Fluid Waste Management:

Principles and Solutions

Disposing of liquid waste is a task that every facility must perform with an eye toward efficiency and cost effectiveness while protecting healthcare workers (HCWs) from exposure to potentially infectious agents.

The Occupational Safety & Health Administration (OSHA) defines regulated waste as “liquid or semi-liquid blood or other potentially infectious materials; contaminated items that would release blood or other potentially infectious materials in a liquid or semi-liquid state if compressed; items that are caked with dried blood or other potentially infectious materials and are capable of releasing these materials during handling; contaminated sharps; and pathological and microbiological wastes containing blood or other potentially infectious materials.”¹

OSHA notes that waste should be placed in containers that are closable; made to contain all contents and prevent leakage of fluids during handling, storage, transport, or shipping; properly labeled; and closed prior to removal to prevent spilling.

The Centers for Disease Control and Prevention’s (CDC’s) Guidelines for Environmental Infection Control in Health-Care Facilities note that precisely defining medical waste on the basis of quantity and type of potential disease-causing agents present is virtually impossible.² Therefore, the guidelines suggest that the most practical approach to medical waste management is to “identify wastes that represent a sufficient potential risk of causing infection during handling and disposal and for which some precautions likely are prudent.” Wastes targeted for handling and disposal precautions include microbiology laboratory waste (e.g., microbiologic cultures and stocks of microorganisms), pathology and anatomy waste, blood specimens from clinics and laboratories, blood products, and other body-fluid specimens.

A single, leak-resistant biohazard bag is usually adequate for containment of regulated medical wastes, according to the guidelines, as long as the bag is sturdy and the waste can be discarded without contaminating the bag’s exterior. If the bag is contaminated or punctured, it should be placed into a second biohazard bag. All bags should be securely closed for disposal. Facilities may need additional precautions to prevent the production of aerosols during the handling of blood-contaminated items for certain rare diseases, such as Lassa fever and Ebola virus infection.

Transporting and storing regulated medical wastes within facilities prior to terminal treatment is often necessary. This should be done regularly to avoid accumulation. Medical wastes that require storage should be kept in “labeled, leak-proof, puncture-resistant containers under conditions that minimize or prevent foul odors. The storage area should be well ventilated and be inaccessible to pests. Any facility that generates regulated medical wastes should have a regulated medical waste management plan to ensure health and environmental safety as per federal, state, and local regulations.”³

The endoscopy suite must, of course, employ a strategy to handle waste in an effective and safe manner. Sue Mihalko, CGRN, administrative manager for the endoscopy center at Royal Oak, Mich.-based William Beaumont Hospital, explains that endoscopic secretions go directly from the scope to a collection canister at her facility. “The canisters are heavy-duty clear plastic that is measurable, so the suction tubing comes from the scope to the canister, and in go the fluids. From the canister, the fluids go to our wall suction, so all of it gets collected in the canister and none of it gets aspirated or suctioned up into our house-wide suction system,” she says. “When the canister reaches a certain level, we change it. In our hospital, we don’t take the canisters and empty them; we place them in large biohazard bins that are covered. All of our suction contents in the containers themselves are thrown into this bin. Our in-house people come at a scheduled time and take those bins away and leave us a new clean bin. Those bins are then taken to a dock, an exterior location on the hospital periphery, and they are picked up by a waste management company.”

“The suction canisters obviously have one port that goes to the patient, and the other goes to the wall unit,” says Nancy Gdowski, supervisor of the endoscopy center at William Beaumont Hospital. “We detach the tubing that’s connected to both of those ports, and there are little caps attached to the canisters themselves, and we cap them right then and there before we even remove it from the holder. They’re securely fastened before we do any lifting or moving of them.”

Mihalko adds that when handling the canisters, HCWs are fully protected at all times by using universal precautions, including gowns, masks, gloves, and eye shields. “They are trained extensively during their orientation in endoscopy, and that’s one of the pieces that we cover in our room setup, turnover, and closure procedures.”

