Liquid medical waste —comprised of blood, body fluids and irrigation solutions — is an unavoidable byproduct of surgical and other medical procedures. Not only does it present a significant financial challenge for healthcare organizations, it also ratchets up safety risks for healthcare workers who must handle and dispose of it.
According to the Occupational Safety and Health Administration, waste should be placed in closable containers that are designed to contain all contents and prevent leakage during handling, storage, transport and/or shipping. The containers should also be properly labeled and closed prior to removal to prevent spilling or splattering of infectious contents. Although failure to follow OSHA’s Bloodborne Pathogens regulations can result in costly citations, some facilities are still opting for the cheapest – and least safe – solution, which is to pour the liquid down a hopper and directly into the sewage system.
"It’s unfortunate, but there are still hospitals out there that are going that route purely because of cost," said Nancy Steinpreis, associate product manager, Bemis Health Care, Sheboygan Falls, WI. On top of that, she said there’s also the challenge of getting facilities to change their old habits. "If they’ve always done it that way, they may ask, ‘Why change now?’"
From a risk management and infection control standpoint, that question is easy to answer. Although pouring may be an inexpensive option on the front end, the practice can prove quite costly once all the associated risks are factored into the equation. Steinpreis said Bemis representatives have seen hospital employees, sans gloves and masks, pouring fluid waste down a hopper. Even if personnel don appropriate personal protective equipment, pouring the infectious liquid can still result in spilling, splashing and aerosolization.
Fortunately, educating healthcare organizations on the risks has made a positive impact on their fluid waste management practices. Couple that with the abundance of waste management products on the market designed to increase safety and efficiency, minimize environmental concerns and regulatory burdens, and prevent dollars from needlessly going down the drain, and it becomes clear why more institutions are adopting a safer, more respectable approach to fluid collection and disposal.
Wading through options
Like most other healthcare product segments, facilities have an array of options when it comes to managing fluid waste.
Solidifying agents, which are used in suction canisters to absorb liquid and turn it into a gel-like substance, are one example. Both sanitizing and non-sanitizing solidifiers are available; sanitizing versions neutralize the biological agents in the canister, allowing the waste to be disposed of in regular hospital waste. It’s also possible to pre-administer the solidifier into the canister and further reduce handling-related risks.
MultiSorb Technologies’ SaniSorb products are "self-bursting," meaning that fluid waste is quickly absorbed and immobilized. Pre-measured pouches – each able to absorb up to 500 cc of body fluids – help eliminate waste, while their self-activating technology dissolves upon contact with fluid and eliminates the need to tear open pouches. The ViraSorb Super Solidifier product from Colby Manufacturing Corp. also makes quick work of fluid waste, rapidly penetrating and gelling the canister contents without stirring or agitation. And because it does not expand the fluid, ViraSorb does not increase red bag waste. While effective, solidifying agents aren’t exactly a low-cost solution. The added weight of the solidifier can add another dollar to already high disposal costs.
Fluid pooling on the floor poses another set of risks. Not only does it present an infection control challenge, it also can lead to slips and falls – all of which can be a major liability issue for healthcare institutions. A number of vendors offer floor suction products aimed at eliminating those risks. Colby’s WaterBoom Quiet Floor Suction Strip controls fluids by creating a dam to hold back and suction an unlimited amount of fluid waste. The company’s WaterBug Quiet Floor Suction Device allows users to easily reposition and maneuver the product to areas affected by fluid waste with a simple push of a foot.
The Promethean Island fluid capture products manufactured by Promethean Medical Technologies Inc. are designed to quickly evacuate spilled fluids during high fluid volume procedures into any existing calibrated collection system, such as canister clusters and fluid management systems.
A case for closed systems
Safer fluid waste and canister handling isn’t limited just to solidifiers, however. In fact, a number of closed system products pull double duty, allowing staff to dispose of suction canister waste by directly emptying contents into the sanitary sewer, with minimal staff contact and involvement.
Such products represent an economical alternative to tossing filled suction canisters into the trash. Dornoch Medical Systems Inc. notes that over 200,000 fluid-filled canisters are dropped in the trash each workday, representing approximately 50 to 70 percent of an O.R.’s infectious waste and 25 percent of a hospital’s total red bag waste. Dornoch’s solution is the Transposal Infectious Fluid Collection and Disposal System, which eliminates suction canisters from the regulated medical waste stream. The Transposal System consists of a Safety Station and High Fluid Cart. The Safety Station empties, cleans and disinfects reusable 2800cc or disposable 1800cc suction canisters. The High Fluid Cart collects up to 48 liters of fluid in one or two reusable reservoirs. The reservoirs are then emptied, cleaned and disinfected in the stand-alone Evac Unit or Safety Station Plus. The system makes it possible for facilities to avoid wrapping canisters in absorbent materials; placing canisters in non-bulk packaging; segregating liquid and solid regulated medical waste; transporting heavy suction canister waste through hallways and elevators; and paying for unnecessary regulated medical waste disposal services – all of which are huge benefits for the typical hospital that generates nearly three tons of suction canister waste each month, according to Dornoch.
Another economical device is Cardinal Health’s SAF-T-Pump waste disposal system, a small, wall-mounted device that operates by simply plumbing it into a water source and sanitary sewer connection. "This is a safe, simple and economical solution to pouring out canister waste. With just a few easy steps, it removes waste from the canister, without splashing," explained Scott Leece, marketing manager, surgical products, Cardinal Health. Employees bring full canisters to the SAF-T-Pump and then make a quick connection between the canister and the pump. The system is powered by tap water and features no motorized or electrical components. Fluid is simply pulled from the canister and into the sanitary sewer via a closed pathway.
