to reduce the risk of exposure, hospital employees should have minimal or no contact time with potentially infectious waste. Using a solidifying agent in suction canisters will aid in reducing staff exposure to waste. Containing or removing surgical waste from the floor with a floor mat or floor suction device will help reduce the possibility of slip and fall accidents.”

Aspen Surgical offers a variety of OR mats, depending on specific needs. These include everything from skid resistant fluid barriers to high absorbency.

Aspen Surgical offers a variety of OR mats, depending on specific needs. These include everything from skid resistant fluid barriers to high absorbency.

What kind of technology, products and systems exist to make surgical fluid waste management and disposal safer?

Wasserman: “Solidifiers help to reduce the threat of exposure to surgical fluid waste by eliminating spilling, splashing and aerosolizing of a liquid. This is helpful when transporting canisters from the OR to the disposal area.”

Merkle: “Today, there are many products available for handling fluid from the surgical field, as well as for management of spilled fluids. Some systems permit safe, efficient draining of suction canisters. There are also systems that permit collection of fluid at the surgical site, followed by transport to a central location to dispose of fluid down a drain. Finally, there are closed systems that collect fluid directly from the suction field and dispose of it directly to the sanitary sewer.

“For collection of ‘deficit fluids,’ or those not collected at the surgical field, a variety of floor-suction devices are available that can be moved around on the floor to effectively wet-vacuum the fluid. There are also absorbent and suction floor mats that function to contain the fluid, and either absorb it or aspirate it into a suction canister. Approximately 80 percent of conventional fluid management cost is for disposable containers, with the remainder going toward red waste disposal. This does not include the cost of protective equipment (masks, gowns, gloves, etc.), and generally considers containers only, not solidifiers that can often double the container cost.

“Facilities disposing of surgical fluids by emptying canisters into a hopper, for example, realize approximately 20 percent savings in fluid disposal costs over those that simply have full canisters removed with red waste. Facilities using solidifiers incur significantly higher costs, as solidifiers can be as costly as the canisters in which they are solidifying fluid. For these facilities, cost can be double that of facilities using a hopper to empty canisters. Again, these estimates do not address the cost of protective gowns, gloves, masks or goggles.”

Bengel: “There are a number of great products in the market to control fluid in the OR. Using products like absorbent floor mats or floor-suction devices will aid in the management of fluids on the floor. The use of these products will reduce the potential for slip and fall accidents in the OR. Aspen’s floor-suction devices pull fluid from the floor and deposit it directly into canisters, where the contents can then be solidified. This reduces the possibility of having an excessive amount of infectious waste on the floor and potential exposure for staff.”
Spence, “Consider an automated fluid disposal system that eliminates exposure and transportation.”

What is the difference between using an open- and closed-loop surgical fluid waste system?

Wasserman: “Closed fluid evacuation systems evacuate fluid from suction canisters into the sanitary sewer with no pouring. This is both a cost-effective and safe option for a clinician who is looking for alternatives to pouring fluid into a hopper.”

Merkle: “Risk of exposure to infectious fluids increases with each added step in the disposal process. Open systems, such as hoppers and floor drains, are very economical, but present the greatest risks of exposure. All systems requiring that action be taken by an individual (e.g. healthcare worker) are open systems at the point of such action.

“Closed systems are those in which there is no action required by the healthcare worker. Wall-mounted, direct-drain systems are the only truly closed systems. For floor systems to collect fluids, all systems are open because it is necessary to dispose of the device that generally still contains some residual fluid.”

Bengel: “The two main concerns for management and disposal of fluid waste in the OR are staff exposure to potentially infectious waste, and slips and falls from procedures where fluid accumulates on the floor. According to the Centers for Disease Control and Prevention (CDC), in 2005, the rate for slips, trips and fall incidents in healthcare workers was 80 percent greater than the entire private industry. Controlling and containing fluid is essential in the OR. Fluid management floor mats and suction products are ideal for managing these potential risks.

Spence: “Closed-loop systems connect directly to the sanitary drain and automatically flush the fluids without exposing the staff. Open systems require manual transportation and disposal of fluids.”

What is your preferred method of managing and disposing of surgical waste in the OR? Why?

Wasserman: “TjeSAF-T Pump is the preferred method because it quickly and safely disposes of liquid medical waste into the sanitary sewer; it avoids the added expense of disposing a full canister in biohazardous waste, and reduces the amount of red bag waste generated when compared to solidified suction canisters.”

Merkle: “We prefer to employ a direct disposal system that is wall-mounted and requires no operator action between the collection point and the disposal point. Direct fluid disposal affords maximum staff isolation from exposure. Fluid collection and disposal should isolate staff from exposure to infectious fluids. Disposing of fluid directly to a drain from the suction field is not only the most cost-effective solution, but it also minimizes the possibility of staff or patient contamination due to inadvertent contact with fluid.

“Closed systems are available that collect fluid from the suction field and dispose of it directly down the drain to the sanitary sewer. These systems have advantages over systems requiring fluid to be transported to a central disposal site. Any transport process introduces additional steps where exposure to fluid can occur. As more effort is made in the area of fluid management, both the processes and technologies will advance, resulting in increased efficiency.”

Spence: “Direct-to-drain automated systems.”

What does the future hold for the management and disposal of surgical fluid waste in terms of both processes and technology?

Merkle, “In the future, facilities can expect to realize significant cost savings, while reducing healthcare worker labor for housekeeping. These factors will contribute to improved healthcare due to reduced exposure to fluid and reduced potential for hospital-acquired infection.”

Spence: “I think we’ll see more facilities adopt closed-system technologies as they continue to realize the benefits of less exposure, reduced risk, faster turnover in ORs, etc. New construction of operating rooms will be designed with fluid management in mind. The technology will only continue to get better, faster and safer as the process is streamlined. Before too long people will wonder how they ever operated without an automated fluid disposal system.”