Fluid Management Products and Methods

Mark A. Ceaser, general manager of OMNI/ajax and executive consultant for Absolute Sorbent Technologies, Inc., says many hospitals use one of a couple methods for disposing of fluid waste. “First of all they dump the fluid waste, which is then sucked up or absorbed using some sort of polymer-based material. What happens is when the fluid hits it, it swells up. Technically the fluid solidifies, but it’s still a gelatinous mass. People are then taking this and putting it at the bottom of their medical waste containers along with a combination of bleach or ammonia solution, to disinfect it right then and there. So then you have a wet mixture that’s getting taken away for incineration.

“The other option is autoclaving, which is a similar type of heat-driven disposal method where they take the materials, whether they be solid or liquid, and they’re steamed and then autoclaved to be landfill buried,” Ceaser concludes.

“The difference in both of those situations as compared to something that we’ve been proposing with cementatious materials is that you’re using a fairly high energy rate with incineration; you need a fair amount of BTUs in order to get the heat you need to burn the waste completely. With autoclaving you need some sort of heat generation and you need to basically ‘cook’ the waste for a certain period of time before it’s deemed sterilized and can be shredded up. With the OMNI technologies, it really doesn’t take up a large amount of landfill space, and you’re not requiring any kind of heat treatment and added energy cost to dispose of the waste.” Given the current state of rising fuel costs, Ceaser contends that this can be an added advantage. “This doesn’t require energy — it’s basically just a cementatious mix; you allow it to harden, and again with the recommendation of the Environmental Protection Agency (EPA) as an approved pesticide, now you can throw it in the landfill — you don’t have to worry about any additional service treatment.”

Peter Donnelly, market applications specialist at Multisorb, notes that many technologies and products exist to treat fluid waste in different ways. “One of the ways we try to help reduce costs and provide innovative solutions for reducing red bag waste is through our SaniSorb and SaniSorb-Plus products,” he says.

“These can be used in a variety of places, but most often in suction canisters. Both products are an absorbent polymer packaged inside a water-soluble pouch. The package can be pre-administered into a suction canister, and once fluids hit it, it will burst open and solidify everything in the suction canister immediately — you go from a liquid waste to a solid waste. Just from reducing splashing and reducing handling issues, that, we’ve found, is a significant improvement.

“SaniSorb-Plus adds an agent that sanitizes the contents of the can to a point where it can be considered drain waste, as opposed to red bag waste, which tremendously reduces the cost,” Donnelly continues. “It solidifies it, and as it is solidifying, the sanitizing agent will neutralize any of the biological agents in the canister. It could just be disposed of with regular hospital waste, but in some cases, with enough water, you can wash it down the drain.” Donnelly also cites a similar product called DriMop®. “DriMop is similar in that it is a super absorbent polymer packaged inside a water-soluble pouch. When liquids hit it, the pouch bursts and captures the liquid, containing it. DriMop is used primarily for test kits. Nowadays, many test kits are done in centralized laboratories, so you have these multiple kits that go through a FedEx shipment, and people will include a couple of DriMop pouches in box, on the off chance that if a test tube or urine specimen bottle breaks open, instead of dripping all over and creating a nasty mess, it’s contained. We don’t stop the spill, but we contain it inside that box.”

John M. Phillips, director of sales and marketing at Colby Manufacturing Corporation, explains that Colby specializes in products that help protect staff and patients from contact with potentially hazardous fluid waste. “When choosing a fluid waste management product, many factors should be taken into consideration: Meeting OSHA’s regulations for employee protection, concern for patient health, and cost effectiveness, to name a few. Using the right product based on the procedure will help achieve the protection HCWs are looking for at a lower cost to the facility. Our selection of fluid waste management products will help effectively control, contain, and dispose of fluids generated during wet procedures.”

These products include the WaterBoom™ Quiet Floor Suction Strip, which is designed to control fluids by strategically placing and creating a dam to hold back and quietly suction an unlimited amount of waste fluid. “It contains fluids in selected areas with its low profile and conforming design providing strong suction of unlimited amounts of fluid while conforming to your OR floor,” Phillips continues.

The WaterBug® Quiet Floor Suction Device controls fluids on the floor by maneuvering it with a push of the foot to areas affected by fluids. It is designed to allow for easy repositioning, controlling fluids over a large floor area.

