Infection Control Today - 08/2004: Clinical Update

No Crying Over Spilt Blood
Managing Fluid Waste Disposal

By Kathy Dix

Its 7 p.m. A surgeon has just completed a very bloody procedure. Theres a tremendous amount of blood and other body fluids to dispose of. How can you best rid your facility of this mess, while keeping costs down and your employees safe?

The disposal of liquid waste is just one of many factors that falls under the umbrella of patient safety, the current watchword in medicine. Theres a focus in healthcare right now regarding reducing risk of exposure. Patient safety and employee safety are the key words today, says Anita Earl, RN, BSN, an infection control consultant based in Illinois.

Obviously, one concern is that you want to minimize risk of exposure. If its a solidifier and a sanitizer, it can save a facility money by converting a bio-hazardous waste to regular waste. It eliminates the potential exposure to harmful pathogens. Some of these products meet most state regulations for converting liquid medical waste so it would be suitable for white bag disposal, which saves a healthcare facility a lot of money, she adds. The fact is, you want to reduce the risk of exposure, the risk of a spill, and potential healthcare worker exposure to patient body fluids.

What we did at the hospital I worked at was to use a solidifying gel on liquid waste in suction canisters. Other liquid waste (like urine) was disposed of down the hopper, says Melba Rhodes, BSN, an infection control consultant in Pineville, La. In general, the solidifying and disinfectant agent is poured into liquid-containing articles such as suction canisters or chest tube drainage systems to prevent the red bags from leaking fluid.

Medical waste has to be disposed of in certain ways, Rhodes continues. Each state has a separate way of handing waste specified in the state sanitary code. Medical waste is included in the environment of care because of the hazard to employee, patient and visitor from improperly disposed-of waste. Closed container systems have the benefits of ease of use and of not forcing healthcare workers to touch the waste themselves, Rhodes observes. Theres less chance of an exposure. But, she says, The drawback is cost.

Even EPA-registered solidifiers do not disinfect, observes Kelly Ticco, marketing manager for Safetec of America, Inc. They only sanitize, which means they reduce, not eliminate, the number of microbes that might be in blood or body fluid. When you add a solidifier to the blood or body fluids, like to a suction canister, its not a treatment. It varies from state to state, but some states even allow you to pour [medical waste] down the drain.

Ticco points out the obvious, which although evident, bears repeating: Its important to solidify, because whoever is handling that canister the nurse, your infection control specialist at the hospital, whoever is cleaning after the procedure even if its an emergency room and theres been someone with severe bleeding and youre cleaning up a floor area, what you dont want is splashing. A solidifier eliminates the aerosolization of potentially infectious blood or body fluid. So youre protecting your employees.

Ticco offers the following example: Say you have a cart, and you have a surgical procedure that generated containers of blood or body fluids, and you are moving those. You are planning on shipping those containers to a disposal facility off-site. Do you really want your employees pushing a cart of potentially infectious fluid waste down the aisle of your hospital or your surgical center? And the potential for spilling and splashing and contamination is huge. By solidifying, you eliminate that possibility.

It is necessary to solidify in many cases; certain Department of Transportation regulations require absorbent material such as a solidifier in the shipment of potentially infectious specimens, such as specimens from a hospital laboratory being shipped to another lab.

When in doubt about what regulations to follow, the APIC (Association for Professionals in Infection Control and Epidemiology) guidelines are a good starting point, says Deb Kleinfeldt, RN, an infection control practitioner at Powell Valley Healthcare in Powell, Wyo. They ask, Does the waste have an existing or possible pathogen? And then they discuss how to handle this waste in the subsequent pages, she says. In our OR, we use a powder that absorbs the fluid so when they tear the room down, the suction canisters have a solid in them rather than a liquid. This powder is also available in the ER, OB and ICU.

Kleinfeldt does not specify which product to use; any that are on the market and on your purchasing list would be fine, she explains. Then you have to get education to your employees or they wont use it correctly and you may as well not bother with any of this. Then write your policies to match the process of using this absorbent. In summary, she says,

  • Review APIC guidelines, chapter 74 to see if there is anything extra special your state requires.
  • Sort out what is needed and doable at your facility.
  • Get samples of this absorbent powder to see which one the staff likes better.
  • Price-compare, but this isnt as important unless you . nd one that is very costly. Then try to go with the more economically priced one.
  • Get the samples in and in-service your staff. Let them use it for a couple of weeks and make them choose one.
  • Then put out a policy and procedure with a memo saying, This is in place.
  • Bring this topic up at your next infection control committee meeting.
  • Do an evaluation of the product to see if there are any glitches in the process and to see if it helped in leaks, etc.

What Are Your Options?

Options for disposing of medical waste vary. Some allow for sanitizing the fluids, enabling the healthcare facility to dispose of it as normal waste rather than medical waste, saving the hospital or clinic a great deal of money over time.

State regulations differ; obviously, those less-concerned with public health allow the potentially pathogenic fluids to be disposed of down a normal drain, not into the sanitary sewer, which is a sewer designed to carry only domestic sanitary sewage and no storm water.1

Products

  • Bemis Health Care offers a suction canister system that reduces exposure to splatters, spills and aerosolization of infectious medical waste. The Vac-U-Station disposable canisters offer bottom drainage ports that open with a simple pull of a handle, allowing contents to empty directly into the sanitary sewer system. This system does not require the use of solidifiers.
  • DiSorb offers SafeSorb, which is strictly a fluid solidifier, not a disinfectant. This product is added to the suction canister before starting a procedure. It does not expand once it comes in contact with the fluid waste. This product also will continue to work for several days, so additional . uid can solidify later. DiSorb offers a cost-analysis program to help establish which method of managing liquid waste is best for your facility.
  • Dornoch Medical offers a Safety Station and High Fluid Cart; the Safety Station empties, cleans, and disinfects reusable 1800 or 2800cc suction canisters. The High Fluid Cart collects up to 48 liters of fluid in one or two reusable reservoirs.
  • Omni/ajax offers the BioSet Body Fluid Encapsulant/Solidifier, which is a patented cementatious mixture designed for reducing the risk of contamination and exposure. The BioSet works by quickly absorbing fluid, and the cementatious reaction will continue to solidify the mass.
  • Metrex offers several products, including the PremiCide┬« Sanitizer/Solidifier with a special PremiGuard Cap, as well as the Canister Express┬« Solidifying Beads, a Solidifier Suction Canister Fluid Solidi. cation System, and the Vital 1┬« Biohazardous Spill Clean-Up Beads and Kit.
  • Safetec of America, Inc., offers the RED-Z solidi. er for cleanup and removal of body fluids, as well as GREEN-Z and YELLOW-Z. Red Z and Yellow Z offer a deodorizer as well as solidi. er and Green Z offers a deodorant-free incinerator-friendly version.
  • Stericycle offers several products for solidifying liquid waste, including Steri*Safe Solidifier, which comes in powder form. It gels liquid waste using a super-absorbent polymer granule similar to those used in diapers.
  • Stryker Medical Systems offers the Neptune Waste Management System, which provides both . uid waste management and smoke evacuation. The system collects and disposes of liquid medical waste in its closed system and involves little employee exposure.

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