Cardinal’s CRD semi-rigid container, a blend between a liner and rigid canister, offers additional safety and economic benefits. Because the construction is more flexible, the product reduces the risk of shattering or cracking, according to Leece. It also reduces environmental burden. "They weigh half as much as hard canisters of similar size," he continued.
Bemis’ Quick-Drain is a confined system that utilizes the company’s Hi-Flow Canisters and Quick-Fit Suction Liners. Because per-use costs, such as solidifiers and disposables are eliminated, system changeover and equipment costs can be recouped in just months. For one prominent New York City hospital, return on investment took only one month. After implementing the Quick-Drain system and abandoning the practice of disposing full canisters in red bag waste, the facility was able to save $900,000 annually in disposal costs alone. The rinse feature allowed the facility to place 99 percent of the canisters into white bag waste.
Although most canister-based systems are designed to work only with that same vendor’s canisters, DeRoyal’s Aqua-Box is designed to empty and discard fluid from any suction canister, liner, collection bag, kick bucket or other fluid collection source. Another benefit? The compact, standalone unit can be installed in just about any wall-mounted location, freeing up valuable floor space.
Healthcare facilities looking to eliminate their reliance on canisters altogether don’t have to look far, either.
Stryker Instruments’ Neptune Waste Management System, which combines fluid waste management and smoke evacuation in one unit, collects and disposes of waste within a totally closed system – without the need for canisters and with very little human intervention.
"This is a completely closed system that requires no manual
connection," noted Dru Hoskins, associate
Completely closed systems, which require installation of drain plumbing, are a particularly good option for healthcare institutions undergoing renovation or new construction.
MD Technologies Inc. has built a solid reputation around its closed, canister-free system. The Environ-mate DM6000 Series Suction-Drain System is a compact, wall-mounted unit that collects fluid directly from the suction field and disposes it directly into the sanitary sewer. The units connect to a central vacuum system.
"With this system, there is no one handling the fluid, so there is no risk to employees," said MD Technologies president Bill Merkle. Its quiet operation is another noteworthy plus. Many self-contained units operate like shop vacuums and are noisy, he explained. "There is zero noise factor with our system."
Facilities that incorporate the Environ-mate system into their new construction or renovation plans can enjoy a rapid return on investment. Merkle said the system can pay for itself in as little as one year.
"When you can eliminate canisters and safely dispose fluid into the sanitary sewer, without putting employees at risk, the savings add up quickly."
Closed systems are catching on. Approximately 500 Environ-mate units are in place in more than 130 facilities, according to Merkle.
The daily grind
Facilities seeking a cost-effective, environmentally friendly solution for onsite medical waste handling have yet another option at their disposal: technology that sterilizes medical waste and then converts it to a finely shredded, unrecognizable material that can be disposed of along with regular municipal waste. Any material that constitutes red bag waste can be processed in the systems – even needles and disposable stainless steel instruments.
This hardware- and software-driven technology, offered by Baltimore-based Red Bag Solutions, and Ecolotec LLC, Huntsville, AL, disposes of waste at the point of generation and eliminates the need for medical waste tracking. Reduced liability, less handing, transport and reliance on third party disposal, and the ability to reduce the amount of waste volume by at least 80 percent are just a few of the added benefits the technology can provide.
Flexibility has been key for Red Bag Solutions, which gives customers the option of running the system themselves onsite or adopting a turnkey approach where Red Bag Solutions runs and manages the process for them, providing all equipment, operations, maintenance and consumables.
"Customers can use the system with no capital outlay," said Bill Norton, executive vice president, Red Bag Solutions, adding that that cost is simply built into the price per pound. Customers do have the option of leasing the equipment and purchasing it outright, however.
Gary Gilliam, Ecolotec’s executive vice president and general manager, said the 1700 RPM blades on Ecolotec’s new MW200 Medical Waste Processor is capable of completely shredding sterile waste in fewer than ten minutes per cycle. He pointed out that the cost factors are equally impressive – Ecolotec’s system costs only two to four cents per pound, compared to incinerators and waste haulers, which run between 18 cents and $1 and 19 cents to 50 cents per pound, respectively.
"You simply can’t screw up with this system. It either operates right or it doesn’t operate at all," Gilliam said. He explained that employees simply pick up the bag, place it in the machine, close the lid and push a button. "The software has been programmed so operators cannot open the machine during operation and be exposed." Ecolotec’s next generation machine, debuting by year’s end, will have an Ethernet connection to allow for remote troubleshooting and diagnostics.
Both Red Bag Solutions’ and Ecolotec’s systems can tackle another challenge: patient confidentiality. Because of the machines’ shredding capabilities, facilities can safely and easily destroy confidential documents. One Red Bag Solutions customer installed the system in an ambulance bay in August and has been able to eliminate confidential document expenses and cut biomedical waste costs by 62 percent. Even with the purchase of the Red Bag Solutions machine, projected 2006 savings will meet or exceed $30,000.
According to Ecolotec’s Gilliam, customers are being increasingly driven to technology that serves more than one purpose. "The issues of both waste management and patient confidentiality are at the forefront of virtually every healthcare organization’s mind. A system that can reduce their liability risks [on numerous fronts] will be a sound investment."
Regardless of the type of waste management system a facility chooses, one thing remains certain: questionable waste handling will likely become a thing of the past as technology advances, costs of operation and ownership inch even lower, and facilities aim to adopt safer, more responsible practices.
As Stryker’s Hoskins put it, "Whether it’s the use of solidifiers, closed systems [or other waste management solutions], what matters most is that more and more [facilities] will get away from the unsafe practice of pouring fluid waste down the hopper." HPN