The ViraSorb® Super Solidifier is another Colby product that is designed to control fluids by quickly penetrating the canister contents and gelling rapidly without stirring or agitation. “It contains fluid by staying solid, facilitating safer handling and transport of medical waste,” Phillips states. “ViraSorb does not cause fluid expansion, so it will not increase your red bag waste.”

Colby also offers SurgiSafe® Absorbent Floor Mats, which are designed to control the flow of fluids by strategically placing the mat, helping to prevent the spread of potentially hazardous fluids. “It contains fluid with superior absorbency, retention, and durability. SurgiSafe Mats alone control and contain fluid waste and should be disposed of as normal hazardous waste in accordance with your facility’s protocol,” Phillips concludes.

Scott Leece, marketing manager, surgical products, Cardinal Health, recommends two approaches to better manage liquid waste management — the SAF-T Pump™ system for waste disposal and its CRD™ semi-rigid canister for waste collection. “Cardinal Health’s SAF-T Pump system provides healthcare workers with an easy way to dispose of suction canister waste directly into the sanitary sewer while greatly reducing the potential for exposure to bloodborne pathogens often found in this waste,” he says. “The SAF-T Pump is a small, wall-mounted device installed simply by plumbing it into a water source and a sanitary sewer connection. Users bring full canisters to the SAF-T Pump, make one quick connection between the canister and the pump, and the liquid waste is drawn from the canister into the sanitary sewer via a closed pathway. This eliminates the risk of exposure to splashing waste or aerosol droplets that can form when canisters are emptied into open sinks.” 

Leece notes that the system is powered entirely by tap water and has no motorized or electrical components. “It is extremely reliable and virtually maintenance-free,” he continues. “Using the SAF-T pump increases staff safety and eliminates the need to throw full or solidified canisters into red bag waste, thus greatly reducing red bag disposal costs.

 “Cardinal Health also recommends that facilities use its CRD™ semi-rigid canister instead of hard canisters to reduce red bag disposal costs,” Leece continues. “CRD canisters weigh as much as 50 percent less than similar-sized hard canisters. This weight difference can translate into savings of nearly 10 cents per canister for a typical healthcare facility (based on the national average red bag waste disposal cost of 30 cents per pound). In addition, CRD is sturdy yet lightweight, easily stacks for storage, and readily compacted, thus minimizing the space required in the red bag trash.” 

MD Technologies Inc. produces the Environ-mate™ DM6000 Series. These Suction-Drain™ Systems provide fluid waste management for surgery, endoscopy, and SPD/utility room applications, according to Bill Merkel of MD Technologies. “Compact, wall-mounted units collect fluids directly from the suction field and dispose directly to sanitary sewer,” he says. “The Environ-mate™ DM6000 Series units isolate healthcare workers from exposure to suctioned fluids, and systems offer tremendous cost savings due to reduced requirements for disposable supplies. The first Environ-mate unit was placed into service in 1990. These systems are ideally suited to new construction or remodeling projects because they require installation of drain plumbing. Units connect to central vacuum.” 

Merkel contends that advantages of the Environ-mate Suction- Drain Systems include cost savings, floor space savings, and isolation from suctioned fluids. “Savings are realized on the costs of disposable canisters and solidifying agents, as well as waste disposal/incineration costs. Floor space is not required due to wall-mounted unit design. Isolation from suctioned fluids is exceptional because fluid is directly disposed of to the sewer, and no secondary operations are required, such as transporting containers to a central draining station.” 

Three DM6000 Series units are available, Merkel continues. “The DM6000 is used in SPD/utility rooms with an optional footswitch. The DM6000-2, for endoscopy, has two independent suction inputs for EGD (Esophagogastroduodenoscopy), ERCP (endoscopic retrograde cholangiopancreatography), and bronchoscopy procedures, or to offer a back-up suction source in single-field procedures (such as colonoscopies). The compact DM6000-2A has unlimited fluid capacity, and is indispensable in the operating room for arthroscopy, urology, and cystoscopy procedures. An optional fluid totalizer records fluid volume aspirated.” 

For references, visit www.endonurse.comOnline 

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