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Cooley Dickinson Hospital,
Northampton, MA
Hospital product purchasing decisions can be extremely
complex, with consideration typically given to a long list of factorsı
such as technical properties and performance, efficacy and efficiency,
economic attributes and ease of use for clinicians.
Though safety and risk to patient-care workers is often
a consideration, it is seldom the key driver in a purchasing decision.
But staff safety was the primary reason that management at Cooley
Dickinson Hospital in Northampton, MA, decided to find a new approach to
disposal of infectious fluid wastes. "Our number-one concern was the
potential for staff exposure to infectious waste because the disposal
method then in use at our hospital failed to safeguard our surgical
technicians, nurses and other workers," recalls Lisa Roux, director of
surgical services at Cooley Dickinson.
Handling waste
The hospital was using a liner system, then capping their suction
canisters and placing them in red bag trash. Staff also were using large
disposable suction canisters that they would siphon to empty. With six
operating rooms and 5,500 surgical cases per year at the growing 125-bed
hospital, infectious fluid waste (IFW) disposal meant considerable
expenditures for staff time, disposal fees for red bag waste and
purchase of single-use canisters and other disposables.
Cooley Dickinson Hospital needed a new way to handle IFW
that would improve staff safety, while better controlling the costs
associated with IFW disposal. After consulting with Dornoch Medical
Systems Inc., Roux and her colleagues began a trial use of Dornoch’s
Transposal System in the O.R. This patented technology disposes of
infectious fluid waste safely through a closed system that discharges
waste into the facility’s sanitary sewer—as recommended by the CDC, EPA
and AORN—while cleaning and disinfecting reusable canisters and
reservoirs.
For the 30-day trial of Dornoch’s system at Cooley
Dickinson Hospital, a Transposal Safety Station Plus was placed in a
dirty utility room in the surgery department. The completely closed unit
empties, cleans and disinfects 2800cc or 1800cc reusable canisters. The
Safety Station Plus also is used to empty, clean and disinfect Dornoch’s
High Fluid Carts, a portable closed unit used to collect up to 48,000 cc
of fluid.
Cooley Dickinson’s trial incorporated both the reusable
canisters and three High Fluid Carts that were rotated in the operating
rooms as needed. Monique Desautels, CST, said that the hospital staff
easily adopted the Transposal system in part because the reusable
canisters required no change of practice. "The staff also liked the High
Fluid Cart because there is no splashing while emptying the reservoirs
and we found it is very easy to use," she says.
Mary Beth Chevalier, shift charge nurse and first R.N.
assistant, said she appreciated the reduction of exposure to infectious
fluids, adding, "The system exceeded my expectations because, not only
is it safer than the practice we used before, it is much easier to empty
and saves time." Roux felt that a great advantage of High Fluid Carts is
that they eliminate lifting of heavy jugs. In addition, they are easy to
transport.
Cost issues
To assess the cost issue, Roux had housekeeping staff weigh all IFW
for the entire week prior to testing Dornoch’s system. Weighing also was
done during the first week that the Transposal system was in place.
"Both the O.R. staff and environmental services saw an
immediate reduction in the volume of infectious fluid waste," Roux said.
"The Transposal system reduced our weekly waste volume from the O.R. by
437 pounds of red bag waste."
With average disposal fees of about 34 cents per pound,
the hospital stood to save thousands of dollars in the first six months.
Nationally, though IFW represents only about 20 percent of all hospital
waste, it accounts for more than 75 percent of disposal costs. According
to a recent bulletin from the University of Minnesota’s Technical
Assistance Program, "A vacuum system that uses reusable canisters or
empties directly into the sanitary sewer can help a facility cut its
infectious waste volume, and save money on labor, disposal and canister
purchase costs." The MTAP bulletin also estimated that, in a typical
hospital, "…$75,000 would be saved annually in suction canister
purchase, management and disposal cost if a canister-free vacuum system
was installed."
Following the successful trial, Roux recommended the
Transposal System be adopted hospital wide. A few months later, the
entire hospital implemented Dornoch’s technology. One Safety Station was
installed in Central Sterile Processing and was used house-wide.
In-service training was provided to all users and the maintenance
department received additional training on the equipment.
A Dornoch Transport Cart was placed in each department
for temporary storage of canisters containing waste. At least once a
day, and more often as need, carts are taken to Central Sterile
Processing where canisters and emptied and cleaned. Transport carts with
clean canisters are returned to the departments where they originated.
The endoscopy staff noticed that suction is stronger with Transposal’s
rigid canisters than with the liner system they previously used.
Same-day surgery staff expressed appreciation that they no longer have
to discard canisters.
Roux says that the hospital is pleased with the new
system. "Everyone uses the Safety Station Plus to process the canisters
now," she said. "Response to the new system was outstanding and it is a
widely accepted practice."
Complying with federal and state regulations pertaining
to IFW is made easier and less expensive with Dornoch’s Transposal
System. OHSA essentially banned the practice of pouring IFW down the
drain when it enacted the Blood-borne Pathogens Standard in 1991.² This
standard requires the institution of engineering and work practice
controls to eliminate or minimize occupational exposure to blood-borne
pathogens, including those found in suction canister waste. New DOT
regulations that went into effect two years ago require expensive
special packaging for containers of IFW. And the EPA signed an agreement
with the American Hospital Association and its member hospitals four
years ago to reduce overall hospital waste volume by 33 percent by 2005,
and 50 percent by 2010. Dornoch’s Transposal System addresses all of
those regulatory issues.
The regulatory pressures, safety concerns and financial
considerations have led more than two-thirds of U.S. hospitals to
eliminate the practice of pouring infectious fluid wastes into a drain,
according to a survey by Dornoch Medical.³ Company officials say that,
while some hospitals have adopted either capping or solidifying, they
are still expensive practices therefore, many are finding Dornoch’s
solution to be preferable.
HPN
