Fluid Waste Removal: Are You Ready for the Challenge?
By Stanley R Shelver, RN, MHA
Infectious fluid waste disposal presents multiple challenges to healthcare managers -- including control of infections and costs -- motivating many to seek new alternatives to past disposal practices.
Incineration costs continue to increase, as do annual license fees demanded by the Environmental Protection Agency (EPA). Your facility may use a local landfill or you may have your contaminated waste hauled out of state at a premium cost. Does your facility provide cold storage for the waste before it is removed? Can you afford to microwave your contamination before it is shredded and compacted? Trash and contaminated waste are a major concern and budgetary issue for operating room and infection control practitioner (ICP) and other healthcare administrators. This year may be the right time for you to consider some changes.
As an operating room director for a 640-bed, Level I trauma, tertiary-care referral facility in Kansas City, my daily responsibilities include trash and contaminated waste. There are three obligations in the management of contaminated waste: How is staff protected? What is the financial impact? And what is the environment impact?
In the past, most hospitals and other healthcare facilities, including mine, poured all suction canister contents down the drain, but it was not an acceptable or enjoyable process. Given today's environment, with HIV and hepatitis raising awareness of proper procedures for handling infectious fluids, pouring is clearly out of the question. The Occupational Safety and Health Administration (OSHA) essentially banned the practice when enacting the Bloodborne Pathogens Standard in 1991.1 This standard requires the implementation of engineering and work practice controls to eliminate or minimize occupational exposure to bloodborne pathogens, including those found in suction canister waste.
Some facilities have disposed of infectious fluid wastes by having staff cap suction canisters, placing them into red bags and having them hauled away. Some hospitals have even placed red bags in boxes for removal by a waste hauler. This approach obviously produces a large volume of red-bag waste that incurs high disposal costs and eliminates reuse of canisters.
Based on where your facility is located, your choices may be dictated by state, county and municipal regulations. In the past decade there has been a decrease in the number of facilities that incinerate their trash. Even though some facilities may still incinerate, the regulatory controls will significantly limit those facilities. The limiting factors include increased air quality standards, increased licensure fees and additional hauling and landfill fees. There are less expensive methods for waste removal. At many facilities, it is normal practice to pour the suction canister contents into hoppers and use red bags and rigid boxes for the remainder of the trash. Some hospitals sort trash into non-contaminated (plastic), non-contaminated "other" and contaminated/red bag trash. Where you work makes a difference in what managers must do to avoid fines and litigation.
With each of these sorting processes, healthcare workers (HCWs) directly manage trash and are exposed to potential contamination. Some hospitals donate the discarded prep kits to schools for use as pencil boxes, but that is only a small segment of tons of trash that must be eliminated from the waste stream.
In the past few years, states have imposed tariff and taxes on out-of-state trash. The tariffs is higher if contaminated waste is involved. For example, Oklahoma hospital trash that is hauled to Texas has higher tariffs than waste that is processed and hauled within the state. Additional options for decreasing hauling costs are to microwave the trash either in a unit the size of an 18-wheel tractor trailer and then grind and compress the material so that it can be hauled at the lower, non-contaminated rate.
Even though there are two components of contaminated and non-contaminated waste products, let's turn our attention to the contaminated contents from suction canisters, which directly impacts nursing staff.
The weight and volume of the suction canister is the most significant item in the contaminated waste stream. HCWs cringe at the task of pouring liquid waste -- as it splashes, the odor is unpleasant and the contents are aerosolized when the liquids are dispensed into the hopper. Countless resources have been expended to deal with this single item, including commercial products devised to solidify the suction canister contents.
Solidification does not reduce the weight of the contaminated trash. A second concern is that infected whole blood that is solidified is not decontaminated or neutralized by solidifiers. As a result, the waste stream will still send contaminated waste into landfills. Directors must review and assess methods that will reduce the splash, odor and contamination problems associated with handling suction canister contents.
Is your facility charged by volume or weight or both? Expect to pay two different rates for contaminated and non-contaminated waste. With the estimated cost of 40 cents per pound and an average weight of 8 pounds per canister, $3.20 does not seem to impact a multi-million dollar budget until the assessment is made. How many canisters are used daily? Do you use tandem set-ups? How much fluid do you use for ACLs and cysto cases? These considerations are compounded by the annual volume of the operating room. Add to this the cost of red bags and boxes, and these expenses are significant.
Companies have developed various additives that congeal or solidify suction canister contents. This eliminates many of the hazards associated with the pouring of canister contents but it does not eliminate landfill contamination. Companies generally use plasma and not whole blood in their simulated operating room environments. The solidifiers have not generally been able to destroy viral and bacterial agents, thus keeping dangerous waste in a suspension. Contamination is then placed in a landfill.
The environmental impact of processing, hauling and disposing of medical waste has been a concern for many years. The EPA entered into a voluntary partnership four years ago with the American Hospital Association and its member hospitals to reduce overall hospital waste volume by 33 percent by 2005 and 50 percent by 2010.2
OSHA regulations, cost considerations and common sense have prompted more than two-thirds of all hospitals to use alternative methods for surgical fluids disposal.3 Many are using new technologies on the market to implement OSHA-mandated engineering controls for the safe disposal of fluid medical waste onsite. These systems use large reusable reservoirs or suction canisters to confine fluids prior to discharge into the sanitary sewer system. Unlike manual pouring, these systems do not expose HCWs to body fluids during disposal. In addition, infectious waste transportation and disposal costs are significantly lower with these systems.
Engineering controls that support onsite disposal of fluid waste present the least change for HCWs who pour fluids into hopper sinks. More importantly, these systems eliminate fluids close to the site of generation, thus protecting OR personnel, other employees and the public living downstream from the waste. These systems require an investment in capital equipment, ranging from a few thousand to several hundred thousand dollars depending on the system selected.
My facility has adopted this advanced technology in which reuseable suction canisters are inserted into a machine. The HCW walks away and the machine does the rest. Three concerns are achieved: HCWs are protected, costs are comparable, if not less than what was paid to remove the volume and weight of the suction canisters, and the volume of waste going to the landfill is reduced. We have been doing our part to be stewards of our trust since 1999 by using a product made by Dornoch Medical Company called the red-a-way system, and we are phasing in the company's newest technology, the Transposal system. We have found both systems to be employee focused, affordable and environmentally conscious.
We are all part of the contaminated waste stream. It is rewarding to do your part in reducing waste while introducing new technology that improves infection control and staff safety and reducing costs.
Stanley R Shelver, RN, MHA, is director of surgical services at Saint Luke's Hospital of Kansas City, Mo.